Postpartum thyroiditis: problems of prognosis and monitoring
Keywords:postpartum thyroiditis, risk factors, monitoring, review
AbstractPregnancy is accompanied by significant hormonal and immune fluctuations aimed at ensuring the growth and development of the fetus, as well as the immunotоlerance of a pregnant woman to the protein components of the fetus. In the postpartum period, a return syndrome may develop, which is associated with an exacerbation of old and the emergence of new hormonal and autoimmune diseases. They include postpartum thyroiditis (PРT), or postpartum thyroid dysfunction. The review presents the risk factors for the development of PРT from a modern perspective, the main risks associated with this disease for a woman; describes a clinical case of PРT, and a variant of the monitoring algorithm for women with PРT, based on literature and personal experience. PPT is a syndrome of transient (and in some cases permanent) thyroid dysfunction that develops during the first year (usually in 3–4 months) after childbirth or abortion. In essence, it is an autoimmune process in the thyroid gland, which is characterized by changes in the humoral and cellular parts of the immune system. The disease is characterized by a three-phase course: transient thyrotoxicosis with duration of 1.5–2 months; euthyroid state for 1–1.5 months with a subsequent decrease in thyroid function, which lasts up to 3–4 months. The total duration of PPT is 19–32 weeks. However, such an algorithm of PPT occurs in about 22 % of cases, in 30 % there is only isolated hyperthyroidism, and in 48 % — hypothyroidism. It was found that although in most cases thyroid function is normalized a year after delivery, the risk of developing persistent hypothyroidism increases in future. The incidence of PPT is quite wide in different regions of the world, from 1.1 % in Thailand to 21.1 % in Canada. On average, it is found in 5–9 % of the total population of women in the postpartum period, in Europe — in 3.3–8.7 %.
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