Exp Clin Endocrinol Diabetes 2002; 110(4): 171-175
DOI: 10.1055/s-2002-32148
Articles

© Johann Ambrosius Barth

Postpartum thyroiditis in India: Prevalence of postpartum thyroiditis in Kashmir Valley of Indian Sub-continent

A. H. Zargar 1 , I. H. Shah 1 , S. R. Masoodi 1 , B. A. Laway 1 , M. Salahuddin 2 , I. A. Bhat 3
  • 1 Department of Endocrinology, Sheri-Kashmir Institute of Medical Sciences Srinagar, Kashmir, India
  • 2 Department of Immunology, Sheri-Kashmir Institute of Medical Sciences Srinagar, Kashmir, India
  • 3 Department of Community Medicine, Sheri-Kashmir Institute of Medical Sciences Srinagar, Kashmir, India
Further Information

Publication History

received 5 June 2001 first decision 6 July 2001

accepted 2 November 2001

Publication Date:
10 June 2002 (online)

Summary

Various studies have reported a spectrum of thyroid dysfunction in the postpartum period. Postpartum thyroiditis is a syndrome of thyroid dysfunction that occurs in the first year after parturition. Prevalence of postpartum thyroiditis has been reported to vary from 3 to 6 percent in different regions of the world. Kashmir Valley is inhabited by a relatively homogenous racial group and the Valley has been documented to have significant iodine deficiency. We studied the prevalence and pattern of postpartum thyroiditis in an urban region of this Valley.

120 women were registered within first month of postpartum period for the study along with one hundred controls. Of these 120 women, 104 reported for follow-up at 3 months postpartum and 106 reported for follow-up at 6 months postpartum. Initial and subsequent clinical details at follow-up were recorded on a pre-determined questionnaire. Overall, postpartum thyroiditis (PPT) was seen in 8 (7%) study subjects. Of these 8 patients with PPT, 4 had biochemical evidence of thyrotoxicosis at first month, 3 developed biochemical thyrotoxicosis at 3-month follow-up while as one study subject developed thyrotoxicosis at 6 months. Most of these subjects were antithyroid antibodies (anti-microsomal and anti-thyroglobulin) positive. We conclude that iodine deficient status of the community doesn't seem to influence the incidence of PPT.

