Shahbazian H B, Sarvghadi F, Azizi F
Endocrine Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
Eur J Endocrinol. 2001 Oct;145(4):397-401. doi: 10.1530/eje.0.1450397.
To determine the prevalence of postpartum thyroiditis (PPT), one of the autoimmune disorders of the thyroid which usually occurs in women in the first year after parturition. PPT presents with periods of transient thyrotoxicosis and hypothyroidism, in many cases resulting in permanent hypothyroidism.
The study involved 1040 mothers who had contacted five health centers in Tehran for vaccination of their children.
Signs and symptoms of hypothyroidism and thyrotoxicosis, and the presence of goiter (using the World Health Organization classification), were sought. Serum T3, T4, TSH, anti-TPO and anti-Tg antibodies were measured at 3, 4.5, 6 and 9 months after parturition. In those with hypothyroidism or thyrotoxicosis and a matched group of normal women, thyroid sonography was performed.
The prevalence of thyroiditis was 11.4%. Hypothyroidism and thyrotoxicosis occurred in 68 and 42 mothers respectively. Nine had thyrotoxicosis followed by hypothyroidism. There was one case of Graves' disease. Out of 68 hypothyroid patients, 33 women underwent treatment with levothyroxine (because of the severity of symptoms) for 12 months. Six women showed increased TSH at 6 weeks after discontinuation of thyroxine. Stage II goiter (World Health Organization classification) were observed in 21.8% of patients and in 6.7% of pospartum euthyroid women (P<0.001). Positive anti-TPO was found in 61.5% of patients and in 19% of the control group; positive anti-Tg was found in 58% of patients and in 6% of the control group (P<0.001). Sonographic changes were observed in 96% of the patients and in 7% of the control group (P<0.001). There was no significant correlation between the occurrence of thyroiditis and parity, the age of the mother, a previous history of thyroid disease in the patient or family, breast-feeding, or the gender of the child.
The results of this study show a high prevalence of PPT in Tehranian women. This may be due to the length and frequency of follow-up and/or the transition from low to adequate iodine intake. The major difference with respect to other studies is the low frequency of the biphasic form of PPT.
确定产后甲状腺炎（PPT）的患病率，产后甲状腺炎是一种甲状腺自身免疫性疾病，通常发生在产后第一年的女性中。产后甲状腺炎表现为短暂的甲状腺毒症和甲状腺功能减退期，在许多情况下会导致永久性甲状腺功能减退。
该研究纳入了1040名曾联系德黑兰五个健康中心为其子女接种疫苗的母亲。
寻找甲状腺功能减退和甲状腺毒症的体征和症状，以及甲状腺肿的存在情况（采用世界卫生组织分类法）。在产后3、4.5、6和9个月测量血清三碘甲状腺原氨酸（T3）、甲状腺素（T4）、促甲状腺激素（TSH）、抗甲状腺过氧化物酶（anti-TPO）和抗甲状腺球蛋白（anti-Tg）抗体水平。对于患有甲状腺功能减退或甲状腺毒症的母亲以及一组匹配的正常女性，进行甲状腺超声检查。
甲状腺炎的患病率为11.4%。分别有68名和42名母亲出现甲状腺功能减退和甲状腺毒症。9名母亲先出现甲状腺毒症后出现甲状腺功能减退。有1例格雷夫斯病。在68名甲状腺功能减退患者中,33名女性因症状严重接受了左甲状腺素治疗12个月,6名女性在停用甲状腺素6周后促甲状腺激素水平升高。21.8%的患者和6.7%的产后甲状腺功能正常的女性出现Ⅱ期甲状腺肿（世界卫生组织分类法）（P<0.001）。61.5% 的患者抗甲状腺过氧化物酶抗体呈阳性,而对照组为19%；58% 的患者抗甲状腺球蛋白抗体呈阳性,而对照组为6%（P<0.001）。96% 的患者出现超声改变,而对照组为7%（P<0.001）。甲状腺炎的发生与产次、母亲年龄、患者或家族既往甲状腺疾病史、母乳喂养或孩子性别之间无显著相关性。
本研究结果显示德黑兰女性产后甲状腺炎的患病率较高。这可能归因于随访的时长和频率，以及碘摄入量从低到充足的转变。与其他研究相比，主要差异在于产后甲状腺炎双相型的发生率较低。
