Postpartum Thyroiditis Patients Research Articles

Doppler ultrasonographical findings in the differential diagnosis of post-partum thyroiditis

To investigate the effects of haemodynamic indices on colour Doppler ultrasound in differential diagnosis in patients with postpartum thyroiditis and with Graves' disease. The cross-sectional study was conducted at the Endocrinology Polyclinic of Medical Park Hospital, Ordu, Turkey, from March 2017 to May 2018 and comprised patients referred from the Gynaecology Department for routine check-up after parturition within the first 6 months. The patients were divided into two groups. Group 1 had postpartum thyroiditis patients and Group 2 had those of Graves' disease. In both groups, parameters measured were peak systolic velocity, end-diastolic velocity and resistive index of the inferior thyroid artery with proper angle (45-60⁰) on colour Doppler ultrasound. Data was analysed using SPSS 20. Of the 42 subjects,18(42.85%) were in Group 1 and 24(57.14%) were in Group 2. Peak systolic velocity and end-diastolic velocity values of the inferior thyroid artery were higher in Group 2 compared to Group 1 (p<005). (p<0.05), while the resistive index value was significantly higher in Group 1 compared to Group 2. Due to its wide availability, the use of colour Doppler ultrasound parameters indicating parenchymal perfusion were found to be broadly useful in distinguishing between postpartum thyroiditis and Graves' disease.

Sustained high levels of serum leptin rather than IL-6 observed in patients with postpartum thyroiditis during their first postpartum year

The purpose of the study is to explore the roles of leptin and interleukin-6 (IL-6) during the first postpartum year in the occurrence and development of postpartum thyroiditis (PPT). We retrospectively collected serum samples from 57 PPT patients consisting of 34 overt PPT (O-PPT) and 23 subclinical PPT (S-PPT) in addition to 37 healthy postpartum women at four postpartum time points, i.e., 3-day and 3, 6, 12-month postpartum. Serum leptin and IL-6 levels were measured by radioimmunoassay and ELISA assay, respectively. Leptin level and leptin/BMI (LEP/BMI) ratio were higher in PPT patients than in control during the first postpartum year, but were not significantly different between O-PPT and S-PPT. However, a similar trend but did not reach significant difference in IL-6 level was observed during the postpartum period in PPT patients and control women. We conclude that a sustained high level of serum leptin after delivery may be involved in the pathogenesis of PPT. IL-6 does not contribute to the development of PPT.

A two-year follow-up study of 58 patients with postpartum thyroiditis

Objective To investigate the cumulative incidence of persistent hypothyroidism in patients who were diagnosed as postpartum thyroiditis ( PPT),and to determine the factors associated with the development of persistent hypothyroidism in those patients.Methods The present study was performed as the continuous study followed by the former epidemiological survey on PPT,in which 58 patients with PPT (35 overt PPT and 23 subclinical PPT) were diagnosed.The 58 patients were followed up at 12th month postpartum,and then for every 6 months until 24 months postpartum.Fasting blood samples were taken for testing serum TSH,thyroid peroxidase antibody ( TPOAb),and thyroglobulin antibody ( TgAb ).Free T3 ( FT3 ),free T4 ( FT4 ),and TSH receptor antibody ( TRAh ) were detected if TSH was abnormal.50 healthy postpartum women were used as control group.Results Of the total 58 PPT patients,91,4％ ( n =53 ) were successfully followed.Five patients with overt PPT and 6 patients with subclinical PPT developed persistent hypothyroidism,and the cumulative incidence of persistent hypothyroidism in the studied PPT patients was 20.8％.Among 15 PPT patients who had a classical biphasic course (a thyrotoxic phase followed by a hypothyroid phase),persistent hypothyroidism was seen in 26.7％ (n =4 ).Among 11 PPT patients with hypothyroidism only,persistent hypothyroidism was seen in 63.6％ ( n =7).On the contrary,none of the patients with thyrotoxicosis only had persistent hypothyroidism.All of the patients who developed persistent hypothyrodism had a higher TSH levels than 4.8 mU/L at 6th month postpartum.Before delivery,TSH levels of the patients developed persistent hypothyroidism were significantly higher than those of the patients with transient hypothyroidism,and this was the case at the 12th month postpartum ( all P＜0.01 ).PPT patients maintained a relatively higher rate of thyroid autoantibodies.The positive rate of TPOAb at the 12th,18th,and 24th month postpartum was 56.6％,50.9％,and 52.8％,respectively; and the positive rate of TgAb being 35.8％,30.2％,and 30.2％,respectively.Both the positive rate and titer of TPOAb in patients with overt PPT were higher than those in patients with subclinical PPT at the 18th and 24th month postpartum (P＜0.05).Conclusions 20.8％ patients with PPT developed persistent hypothyroidism at the 24th month postpartum.Whether a patient with PPT would develop persistent hypothyroidism depends on his clinical feature and TSH level. Key words: Postpartum thyroiditis; Persistent hypothyroidism; Transient hypothyroidism; Thyroid autoantibodies

