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Postpartum thyroiditis: long-term follow-up
Anna Lucas1, Eduarda Pizarro, María Luisa Granada
1Department of Endocrinology and Nutrition, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain. alucas@ns.hugtip.scs.es
Objective:
To determine the incidence of persistent hypothyroidism (PH) after a long follow-up in 45 patients with postpartum thyroiditis (PPT) from a nonselected population of 641 pregnant women (PPT incidence 7.8%) and the clinical and biochemical factors associated with PPT evolution.
Design And Patients:
The 45 women who developed PPT were followed for 8.1 +/- 2.2 years after delivery.
Measurements:
Age at delivery, family and personal history, smoking, newborn gender, breast-feeding, and PPT course were recorded. Thyrotropin (TSH) and free thyroxine (T(4)) concentrations and antithyroid antibodies were evaluated at each visit. PH was considered when it persisted one year after being diagnosed.
Results:
Fourteen of 45 patients with PPT developed PH with a probability of 56% after a PPT episode with hypothyroidism. None of the patients who developed hyperthyroidism alone during PPT evolved to PH. PH risk was higher if the newborn was a girl (relative risk [RR] 3.88) and increased for each additional TSH unit during PPT and for every additional year of the mother's age.
Conclusions:
The probability of developing PH after a PPT with hypothyroidism episode is 56%. PPT screening in all women permits us to establish levothyroxine treatment, if necessary, before a new pregnancy.
