Postpartum thyroiditis and autoimmune thyroiditis in women of childbearingage: Recent insights and consequences for antenatal and postnatal care

Postpartum thyroiditis is a syndrome of transient or permanent thyroid dysf unction occurring in the first year after de. livery and based on an autoim mune inflammation of the thyroid. The prevalence ranges from 5-7%. We discu ss the role of antibodies (especially thyroid peroxidase antibodies), compl ement, activated T cells, and apoptosis in the outbreak of postpartum thyro iditis. Postpartum thyroiditis is conceptualized as an acute phase of autoi mmune thyroid destruction in the context of an existing and ongoing process of thyroid autosensitization. From pregnancy an enhanced state of immune t olerance ensues. A rebound reaction to this pregnancy-associated immune sup pression after delivery explains the aggravation of autoimmune syndromes in the puerperal period, e.g., the occurrence of clinically overt postpartum thyroiditis. Low thyroid reserve due to autoimmune thyroiditis is increasin gly recognized as a serious health problem. 1) Thyroid autoimmunity increas es the probability of spontaneous fetal loss. 2) Thyroid failure due to aut oimmune thyroiditis-often mild and subclinical-can lead to permanent and si gnificant impairment in neuropsychological. performance of the offspring. 3 ) Evidence is emerging that as women age subclinical. hypothyroidism-as a s equel of postpartum thyroiditis-predisposes them to cardiovascular disease. Hence, postpartum thyroiditis is no longer considered a mild and transient disorder. Screening is considered.