Association of CT60 cytotoxic T lymphocyte antigen-4 gene polymorphism with thyroid autoantibody production in patients with Hashimoto's and postpartum thyroiditis

Strong genetic contribution has been demonstrated to influence the development of autoimmune thyroid disease (AITD) as well as thyroid autoantibody production. In order to assess the relation between CT60 cytotoxic T lymphocyte antigen-4 (CTLA-4) gene polymorphism and thyroid autoantibody production, we investigated 180 consecutive newly diagnosed patients with two forms of AITD, 105 with Hashimoto's thyroiditis (HT) and 75 with postpartum thyroiditis (PPT). We evaluated thyroid function, measured antibodies against thyroid peroxidase (TPO) and thyroglobulin (Tg), and determined CT60 CTLA-4 gene polymorphism. In HT, TPO antibody median value was significantly lower in the AA compared to the AG and GG genotypes (65, 122 and 319 U/ml, P<0.005), while the Tg antibody median value was lower in the AA compared to the AG genotype (91 and 189 U/ml, P<0.02). In PPT, the frequency of thyroid autoantibody-positive patients was higher among G-allele-carrying genotypes (P<0.04). Similar to HT, the TPO antibody median value was lower in the AA compared to the AG and GG genotypes (12, 130 and 423 U/ml, P<0.006). Hypothyroid PPT patients were more often thyroid autoantibody-positive (P<0.005) and the TPO antibody median value was higher compared to hyperthyroid PPT patients (500 and 32 U/ml, P<0.0001). The frequency of the G-allele was significantly higher among hypothyroid patients (P<0.05). Our data suggest that in both HT and PPT, the CT60 CTLA-4 gene polymorphism contributes importantly to thyroid autoantibody production. In PPT, the genotype also seems to influence thyroid function, as patients with the polymorphous allele are more prone to develop hypothyroid form of PPT.

Dynamic Changes of IgG Subtypes of Thyroid Peroxidase Antibody in Patients with Postpartum Thyroiditis

Aim: To clarify dynamic changes of IgG subtypes of thyroid peroxidase antibody (TPOAb) during the first postpartum year in Chinese patients diagnosed with postpartum thyroiditis (PPT). Methods: We retrospectively collected serum samples before and 3, 6, 9 and 12 months postpartum from 58 PPT patients. Levels of TPOAb and its IgG subtypes were examined by ELISA. Results: Titers of total TPOAb and its IgG subtypes were lowest before delivery in PPT patients. Following delivery, titers of total TPOAb increased. Concentrations of IgG1 and IgG4 subtypes increased for 3 months postpartum, then became stable. Concentrations of the IgG2 subtype increased gradually until 9 months postpartum. Concentrations of the IgG3 subtype reached a peak at 6 months postpartum and remained at a high level thereafter. In PPT patients with an episode of hypothyroidism, levels of total TPOAb and of the IgG subtypes as well as the IgG1/IgG4 ratios were significantly higher than those in patients with an episode of hyperthyroidism and normal controls. Correlations between titers of TPOAb and thyroid-stimulating hormone levels (positive) and free T₄ levels (negative) were seen 6 months postpartum. Conclusion: TPOAb is related to thyroid injury and the IgG1 subtype of TPOAb may play a major role in the damage of the thyroid in PPT.

