Post-partum and non-post-partum relapsing Graves’ hyperthyroidism display different response to anti-thyroid drugs

Rotondi, Mario; Capelli, Valentina; Coperchini, Francesca; Pinto, Sara; Croce, Laura; Tonacchera, Massimo; Chiovato, Luca

doi:10.1530/eje-17-1063

Cited by 11 publications

(5 citation statements)

References 24 publications

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“…Another study found different responses to re-treatment between those who had a recurrence in the postpartum period vs. those whose GD recurred outside the postpartum setting. In a retrospective study of 43 women of childbearing age with GD recurrence, those who relapsed in the post-partum period were more likely to undergo remission with a significant reduction in TRAb levels, compared to those who relapsed outside of the post-partum period (79 vs. 32%%) [45].…”

Section: Postpartum Graves' Diseasementioning

confidence: 97%

“…Up to 20-30% of women treated with anti-thyroid drugs are able to stop antithyroid drug therapy by the third trimester [40]. Several studies have demonstrated that the rebound of immunity in the postpartum period is associated with new-onset GD [41][42][43] or recurrence of GD [44,45], although this finding has not been universal [46]. A retrospective analysis reported that for parous women 45% of GD had its onset in the postpartum period, while the onset occurred in subsequent years for the other 55% [41].…”

Section: Postpartum Graves' Diseasementioning

confidence: 99%

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An update on thyroid disorders in the postpartum period

Peng

Pearce

2022

J Endocrinol Invest

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Purpose To review the pathophysiology, diagnosis and management of postpartum thyroid dysfunction, and related management of thyroid disorders during lactation. Methods We reviewed the literature on postpartum thyroid dysfunction and management of thyroid disorders during lactation. ResultsThe postpartum period is characterized by a rebound from the immunotolerance induced by pregnancy. Routine thyroid function screening is not recommended for asymptomatic women in the postpartum period. Testing thyroid function should be considered at 6-12-week postpartum for high-risk populations, including women with a previous episode of postpartum thyroiditis, Graves' disease, or those with Hashimoto's thyroiditis on thyroid hormone replacement, known thyroid peroxidase antibody positivity, type 1 diabetes mellitus, other nonthyroidal autoimmune disease, or chronic hepatitis C. A serum TSH should also be checked in the setting of postpartum depression or difficulty lactating. If patients have thyrotoxicosis, new-onset or recurrent Graves' disease must be differentiated from postpartum thyroiditis, because the management differs. Periodic thyroid function testing is recommended following recovery from postpartum thyroiditis due to high lifetime risk of developing permanent hypothyroidism. Levothyroxine, and the lowest effective dose of antithyroid drugs, (propylthiouracil, methimazole, and carbimazole) can be safely used in lactating women. The use of radiopharmaceutical scanning is avoided during lactation and radioactive iodine treatment is contraindicated. Conclusions Diagnosing postpartum thyroid dysfunction is challenging, because symptoms may be subtle. A team approach involving primary care providers, endocrinologists, and obstetricians is essential for transitioning thyroid care from the gestational to the postpartum setting.

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Section: Postpartum Graves' Diseasementioning

confidence: 97%

Section: Postpartum Graves' Diseasementioning

confidence: 99%

An update on thyroid disorders in the postpartum period

Peng

Pearce

2022

J Endocrinol Invest

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“…Postpartum‐associated rebound immune phenomena may also favor relapse of hyperthyroidism [117, 118]. Among women in remission after ATD treatment, relapse occurred more frequently in women who then had a successful pregnancy than in those who had no pregnancy [119], although women with hyperthyroidism relapsing in the postpartum period had a greater decrease in TSHR‐Ab levels and a higher rate of remission compared to women whose relapse of hyperthyroidism was independent of pregnancy/being postpartum [120]. As far as GO is concerned, no differences in GO prevalence and degree of severity were found in women whose hyperthyroidism relapsed in the postpartum period [120].…”

Section: Introductionmentioning

confidence: 99%

Current concepts regarding Graves’ orbitopathy

Bartalena

Tanda

2022

J Intern Med

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“…More recently, a specifically designed study compared the clinical and biochemical phenotype of patients with relapsing Graves' hyperthyroidism according to a PP and a non-PP (NPP) onset. The results demonstrated an overall identical phenotype as assessed by superimposable FT3, TRAb titers, thyroid volume, smoking habit, presence, and degree of orbitopathy at diagnosis of relapse independently of a PP or NPP onset (25). More importantly, despite similar starting dose of MMI and duration of treatment, patients with a PP relapse were characterized by a strikingly higher success rate of MMI as opposed to those with NPP relapse (79% vs. 32%).…”

Section: Peculiar Aspects Of Pp Relapses Of Gdmentioning

confidence: 76%

Graves' Disease and the Post-partum Period: An Intriguing Relationship

et al. 2019

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The post-partum period is an immunologically peculiar period in a woman's life. Indeed, most of the pregnancy-related immune changes gradually revert in the 12 months following delivery. Although the post-partum period has long been identified as a period of aggravation of autoimmune thyroid diseases, most of the currently available studies took into account the relationship between post-partum and autoimmune thyroiditis. More recently, the potential repercussions of the post-partum period on Graves' disease were also taken into account. The present mini review will briefly overview the most recent advances in our knowledge of the immunology of the post-partum period in relation with the potential repercussions on the clinical course of Graves' disease. Moreover, some peculiar aspects of post-partum Graves' disease in terms of clinical and biochemical presentation, diagnostic challenges, and specific therapeutic considerations also taking into account the recommendation of the latest clinical guidelines on the management of thyroid diseases in pregnancy will be overviewed.

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Post-partum and non-post-partum relapsing Graves’ hyperthyroidism display different response to anti-thyroid drugs

Abstract: Relapsing Graves' hyperthyroidism in the PP period is more prone to undergo a remission after a second course of MMI treatment. In these patients, a conservative therapeutic approach is more appropriate.

Cited by 11 publications

References 24 publications

An update on thyroid disorders in the postpartum period

An update on thyroid disorders in the postpartum period

Current concepts regarding Graves’ orbitopathy

Graves' Disease and the Post-partum Period: An Intriguing Relationship

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