We conclude that the prevalence of postpartum thyroid dysfunction in our geographical area ranges from 6.7% to 13.3%, considering, respectively, all pregnant women that were examined (n = 754) or only the number of puerperal women actually followed-up (n = 368). A transient form of thyroid autoimmune reaction characterized by elevated serum levels of anti-TPO that progressively declined or disappeared was observed in 29 puerperal women. Sonographic structural and echogenicity changes in the thyroid gland and borderline positive anti-TPO levels (between 60 and 100 U/ml) during pregnancy were considered to be of predictive value for development of postpartum thyroid dysfunction.

We evaluated the prevalence of antithyroid peroxidase antibodies (anti-TP0 Ab) in 402 patients with thyroid disease and 30 healthy controls by a commercial radioimmunoassay (RIA) and compared the results with the passive hemagglutination (HA) method. The patients in the study had autoimmune thyroid disorders (AITD) such as Graves' disease and Hashimoto's disease or had nonautoimmune thyroid diseases (NAITD) such as thyroid cancer, congenital goiter, endemic goiter, and nodular goiter. Subjects were recruited from a population with a mild iodine deficiency (Sao Paulo, Brazil). The effect of specific therapy (for either thyrotoxicosis or chronic thyroiditis) on the circulating anti-TPO levels was also investigated. Positive anti-TPO Ab was detected in 89.9% of the patients with AITD as compared with a prevalence of positive tests of only 4.8% in patients with NAITD. Positive microsomal antibody (M Ab) was found in 68.4% of the patients with AITD and in 6.4% of the patients with NAITD. A positive and significant correlation was obtained between M Ab and anti-TPO Ab. A positive anti-TPO test with negative anti-M was found in 14.1% of the patients with AITD but in only 4.3% of the patients with NAITD and normal controls. These results suggest that anti-TPO Ab by RIA is more sensitive and specific than M Ab by HA. In patients with AITD, anti-TPO Ab levels usually decreased after treatment, suggesting that this parameter could be used in the follow-up of these thyroid disorders.

Treatment of large multinodular goiter (MNG) with radioiodine preceded by recombinant human thyrotropin (0.1 mg rhTSH) has been shown to be a safe alternative for patients with comorbidities that preclude surgery. However, the increase in serum thyroid hormones that follows both treatments may be harmful for some patients, particularly those with underlying cardiovascular disease. In this study, we evaluated cardiac parameters (clinical, ECG, 24-h Holter, Doppler echocardiogram, treadmill stress test) in 27 of 42 patients (ages 42-80 years) with large MNGs who were treated with rhTSH before receiving 30 mCi radioiodine therapy. At baseline, 18 patients had subclinical and six patients had overt iodine-induced hyperthyroidism. All patients had a transient surge in serum levels of free T4 and total T3 into the hyperthyroid range after therapy. However, repeated cardiac evaluation did not show significant changes as compared with baseline evaluation. In conclusion, rhTSH stimulated RAI treatment of MNG did not affect structural and functional parameters of the heart, despite transient high-serum levels of thyroid hormones.

RESUMOAvaliamos prospectivamente a função, as imagens ultra-sonográficas e a auto-imunidade tireóidea em grupo racial heterogêneo de 800 mulheres grávidas, primíparas ou multíparas (1 a 7 gestações prévias) atendidas em hospital universitário de São Paulo durante o pré-natal. Quarenta e seis pacientes foram excluídas do estudo por apresentarem diagnóstico confirmado de doença tireóidea anterior; das 754 restantes, 386 abandonaram o seguimento antes ou após o parto. Assim, a coorte avaliada no puerpério constituiu-se de 368 puérperas, examinadas aos 3, 6, 12 meses e no 2º ano pós-parto. Embora 29 pacientes tenham tido aumento transitório daqueles anticorpos antitireóideos, caracterizando reação de auto-imunidade, estes progressivamente declinaram ou tornaram-se negativos durante o puerpério. Entretanto, nenhuma destas evoluiu com disfunção tireóidea durante o acompanhamento. Quarenta e nove pacientes (13,3%) desenvolveram progressivamente alterações funcionais da tireóide (principalmente hipotireoidismo), provavelmente devido à TPP. Além disso, a continuação do seguimento mostrou que em 18 a 24 meses, 42 mostraram níveis séricos de anti-TPO mais elevados, em comparação aos valores do primeiro ano. Os fatores de risco para o desenvolvimento da TPP, presentes durante a gravidez, foram: (1) níveis relativamente baixos de anti-TPO, entre 60 e 100U/mL [risco relativo ou odds ratio de 3,1] e (2) alterações estruturais ultrasonográficas da tireóide no primeiro trimestre [odds ratio de 6,4]. Concluí-mos que a prevalência de TPP em hospital público de São Paulo foi de 13,3%, considerando as 368 pacientes seguidas. Em 29 puérperas foi diagnosticada forma transitória de reação tireóidea auto-imune, caracterizada por elevação dos níveis séricos de anti-TPO, que posteriormente regrediram. ABSTRACTWe evaluated thyroid function, ultrasound images and presence of autoantibodies in a mixed racial group of 800 unselected primiparous or multiparous (1-7 previous pregnancies) pregnant women attended in a public hospital in the city of São Paulo. Forty-six patients were excluded from the study because of a confirmed diagnosis of a thyroid condition. Thus, a total of 754 women were available for further studies in the postpartum period. A relatively large number of those patients (n= 386) were lost or unavailable to follow-up either before or after delivery. A cohort of 386 puerperal healthy women was followed-up regularly at 3, 6, 12 and 24 months during the postpartum period, with regular thyroid function tests, random urine iodine measurements, assays for serum autoantibodies against thyroid antigens and imaging by ultrasound. Twenty-nine patients had a transient rise of anti-TPO-Ab characterizing an autoimmune reaction. These antibodies titres progressively declined or became negative. Moreover none of these patients have evidence for altered thyroid function during the 18-24 months of follow-up. Forty-nine patients (13.3%) changed their thyroid status, mainly to hypothyroidism, indicating perspectivas

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