CoChat
Sign Up
Cited by 131Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryThyroid Cancer Diagnosis and Treatment

The DOI matches its Crossref record; 43 of the 43 references it cites were found in a registry or an index.

Postpartum Thyroiditis

Stagnaro-Green, Alex·2002·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2002-020524
Open this paper in CoChat — free account

Abstract

Postpartum thyroiditis is a common thyroid disorder that presents during the first postpartum year. It is the occurrence of either transient hyperthyroidism, transient hypothyroidism, or transient hyperthyroidism followed by transient hypothyroidism (Fig. 1). Most, but not all, women are euthyroid 1 yr postpartum. Postpartum thyroiditis is an exacerbation of an underlying autoimmune thyroiditis, aggravated by the immunological rebound that follows the partial immunosuppression of pregnancy (1–3). Women who express human leukocyte antigen haplotypes DR-3, DR-4, and DR-5 have an increased risk for postpartum thyroiditis. In women who develop postpartum thyroiditis, CD4+/CD8+ and CD4 + 2H4+ ratios are elevated throughout pregnancy and the postpartum (4). Histologically, thyroid aspirates reveal either a lymphocytic infiltrate or diffuse destruction, changes similar to those seen in both Hashimoto’s thyroiditis (2, 3, 5) and painless sporadic silent thyroiditis (6). In essence, the immunological rebound that follows the end of pregnancy precipitates the clinical expression of Hashimoto’s disease, which before pregnancy was clinically silent (2). The time course and pattern of thyroid function tests in postpartum thyroiditis. Patients who experience the hypothyroid phase of postpartum thyroiditis can either return to the euthyroid state by 1 yr postpartum or remain hypothyroid. The prevalence of postpartum thyroiditis varies widely. Although geographic differences account for some of the variance, a critical factor has been methodological differences in study design. Not only has every prevalence study used a different methodology, but few studies performed their initial screen during pregnancy. Consequently, some of the women diagnosed with postpartum thyroiditis may have had preexisting Hashimoto’s disease. In calculating the prevalence rate of postpartum thyroiditis, only the 13 studies that met the following criteria were included: 1) follow-up extended until a minimum of 5 months postpartum, and 2) patients were evaluated on at least two distinct time points postpartum. All 13 studies were prospective, with screening for postpartum thyroiditis performed at predetermined time periods, dictated by study protocol. The prevalence of postpartum thyroiditis ranges between 1.1% and 16.7% (1, 3, 5, 7–15), with a mean prevalence rate of 7.2%. In individuals with type 1 diabetes mellitus, the prevalence rate triples (16, 17). Specifically, in the New York metropolitan area, the general prevalence of postpartum thyroiditis of 8.8% increased to 25% in women with type 1 diabetes (16). The increased prevalence of postpartum thyroiditis in women with type 1 diabetes mellitus is not surprising, because both are autoimmune disorders. Furthermore, prior studies have demonstrated an increased prevalence of thyroid antibodies in individuals with type 1 diabetes. Postmiscarriage thyroiditis also occurs, but no prevalence data are available (18, 19). Furthermore, as in type 1 diabetes, I postulate that women with other autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, and scleroderma would have an increased prevalence of postpartum thyroiditis. However, no studies to date have evaluated the prevalence of postpartum thyroiditis in these disorders. The recurrence rate in postpartum thyroiditis is high. Seventy percent of women with a prior episode of postpartum thyroiditis develop a recurrence in the subsequent pregnancy. Antithyroid peroxidase-positive women, who did not develop postpartum thyroiditis during an initial pregnancy, have a 25% chance of having postpartum thyroiditis after the next pregnancy. In contrast, women who had neither antithyroid peroxidase nor postpartum thyroiditis during an initial pregnancy, do not develop postpartum thyroiditis in future pregnancies (20). A total of 371 episodes of postpartum thyroiditis are described in the 13 prevalence studies. The most common presentation, found in 43% of the cases, was hypothyroidism without preceding hyperthyroidism. Hyperthyroidism, by itself, was present in 32% of the reported cases. Least common, comprising 25% of the episodes, was hyperthyroidism, followed by hypothyroidism. Symptoms can occur during either phase of postpartum thyroiditis. The hyperthyroid symptoms are typically subtle. It is often diagnosed retrospectively, with the symptoms recognized at the time of diagnosis of hypothyroidism. The hypothyroid phase can also go unrecognized. Consequently, an undetermined percentage of women with postpartum thyroiditis remain undiagnosed. This is due to a woman experiencing minimal or no symptoms, the attribution of symptoms to the demands of child rearing, or a lack of recognition of the symptoms by the physician. The hyperthyroid phase of postpartum thyroiditis occurs between 2 and 10 months postpartum. Most commonly, it presents at 3 months. Symptoms more common in women with hyperthyroid postpartum thyroiditis include palpit

Overview

Integrity signals

Registry

Crossref · 10.1210/jc.2002-020524

Cites

43 of 43 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Verification

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Citations

Cites

Research works printed but not linked: 4

  1. Stagnaro-Green, Obstet Gynecol, 80, 490
  2. Technical Bulletin, 181, 1
  3. Gharib, 1999, Subclinical hypothyroidism during pregnancy: position statement from the American Association of Clinical Endocrinologists., Endocr Pract, 5, 367
  4. 1996, Guide to clinical preventive services, 2nd Ed, Baltimore: Williams & Wilkins;, 214

Cited by

Sorted by citations

See all 131

Related

See all

Metadata

Authors
Stagnaro-Green, A.
Affiliations
Division of Endocrinology, Diabetes and Bone Diseases, Mount Sinai School of Medicine, New York, New York 10029
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2002-09-01
Volume
87
Issue
9
Pages
4042-4047
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2002-020524
OpenAlex
W125544890
Cited by
131
References
43
Citations by year
2026: 3 · 2025: 1 · 2024: 3 · 2023: 4 · 2022: 2 · 2021: 3 · 2020: 5 · 2019: 4 · 2018: 1 · 2017: 1 · 2016: 4 · 2015: 9 · 2014: 13 · 2013: 8 · 2012: 6
FWCI
0.76
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
Funders
American Thyroid Association
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
Keywords
postpartum thyroiditis, transient hyperthyroidism, transient hypothyroidism, Hashimoto's thyroiditis, autoimmune thyroiditis, prevalence, prevalence studies, type 1 diabetes, pregnancy, thyroid function tests, silent thyroiditis, thyroid histology, CD4/CD8 ratio
MeSH terms
Female, Humans, Puerperal Disorders, Thyroiditis, Time Factors, Prevalence

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review