Postpartum thyroiditis: problems of prognosis and monitoring


  • O.A. Goncharova Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine



postpartum thyroiditis, risk factors, monitoring, review


Pregnancy 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 %.


Download data is not yet available.


De Groot L, Abalovich M, Alexander EK, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(8):2543-2565. doi:10.1210/jc.2011-2803.

Argatska AB, Nonchev BI. Postpartum thyroiditis. Folia Med (Plovdiv). 2014;56(3):145-151. doi:10.2478/folmed-2014-0021.

Glinoer D. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocr Rev. 1997;18(3):404-433. doi:10.1210/edrv.18.3.0300.

Soldin OP. When thyroidologists agree to disagree: comments on the 2012 Endocrine Society pregnancy and thyroid disease clinical practice guideline. J Clin Endocrinol Metab. 2012;97(8):2632-2635. doi:10.1210/jc.2012-2529.

Negro R, Formoso G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab. 2006;91(7):2587-2591. doi:10.1210/jc.2005-1603.

Dong AC, Stagnaro-Green A. Differences in Diagnostic Criteria Mask the True Prevalence of Thyroid Disease in Pregnancy: A Systematic Review and Meta-Analysis. Thyroid. 2019;29(2):278-289. doi:10.1089/thy.2018.0475.

Lazarus JH, Premawardhana LD. Screening for thyroid disease in pregnancy. J Clin Pathol. 2005;58(5):449-452. doi:10.1136/jcp.2004.021881.

Biryukova YeV. A contemporary view on a role played by selenium in physiology and pathology of the thyroid gland. Effektivnaia farmakoterapiia. 2017;(8):34-41. (in Russian).

Sergi M, Tomlinson G, Feig DS. Changes suggestive of post-partum thyroiditis in women with established hypothyroidism: incidence and predictors. Clin Endocrinol (Oxf). 2015;83(3):389-393. doi:10.1111/cen.12604.

Goncharova OA. Ways to improve the prevention of postpartum thyroiditis (review with own data). Mìžnarodnij endokrinologìčnij žurnal. 2016;(76):112-117. doi:10.22141/2224-0721.4.76.2016.77823. (in Russian).

Zaletel K, Krhin B, Gaberscek S, Bicek A, Pajic T, Hojker S. Association of CT60 cytotoxic T lymphocyte antigen-4 gene polymorphism with thyroid autoantibody production in patients with Hashimoto's and postpartum thyroiditis. Clin Exp Immunol. 2010;161(1):41-47. doi:10.1111/j.1365-2249.2010.04113.x.

De Farias CR, Cardoso BR, de Oliveira GM, et al. A randomized-controlled, double-blind study of the impact of selenium supplementation on thyroid autoimmunity and inflammation with focus on the GPx1 genotypes. J Endocrinol Invest. 2015;38(10):1065-1074. doi:10.1007/s40618-015-0285-8.

Manetti L, Parkes AB, Lupi I, et al. Serum pituitary antibodies in normal pregnancy and in patients with postpartum thyroiditis: a nested case-control study. Eur J Endocrinol. 2008;159(6):805-809. doi:10.1530/EJE-08-0617.

Duan J, Kang J, Deng T, Yang X, Chen M. Exposure to DBP and High Iodine Aggravates Autoimmune Thyroid Disease Through Increasing the Levels of IL-17 and Thyroid-Binding Globulin in Wistar Rats. Toxicol Sci. 2018;163(1):196-205. doi:10.1093/toxsci/kfy019.

Katagiri R, Yuan X, Kobayashi S, Sasaki S. Effect of excess iodine intake on thyroid diseases in different populations: A systematic review and meta-analyses including observational studies. PLoS One. 2017;12(3):e0173722. doi:10.1371/journal.pone.0173722.

Leung AM, Braverman LE. Iodine-induced thyroid dysfunction. Curr Opin Endocrinol Diabetes Obes. 2012;19(5):414-419. doi:10.1097/MED.0b013e3283565bb2.

Pedersen IB, Knudsen N, Carlé A, et al. A cautious iodization programme bringing iodine intake to a low recommended level is associated with an increase in the prevalence of thyroid autoantibodies in the population. Clin Endocrinol (Oxf). 2011;75(1):120-126. doi:10.1111/j.1365-2265.2011.04008.x.

Goyal G, Panag K, Garg R. Prevalence of thyroid disorders in hepatitis C virus positive patients on interferon and antiviral therapy. Int J Appl Basic Med Res. 2016;6(4):245-248. doi:10.4103/2229-516X.192587.

Nagayama Y. Radiation-related thyroid autoimmunity and dysfunction. J Radiat Res. 2018;59(suppl_2):ii98-ii107. doi:10.1093/jrr/rrx054.

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):1081-1125. doi:10.1089/thy.2011.0087.

Jameson JL, De Groot LJ, De Kretser DM, authors; Jameson JL, De Groot LJ, editors. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia: Elsevier/Saunders; 2015. 2704 p.

Tingi E, Syed AA, Kyriacou A, Mastorakos G, Kyriacou A. Benign thyroid disease in pregnancy: A state of the art review. J Clin Transl Endocrinol. 2016;6:37-49. doi:10.1016/j.jcte.2016.11.001.

