Postpartum thyroiditis natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
Prognosis is generally good, 25-30% in 3.5 to 8.7-year patients with [[postpartum thyroiditis]] PPT develop [[hypothyroidism]]. The symptoms of postpartum thyroiditis, PPT usually develop in the twelve months after delivery, abortion or miscarriage of fetus and start with symptoms depending on clinical course that it follows. Common complications of include hypothyroidism, postpartum depression, fetal mental retardation in future pregnancies in diagnosed cases and overt hyperthyroid symptoms in future pregnancies. Prognosis is generally good and 90% of patient recover to normal state after 12 months of postpartum.
[[Prognosis]] is generally good, 25-30% in 3.5 to 8.7-year patients with [[postpartum thyroiditis]] [[Postpartum thyroiditis|PPT]] develop [[hypothyroidism]]. The symptoms of [[postpartum thyroiditis]] usually develop in the twelve months after delivery, abortion or [[miscarriage]] of fetus and start with symptoms depending on clinical course that it follows. Common complications of include [[hypothyroidism]], [[Postpartum depression (patient information)|postpartum depression]], [[Mental retardation|fetal mental retardation]] in future pregnancies in diagnosed cases and overt [[Hyperthyroidism|hyperthyroid]] symptoms in future pregnancies. Prognosis is generally good and 90% of patient recover to normal state after 12 months of postpartum.


