Pregnancy and Postpartum Thyroiditis: Intimate Connections
Ahmed RG*
Department of Zoology, Beni-Suef University, Egypt
Submission: February 26, 2018; Published: March 07, 2018
*Corresponding author: Division of Anatomy and Embryology, Department of Zoology, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt, Tel: 002-010-91471828, Email: ahmedragab08@gmail.com
How to cite this article: Ahmed RG. Pregnancy and Postpartum Thyroiditis: Intimate Connections. Anatomy Physiol Biochem Int J: 2018; 4(3): 555639. DOI: 10.19080/APBIJ.2018.04.555639.
Abbrevations: THs: Thyroid Hormones; TPO: Thyroid Peroxidase; TSH-R: Thyroid-Stimulating Hormone-Receptor; Tg: Thyroglobulin
Commentary
Among various states that need total hip arthroplasty, about 90% of cases are osteoarthrosis, and others are: avascular necrosis of the femoral head, femoral neck fracture or traumatic joint injury, inflammatory arthropathy [1]. Year after year, implants are inhanced, among other means, with the use of new biomaterials. In general, biomaterials are widely applied in orthopedics and traumatology. These are frames and carbon materials, bioactive glass, natural and synthetic polymers and composites developed on their basis [2-5]. Among biomaterials, we can mention metal materials and their alloys, titanium with different coatings, of which implants and devices for intramedullary and external fixation are made.
The normal ranges of the maternal thyroid hormones (THs) during the gestation are required to get a regular development during the prenatal and postnatal periods [1-65]. On the other hand, postpartum thyroiditis represents as a transient thyroid disorders (inflammation in the thyroid gland) due to thyroid autoantibodies (positive thyroid peroxidase (TPO), thyroid-stimulating hormone-receptor (TSH-R) and thyroglobulin (Tg)) and lymphocytic infiltration of the thyroid that happens during the postpartum period [66-71]. The release of stored thyroxine (T4) and 3,5,3’-triodothyronine (T3) can cause a destructive thyroiditis and transient thyrotoxicosis. Postpartum thyroiditis can be classified into De Quervain’s (painful subacute, granulomatous thyroiditis), Hashimoto’s (chronic lymphocytic/autoimmune), painless sporadic, painless postpartum, and Riedel’sthyroiditis (invasive fibrous thyroiditis)[68-70].
Postpartum thyroiditis can alter the cellular immunity as the following [65]:
1. Elevationthe thyroidal β cells [71]
2. Elevationthe peripheral large granular lymphocytes [72]
3. Increase the peripheral lymphocyte CD4+/CD8+ratio [73,74]
4. Elevationthe thyroidal lymphocyte helper (CD4+)/suppressor (CD8+) ratio [71]. Moreover, postpartum thyroiditis can change the humoral immunity as the following
a. elevation the complement activation [75]
b. Thyroid microsomal antibodies rebound [71], and
c. Increased IgG1 TPO antibody subclass [76]. In addition, amiodarone, lithium or therapy using interferon-α and interleukin-2 are a common causes of postpartum thyroiditis [68,69,71]. On the other hand, there are several symptoms of postpartum thyroiditis such as fatigue, palpitations, muscle stiffness, irritable, tachycardia, depression, psychoneurosis, anxiety, hair loss, weight loss, dry hair, coldness, careless, and impaired concentration/memory [66].
From the previous data, it can be concluded that postpartum thyroiditis may interrupt the actions of THs and cause several complications during the neonatal and adulthood periods. However, the mechanisms underlying postpartum thyroiditis remain indefinite. The present view highlights the necessity to measure thyroid autoantibodies, a marker for early detection of postpartum thyroiditis, in the first trimester of pregnancy. Also, following the thyroid function should be acquired in antibody-positive dam at the initial and final postpartum stages (at 3 and 6 months after delivery). Thus, adjustment of thyroid functions is warranted to avoid postpartum thyroiditis and to improve the adulthood consequence. Further experiments are needed to determine the association between pregnancy, postpartum thyroiditis and neonatal and adulthood consequences, and to discover new diagnostic assays or treatments [77-85].
