[Postpartum thyroiditis as the first clinical manifestation of autoimmune polyendocrine syndrome type 2 ­ case report].

Postpartum thyroiditis is a form of autoimmune thyroiditis developing during the first 12 months postpartum in 5-10% of women as a consequence of the immunologic flare following the immune suppression of pregnancy. Autoimmune polyendocrine syndromes are rarely diagnosed conditions characterized by the association of at least two organspecific autoimmune disorders, and on the basis of their clinical picture, they may be divided into four different types. The underestimation of their real frequency probable results from physicians' inadequate knowledge of these clinical entities and sometimes their atypical clinical picture. Although autoimmune thyroid disease may be a component of both type 2 and 3 autoimmune polyendocrine syndromes, but the association between postpartum thyroiditis and autoimmune conditions of other endocrine organs has very rarely been described in literature. We report a case of a young woman, who after two subsequent pregnancies developed postpartum thyroiditis of different clinical pictures. After her second pregnancy, postpartum thyroiditis was followed by the development of autoimmune adrenal failure and premature ovarian failure, which allowed to diagnose type 2 autoimmune polyendocrine syndrome. Our case study suggests that every person with postpartum thyroiditis, particularly if this disorder is accompanied by atypical clinical manifestation, should be assessed for the possible presence of autoimmune polyendocrine syndrome.

The effect of vitamin D on thyroid autoimmunity in non-lactating women with postpartum thyroiditis.

The study included 38 non-lactating l-thyroxine-treated women with postpartum thyroiditis (PPT) and 21 matched healthy postpartum women. Women with vitamin D deficiency were treated with oral vitamin D (4000 IU daily), whereas women with vitamin D insufficiency and women with normal 25-hydroxy vitamin levels were either treated with vitamin D (2000 IU daily) or left untreated. Serum hormone levels and thyroid antibody titers were measured at the beginning of the study and 3 months later. 25-hydroxy vitamin D levels were lower in women with PPT than in healthy women. Thyroid peroxidase and thyroglobulin antibody titers inversely correlated with vitamin D status. Apart from increasing serum levels of 25-hydroxy vitamin D and decreasing serum levels of parathyroid hormone, vitamin D reduced titers of thyroid peroxidase antibodies and this effect was stronger in women with vitamin D deficiency. The study's results suggest that vitamin D supplementation may bring benefits to l-thyroxine-treated women with PPT.

Abordaje del manejo de la disfunción tiroidea en la gestación. Documento de consenso de la Sociedad Andaluza de Endocrinología y Nutrición (SAEN) / Thyroid dysfunction in pregnancy. Consensus document. Andalusian Society of Endocrinology and Nutrition (SAEN)

En nombre de la Sociedad Andaluza de Endocrinología y Nutrición (SAEN) se ha elaborado un consenso sobre la atención a la mujer gestante que presenta algún tipo de disfunción tiroidea, basándose en la revisión de la bibliografía actualizada y sobre todo de las guías de buena práctica clínica. Se desarrolla bajo distintos epígrafes o apartados en los que se contempla tanto el diagnóstico como el tratamiento del hipotiroidismo clínico y subclínico, el hipertiroidismo franco y subclínico, la hipotiroxinemia y la tiroiditis posparto, así como la justificación de la realización de cribado universal de la disfunción tiroidea durante la gestación, proporcionando a los profesionales que asisten a estas pacientes un arma de toma de decisiones razonada (AU)

A position statement on the diagnosis and treatment of thyroid dysfunction in pregnancy has been agreed on behalf of The Sociedad Andaluza de Endocrinología y Nutrición (SAEN), based on a review of the literature to date and all good clinical practice guidelines. The document is set out in different sections as regards the diagnosis and treatment of, overt and subclinical hypo- and hyperthyroidism, isolated hypothyroxinaemia and postpartum thyroiditis. It also justifies the implementation of universal screening for thyroid dysfunction in pregnancy, and provides practitioners who care for these patients with tool for rational decision making (AU)

Thyroid disorders during pregnancy and postpartum.

