This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Muller, A. F. Articles by Berghout, A. Search for Related Content PubMed PubMed Citation Articles by Muller, A. F. Articles by Berghout, A.

Postpartum Thyroiditis and Autoimmune Thyroiditis in Women of Childbearing Age: Recent Insights and Consequences for Antenatal and Postnatal Care

Departments of Immunology (A.M., H.D.) and Internal Medicine (A.M.), Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; and Department of Internal Medicine (A.B.), Medical Center Rijnmond Zuid, 3075 EA Rotterdam, The Netherlands

Correspondence: Address all correspondence and requests for reprints to: A. F. Muller M.D., Department of Internal Medicine, Diakonessenhuis Utrecht, Bosboomstraat 1, 3508 TG, Utrecht, The Netherlands. E-mail: amuller{at}diakhuis.nl

Postpartum thyroiditis is a syndrome of transient or permanent thyroid dysfunction occurring in the first year after delivery and based on an autoimmune inflammation of the thyroid. The prevalence ranges from 5–7%. We discuss the role of antibodies (especially thyroid peroxidase antibodies), complement, activated T cells, and apoptosis in the outbreak of postpartum thyroiditis. Postpartum thyroiditis is conceptualized as an acute phase of autoimmune thyroid destruction in the context of an existing and ongoing process of thyroid autosensitization. From pregnancy an enhanced state of immune tolerance ensues. A rebound reaction to this pregnancy-associated immune suppression after delivery explains the aggravation of autoimmune syndromes in the puerperal period, e.g., the occurrence of clinically overt postpartum thyroiditis. Low thyroid reserve due to autoimmune thyroiditis is increasingly recognized as a serious health problem. 1) Thyroid autoimmunity increases the probability of spontaneous fetal loss. 2) Thyroid failure due to autoimmune thyroiditis—often mild and subclinical—can lead to permanent and significant impairment in neuropsychological performance of the offspring. 3) Evidence is emerging that as women age subclinical hypothyroidism—as a sequel of postpartum thyroiditis—predisposes them to cardiovascular disease. Hence, postpartum thyroiditis is no longer considered a mild and transient disorder. Screening is considered.

This article has been cited by other articles:

				H. Marx, P. Amin, and J. H Lazarus Hyperthyroidism and pregnancy BMJ, March 22, 2008; 336(7645): 663 - 667. [Full Text] [PDF]

				E. E. Wasserman, K. Nelson, N. R. Rose, W. Eaton, J. P. Pillion, E. Seaberg, M. V. Talor, L. Burek, A. Duggan, and R. H. Yolken Maternal Thyroid Autoantibodies during the Third Trimester and Hearing Deficits in Children: An Epidemiologic Assessment Am. J. Epidemiol., March 15, 2008; 167(6): 701 - 710. [Abstract] [Full Text] [PDF]

				M. Rotondi, L. Chiovato, S. Romagnani, M. Serio, and P. Romagnani Role of Chemokines in Endocrine Autoimmune Diseases Endocr. Rev., August 1, 2007; 28(5): 492 - 520. [Abstract] [Full Text] [PDF]

				Subsection Reports J. Clin. Endocrinol. Metab., August 1, 2007; 92(8_suppl): s8 - s47. [Full Text] [PDF]

				M. Abalovich, N. Amino, L. A. Barbour, R. H. Cobin, L. J. De Groot, D. Glinoer, S. J. Mandel, and A. Stagnaro-Green Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline J. Clin. Endocrinol. Metab., August 1, 2007; 92(8_suppl): s1 - s47. [Abstract] [Full Text] [PDF]

				A. TSATSOULIS The Role of Stress in the Clinical Expression of Thyroid Autoimmunity Ann. N.Y. Acad. Sci., November 1, 2006; 1088(1): 382 - 395. [Abstract] [Full Text] [PDF]

				B. M. Casey and K. J. Leveno Thyroid disease in pregnancy. Obstet. Gynecol., November 1, 2006; 108(5): 1283 - 1292. [Abstract] [Full Text] [PDF]

				E. N Pearce Diagnosis and management of thyrotoxicosis. BMJ, June 10, 2006; 332(7554): 1369 - 1373. [Full Text] [PDF]

				R. J. Kaaja and I. A. Greer Manifestations of Chronic Disease During Pregnancy JAMA, December 7, 2005; 294(21): 2751 - 2757. [Abstract] [Full Text] [PDF]

				C. P. Stowell and J. W. Barnhill Acute Mania in the Setting of Severe Hypothyroidism Psychosomatics, June 1, 2005; 46(3): 259 - 261. [Abstract] [Full Text] [PDF]

				J H Lazarus and L D K E Premawardhana BEST PRACTICE NO 184 Screening for thyroid disease in pregnancy J. Clin. Pathol., May 1, 2005; 58(5): 449 - 452. [Abstract] [Full Text] [PDF]

				M. T. Stein, D. B. Kessler, and E. Hubbard Failure to Thrive in a 4-Month-Old Nursing Infant Pediatrics, November 1, 2004; 114(5/S2): 1468 - 1472. [Full Text] [PDF]

				N. F. Col, M. I. Surks, and G. H. Daniels Subclinical Thyroid Disease: Clinical Applications JAMA, January 14, 2004; 291(2): 239 - 243. [Abstract] [Full Text] [PDF]

				G. MASTORAKOS and I. ILIAS Maternal and Fetal Hypothalamic-Pituitary-Adrenal Axes During Pregnancy and Postpartum Ann. N.Y. Acad. Sci., November 1, 2003; 997(1): 136 - 149. [Abstract] [Full Text] [PDF]

				Y. Tomer and T. F. Davies Searching for the Autoimmune Thyroid Disease Susceptibility Genes: From Gene Mapping to Gene Function Endocr. Rev., October 1, 2003; 24(5): 694 - 717. [Abstract] [Full Text] [PDF]

				E. N. Pearce, A. P. Farwell, and L. E. Braverman Thyroiditis N. Engl. J. Med., June 26, 2003; 348(26): 2646 - 2655. [Full Text] [PDF]

				A. A. Kokandi, A. B. Parkes, L. D. K. E. Premawardhana, R. John, and J. H. Lazarus Association of Postpartum Thyroid Dysfunction with Antepartum Hormonal and Immunological Changes J. Clin. Endocrinol. Metab., March 1, 2003; 88(3): 1126 - 1132. [Abstract] [Full Text] [PDF]

				A. Stagnaro-Green Postpartum Thyroiditis J. Clin. Endocrinol. Metab., September 1, 2002; 87(9): 4042 - 4047. [Full Text] [PDF]