Conflict of Interest
The author declares that no competing financial interests exist.
References
- El-bakry AM, El-Ghareeb AW, Ahmed RG (2010) Comparative study of the effects of experimentally-induced hypothyroidism and hyperthyroidism in some brain regions in albino rats. Int J Dev Neurosci 28(5): 371-389.
- Ahmed RG (2011) Perinatal 2,3,7,8-tetrachlorodibenzo-p-dioxin exposure alters developmental neuroendocrine system. Food Chem Toxicology 49(6): 1276-1284.
- Ahmed RG (2012) Maternal-newborn thyroid dysfunction. In: Ahmed RG (Ed.), LAP LAMBERT Academic Publishing GmbH & Co KG Germany, pp. 1-369.
- Ahmed RG (2012) Maternal-fetal thyroid interactions, Thyroid Hormone. In Agrawal NK (Ed.), Tech Open Access Publisher, London, UK, pp. 125-156.
- Ahmed RG (2013) Early weaning PCB 95 exposure alters the neonatal endocrine system: thyroid adipokine dysfunction. J Endocrinol 219(3): 205-215.
- Ahmed RG (2014) Editorial: Do PCBs modify the thyroid-adipokine axis during development? Annals Thyroid Res 1(1): 11-12.
- Ahmed RG (2015) Hypothyroidism and brain development. Avid Science, Telangana, India, p. 1-40.
- Ahmed RG (2015) Hypothyroidism and brain developmental players. Thyroid Research J 8(2): 1-12.
- Ahmed RG (2015) Editorials and Commentary: Maternofetal thyroid action and brain development. J of Advances in Biology 7(1): 1207- 1213.
- Ahmed RG (2016) Gestational dexamethasone alters fetal neuroendocrine axis. Toxicology Letters 258: 46-54.
- Ahmed RG (2016) Neonatal polychlorinated biphenyls-induced endocrine dysfunction. Ann Thyroid Res 2(1): 34-35.
- Ahmed RG (2016) Maternal iodine deficiency and brain disorders. Endocrinol Metab Syndr 5: 223.
- Ahmed RG (2016) Maternal bisphenol A alters fetal endocrine system: Thyroid adipokine dysfunction. Food Chem Toxicology 95: 168-174.
- Ahmed RG (2017) Hyperthyroidism and developmental dysfunction. Arch Med 9: 4.
- Ahmed RG (2017) Anti-thyroid drugs may be at higher risk for perinatal thyroid disease. EC Pharmacology and Toxicology 4(4): 140-142.
- Ahmed RG (2017) Perinatal hypothyroidism and cytoskeleton dysfunction. Endocrinol Metab Syndr 6: 271.
- Ahmed RG (2017) Developmental thyroid diseases and monoaminergic dysfunction. Advances in Applied Science Research 8(3): 1-10
- Ahmed RG (2017) Hypothyroidism and brain development. J Anim Res Nutr 2(2): 13.
- Ahmed RG (2017) Antiepileptic drugs and developmental neuroendocrine dysfunction: Every why has A Wherefore. Arch Med 9(6): 2.
- Ahmed RG (2017) Gestational prooxidant-antioxidant imbalance may be at higher risk for postpartum thyroid disease. Endocrinol Metab Syndr 6(5): 279.
- Ahmed RG (2017) Synergistic actions of thyroid-adipokines axis during development. Endocrinol Metab Syndr 6: 280.
- Ahmed RG (2017) Thyroid-insulin dysfunction during development. International Journal of Research Studies in Zoology 3(4): 73-75.
- Ahmed RG (2017) Developmental thyroid diseases and cholinergic imbalance. International Journal of Research Studies in Zoology 3(4): 70-72.
- Ahmed RG (2017) Thyroid diseases and developmental adenosinergic imbalance. Int J Clin Endocrinol 1(2): 53-55.
- Ahmed RG (2017) Maternal anticancer drugs and fetal neuroendocrine dysfunction in experimental animals. Endocrinol Metab Syndr 6(6): 281.
- Ahmed RG (2017) Letter: Gestational dexamethasone may be at higher risk for thyroid disease developing peripartum. Open Journal of Biomedical & Life Sciences 3(2): 1-6.
- Ahmed RG (2017) Deiodinases and developmental hypothyroidism. EC Nutrition 11(5): 183-185.
- Ahmed RG (2017) Maternofetal thyroid hormones and risk of diabetes. Int J of Res Studies in Medical and Health Sciences 2(10): 18-21.
- Ahmed RG (2017) Association between hypothyroidism and renal dysfunctions. International Journal of Research Studies in Medical and Health Sciences 2(11): 1-4.
- Ahmed RG (2017) Maternal hypothyroidism and lung dysfunction. International Journal of Research Studies in Medical and Health Sciences 2(11): 8-11.
- Ahmed RG (2017) Endocrine disruptors; possible mechanisms for inducing developmental disorders. IJBSM 2(4): 157-160.
- Ahmed RG (2017) Maternal thyroid hormones trajectories and neonatal behavioral disorders. ARC Journal of Diabetes and Endocrinology 3(2): 18-21.
- Ahmed RG (2017) Maternal thyroid dysfunction and neonatal cardiac disorders. Insights Biol Med 1: 92-96.
- Ahmed RG (2018) Maternal hypothyroidism and neonatal testicular dysfunction. International Journal of Research Studies in Medical and Health Sciences 3(1): 8-12.
- Ahmed RG (2018) Maternal hypothyroidism and neonatal depression: Current perspective. International Journal of Research Studies in Zoology 4(1): 6-10.
- Ahmed RG (2018) Non-genomic actions of thyroid hormones during development. App Clin Pharmacol Toxicol: ACPT-108.
- Ahmed RG (2018) Maternal thyroid function and placental hemodynamics. ARC Journal of Animal and Veterinary Sciences 4(1): 9-13.
- Ahmed RG (2018) Interactions between thyroid and growth factors during development. ARC Journal of Diabetes and Endocrinology 4(1): 1-4.
- Ahmed RG (2018) Maternal thyroid hormones and neonatal appetite. ARC Journal of Nutrition and Growth 4(1): 18-22.
- Ahmed RG (2018) Genomic actions of thyroid hormones during development. ARC Journal of Diabetes and Endocrinology 4(1): 5-8.
- Ahmed RG (2018) Dysfunction of maternal thyroid hormones and psychiatric symptoms. American Research Journal of Endocrinology 2(1): 1-6.
- Ahmed RG (2018) Is there a connection between maternal hypothyroidism and developing autism spectrum disorders? ARC Journal of Neuroscience 3(1): 5-8.
- Ahmed RG (2018) Maternal thyroid dysfunctions and neonatal bone mal development. American Research Journal of Endocrinology.
- Ahmed RG (2018) Maternal thyroid disorders and risk of neonatal seizure: Current perspective. ARC Journal of Neuroscience 3(1): 21-25.
- Ahmed RG (2018) Gestational dioxin acts as developing neuroendocrine-disruptor. EC Pharmacology and Toxicology 6(3): 96- 100.
- Ahmed RG (2018) Maternal thyroid dysfunction and risk of neonatal stroke. ARC Journal of Animal and Veterinary Sciences 4(1): 22-26.
- Ahmed RG (2018) Maternal thyroid disorders and developing skin dysfunctions. ARC Journal of Dermatology 3(1): 13-17.
- Ahmed RG (2018) Maternal hypothyroidism-milk ejections: What is the link? ARC Journal of Nutrition and Growth 4(1): 29-33.
- Ahmed RG (2018) Does maternal antepartum hypothyroidism cause fetal and neonatal hyponatremia? ARC Journal of Diabetes and Endocrinology 4(1).
- Ahmed RG (2018) Maternal hypothyroidism and rheumatoid arthritis. International Journal of Research Studies in Medical and Health Sciences Volume 3(2).
- Ahmed RG (2018) Developmental thyroid and skeletal muscle dysfunction. ARC Journal of Diabetes and Endocrinology 4(1).
