POSTPARTUM THYROIDITIS

Yıl 2021, Cilt: 8 Sayı: 3, 96 - 98, 01.10.2021

Onur Çelik , İbrahim Kılıççalan

Öz

Postpartum thyroiditis is an autoimmune disease of the thyroid gland seen in approximately 8% of women in the postpartum period. Postpartum thyroiditis is a triphasic disease consisting of hyperthyroid, hypothyroid, and euthyroid phases. The pathogenesis of postpartum thyroiditis is not known exactly. However, there are various mechanisms related to pathogenesis. One of these is related to the fetal cell/DNA circulating in the maternal blood to settle in the thyroid gland and the maternal immune system to develop an autoimmune reaction against the thyroid gland in the postpartum period. During pregnancy, fetal cells settle in the thyroid gland and no reaction occurs due to pregnancy-related immunosuppression. Postpartum thyroiditis occurs because immunosuppression disap- pears in the postpartum period. The method of examining fetal cell/DNA in maternal blood during pregnancy is a non-invasive prenatal test. The non-invasive prenatal testing is a screening test used to detect chromosomal anomalies and some other chromosomal defects. However, there is to our knowledge, not enough studies in the literature directly investigating the relationship between the number of fetal cells/DNA in maternal blood and the development of postpartum thyroiditis. Having reviewed the literature around this topic it can be assumed that there can be a difference in the level of damage in the thyroid gland in the postpartum period, depending on the level of difference in the number of fetal cells in the thyroid gland. In addition, future studies will pave the way for studies on the relationship between autoimmune diseases occurring in the post-pregnancy period and the number of fetal DNA/cells in maternal blood during preg- nancy. Therefore, an early diagnosis of pregnancy-related autoimmune diseases will be enabled.

Anahtar Kelimeler

Postpartum thyroiditis, pregnancy, hyperthyroidism, hypothyroidism, prenatal diagnosis

Kaynakça

• 1. Amino N, Mori H, Iwatani Y et al. High prevalence of transient post-partum thy- rotoxicosis and hypothyroidism. N Engl J Med 1982;306(14):849-52.
• 2. Alexander EK, Pearce EN, Brent GA et al. 2017 guidelines of the American thy- roid association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 2017;27(3):315-89.
• 3. Keely EJ. Postpartum thyroiditis: an autoimmune thyroid disorder which predicts future thyroid health. Obstet Med 2011;4(1):7-11.
• 4. Stagnaro-Green A. Postpartum thyroiditis. Best Pract Res Clin Endocrinol Metab 2004;18(2):303-16.
• 5. Nicholson WK, Robinson KA, Smallridge RC et al. Prevalence of postpartum thy- roid dysfunction: a quantitative review. Thyroid 2006;16(6):573-82.
• 6. Negro R, Greco G, Mangieri T et al. The influence of selenium supplementation on postpartum thyroid status in pregnant women with thyroid peroxidase auto- antibodies. J Clin Endocrinol Metab 2007;92(4):1263-8.
• 7. Stagnaro-Green A. Approach to the patient with postpartum thyroiditis. J Clin Endocrinol Metab 2012;97(2):334-42.
• 8. Groer M, Jevitt C. Symptoms and signs associated with postpartum thyroiditis. J Thyroid Res 2014;2014:531969.
• 9. LiVolsi VA. Postpartum thyroiditis. The pathology slowly unravels. Am J Clin Pathol 1993;100(3):193-5.
• 10. Prummel MF, Wiersinga WM. Thyroid peroxidase autoantibodies in euthyroid subjects. Best Pract Res Endocrinol Metab 2005;19(1):1-15.
• 11. Kokandi AA, Parkes AB, Premawardhana LD et al. Association of postpartum thyroid dysfunction with antepartum hormonal and immunological changes. J Clin Endocrinol Metab 2003;88(3):1126-36.
• 12. Ando T, Davies TF. Clinical Review 160: Postpartum autoimmune thyroid disease: the potential role of fetal microchimerism. J Clin Endocrinol Metab 2003;88(7):2965-71.
• 13. Lepez M, Vandewoestyne M, Deforce D. Fetal microchimeric cells in autoim- mune thyroid diseases: harmful, beneficial or innocent for the thyroid gland? Chimerism 2013;4(4):111-8.
• 14. Vestergaard P. Smoking and thyroid disorders--a meta-analysis. Eur J Endocrinol 2002;146(2):153-61.
• 15. Abalovich M, Amino N, Barbour LA et al. Management of thyroid dysfunction during pregnancy and postpartum. Endocrine Society Clinical Practice Guide- line. J Clin Endocrinol Metab 2007;92(8):1-7.
• 16. Stagnaro-Green A. Postpartum thyroiditis. Best Pract Res Clin Endocrinol Metab 2004;18(2):303-16.
• 17. Nguyen CT, Mestman JH. Postpartum thyroiditis. Clin Obstet Gynecol 2019;62(2):359-64.
• 18. Samuels MH. Subacute, silent, and postpartum thyroiditis. Med Clin North Am 2012;96(2):223-33.
• 19. Shahbazian HB, Sarvghadi F, Azizi F. Ultrasonographic characteristics and fol- low-up in post-partum thyroiditis. J Endocrinol Invest 2005;28(5):410-2.
• 20. Allyse M, Minear MA, Rote M et al. Non-invasive prenatal testing: a review of in- ternational implementation and challenges. Int J Women’s Health 2015;7:113-26.
• 21. Akolekar R, Beta J, Picciarelli G, et al. Procedure-related risk of miscarriage fol- lowing amniocentesis and chorionic villus sampling: a systematic review and me- ta-analysis. Ultrasound Obstet Gynecol 2015;45(1):16-26.
• 22. Practice bulletin No. 162: prenatal diagnostic testing for genetic disorders. Obstet Gynecol 2016;127(5):108-22
• 23. Lo YMD, Corbetta N, Chamberlain PF et al. Presence of fetal DNA in maternal plasma and serum. Lancet 1997;350(9076):485-7.
• 24. Norwitz ER, Levy B. Noninvasive prenatal testing: the future is now. Rev Obstet Gynecol 2013;6(2):48-62.
• 25. Wright CF, Burton H. The use of cell-free fetal nucleic acids in maternal blood for non-invasive prenatal diagnosis. Hum Reprod Update 2009;15(1):139-51.
• 26. Russo ML, Blakemore KJ. A historical and practical review of first trimester aneu- ploidy screening. Semin Fetal Neonatal Med 2014;19(3):183-7.
• 27. Chiu RWK, Lo YMD. Non-invasive prenatal diagnosis by fetal nucleic acid analysis in maternal plasma: the coming of age. Semin Fetal Neonatal Med 2011;16(2):88-93.
• 28. Yaron Y. The implications of non-invasive prenatal testing failures: a review of an under-discussed phenomenon. Prenat Diagn 2016;36(5):391-6.
• 29. Stagnaro-Green A, Abalovich M, Alexander E et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 2011;21(10):1081-125.