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
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*The symptoms of [[postpartum thyroiditis]], PPT  usually develop in the twelve months after devilry , [[abortion]] or [[miscarriage]] of [[fetus]] and start with symptoms depending on clinical course that it follows.  
*The symptoms of [[postpartum thyroiditis]], PPT  usually develop in the twelve months after devilry , [[abortion]] or [[miscarriage]] of [[fetus]] and start with symptoms depending on clinical course that it follows.  
*There are three clinical courses:  
*There are three clinical courses:  
:*Classic triphasic: 25% of patients of PPT come to clinical attention with symptoms of [[hyperthyroidism]] starting from sixth [[postpartum]] week<ref name="pmid10874538">{{cite journal| author=Stagnaro-Green A| title=Recognizing, understanding, and treating postpartum thyroiditis. | journal=Endocrinol Metab Clin North Am | year= 2000 | volume= 29 | issue= 2 | pages= 417-30, ix | pmid=10874538 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10874538  }} </ref> followed by hypothyroidism around sixth postpartum month and then euthyroidisum by the of 12 months of postpartum .<ref name="pmid22312089">{{cite journal| author=Stagnaro-Green A| title=Approach to the patient with postpartum thyroiditis. | journal=J Clin Endocrinol Metab | year= 2012 | volume= 97 | issue= 2 | pages= 334-42 | pmid=22312089 | doi=10.1210/jc.2011-2576 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22312089  }} </ref>
:*'''Classic triphasic''': 25% of patients of [[Postpartum thyroiditis|PPT]] come to clinical attention with symptoms of [[hyperthyroidism]] starting from sixth [[postpartum]] week<ref name="pmid10874538">{{cite journal| author=Stagnaro-Green A| title=Recognizing, understanding, and treating postpartum thyroiditis. | journal=Endocrinol Metab Clin North Am | year= 2000 | volume= 29 | issue= 2 | pages= 417-30, ix | pmid=10874538 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10874538  }} </ref> followed by hypothyroidism around sixth postpartum month and then euthyroidisum by the of 12 months of postpartum .<ref name="pmid22312089">{{cite journal| author=Stagnaro-Green A| title=Approach to the patient with postpartum thyroiditis. | journal=J Clin Endocrinol Metab | year= 2012 | volume= 97 | issue= 2 | pages= 334-42 | pmid=22312089 | doi=10.1210/jc.2011-2576 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22312089  }} </ref>
:*Biphasic [[hyperthyroidism]]: 32 % patients of PPT develops symptoms of [[hyperthyroidism]] followed recovery.<ref name="pmid22312089">{{cite journal| author=Stagnaro-Green A| title=Approach to the patient with postpartum thyroiditis. | journal=J Clin Endocrinol Metab | year= 2012 | volume= 97 | issue= 2 | pages= 334-42 | pmid=22312089 | doi=10.1210/jc.2011-2576 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22312089  }} </ref>
:*'''Biphasic [[hyperthyroidism]]''': 32 % patients of '''PPT''' develops symptoms of [[hyperthyroidism]] followed recovery.<ref name="pmid22312089">{{cite journal| author=Stagnaro-Green A| title=Approach to the patient with postpartum thyroiditis. | journal=J Clin Endocrinol Metab | year= 2012 | volume= 97 | issue= 2 | pages= 334-42 | pmid=22312089 | doi=10.1210/jc.2011-2576 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22312089  }} </ref>
:*Biphasic [[hypothyroidism]]: 43 % patients of PPT develops symptoms of [[hypothyroidism]] followed recovery .<ref name="pmid22312089">{{cite journal| author=Stagnaro-Green A| title=Approach to the patient with postpartum thyroiditis. | journal=J Clin Endocrinol Metab | year= 2012 | volume= 97 | issue= 2 | pages= 334-42 | pmid=22312089 | doi=10.1210/jc.2011-2576 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22312089  }} </ref>  
:*'''Biphasic [[hypothyroidism]]''': 43 % patients of [[Postpartum thyroiditis|PPT]] develops symptoms of [[hypothyroidism]] followed recovery .<ref name="pmid22312089">{{cite journal| author=Stagnaro-Green A| title=Approach to the patient with postpartum thyroiditis. | journal=J Clin Endocrinol Metab | year= 2012 | volume= 97 | issue= 2 | pages= 334-42 | pmid=22312089 | doi=10.1210/jc.2011-2576 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22312089  }} </ref>  
*If left untreated, 25-30% of patients with PPT may progress to develop [[hypothyroidism]]<ref name="pmid10634366">{{cite journal| author=Premawardhana LD, Parkes AB, Ammari F, John R, Darke C, Adams H et al.| title=Postpartum thyroiditis and long-term thyroid status: prognostic influence of thyroid peroxidase antibodies and ultrasound echogenicity. | journal=J Clin Endocrinol Metab | year= 2000 | volume= 85 | issue= 1 | pages= 71-5 | pmid=10634366 | doi=10.1210/jcem.85.1.6227 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10634366  }} </ref>
*If left untreated, 25-30% of patients with [[Postpartum thyroiditis|PPT]] may progress to develop [[hypothyroidism]]<ref name="pmid10634366">{{cite journal| author=Premawardhana LD, Parkes AB, Ammari F, John R, Darke C, Adams H et al.| title=Postpartum thyroiditis and long-term thyroid status: prognostic influence of thyroid peroxidase antibodies and ultrasound echogenicity. | journal=J Clin Endocrinol Metab | year= 2000 | volume= 85 | issue= 1 | pages= 71-5 | pmid=10634366 | doi=10.1210/jcem.85.1.6227 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10634366  }} </ref>
*Patients who are anti-TPO antibodies positive,HLA-DRW9 and/or HLA-DRB51 <ref name="pmid3162458">{{cite journal| author=Tachi J, Amino N, Tamaki H, Aozasa M, Iwatani Y, Miyai K| title=Long term follow-up and HLA association in patients with postpartum hypothyroidism. | journal=J Clin Endocrinol Metab | year= 1988 | volume= 66 | issue= 3 | pages= 480-4 | pmid=3162458 | doi=10.1210/jcem-66-3-480 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3162458  }} </ref> , and developed hypothyroid phase of PPT, are at increased risk of developing permanent  [[hypothyroidism]].<ref name="StuckeyKent2010">{{cite journal|last1=Stuckey|first1=B G A|last2=Kent|first2=G N|last3=Ward|first3=L C|last4=Brown|first4=S J|last5=Walsh|first5=J P|title=ORIGINAL ARTICLE: Postpartum thyroid dysfunction and the long-term risk of hypothyroidism: results from a 12-year follow-up study of women with and without postpartum thyroid dysfunction|journal=Clinical Endocrinology|volume=73|issue=3|year=2010|pages=389–395|issn=03000664|doi=10.1111/j.1365-2265.2010.03797.x}}</ref>
*Patients who are anti-TPO [[antibodies]] positive,HLA-DRW9 and/or HLA-DRB51<ref name="pmid3162458">{{cite journal| author=Tachi J, Amino N, Tamaki H, Aozasa M, Iwatani Y, Miyai K| title=Long term follow-up and HLA association in patients with postpartum hypothyroidism. | journal=J Clin Endocrinol Metab | year= 1988 | volume= 66 | issue= 3 | pages= 480-4 | pmid=3162458 | doi=10.1210/jcem-66-3-480 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3162458  }} </ref>, and developed [[Hypothyroidism|hypothyroid]] phase of [[Postpartum thyroiditis|PPT]], are at increased risk of developing permanent  [[hypothyroidism]].<ref name="StuckeyKent2010">{{cite journal|last1=Stuckey|first1=B G A|last2=Kent|first2=G N|last3=Ward|first3=L C|last4=Brown|first4=S J|last5=Walsh|first5=J P|title=ORIGINAL ARTICLE: Postpartum thyroid dysfunction and the long-term risk of hypothyroidism: results from a 12-year follow-up study of women with and without postpartum thyroid dysfunction|journal=Clinical Endocrinology|volume=73|issue=3|year=2010|pages=389–395|issn=03000664|doi=10.1111/j.1365-2265.2010.03797.x}}</ref>