Stagnaro-Green A. Approach to the patient with postpartum thyroiditis. J Clin Endocrinol Metab. 2012;97(2):334-342. doi:10.1210/jc.2011-2576.

Pashkovska NV. Selenium and autoimmune thyroid disorders. Mìžnarodnij endokrinologìčnij žurnal. 2017;13(1):33-38. doi:10.22141/2224-0721.13.1.2017.96753. (in Ukrainian).

Di Bari F, Granese R, Le Donne M, Vita R, Benvenga S. Autoimmune Abnormalities of Postpartum Thyroid Diseases. Front Endocrinol (Lausanne). 2017;8:166. doi:10.3389/fendo.2017.00166.

Alexander EK, Pearce EN, Brent GA, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017;27(3):315-389. doi:10.1089/thy.2016.0457.

Nonchev BI, Argatska AV, Pehlivanov BK, Orbetzova MM. Risk Factors for Postpartum Thyroid Dysfunction in Euthyroid Women Prior to Pregnancy. Folia Med (Plovdiv). 2017;59(2):190-196. doi:10.1515/folmed-2017-0027.

Vaidya B, Anthony S, Bilous M, et al. Detection of thyroid dysfunction in early pregnancy: Universal screening or targeted high-risk case finding? J Clin Endocrinol Metab. 2007;92(1):203-207. doi:10.1210/jc.2006-1748.

Moon HW, Chung HJ, Park CM, Hur M, Yun YM. Establishment of trimester-specific reference intervals for thyroid hormones in Korean pregnant women. Ann Lab Med. 2015;35(2):198-204. doi:10.3343/alm.2015.35.2.198.

Springer D, Zima T, Limanova Z. Reference intervals in evaluation of maternal thyroid function during the first trimester of pregnancy. Eur J Endocrinol. 2009;160(5):791-797. doi:10.1530/EJE-08-0890.

Hyer SL. Caring for women with thyroid disorders in pregnancy. BJM. 2018;26(7):434-439. doi:10.12968/bjom.2018.26.7.434.

Vaidya B, Hubalewska-Dydejczyk A, Laurberg P, Negro R, Vermiglio F, Poppe K. Treatment and screening of hypothyroidism in pregnancy: results of a European survey. Eur J Endocrinol. 2012;166(1):49-54. doi:10.1530/EJE-11-0729.

Stagnaro-Green A, Pearce E. Thyroid disorders in pregnancy. Nat Rev Endocrinol. 2012;8(11):650-658. doi:10.1038/nrendo.2012.171.

Mao J, Pop VJ, Bath SC, Vader HL, Redman CW, Rayman MP. Effect of low-dose selenium on thyroid autoimmunity and thyroid function in UK pregnant women with mild-to-moderate iodine deficiency. Eur J Nutr. 2016;55(1):55-61. doi:10.1007/s00394-014-0822-9.

Negro R, Greco G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. The influence of selenium supplementation on postpartum thyroid status in pregnant women with thyroid peroxidase autoantibodies. J Clin Endocrinol Metab. 2007;92(4):1263-1268. doi:10.1210/jc.2006-1821.

Goncharova OA, Karachentsev IuI. Autoimmunnaia patologiia shchitovidnoi zhelezy [Autoimmune thyroid pathology]. Kyiv: Publisher Zaslavsky OYu; 2017. 212 p. (in Russian).

Goncharova OA. Justification for the need for correction selenium status in the treatment of thyroid pathology in the population of Ukraine (literature review and own observations). Endokrynologia. 2018;23(4):362-368. doi:10.31793/1680-1466.2018.23-4.362. (in Russian).

Hubalewska-Dydejczyk A, Duntas L, Gilis-Januszewska A. Pregnancy, thyroid, and the potential use of selenium. Hormones (Athens). 2020;19(1):47-53. doi:10.1007/s42000-019-00144-2.

Ventura M, Melo M, Carrilho F. Selenium and Thyroid Disease: From Pathophysiology to Treatment. Int J Endocrinol. 2017;2017:1297658. doi:10.1155/2017/1297658.

Tara F, Maamouri G, Rayman MP, et al. Selenium supplementation and the incidence of preeclampsia in pregnant Iranian women: a randomized, double-blind, placebo-controlled pilot trial. Taiwan J Obstet Gynecol. 2010;49(2):181-187. doi:10.1016/S1028-4559(10)60038-1.

Pieczyńska J, Grajeta H. The role of selenium in human conception and pregnancy. J Trace Elem Med Biol. 2015;29:31-38. doi:10.1016/j.jtemb.2014.07.003.

Amorós R, Murcia M, Ballester F, et al. Selenium status during pregnancy: Influential factors and effects on neuropsychological development among Spanish infants. Sci Total Environ. 2018;610-611:741-749. doi:10.1016/j.scitotenv.2017.08.042.



How to Cite

Goncharova, O. (2021). Postpartum thyroiditis: problems of prognosis and monitoring. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), 16(5), 414–420.



Literature Review

Most read articles by the same author(s)

1 2 > >>