Kuma Hospital , Center for Excellence in Thyroid Care, Kobe, Japan .
Thyroid. 2014 Jun;24(6):1027-31. doi: 10.1089/thy.2013.0585. Epub 2014 Mar 6.
Postpartum thyroid dysfunction occurs in approximately 5-10% of women in the general population within one year of delivery. Differentiation of postpartum Graves' thyrotoxicosis (PPGr) from postpartum destructive thyrotoxicosis (PPDT) is essential because of the difference in treatment measures between the two. However, it is sometimes difficult because radioactive iodine uptake is contraindicated when patients are lactating. We examined the usefulness of determining the time of onset postpartum and measurement of antithyrotropin (anti-TSH) receptor antibodies and thyroid blood flow.
Forty-two patients with newly developed thyrotoxicosis after delivery were examined: 18 had Graves' disease and 24 had destructive thyrotoxicosis. Serum free thyroxine (fT4), free triiodothyronine (fT3), and TSH were measured by chemiluminescent immunoassays. Anti-TSH receptor antibodies (TRAb), antithyroglobulin antibodies (TgAb), and antithyroid peroxidase antibodies (TPOAb) were measured by the Elecsys electrochemiluminescence immunoassay. Thyroid volume and blood flow (TBF) were measured quantitatively by color flow Doppler ultrasonography.
Onset of thyrotoxicosis was distributed from 2 to 12 months postpartum. Twelve (85.7%) of 14 patients who developed thyrotoxicosis at three months or earlier after delivery had PPDT. On the other hand, all 11 patients who developed thyrotoxicosis at 6.5 months or later had PPGr. All patients with PPGr had positive TRAb (14.9±14.9 IU/L, mean±standard deviation (SD)) and all patients with PPDT had negative TRAb (0.1±0.3 IU/L, p<0.0001). Fifteen (83.3%) of 18 PPGr patients had high TBF of more than 4.0% (8.9±4.4), and all PPDT patients had low TBF of <4.0% (1.6±1.0, p<0.0001). The fT3/fT4 ratio was higher in PPGr (64.0±23.9) than in PPDT (38.9±13.1, p<0.0002), but absolute values overlapped between the two.
Early onset of thyrotoxicosis postpartum was associated mainly with PPDT, and a late onset was suggestive of PPGr. Positive TRAb and high TBF >4.0% are indicators of postpartum onset of Graves' disease.
在产后一年内，一般人群中约有 5-10%的女性会发生产后甲状腺功能障碍。由于两种疾病的治疗措施不同，区分产后 Graves 病性甲状腺毒症（PPGr）和产后破坏性甲状腺毒症（PPDT）至关重要。然而，由于患者在哺乳期时禁忌使用放射性碘，因此有时会很困难。我们研究了确定产后发病时间以及测定抗促甲状腺激素（anti-TSH）受体抗体和甲状腺血流的有用性。
检查了 42 例产后新发生的甲状腺毒症患者：18 例为 Graves 病，24 例为破坏性甲状腺毒症。通过化学发光免疫分析测定血清游离甲状腺素（fT4）、游离三碘甲状腺原氨酸（fT3）和 TSH。采用 Elecsys 电化学发光免疫分析法测定抗促甲状腺激素受体抗体（TRAb）、抗甲状腺球蛋白抗体（TgAb）和抗甲状腺过氧化物酶抗体（TPOAb）。通过彩色多普勒超声定量测量甲状腺体积和血流（TBF）。
甲状腺毒症的发病时间分布在产后 2 至 12 个月。14 例在产后 3 个月或更早发生甲状腺毒症的患者中，有 12 例（85.7%）为 PPDT。另一方面，所有在 6.5 个月或更晚发生甲状腺毒症的患者均为 PPGr。所有 PPGr 患者均有阳性 TRAb（14.9±14.9IU/L，平均值±标准差（SD）），所有 PPDT 患者均为阴性 TRAb（0.1±0.3IU/L，p<0.0001）。18 例 PPGr 患者中有 15 例（83.3%）的 TBF 超过 4.0%（8.9±4.4），所有 PPDT 患者的 TBF 均低于 4.0%（1.6±1.0，p<0.0001）。PPGr 的 fT3/fT4 比值高于 PPDT（64.0±23.9 对 38.9±13.1，p<0.0002），但两者的绝对值存在重叠。
产后早期发病的甲状腺毒症主要与 PPDT 有关，晚期发病提示为 PPGr。阳性 TRAb 和 TBF>4.0%是产后 Graves 病发病的指标。