===Complications===
===Complications===
*Common complications of  include:
*Common complications of  include:
**Hypothyroidism<ref name="pmid108745383">{{cite journal| author=Stagnaro-Green A| title=Recognizing, understanding, and treating postpartum thyroiditis. | journal=Endocrinol Metab Clin North Am | year= 2000 | volume= 29 | issue= 2 | pages= 417-30, ix | pmid=10874538 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10874538  }}</ref>
**[[Hypothyroidism]]<ref name="pmid108745383">{{cite journal| author=Stagnaro-Green A| title=Recognizing, understanding, and treating postpartum thyroiditis. | journal=Endocrinol Metab Clin North Am | year= 2000 | volume= 29 | issue= 2 | pages= 417-30, ix | pmid=10874538 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10874538  }}</ref>
**Postpartum depression<ref name="pmid108745382">{{cite journal| author=Stagnaro-Green A| title=Recognizing, understanding, and treating postpartum thyroiditis. | journal=Endocrinol Metab Clin North Am | year= 2000 | volume= 29 | issue= 2 | pages= 417-30, ix | pmid=10874538 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10874538  }}</ref>
**[[Postnatal depression|Postpartum depression]]<ref name="pmid108745382">{{cite journal| author=Stagnaro-Green A| title=Recognizing, understanding, and treating postpartum thyroiditis. | journal=Endocrinol Metab Clin North Am | year= 2000 | volume= 29 | issue= 2 | pages= 417-30, ix | pmid=10874538 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10874538  }}</ref>
**Recurrence <ref name="pmid7062963">{{cite journal| author=Amino N, Mori H, Iwatani Y, Tanizawa O, Kawashima M, Tsuge I et al.| title=High prevalence of transient post-partum thyrotoxicosis and hypothyroidism. | journal=N Engl J Med | year= 1982 | volume= 306 | issue= 14 | pages= 849-52 | pmid=7062963 | doi=10.1056/NEJM198204083061405 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7062963  }} </ref>
**Recurrence <ref name="pmid7062963">{{cite journal| author=Amino N, Mori H, Iwatani Y, Tanizawa O, Kawashima M, Tsuge I et al.| title=High prevalence of transient post-partum thyrotoxicosis and hypothyroidism. | journal=N Engl J Med | year= 1982 | volume= 306 | issue= 14 | pages= 849-52 | pmid=7062963 | doi=10.1056/NEJM198204083061405 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7062963  }} </ref>
**Fetal mental retardation in future pregnancies in diagnosed cases.<ref name="pmid3394739">{{cite journal| author=Hayslip CC, Fein HG, O'Donnell VM, Friedman DS, Klein TA, Smallridge RC| title=The value of serum antimicrosomal antibody testing in screening for symptomatic postpartum thyroid dysfunction. | journal=Am J Obstet Gynecol | year= 1988 | volume= 159 | issue= 1 | pages= 203-9 | pmid=3394739 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3394739  }} </ref>
**Fetal [[mental retardation]] in future pregnancies in diagnosed cases.<ref name="pmid3394739">{{cite journal| author=Hayslip CC, Fein HG, O'Donnell VM, Friedman DS, Klein TA, Smallridge RC| title=The value of serum antimicrosomal antibody testing in screening for symptomatic postpartum thyroid dysfunction. | journal=Am J Obstet Gynecol | year= 1988 | volume= 159 | issue= 1 | pages= 203-9 | pmid=3394739 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3394739  }} </ref>
**Overt hyperthyroid symptoms in future pregnancies.<ref name="pmid7062963">{{cite journal| author=Amino N, Mori H, Iwatani Y, Tanizawa O, Kawashima M, Tsuge I et al.| title=High prevalence of transient post-partum thyrotoxicosis and hypothyroidism. | journal=N Engl J Med | year= 1982 | volume= 306 | issue= 14 | pages= 849-52 | pmid=7062963 | doi=10.1056/NEJM198204083061405 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7062963  }} </ref>
**Overt [[Hyperthyroidism|hyperthyroid]] symptoms in future pregnancies.<ref name="pmid7062963">{{cite journal| author=Amino N, Mori H, Iwatani Y, Tanizawa O, Kawashima M, Tsuge I et al.| title=High prevalence of transient post-partum thyrotoxicosis and hypothyroidism. | journal=N Engl J Med | year= 1982 | volume= 306 | issue= 14 | pages= 849-52 | pmid=7062963 | doi=10.1056/NEJM198204083061405 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7062963  }} </ref>


