Document Detail


Increased postpartum thyroxine replacement in Hashimoto's thyroiditis.
MedLine Citation:
PMID:  20615129     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The thyroidal response of pregnant patients with established Hashimoto's thyroiditis remains poorly described. The aim of this study was to determine the impact of pregnancy on Hashimoto's thyroiditis as revealed by changes in postpregnancy levothyroxine requirements.
METHODS: We performed a retrospective study of 799 hypothyroid patients in a university hospital. We reviewed the clinical records and selected a group of well-documented pregnant (n = 34) and nonpregnant (n = 32) hypothyroid women for study. We reviewed levothyroxine intake and serum thyrotropin (TSH) levels during three consecutive 9-month time intervals that were immediately before, during, and after pregnancy. We compared the percent change in levothyroxine dose between the prepregnancy level and each trimester during and after pregnancy.
RESULTS: There were two patterns of levothyroxine supplementation during gestation. In pattern 1 (n = 11) there was either no change or a single levothyroxine dose increase with no subsequent changes in each trimester (T1 = T2 = T3). In pattern 2 (n = 18), multistep levothyroxine dose increases were required throughout pregnancy (T1 < T2 < T3) to maintain desired TSH levels (<2.0 mU/L). Women with pattern 2 had mean TSH levels during gestation that differed significantly from pattern 1 (2.8 +/- 0.5 vs. 1.3 +/- 0.1 mU/L respectively; p < 0.03). Further, in multivariate logistic regression, women with pattern 2 were 62 times more likely than women with pattern 1 to have a levothyroxine dose at least 20% above baseline at 3 months postpartum (p = 0.04).
CONCLUSIONS: We showed that >50% of hypothyroid women with Hashimoto's thyroiditis experienced an increase in levothyroxine requirements in the postpartum compared to pregestational doses. This pattern of enhanced levothyroxine need was most likely dependent on the preexisting thyroid functional reserve and postpartum progression of autoimmune destruction.
Authors:
Juan C Galofré; Richard S Haber; Adele A Mitchell; Rachel Pessah; Terry F Davies
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Thyroid : official journal of the American Thyroid Association     Volume:  20     ISSN:  1557-9077     ISO Abbreviation:  Thyroid     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-03     Completed Date:  2010-11-16     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  9104317     Medline TA:  Thyroid     Country:  United States    
Other Details:
Languages:  eng     Pagination:  901-8     Citation Subset:  IM    
Affiliation:
Thyroid Research Unit, Mount Sinai School of Medicine, The Mount Sinai Hospital , The James J. Peters VA Medical Center, New York, NY 10029, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Female
Hashimoto Disease / drug therapy*
Humans
Middle Aged
Models, Statistical
Postpartum Period
Pregnancy
Pregnancy Complications / diagnosis*,  pathology
Retrospective Studies
Thyrotropin / metabolism
Thyroxine / therapeutic use*
Time Factors
Grant Support
ID/Acronym/Agency:
DK069713/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
7488-70-2/Thyroxine; 9002-71-5/Thyrotropin
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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