Circulating lymphocyte subsets and regulatory T cells in patients with postpartum thyroiditis during the first postpartum year

The lymphocyte subsets and the percentages of activated T cells or regulatory T cells were observed during the course of postpartum thyroiditis (PPT). Heparin anticoagulant vein bloods were collected at 3, 6, 9 and 12 months postpartum consequently from 27 PPT patients and 23 normal postpartum subjects. Lymphocyte surface antigen CD3, CD4, CD8, HLA-DR and CD25 were stained in appropriate combination and detected with fluorescence-activated cell sorter analysis. The percentage of CD4 was significantly lower in both PPT groups with biphasic diseases and isolated hypothyroidism at 3 months postpartum as compared to control postpartum women separately (both P < 0.05). Then, decreased CD4/CD8 ratios were also appeared in these groups. Patients with both positive TPOAb and TgAb had higher percentage of activated T (HLA-DR(+)CD3(+)) cells compared to control postpartum women at 3 months postpartum (P < 0.05). The percentage of activated T cells correlated with a raised percentage of CD8(+) T cell subset (P < 0.001) and a decreased percentage of regulatory T (CD25(+)CD4(+)) cells (P < 0.01). The percentages of regulatory T cells were significantly higher in control postpartum women at 3, 6 and 9 months postpartum compared with non-postpartum women (P < 0.05). However, it was lower in PPT patients at 3 months compared to itself at 6 and 9 months postpartum (P < 0.05). In the early postpartum period of PPT patients, a reduced helper/inducer T cell subset, an increased percentage of activated T cells and a reduced percentage of regulatory T cells were reported, indicating that T cells may play a key role in the pathogenesis of PPT.

Ultrasonographic characteristics and follow-up in post-partum thyroiditis

Post-partum thyroiditis (PPT) is an autoimmune disorder of the thyroid gland, which occurs in the first year after parturition. This study was designed to evaluate sonographic characteristics in a group of PPT patients in Tehran. The study group consisted of 119 PPT patients and 97 normal post-partum women as the control group. Physical examination of thyroid and ultrasonography were carried out monthly in PPT patients until remission for up to 12 months post-partum and 65 patients were followed-up until the end of the study. Visible goiter was detected in 21.8% of patients and 6.7% of the control group (p < 0.001). Hypoechogenecity in thyroid sonography was present in 98.5% of patients and 7% of the control group (p < 0.001). Initially mean thyroid volume in PPT patients was found to be 77% more than that of the control group. After remission, mean thyroid volume decreased by 25% in PPT patients. At 12 months after delivery, only 6 patients had abnormal thyroid function tests, while 4 patients with TSH > 10 mU/I still showed hypoechogenicity in thyroid sonography. In conclusion, sonography may be recommended as an adjuvant to laboratory tests in evaluation of PPT patients.

Post-partum thyroiditis in a mediterranean population: a prospective study of a large cohort of thyroid antibody positive women at the time of delivery.

Post-partum thyroiditis (PPT) is a common disease with important clinical sequelae. Its clinical features, association with antimicrosomal antibodies (TPOAb) and long-term prognosis are not thoroughly described in Mediterranean populations. The aims of this study were: 1) to describe clinical features of PPT in a Greek population, 2) to associate TPOAb with PPT presence, and 3) to identify long-term prognosis of PPT. 1,594 consecutive post-partum women were studied within 3 days of their delivery. Women with positive TPOAb were followed-up for one yr for clinical and biochemical evidence of PPT. Incidence of positive TPOAb was 5.2% whereas incidence of PPT was 2.4%. PPT was presented as hyperthyroidism alone (18%), hypothyroidism alone (40%) and hyperthyroidism followed by hypothyroidism (42%). A titer of 1:1600, immediately post-partum, could predict PPT with 97% sensitivity and 91% specificity. History of PPT in previous pregnancies was associated with PPT in the current pregnancy. This association did not exist with maternal age, gestation duration, parity, abortions, sex of the newborn, birth-weight or smoking. Long-term hypothyroidism developed in 21% of women. Observation and post-partum thyroid function testing, where PPT is suspected, seems to constitute the best clinical approach. There is need for long-term follow-up in PPT patients.

