Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, Messina, Italy.
Front Endocrinol (Lausanne). 2020 Apr 17;11:220. doi: 10.3389/fendo.2020.00220. eCollection 2020.
Postpartum thyroiditis (PPT) has a prevalence of 1-22%, with an ~50% rate of evolution into permanent hypothyroidism (PH). PPT risk is assessed by measuring serum thyroid antibodies during gestation, as 1/3-1/2 of Ab+ve pregnant women will develop PPT. Family and personal history positive for autoimmune non-thyroid diseases (AINTDT), and consumption of swordfish increases while consumption of small oily fish decreases the risk of PPT. Monitoring thyroid function in a very high-risk subgroup avoids the costs of the Ab-based universal screening. We aimed at identifying such subgroup in 412 women followed from week 7-11 of gestation to month 12 postpartum. At study entry, we measured serum TPOAb, TgAb, TSH, FT4, FT3, and evaluated seafood consumption, familial history for thyroid diseases and AINTD, and personal history for AINTD. We measured TSH, FT4, FT3 at 1.5, 3, 6, and 12 months postpartum. PPT occurred in 63 women (15.3%), and PH in 34/63 (54%). Based on positivity/negativity for the three histories, women were classified into 8 categories, with PPT rates of 3.8-100%. Seafood consumption allowed further separation of subgroups having different PPT risks. We considered 11 possible strategies, termed [a] through [k]. Strategy [a] consisted in omitting gestational screening, while performing universal postpartum monitoring with TSH and one thyroid hormone; strategy [k] consisted in selective gestational screening with TPOAb and TgAb, based on history and fish consumption, and selective postpartum monitoring in TPOAb and/or TgAb+ve women. The 100% sensitivity, specificity and diagnostic accuracy of strategy [a] were counterbalanced by the highest costs (Euro 32,960 or 523 per each PPT caught). The corresponding numbers for strategy [k] were 78, 95, 93%, and Euro 8,920 or 182/PPT caught. These savings stem from gestational screening being done in 186 women, and postpartum monitoring done in 65/186 women. One gestational screning-free strategy was the cheapest (Euro 2,080 or 83/PPT caught), because based on postpartum monitoring of only 26 women, but had the lowest sensitivity (40%). Identification of pregnant women having different risks for PPT is feasible, with the costless evaluation of history and seafood consumption driving gestational screening of thyroid antibody status and postpartum monitoring of thyroid function.
产后甲状腺炎（PPT）的患病率为 1-22%，约有 50%的患者会发展为永久性甲状腺功能减退症（PH）。通过在妊娠期间测量血清甲状腺抗体来评估 PPT 的风险，因为 1/3-1/2 的 Ab+ve 孕妇会发展为 PPT。家族和个人自身免疫性非甲状腺疾病（AINTDT）病史阳性，以及剑鱼摄入量增加，而小油性鱼类摄入量减少，都会降低 PPT 的风险。在一个非常高危的亚组中监测甲状腺功能可以避免基于抗体的普遍筛查的费用。我们的目的是在 412 名从妊娠 7-11 周至产后 12 个月的孕妇中确定这样的亚组。在研究开始时，我们测量了血清 TPOAb、TgAb、TSH、FT4、FT3，并评估了海鲜摄入量、甲状腺疾病和 AINTD 的家族史以及 AINTD 的个人史。我们在产后 1.5、3、6 和 12 个月测量了 TSH、FT4、FT3。63 名妇女（15.3%）发生了 PPT，34/63 名（54%）发生了 PH。基于三个病史的阳性/阴性，将妇女分为 8 个类别，PPT 发生率为 3.8-100%。海鲜摄入量允许进一步分离具有不同 PPT 风险的亚组。我们考虑了 11 种可能的策略，分别标记为[a]至[k]。策略[a]是省略妊娠筛查，而对 TSH 和一种甲状腺激素进行普遍的产后监测；策略[k]是基于病史和鱼类摄入量，用 TPOAb 和 TgAb 进行选择性妊娠筛查，并用 TPOAb 和/或 TgAb+ve 妇女进行选择性产后监测。策略[a]的 100%敏感性、特异性和诊断准确性被最高成本（32960 欧元或每例 PPT 523 欧元）所抵消。策略[k]的相应数字为 78、95、93%，以及 8920 欧元或每例 PPT 182 欧元。这些节省来自于对 186 名妇女进行妊娠筛查，以及对 65/186 名妇女进行产后监测。一种不进行妊娠筛查的策略是最便宜的（2080 欧元或每例 PPT 83 欧元），因为只对 26 名妇女进行了产后监测，但敏感性最低（40%）。确定具有不同 PPT 风险的孕妇是可行的，通过对病史和海鲜摄入量的免费评估来驱动甲状腺抗体状态的妊娠筛查和产后甲状腺功能监测。
