Postpartum thyroiditis

Classification according to ICD-10
O90.5	Postpartum thyroiditis
ICD-10 online (WHO version 2019)

In the postpartum thyroiditis , also known as postpartum thyroiditis referred to, is an inflammation of the thyroid gland ( thyroiditis ), which a few months after a pregnancy (lat. Postpartum , postpartum ) can occur. It is probably an autoimmune disease ; it is mainly viewed as a special form of chronic lymphocytic thyroiditis (Hashimoto's thyroiditis).

In most cases, the disease is mild. Symptoms of an overactive thyroid gland ( hyperthyroidism ) as well as an underactive thyroid gland (hypothyroidism) can occur. There is no pain. Postpartum thyroiditis usually heals within a year without further treatment, so that the symptoms then disappear and thyroid function returns to normal. Drug therapy is only required if the symptoms are pronounced.

Frequency and risk factors

The literature on the incidence of postpartum thyroiditis varies considerably. In a large review article, the incidence of disease ( prevalence ) was around seven percent. Women who suffer from congenital diabetes (type 1 diabetes mellitus) and women in whom thyroid antibodies are found have an increased risk of developing postpartum thyroiditis after pregnancy. For example, the risk of getting sick in people with insulin-dependent diabetes mellitus is around 25 percent. Women who have already been infected with thyroid peroxidase antibodies ( TPO antibodies ) have a significantly higher risk of developing postpartum thyroiditis again after future pregnancies. The likelihood of recurrence in this case is around 70 percent. In addition, a familial accumulation of autoimmune thyroid diseases and postpartum thyroiditis is known.

Cause and origin

The cause of the development of the disease has not yet been conclusively clarified. There is some evidence that postpartum thyroiditis is an autoimmune disease. On the one hand, antibodies against thyroid peroxidase (TPO antibodies) are detectable in about 80% of the cases, as in Hashimoto's thyroiditis. Thyroid peroxidase is one of the enzymes involved in the production of thyroid hormones. About half of the women in whom elevated thyroid peroxidase antibodies are detectable at the beginning of pregnancy develop thyroid dysfunction after giving birth in the sense of postpartum thyroiditis. On the other hand, an association of post-partum thyroiditis with certain human leukocyte antigens ( HLA antigens ), in particular HLA-DR5, could be demonstrated. In addition to the autoimmunogenic genesis and familial accumulation, the latter also speaks for a genetic or hereditary component in the development of the disease.

The histological examination of infected thyroid tissue was able to show that it is an inflammatory disease. The histological picture of postpartum thyroiditis is characterized by the invasion of lymphocytes . Based on this picture and the course of the disease (see below: clinical picture), like so-called silent thyroiditis, it belongs to the group of subacute lymphocytic thyroiditis .

Clinical picture

The very variable clinical picture of postpartum thyroiditis can resemble that of so-called silent thyroiditis , which is also considered a variant of Hashimoto's thyroiditis.

The classic course of postpartum thyroiditis is characterized by three phases: one to six months after delivery, the patients develop a temporary hyperthyroidism lasting about two months, followed by a four to eight month phase of hypothyroidism. The thyroid function then returns to normal. However, it has been found that this course, described as classic, only occurs in about a third of the patients. In the majority of women, the disease manifests itself either exclusively in the form of a temporary (transient) hypothyroidism or a temporary hyperthyroidism. In about 80 percent of the cases, the sick women are symptom-free after one year. In addition, there are even more rare courses such as the transition to permanent (persistent) hypothyroidism.

The symptoms that occur with postpartum thyroiditis depend on the course or phase of the disease and are also very variable. In most cases, you will experience only mild symptoms of hyperthyroidism (such as a slightly accelerated heart rate ) or hypothyroidism.

treatment

The therapy depends on the clinical course of the disease. Therapy is only necessary if the symptoms are severe. Symptoms of hyperthyroidism can be alleviated symptomatically with beta blockers. Therapy with thyreostatics is contraindicated due to the pathogenesis, since there is no increased formation, but increased release of thyroid hormones as a result of the inflammatory reaction. Hypothyroidism symptoms can be treated temporarily by substituting thyroid hormones, usually thyroxine .

Literature and Sources

Main sources

• KD Burman et al: Postpartum thyroiditis. UpToDate September 2007
• R. Hörmann: Thyroid Diseases. 4th edition. ABW-Wissenschaftsverlag, 2005, ISBN 3-936072-27-2 , p. 182.
• EN Pearce et al.: Thyroiditis. N Engl J Med . 2003 Jun 26; 348 (26), pp. 2646-2655. PMID 1727826
• E. Roti et al: Clinical review 29: Postpartum thyroiditis. In: J Clin Endocrinol Metab . 1992 Jan; 74 (1), pp. 3-5. PMID 1727826
• M. Schott et al: Autoimmune thyroid diseases. In: Deutsches Ärzteblatt. 2006; 103, pp. A3023-3032. (Online version)

Individual evidence

1. ↑ M. Abalovich et al .: Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline. In: J Clin Endocrinol Metab. 2007 Aug; 92 (8), pp. S1-7. Epub 2007 Jun 3. PMID 17948378
2. ↑ ^{a b} M. Alvarez-Marfany et al .: Long-term prospective study of postpartum thyroid dysfunction in women with insulin dependent diabetes mellitus. In: J Clin Endocrinol Metab. 1994 Jul; 79 (1), pp. 10-16. PMID 8027213
3. ↑ M. Sakaihara: Postpartum thyroid dysfunction in women with normal thyroid function during pregnancy. In: Clin Endocrinol (Oxf). 2000 Oct; 53 (4), pp. 487-492. PMID 11012574
4. ^ JH Lazarus et al .: Clinical aspects of recurrent postpartum thyroiditis. In: Br J Gen Pract. 1997; 47, pp. 305-308. PMID 9219408
5. ↑ MT Vargas et al .: Antithyroid microsomal antibodies and HLA-DR5 are associated with postpartum thyroid dysfunction: evidence supporting an autoimmune pathogenesis. In: J Clin Endocrinol Metab. 1988; 67, pp. 327-333. PMID 3260599

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !