those who are known to be TPO-Ab positive, those with other autoimmune disorder especially type 1 diabetes and those with previous postpartum thyroiditis should have a TSH level done at three and six months postpartum.1 If TPO-Ab’s are not detected in the first trimester, no further screening is required. Given the ability to identify women at high risk, the next question is, can it be prevented? Iodine supplementation has not been shown to be helpful or harmful.18,19 However, there is increasing evidence of promise for selenium repletion both through animal and human studies.2,33,34 Negro screened 2227 Caucasian women to find 169 euthyroid TPO-Ab-positive women who were randomly assigned to 200 g/day of selenomethionine or placebo, starting after 12 weeks gestation and continued postpartum. as a potential means to prevent postpartum thyroiditis in women at risk but further studies are required before recommendations for its use can be made. 2002;87:4042 The hypothyroid phase may be asymptomatic or may be associated with marked hypothyroid symptoms including fatigue, constipation, loss of concentration and poor memory. The evidence for the association of postpartum thyroiditis and postpartum major depression is definitely conflicting. 1 Both thyroid hormone levels and autoantibodies, self-employed of thyroid function, have been analyzed for association with postpartum major depression. Kent screened 748 Australian ladies at 4.5C5.5 months postpartum with thyroid hormone levels, TPO-Ab and General Health Questionnaire for depression and anxiety. There was an 11.5% prevalence of anxiety and 9.4% prevalence of major depression, but no relationship to thyroid hormone levels or antibodies.31 If a woman is diagnosed with major depression, thyroid function checks (TFTs) should be done, but there is not a strong plenty of association to use the risk of postpartum major depression as a reason to display without symptoms. If the woman is definitely symptomatic from hypothyroidism, if the TSH is GSK1324726A (I-BET726) definitely 10 mU/mL or if the woman is definitely planning another pregnancy in the near future, treatment Mouse monoclonal to CD2.This recognizes a 50KDa lymphocyte surface antigen which is expressed on all peripheral blood T lymphocytes,the majority of lymphocytes and malignant cells of T cell origin, including T ALL cells. Normal B lymphocytes, monocytes or granulocytes do not express surface CD2 antigen, neither do common ALL cells. CD2 antigen has been characterised as the receptor for sheep erythrocytes. This CD2 monoclonal inhibits E rosette formation. CD2 antigen also functions as the receptor for the CD58 antigen(LFA-3) should be initiated.3 There should be an attempt to withdraw the thyroid hormone alternative therapy either within a 12 months or once pregnancy is no longer desired, to determine whether there is long term hypothyroidism and need for lifelong alternative. PERMANENT HYPOTHYROIDISM AND POSTPARTUM THYROIDITIS The postpartum period is definitely a window of opportunity for estimating the risk of long term hypothyroidism (Number?1). Premawardhan = 48), TPO-Ab-positive ladies who did not develop postpartum thyroiditis (= 50) and TPO-Ab-negative ladies (= 70) at 77C81 weeks postpartum and found thyroid dysfunction in 46%, 4% and 1.4%, respectively ( 0.001). The 4% risk in ladies who did not develop postpartum thyroiditis is similar to the 2%/12 months risk of progression to hypothyroidism seen in TPO-Ab-positive individuals without an intervening pregnancy. The strongest predictors of long-term thyroid dysfunction were higher TPO-Ab titres, TSH 20 mIU/L and hypo-echogenicity on a thyroid ultrasound in the postpartum period. Open in a separate window Number 1 Estimations of risk for developing postpartum thyroiditis and long term hypothyroidism Testing AND PREVENTION STRATEGIES FOR POSTPARTUM THYROIDITIS Since we can determine ladies at high risk of developing postpartum thyroiditis and there is an association with a significant risk of future lifelong hypothyroidism, some have recommended that all ladies become screened for TPO-Ab’s in pregnancy. However, given the lack of evidence that early treatment ameliorates symptoms, common screening is not recommended.1 It is important to recognize that a female may become pregnant within the 1st 12 months postpartum when her thyroid function is fluctuating, which could have significant impact on her next pregnancy. Thus, ladies at high risk e.g. those who are known to be TPO-Ab positive, those with additional autoimmune disorder especially type 1 diabetes and those with earlier postpartum thyroiditis should have a TSH level carried out at three and six months postpartum.1 If TPO-Ab’s are not detected in the 1st trimester, no further screening is required. Given the ability to determine ladies at high risk, the next query is, can it be prevented? Iodine supplementation has not been shown to be helpful or harmful.18,19 However, there is increasing evidence of promise for selenium repletion both through animal and human being studies.2,33,34 Negro screened 2227 Caucasian ladies to find 169 euthyroid TPO-Ab-positive ladies who have been randomly assigned to 200 g/day time of selenomethionine or placebo, starting after 12 weeks gestation and continued postpartum. The results were compared with 85 TPO-Ab bad, euthyroid, age-matched settings. Both TPO-Ab-positive organizations showed a significant decrease in TPO-Ab titre during pregnancy, with the selenium group possessing a much lower rebound in titre postpartum. Those ladies GSK1324726A (I-BET726) who received selenium did not show any progression of swelling (based on ultrasound echogenicity) during the one year follow-up, whereas the pattern significantly worsened in those who did not receive selenium. In all, 27.3% of the selenium-supplemented group versus 44.6% in the no selenium group experienced evidence of moderate or advanced thyroiditis on ultrasound at 12 months postpartum. The pace of postpartum thyroiditis was significantly reduced in the group that received GSK1324726A (I-BET726) selenium, 28.6% compared with 48.6% (relative risk [RR] 0.59; 95% CI 0.38C0.90), while was the rate of permanent hypothyroidism, 11.7 versus 20.3% (RR 0.58; 95% CI 0.27C1.24). In the TPO-Ab-negative control group, 3.7% had postpartum thyroid dysfunction. Although there were no adverse events related to selenium supplementation with this study, caution must be used, since selenium supplementation in iodine-deficient areas may exacerbate hypothyroidism significantly.35 Even though results are motivating, a recent Cochrane evaluate highlights the importance of further large-scale randomized.