Solomon B L, Fein H G, Smallridge R C
Department of Clinical Investigation, Walter Reed Army Medical Center, Washington, DC 20307-5001.
J Fam Pract. 1993 Feb;36(2):177-82.
Postpartum thyroiditis is a common but frequently unrecognized disorder, affecting approximately 5% of women during the first 12 months after delivery. We investigated whether the antimicrosomal antibody titer could be used to determine which women with positive titers postpartum (1) might develop symptomatic or biochemical abnormalities within the first postpartum year (early disease), (2) might require therapy with thyroid hormone, and (3) might have persistent abnormalities (late disease).
Women (n = 55) who had positive antimicrosomal antibody titers at delivery were prospectively followed for 11 to 45 months. Titers were evaluated again at 6 to 10 weeks postpartum and approximately every 8 weeks for the first year.
Early disease occurred in 40 of 55 (73%) women, late disease occurred in 29 of 55 (53%) women, and treatment was required by 21 of 55 (38%) women. The occurrence of early disease was associated with the occurrence of late disease (P < .05). The chances of developing early disease were 6 to 1 (P = .01) when serum titers of antimicrosomal antibodies were > or = 400 at delivery, and 5 to 1 (P = .02) when titers were > or = 1600 at 6 to 10 weeks postpartum. The chances of being given thyroid hormone therapy were 23 to 1 (P = .006) when titers at delivery were > or = 6400, and 6 to 1 when titers at 6 to 10 weeks postpartum were > or = 6400 (P = .004). Titers were not useful in estimating who would have late disease.
Screening for postpartum thyroid dysfunction after delivery using antimicrosomal antibody titers is highly useful. The titer value can help guide the physician in the care of patients with postpartum thyroiditis whose disease may not be self-limiting and who will probably require thyroid hormone therapy.
产后甲状腺炎是一种常见但常未被认识的疾病，在产后12个月内约5%的女性会受到影响。我们研究了抗微粒体抗体滴度是否可用于确定产后抗体滴度呈阳性的女性中：（1）哪些可能在产后第一年内出现症状性或生化异常（早期疾病）；（2）哪些可能需要甲状腺激素治疗；（3）哪些可能存在持续性异常（晚期疾病）。
对分娩时抗微粒体抗体滴度呈阳性的55名女性进行前瞻性随访11至45个月。产后6至10周再次评估滴度，在第一年中大约每8周评估一次。
55名女性中有40名（73%）发生早期疾病，29名（53%）发生晚期疾病，55名中有21名（38%）女性需要治疗。早期疾病的发生与晚期疾病的发生相关（P <.05）。分娩时抗微粒体抗体血清滴度≥400时，发生早期疾病的几率为6比1（P =.01），产后6至10周滴度≥1600时，几率为5比1（P =.02）。分娩时滴度≥6400时，接受甲状腺激素治疗的几率为23比1（P =.006），产后6至10周滴度≥6400时，几率为6比1（P =.004）。滴度对估计谁会发生晚期疾病并无帮助。
产后使用抗微粒体抗体滴度筛查甲状腺功能障碍非常有用。滴度值可帮助医生护理产后甲状腺炎患者，这些患者的疾病可能不会自行缓解且可能需要甲状腺激素治疗。