Postpartum thyroiditis: epidemiology and clinical evolution in a nonselected population.

Postpartum thyroiditis (PPT) presents in approximately 5% of women. Its incidence, clinical characteristics, and evolution were studied in a nonselected population of Mediterranean women. Six hundred five healthy women, recruited between the 36th week of pregnancy and the 4th postpartum day, underwent initial clinical and biological evaluation and postpartum at 1 (n = 605), 3 (n = 552), 6 (n = 574), 9 (n = 431), and 12 (n = 444) months. PPT was diagnosed in women with transient hyperthyroidism between 1 and 3 months postpartum and/or hypothyroidism between 3 and 6 months postpartum. Permanent hypothyroidism was considered if it was overt and persisted one year after diagnosis. The incidence rate of PPT was 7.8%. Eighty-two percent of PPT patients had hormone abnormalities at the 6th month postpartum, 8.8% showed depression and 51% goiter. PPT was manifest as hyperthyroidism plus hypothyroidism in 35.5% of patients, because only transient hyperthyroidism in 22.2% and as hypothyroidism alone in 42.3%. Five patients with hypothyroidism during PPT (0.82% of the initial population, 11.1% of PPT patients, and 15.6% of hypothyroidism PPT patients) presented permanent hypothyroidism after a follow-up of 39.8 (4.2) months. PPT was found in 7.8% of general Mediterranean population. We recommend evaluation at the 6th postpartum month to diagnose the majority of PPT women and indefinite follow-up of hypothyroid PPT patients to detect permanent hypothyroidism.

A Long-Term Follow-Up of Postpartum Thyroiditis

To investigate the long-term outcome of postpartum thyroiditis (PPT), 43 patients with PPT and 171 control women were evaluated 3.5 (range 2-4) years postpartum. Ten (23%) PPT patients were hypothyroid compared to none of the controls (P less than 0.001). Factors associated with the development of hypothyroidism were high antimicrosomal antibody titre measured at 16 weeks gestation (P less than 0.01), severity of hypothyroid phase of PPT, multiparity, and a previous history of spontaneous abortion. The presence of microsomal antibody but no PPT in one pregnancy did not prevent the occurrence of PPT in the next pregnancy in two patients and a further five patients had PPT in two successive pregnancies. There was no association between HLA haplotype, family history of thyroid disease, smoking or frequency of oral contraception, and the development of long-term hypothyroidism after PPT. It is concluded that permanent hypothyroidism is an important sequel to PPT and patients with PPT should be followed up appropriately.

A LONG‐TERM FOLLOW‐UP OF POSTPARTUM THYROIDITIS

To investigate the long-term outcome of postpartum thyroiditis (PPT), 43 patients with PPT and 171 control women were evaluated 3.5 (range 2-4) years postpartum. Ten (23%) PPT patients were hypothyroid compared to none of the controls (P less than 0.001). Factors associated with the development of hypothyroidism were high antimicrosomal antibody titre measured at 16 weeks gestation (P less than 0.01), severity of hypothyroid phase of PPT, multiparity, and a previous history of spontaneous abortion. The presence of microsomal antibody but no PPT in one pregnancy did not prevent the occurrence of PPT in the next pregnancy in two patients and a further five patients had PPT in two successive pregnancies. There was no association between HLA haplotype, family history of thyroid disease, smoking or frequency of oral contraception, and the development of long-term hypothyroidism after PPT. It is concluded that permanent hypothyroidism is an important sequel to PPT and patients with PPT should be followed up appropriately.

Natural killer cell activity and serum autoantibodies in women with postpartum thyroiditis.