References

  • 1 Amino N, Miyai K, Kuro R, Tanizawa O, Azukizawa M, Takai S, Tanaka F, Nishi K, Kawashima M, Kumahara Y. Transient postpartum hypothyroidism: Fourteen cases with autoimmune thyroiditis.  Annals Intern Med. 1977;  87 155-159
  • 2 Amino N, Miyai K, Onishi T, Hashimoto T, Arai K, Ishibashi K, Kumahara Y. Transient hypothyroidism after delivery in autoimmune thyroiditis.  J Clin Endocrinol Metab. 1976;  42 296-301
  • 3 Amino N, Mori H, Iwatani Y, Tanizawa O, Kawashima M, Tsuge I, Ibaragi K, Kumahara Y, Miyai K. High prevalence of transient postpartum thyrotoxicosis and hypothyroidism.  New Engl J Med. 1982;  306 849-852
  • 4 Amino N, Tada H. Autoimmune thyroid disease: thyroiditis. In: DeGroot LJ (ed) Endocrinology, Third Edition WB Saunders, Philadelphia 1995: 726-741
  • 5 Bech K. Importance of cytolytic activity and dietary iodine in the pathogenesis of postpartum thyroiditis.  Allergy. 1988;  43 61-164
  • 6 Colvin R B, Bhan A K, McCluskey R T. (ed) .Autoantibodies. In: Diagnostic Immunopathology, Second Edition Raven Press Ltd, New York 1995: 202-227
  • 7 Forbes I J, Roitt I M, Doniach D, Solomon I L. The thyroid cytotoxic autoantibody.  J Clin Investigation. 1962;  41 996-999
  • 8 Freeman R, Rosen H, Thysen B. Incidence of thyroid dysfunction in an unselected postpartum population.  Arch Intern Med. 1986;  146 1361-1364
  • 9 Fung H YM, Kologlu M, Collison K, John R, Richards C J, Hall R, MacGregor A M. Postpartum thyroid dysfunction in Mid Glamorgan.  Br Med J. 1988;  296 41-244
  • 10 Goldman J M. Postpartum thyroid dysfunction.  Arch Intern Med. 1986;  146 296-1299
  • 11 Gregory P, Gerard N. Diagnosis and treatment of thyroid disease during pregnancy. In: DeGroot LJ (ed) Endocrinology, Third edition WB Saunders, Philadelphia 1995: 799-820
  • 12 Hayslip C C, Fein H G, O'Donnell V M, Friedman D S, Klein T A, Smallridge R C. The value of serum antimicrosomal antibody testing in screening for symptomatic postpartum thyroid dysfunction.  Am J Obstet Gynecol. 159 ((1)) 1988;  203-209
  • 13 Jansson R, Bernander S, Karlsson A, Levin K, Nilsson G. Autoimmune thyroid dysfunction in the postpartum period.  J Clin Endocrinol Metab. 1984;  58 681-687
  • 14 Jansson R, Totterman T H, Sallstrom J, Dahlberg P A. Intrathyroidal and circulating lymphocyte subsets in different stages of autoimmune postpartum thyroiditis.  J Clin Endocrinol Metab. 1984;  58 942-946
  • 15 Kampe O, Jansson R, Karlsson F A. Effects of L-thyroxine and iodine on the development of autoimmune postpartum thyroiditis.  J Clin Endocrinol Metab. 1990;  70 014-1018
  • 16 Lervang H H, Pryds O, Kristensen H PO. Thyroid dysfunction after delivery: Incidence and clinical course.  Acta Med Scand. 1987;  222 369-374
  • 17 Lucas A, Pizarro E, Granada M L, Salinas I, Foz M, Sanmarti A. Postpartum thyroiditis: epidemiology and clinical evolution in a nonselected population.  Thyroid. 2000;  10 71-77
  • 18 Nikolai T F, Turney S I, Roberts R C. Postpartum lymphocytic thyroiditis: prevalence, clinical course, and long-term follow up.  Arch Intern Med. 1987;  147 21-224
  • 19 Othman S, Phillips D IW, Parkes A B, Richards C J, Harris B, Fung H, Darke C, John R, Hall R, Lazarus J H. A long term follow up of postpartum thyroiditis.  Clin Endocrinol (Oxf). 1990;  32 559-564
  • 20 Rajatanavin R, Chailurkit L O, Tirarungsiku U, Chalayondeja W, Jittivanich U, Puapradit W. Postpartum thyroid dysfunction in Bangkok: a geographic variation in the prevalence.  Acta Endocrinol (Copehn). 1990;  122 283-287
  • 21 Rasmussen N G, Hornnes P J, Madsen M H, Rasmussen U F, Hegedus L. Thyroid size and function in healthy pregnant women with thyroid autoantibodies. Relation to development of postpartum thyroiditis.  Acta Endocrinologica (Cophen). 1990;  123 395-401
  • 22 Roberton H EW. Lassitude, coldness, and hair changes following pregnancy and their response to treatment with thyroid extract.  Br Med J. 2 ((Suppl)) 1948;  93-94
  • 23 Weller T H, Coons A H. Fluorescent antibody study with agent of varicella and herpes propagated in vitro.  Proc Soc Exp Biol Med. 1954;  86 789-794
  • 24 Zargar A H, Shah J A, Mir M M, Laway B A, Masoodi S R, Shah N A. Prevalence of goiter in school children in Kashmir valley (India).  Am J Clin Nutr. 1995;  62 020-1021
  • 25 Zargar A H, Sofi F A, Masoodi S R, Laway B A, Shah N A, Wani A I, Masoodi M I. Pattern of salt consumption and awareness about iodine deficiency disorders in Kashmir valley.  IDD Newsletter. 12 ((3)) 1996;  46-48

Prof. Abdul Hamid Zargar, DM

Post Box No. 1098

GPO Srinagar - 190 001

Kashmir, India

Phone: + 91-194-403596

Fax: + 91-194-403470

Email: abdulhamidz@vsnl.com