Relationship between Clinical and Immunological Features of Thyroid Autoimmunity and Ophthalmopathy during Pregnancy.

Jack R Wall,Hooshang Lahooti,Emily J Hibbert,Bernard Champion

doi:10.1155/2015/698470

Jack R Wall, Hooshang Lahooti + Show 2 more

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https://doi.org/10.1155/2015/698470

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Abstract

Problem. Clinical features of Graves' hyperthyroidism (GH) generally improve during pregnancy and rebound in the postpartum period. It is unclear whether the ophthalmopathy that is associated with GH and, less often, Hashimoto's thyroiditis (HT) changes in parallel with the thyroid associated antibody reactions and clinical features or runs a different course. Method of Study. We retrospectively studied 19 patients with autoimmune thyroid disease over 22 pregnancies: 9 pregnancies with GH and 13 with HT. Ophthalmopathy was defined by NOSPECS class. Results. Thyroid peroxidase (TPO) and thyroglobulin (Tg) antibody titres decreased during pregnancy and rose in the postpartum period. During pregnancy, 5 patients with GH and 4 patients with HT developed mild ophthalmopathy and two patients with GH and HT developed new upper eyelid retraction (UER). In the postpartum period, eye scores improved in 3 patients with GH and 3 with HT, remained stable in two and 5 patients, respectively, and worsened in 2 patients with GH and one with HT. Conclusions. In patients with mild to moderate eye signs associated with GH and HT, the orbital and thyroid reactions ran different courses during pregnancy. Since no patient had severe ophthalmopathy, we cannot draw definitive conclusions from this preliminary study.

Highlights

It is well known that the clinical features of Graves’ hyperthyroidism (GH) tend to improve during pregnancy, and smaller doses of antithyroid medication are needed to maintain euthyroidism [1], in parallel with fall in serum titres of thyroid peroxidase (TPO), thyroglobulin (Tg), and TSH receptor (TSHr) antibodies; the antibodies rebound in the postpartum period, at which time the hyperthyroidism often relapses [2]
We studied 19 pregnant women, 7 with GH and 12 with Hashimoto’s thyroiditis (HT), during 22 pregnancies and in the postpartum period to assess the relationship between clinical and immunological parameters of the thyroid and orbital autoimmune reactions in this human model
While symptoms of GH typically improve during pregnancy and rebound in the postpartum period, there have been no studies to examine the relationship between the eye changes and thyroid autoimmunity in patients with GH and HT

Summary

Introduction

It is well known that the clinical features of Graves’ hyperthyroidism (GH) tend to improve during pregnancy, and smaller doses of antithyroid medication are needed to maintain euthyroidism [1], in parallel with fall in serum titres of thyroid peroxidase (TPO), thyroglobulin (Tg), and TSH receptor (TSHr) antibodies; the antibodies rebound in the postpartum period, at which time the hyperthyroidism often relapses [2]. If the eye signs were to improve during pregnancy and rebound in the postpartum period, in parallel with changes in parameters of the thyroid reaction, this would favour ophthalmopathy and thyroid autoimmunity being components of a single disease. We have studied pregnant women with GH and HT through pregnancy and in the early postpartum period, showing that clinical and immunological features of the thyroid and orbital reactions run divergent courses in about 50% of patients

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Discussion