Postpartum thyroiditis (PPT) is a form of painless lymphocytic thyroiditis which is thought to be caused by an exacerbation of underlying subclinical autoimmune thyroid disease during a postpartum period of immune rebound. The purposes of this study were to analyze natural killer cell (NK) functional activity and antibody-dependent cell-mediated cytotoxicity (ADCC) of peripheral blood mononuclear cells in patients with PPT compared to those in normal nonpostpartum and postpartum women. NK activity and ADCC were determined by specific lysis of 51Cr-labeled K562 human erythroleukemia tumor cells at varying effector (mononuclear cell) to target cell ratios. Nineteen PPT patients between 4-9 months [mean, 6.5 +/- 0.4 (+/- SE)] postpartum were compared to 20 nonpostpartum women, 31 healthy women between 4-9 months (6.7 +/- 0.3) postpartum, and 14 women 2 days after delivery. There were significant differences in the NK functional activities of the 4 groups (F = 7.95; P = 0.0002). The mean NK activities, as measured by percent specific lysis at an effector to target cell ratio of 10:1, were 31.1 +/- 3.3%, 20.9 +/- 2.3%, 22.5 +/- 2.8%, and 11.5 +/- 2.0% in the nonpostpartum, PPT, postpartum, and 2-day postpartum groups, respectively. Specific lysis by ADCC was not significantly different from lysis by NK activity in any group. The PPT, postpartum, and 2-day postpartum groups had significantly lower NK activity compared to that in nonpostpartum women (P less than 0.05). Both the PPT and postpartum women had higher NK activities than the 2-day postpartum women (P less than 0.05). However, there were no significant differences in the NK activities of the PPT patients compared to those of the healthy postpartum women. Patients with PPT were also found to have associated autoimmune dysfunction. The PPT group had significantly higher serum antinuclear antibody titers; 8 of 24 patients (33%) had titers of 1:160 or greater compared to only 2 of 29 healthy postpartum women (7.4%; P less than 0.05). Seven of the PPT patients had serum immune complexes, and 3 had TSH receptor antibodies. We conclude that functional NK activity and ADCC in peripheral lymphocytes of PPT patients are not different from those in healthy postpartum women; however, the postpartum women had significantly decreased activity compared to that in nonpostpartum women. These data emphasize the importance of studying healthy postpartum women in investigations of PPT, since the immunological changes in pregnancy and the postpartum period remain largely undefined.

Intrathyroidal and circulating lymphocyte subsets in different stages of autoimmune postpartum thyroiditis.

Postpartum thyroiditis (PPT) is a reversible form of lymphocytic thyroiditis which has been attributed to an aggravation of preexisting subclinical autoimmune thyroiditis. In this study no differences in circulating lymphocyte subsets were found between 9 thyrotoxic and 18 hypothyroid PPT patients and normal subjects. We obtained sufficient numbers of thyroid-infiltrating lymphocytes for surface marker characterization in 3 women in the thyrotoxic phase and in 10 women in the hypothyroid phase of PPT. Cells were identified by conventional T and B cell markers as well as by monoclonal antibodies (OKT) directed against different T cell subsets in a microscale immunofluorescence assay. In the hypothyroid patients a relative accumulation of B cells (31% vs. 17%; P less than 0.01 by the Wilcoxon signed rank test) was found within the thyroid when compared to peripheral blood. A relative decrease in intrathyroidal supressor-cytotoxic (OKT 8+) T cells (19% vs. 28%; P less than 0.01) resulted in an increased intrathyroidal helper to suppressor-cytotoxic (OKT 4+/OKT 8+) T cell ratio (3.0 vs. 2.0; P less than 0.01). Intrathyroidal lymphocyte subsets in the thyrotoxic patients were comparable to those in the hypothyroid patients. These findings, which are similar to those we previously obtained in patients with chronic Hashimoto's thyroiditis, may indicate that local synthesis of thyroid-directed autoantibodies is of primary importance in all stages of autoimmune thyroiditis.