Postpartum Thyroiditis and Autoimmune Thyroiditis in Women of Childbearing Age: Recent Insights and Consequences for Antenatal and Postnatal Care
Alex F. Muller,
Hemmo A. Drexhage and
Arie Berghout
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
thyroiddysfunction occurring in the first year after delivery and
basedon an autoimmune inflammation of the thyroid. The prevalence
rangesfrom 5–7%. We discuss the role of antibodies (especially
thyroidperoxidase antibodies), complement, activated T cells, and
apoptosisin the outbreak of postpartum thyroiditis. Postpartum
thyroiditisis conceptualized as an acute phase of autoimmune thyroid
destructionin the context of an existing and ongoing process of
thyroidautosensitization. From pregnancy an enhanced state of immune
toleranceensues. A rebound reaction to this pregnancy-associated
immunesuppression after delivery explains the aggravation of
autoimmunesyndromes in the puerperal period, e.g., the
occurrence of clinicallyovert postpartum thyroiditis. Low thyroid
reserve due to autoimmunethyroiditis is increasingly recognized as a
serious health problem.1) Thyroid autoimmunity increases the
probability of spontaneousfetal loss. 2) Thyroid failure due to
autoimmune thyroiditis—oftenmild and subclinical—can lead to
permanent and significantimpairment in neuropsychological performance
of the offspring.3) Evidence is emerging that as women age
subclinical hypothyroidism—asa sequel of postpartum
thyroiditis—predisposes them tocardiovascular disease. Hence,
postpartum thyroiditis is nolonger considered a mild and transient
disorder. Screening isconsidered.
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