An awareness of the gestational changes to thyroid physiology and the impact of uncontrolled thyroid disease on pregnancy and infant outcome is essential for the successful management of hypothyroidism and hyperthyroidism. This review summarizes strategies for the management of thyroid disease in pregnancy and post partum, and it highlights areas where there is still a lack of consensus.

Serum 25-Hydroxyvitamin D and Parathyroid Hormone Levels in Non-Lactating Women with Post-Partum Thyroiditis: The Effect of L-Thyroxine Treatment.

Vitamin D deficiency seems to be implicated in the onset and progression of some autoimmune disorders. No previous study has investigated vitamin D homeostasis in post-partum thyroiditis. We compared 25-hydroxyvitamin D and parathyroid hormone (PTH) levels between four groups of non-lactating women who gave birth within 12 months before the beginning of the study: hypothyroid women with post-partum thyroiditis (group A; n = 14), euthyroid females with post-partum thyroiditis (group B; n = 14), women with non-autoimmune hypothyroidism (group C; n = 16) and healthy euthyroid females without thyroid autoimmunity (group D; n = 15). In the second part of the study, groups A and C were treated for 6 months with L-thyroxine. Serum levels of 25-hydroxyvitamin D were lower, while PTH higher in patients with post-partum thyroiditis than in patients without thyroid autoimmunity. They were also lower (25-hydroxyvitamin D) or higher (PTH) in group A than in group B, as well as in group C in comparison with group D. L-thyroxine treatment increased 25-hydroxyvitamin D and reduced PTH levels only in hypothyroid women with post-partum thyroiditis. Baseline levels of 25-hydroxyvitamin D correlated with thyroid antibody titres, thyroid function and circulating PTH levels, while the effect of L-thyroxine on serum levels of this vitamin correlated with the changes in thyroid antibody titres and PTH levels. The results of our study suggest the association of vitamin D status with post-partum thyroiditis and L-thyroxine treatment of this disorder.

Hipotiroidismo y bocio en el embarazo / Hypothyroidism and goiter in pregnancy

A pesar de no ser frecuente, la hipofunción tiroidea no controlada en la gestante, puede traer consigo efectos deletéreos sobre la madre y el feto, fundamentalmente cuando se presenta de forma manifiesta. Si se detecta precozmente y se trata de forma adecuada con levotiroxina, los riesgos se minimizan. Las dosis a emplear serán las suficientes para alcanzar un valor de tirotropina de acuerdo con lo recomendado para cada trimestre, y que por lo general serán mayores que en la etapa preconcepcional. El bocio se tratará en algunas condiciones específicas, y lo mismo sucede con la tiroiditis posparto. Pacientes sin disfunción tiroidea, pero con anticuerpos antitiroideos positivos elevados, también serán tratadas(AU)

Despite the rareness of the uncontrolled thyroid hypofunction in the pregnant woman, it may bring deleterious effects for the mother and her fetus, mainly when it is manifested. If early detected and adequately treated with levothyroxin, the risks are minimal. The doses to be used are enough to reach a thyrotropin level in accordance with the recommendations for each pregnancy trimester and they will be generally higher than those of the preconception phase. Goiter will be treated under some specific conditions and the same is valid for the postpartum thyroiditis. The patients without thyroid dysfunction, but with high positive antithyroid antibodies, should also be treated(AU)

Management of hyperthyroidism during pregnancy and lactation.

INTRODUCTION: Poorly treated or untreated maternal overt hyperthyroidism may affect pregnancy outcome. Fetal and neonatal hypo- or hyper-thyroidism and neonatal central hypothyroidism may complicate health issues during intrauterine and neonatal periods. AIM: To review articles related to appropriate management of hyperthyroidism during pregnancy and lactation. METHODS: A literature review was performed using MEDLINE with the terms 'hyperthyroidism and pregnancy', 'antithyroid drugs and pregnancy', 'radioiodine and pregnancy', 'hyperthyroidism and lactation', and 'antithyroid drugs and lactation', both separately and in conjunction with the terms 'fetus' and 'maternal.' RESULTS: Antithyroid drugs are the main therapy for maternal hyperthyroidism. Both methimazole (MMI) and propylthiouracil (PTU) may be used during pregnancy; however, PTU is preferred in the first trimester and should be replaced by MMI after this trimester. Choanal and esophageal atresia of fetus in MMI-treated and maternal hepatotoxicity in PTU-treated pregnancies are of utmost concern. Maintaining free thyroxine concentration in the upper one-third of each trimester-specific reference interval denotes success of therapy. MMI is the mainstay of the treatment of post partum hyperthyroidism, in particular during lactation. CONCLUSION: Management of hyperthyroidism during pregnancy and lactation requires special considerations and should be carefully implemented to avoid any adverse effects on the mother, fetus, and neonate.