===Prognosis===
===Prognosis===
* Prognosis is generally good and 90% of patient recover to normal state after 12 months of postpartum.<ref name="pmid27981252">{{cite journal| author=Alemu A, Terefe B, Abebe M, Biadgo B| title=Thyroid hormone dysfunction during pregnancy: A review. | journal=Int J Reprod Biomed (Yazd) | year= 2016 | volume= 14 | issue= 11 | pages= 677-686 | pmid=27981252 | doi= | pmc=5153572 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27981252  }}</ref>
* [[Prognosis]] is generally good and 90% of patient recover to normal state after 12 months of postpartum.<ref name="pmid27981252">{{cite journal| author=Alemu A, Terefe B, Abebe M, Biadgo B| title=Thyroid hormone dysfunction during pregnancy: A review. | journal=Int J Reprod Biomed (Yazd) | year= 2016 | volume= 14 | issue= 11 | pages= 677-686 | pmid=27981252 | doi= | pmc=5153572 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27981252  }}</ref>
* 25-30% in 3.5 to 8.7-year patients with postpartum thyroiditis develop hypothyroidism.
* 25-30% in 3.5 to 8.7-year patients with [[postpartum thyroiditis]] develop [[hypothyroidism]].


==References==
==References==

Revision as of 18:21, 13 October 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunny Kumar MD [2]

Overview

Prognosis is generally good, 25-30% in 3.5 to 8.7-year patients with postpartum thyroiditis PPT develop hypothyroidism. The symptoms of postpartum thyroiditis usually develop in the twelve months after delivery, abortion or miscarriage of fetus and start with symptoms depending on clinical course that it follows. Common complications of include hypothyroidism, postpartum depression, fetal mental retardation in future pregnancies in diagnosed cases and overt hyperthyroid symptoms in future pregnancies. Prognosis is generally good and 90% of patient recover to normal state after 12 months of postpartum.

Natural History, Complications, and Prognosis

Natural History

  • The symptoms of postpartum thyroiditis, PPT usually develop in the twelve months after devilry , abortion or miscarriage of fetus and start with symptoms depending on clinical course that it follows.
  • There are three clinical courses:

Complications

Prognosis

References

  1. ↑ Stagnaro-Green A (2000). "Recognizing, understanding, and treating postpartum thyroiditis". Endocrinol Metab Clin North Am. 29 (2): 417–30, ix. PMID 10874538.
  2. ↑ 2.0 2.1 2.2 Stagnaro-Green A (2012). "Approach to the patient with postpartum thyroiditis". J Clin Endocrinol Metab. 97 (2): 334–42. doi:10.1210/jc.2011-2576. PMID 22312089.
  3. ↑ Premawardhana LD, Parkes AB, Ammari F, John R, Darke C, Adams H; et al. (2000). "Postpartum thyroiditis and long-term thyroid status: prognostic influence of thyroid peroxidase antibodies and ultrasound echogenicity". J Clin Endocrinol Metab. 85 (1): 71–5. doi:10.1210/jcem.85.1.6227. PMID 10634366.
  4. ↑ Tachi J, Amino N, Tamaki H, Aozasa M, Iwatani Y, Miyai K (1988). "Long term follow-up and HLA association in patients with postpartum hypothyroidism". J Clin Endocrinol Metab. 66 (3): 480–4. doi:10.1210/jcem-66-3-480. PMID 3162458.
  5. ↑ Stuckey, B G A; Kent, G N; Ward, L C; Brown, S J; Walsh, J P (2010). "ORIGINAL ARTICLE: Postpartum thyroid dysfunction and the long-term risk of hypothyroidism: results from a 12-year follow-up study of women with and without postpartum thyroid dysfunction". Clinical Endocrinology. 73 (3): 389–395. doi:10.1111/j.1365-2265.2010.03797.x. ISSN 0300-0664.
  6. ↑ Stagnaro-Green A (2000). "Recognizing, understanding, and treating postpartum thyroiditis". Endocrinol Metab Clin North Am. 29 (2): 417–30, ix. PMID 10874538.
  7. ↑ Stagnaro-Green A (2000). "Recognizing, understanding, and treating postpartum thyroiditis". Endocrinol Metab Clin North Am. 29 (2): 417–30, ix. PMID 10874538.
  8. ↑ 8.0 8.1 Amino N, Mori H, Iwatani Y, Tanizawa O, Kawashima M, Tsuge I; et al. (1982). "High prevalence of transient post-partum thyrotoxicosis and hypothyroidism". N Engl J Med. 306 (14): 849–52. doi:10.1056/NEJM198204083061405. PMID 7062963.
  9. ↑ Hayslip CC, Fein HG, O'Donnell VM, Friedman DS, Klein TA, Smallridge RC (1988). "The value of serum antimicrosomal antibody testing in screening for symptomatic postpartum thyroid dysfunction". Am J Obstet Gynecol. 159 (1): 203–9. PMID 3394739.
  10. ↑ Alemu A, Terefe B, Abebe M, Biadgo B (2016). "Thyroid hormone dysfunction during pregnancy: A review". Int J Reprod Biomed (Yazd). 14 (11): 677–686. PMC 5153572. PMID 27981252.

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