Gn. Kent et al., Postpartum thyroid dysfunction: clinical assessment and relationship to psychiatric affective morbidity, CLIN ENDOCR, 51(4), 1999, pp. 429-438
OBJECTIVE Postpartum thyroid dysfunction (PPTD), diagnosed using biochemica
l criteria, is usually transient with a wide range of reported prevalence r
ates. The specific clinical and psychiatric morbidity associated with PPTD
is still uncertain. The aims of the study were to determine the point preva
lence of PPTD in Australian women at 6 months postpartum and to assess the
specific clinical and psychiatric morbidity in these women.
DESIGN Women who were Caucasian, aged 20-45 years and 4.5-5.5 months postpa
rtum, were randomly selected and invited into the study. The respondents we
re assessed for biochemical and psychiatric morbidity. PPTD for this study
was defined as TSH or free T-4 outside the adult reference range. A double
blind clinical assessment of PPTD women and their matched controls used sta
ndardized clinical hypo- and hyperthyroid clinical indices,
PATIENTS From the total randomly selected sample size of 1816 women, 748 pa
rticipated.
MEASUREMENTS Biochemical measurements were serum TSH, free T-4, microsomal
antibody (MsAb) and thyroid peroxidase antibody (TPOAb), and thyroid recept
or antibodies (only in women with low TSH). Psychiatric assessment involved
screening all participants using the General Health Questionnaire 28, foll
owed by classifying and quantifying severity of cases using DSM-III-R categ
ories for depression and anxiety. Clinical signs and symptoms of hypo- and
hyper-thyroidism were measured using weighted standardized indices. Thyroid
size was assessed by palpation. Achilles tendon reflex time was measured b
y photomotograph.
RESULTS The prevalence of PPTD in the participants was 11.5% (95% Cl 9.2-13
.8%), giving a minimum prevalence for the randomly selected sample of 4.7%
(95% Cl 3.7-5.7%). In the PPTD women, 54% had an elevated TSH, 30% had a su
ppressed TSH and the remainder had a low fT(4) and normal TSH. Positive thy
roid autoantibody titres in the PPTD group were 46.5% for microsomal antibo
dy (MsAb) and 63.9% for thyroid peroxidase antibody (TPOAb), and in the non
-PPTD group were 1.7% and 4.9%, respectively, The 6 month point prevalence
rates of depression, generalized anxiety disorder and panic disorder and/or
agoraphobia were 9.4%, 1.4% and 3.1%, respectively. No relationship was fo
und between PPTD status and the diagnosis of current depression or between
thyroid antibody status and current depression. In women who were diagnosed
as anxious at the time of assessment, the number of anxiety symptoms was h
igher in the PPTD group (P < 0.05). There was no difference in signs and sy
mptom scores for the hypo- and hyperthyroid clinical indices between PPTD w
omen and their controls.
CONCLUSION This study has shown a high prevalence of postpartum thyroid dys
function but there was no difference in the clinical and psychiatric signs
and symptoms between cases and controls. In the social, psychological, phys
ical and endocrine setting of the postpartum period, women with postpartum
thyroid dysfunction are identifiable by the attending physician only by the
ir abnormal thyroid function tests.