Postpartum thyroiditis and hypothalamo-hypophysial insufficiency in the same woman with successive pregnancies: a case report.

OBJECTIVE: Although the incidence of postpartum autoimmune disorders of endocrine glands are not rare, the presence of two different entities in the same patient with two different pregnancies is uncommon. METHODS: We present a 35-year-old woman whose story starts with her first pregnancy when she was 29 years old, she had the diagnosis of postpartum thyroiditis with hypothyroidism.We followed up the patient when she had her second pregnancy. RESULTS: When she was being followed up with levothyroxine replacement, 5 years later she had her second delivery after which she had complaints of polydipsia, polyuria, weight loss and had the diagnosis of central diabetes insipitus and she has started desmopressin treatment and 17 months later the delivery she again applied with amenorrhea, continuation of lactation later she noticed oligomenorrhea, and her gonadotropin levels were found to be low as well as her TSH levels, although the L-thyroxine treatment dose was not changed. Dynamic tests of hypophysis revealed hypophyseal insufficiency and repeated hypophyseal MRI was in concordance with lymphocytic hypophysitis which explains the pattern of endocrinological abnormalities after the second delivery. CONCLUSION: This case signals role of autoimmune mechanisms underlying the endocrinopathies seen after successive pregnancies of the same patient.

[Postpartum thyroiditis: current views on unappreciated disease]. / Poporodowe zapalenie tarczycy - wspólczesne spojrzenie na niedoceniana chorobe.

Postpartum thyroiditis is a form of autoimmune thyroiditis developing during the first 12 months postpartum as a consequence of the immunologic flare following the immune suppression of pregnancy. This disease, found in 5-10% of women in a general population and even more frequently in patients suffering from other autoimmune disorders, may re-occur in about 70% of women after a subsequent pregnancy. Postpartum thyroiditis is strongly associated with antithyroid peroxidase antibodies. Patients may present with symptoms of either thyrotoxicosis or hypothyroidism which may be transient or, in some (20-30%) cases of hypothyroidism, permanent in nature. A thyrotoxic phase of postpartum thyroiditis is usually brief and often unnoticed before a more long-lasting hypothyroid phase occurs. The diagnosis of postpartum thyroiditis is based on the observation of abnormal thyroid function tests in a postpartum antithyroid peroxidase- positive woman. In this paper, we discuss the etiopathogenesis, clinical picture, diagnosis, prognosis and treatment of postpartum thyroiditis and provide the reader with some practical guidance concerning dealing with a patient suffering from this disorder.

[Postparum thyroiditis]. / Poporodowe zapalenie tarczycy.

Postpartum thyroiditis is one of the most common endocrinological disorders annually affecting millions of women world-wide. It is is defined as a syndrome of transient or permanent thyroid dysfunction occurring in the first year after delivery. A thyrotoxic phase of postpartum thyroiditis may be brief and unnoticed before a more long-lasting (permanent in up to 30%) hypothyroid phase occurs. The disease, found in approximately 5-10% of mothers in the general population, is an autoimmune disorder, and thyroid antibody-positive women in the first trimester have a 33% to 50% chance of developing thyroiditis in the postpartum period. Women suffering from other autoimmune conditions, or having a previous or family history of thyroid disease are at increased risk of its development. In this paper we present an overview of the pathogenesis, clinical aspects, diagnosis, and treatment options for postpartum thyroiditis with putting special emphasis on the results of recently published studies.