Postpartum autoimmune thyroid syndrome: A model of aggravation of autoimmune disease
Postpartum autoimmune thyroid syndrome: A model of aggravation of autoimmune disease
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DOI：
10.1089/thy.1999.9.705
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发表时间：
1999-07-01
期刊：
影响因子：
6.6
通讯作者：
Hidaka, Y
中科院分区：
文献类型：
--
作者：
Amino, N;Tada, H;Hidaka, Y
产后甲状腺功能障碍是一个相当常见的问题，在产后期间被发现在大约5%的母亲在一般人口。它发生于亚临床自身免疫性甲状腺炎，在分娩后加重并引起各种类型的甲状腺功能障碍。免疫活动在怀孕期间受到生理抑制，因此胎儿不会被排斥，并在分娩后反弹到正常水平以上。Graves病和桥本甲状腺炎在妊娠期间也会自发改善，分娩后通常会加重。抗甲状腺微粒体抗体（MCAb）筛查产后甲状腺功能异常的高危母亲，60%~ 70%的MCAb阳性母亲发生产后甲状腺功能异常，多数情况下为一过性。甲状腺刺激抗体（TSAb）可以筛查新发Graves病，70%的TSAb阳性母亲发生一过性或持续性产后Graves病，通常发生在产后3至6个月。分娩后的免疫反弹不仅可能导致自身免疫性甲状腺疾病，还可能导致其他自身免疫性疾病，这可能与产后自身免疫性甲状腺疾病的研究策略相似。因此，我们发现，产后类风湿性关节炎的发病率为0.08%的妇女在一般人群中，可以部分预测通过测量类风湿因子在怀孕早期。有几个病例报告的其他自身免疫性疾病的发展后，分娩;产后肾功能衰竭或产后溶血性尿毒症综合征，产后特发性多发性肌炎，产后综合征与抗磷脂抗体，产后自身免疫性心肌炎。许多其他可能的产后自身免疫性疾病仍然是未知的。产褥期疾病应仔细检查与受影响器官自身免疫异常的关系。
Postpartum thyroid dysfunction is rather a common problem during the postpartum period being found in approximately 5% of mothers in the general population. It occurs from subclinical autoimmune thyroiditis that is aggravated after parturition and causes various types of thyroid dysfunction. Immune activity is physiologically suppressed during pregnancy so that the fetus is not rejected, and rebounds above the normal level after parturition. Graves' disease and Hashimoto's thyroiditis also spontaneously ameliorate during pregnancy, and are often aggravated after parturition. The high-risk mothers for postpartum thyroid dysfunction are well screened by antithyroid microsomal antibody (MCAb) and 60% to 70% of MCAb-positive mothers develop postpartum thyroid dysfunction, which is transient in most cases. New onset of Graves' disease may be screened by thyroid-stimulating antibody (TSAb) and 70% of TSAb-positive mothers develop either transient or persistent postpartum Graves' disease that usually occurs 3 to 6 months postpartum. Immune rebound after parturition may cause not only autoimmune thyroid diseases but other autoimmune diseases, which may be investigated with similar strategies to those in postpartum autoimmune thyroid disease. Thus, we found that postpartum onset of rheumatoid arthritis was found in 0.08% of women in the general population and could be partially predicted by measuring rheumatoid factors in early pregnancy. There are several case reports of other autoimmune diseases that develop after delivery; postpartum renal failure or postdelivery hemolytic-uremic syndrome, postpartum idiopathic polymyositis, postpartum syndrome with antiphospholipid antibodies, postpartum autoimmune myocarditis. Many other possible postpartum autoimmune diseases are still unexplored. Puerperal diseases should be carefully examined in relation to autoimmune abnormalities in the affected organs.