- Ahmed OM, Ahmed RG (2012) A New Look At Hypothyroidism. In: Springer D (Ed.), In Tech Open Access Publisher, London, UK, p. 1-20.
- Ahmed OM, El-Gareib AW, El-bakry AM, Abd El-Tawab SM, Ahmed RG (2008) Thyroid hormones states and brain development interactions. Int J Dev Neurosci 26(2): 147-209.
- Ahmed OM, Abd El-Tawab SM, Ahmed RG (2010) Effects of experimentally induced maternal hypothyroidism and hyperthyroidism on the development of rat offspring: I. The development of the thyroid hormones-neurotransmitters and adenosinergic system interactions. Int J Dev Neurosci 28(6): 437-454.
- Ahmed OM, Ahmed RG, El-Gareib AW, El-Bakry AM, Abd El-Tawaba SM (2012) Effects of experimentally induced maternal hypothyroidism and hyperthyroidism on the development of rat offspring: II-The developmental pattern of neurons in relation to oxidative stress and antioxidant defense system. Int J Dev Neurosci 30(6): 517-537.
- Ahmed RG, Davis PJ, Davis FB, De Vito P, Farias RN, et al. (2013) Nongenomic actions of thyroid hormones: from basic research to clinical applications. An update. Immunology, Endocrine & Metabolic Agents in Medicinal Chemistry 13(1): 46-59.
- Ahmed RG, Incerpi S, Ahmed F, Gaber A (2013) The developmental and physiological interactions between free radicals and antioxidant: Effect of environmental pollutants. J of Natural Sci Res 3(13): 74-110.
- Ahmed RG, El-Gareib AW, Incerpi S (2014) Lactating PTU exposure: II- Alters thyroid-axis and prooxidant-antioxidant balance in neonatal cerebellum. Int Res J of Natural Sciences 2(1): 1-20.
- Incerpi S, Hsieh MT, Lin HY, Cheng GY, De Vito P, et al. (2014) Thyroid hormone inhibition in L6 myoblasts of IGF-I-mediated glucose uptake and proliferation: new roles for integrin αvβ3. Am J Physiol Cell Physiol 307(2): C150-C161.
- Candelotti E, De Vito P, Ahmed RG, Luly P, Davis PJ, et al. (2015) Thyroid hormones crosstalk with growth factors: Old facts and new hypotheses. Immun Endoc & Metab Agents in Med Chem 15(1): 71-85.
- De Vito P, Candelotti E, Ahmed RG, Luly P, Davis PJ, et al. (2015) Role of thyroid hormones in insulin resistance and diabetes. Immun Endoc & Metab Agents in Med Chem 15(1): 86-93.
- Ahmed RG, El-Gareib AW, Shaker HM (2018) Gestational 3,3′,4,4′,5-pentachlorobiphenyl (PCB 126) exposure disrupts fetoplacental unit: Fetal thyroid-cytokines dysfunction. Life Sciences 192: 213-220.
- Van Herck SLJ, Geysens S, Bald E, Chwatko G, Delezie E, et al. (2013) Maternal transfer of methimazole and effects on thyroid hormone availability in embryonic tissues. Endocrinol 218(1): 105-115.
- El-Ghareeb AA, El-Bakry AM, Ahmed RG, Gaber A (2016) Effects of zinc supplementation in neonatal hypothyroidism and cerebellar distortion induced by maternal carbimazole. Asian Journal of Applied Sciences 4(4): 1030-1040.
- Ahmed RG, El-Gareib AW (2017) Maternal carbamazepine alters fetal neuroendocrine-cytokines axis. Toxicology 382: 59-66.
- Smallridge RC (2000) Postpartum thyroid disease a model of immunologic dysfunction. Clinical and Applied Immunology Reviews 1(2): 89-103.
- Madeline Bates M, Allahabadia A (2003) Thyroiditis. Surgery 303-304.
- Stagnaro-Green A (2004) Postpartum thyroiditis. Best Practice & Research Clinical Endocrinology & Metabolism 18(2): 303-316.
- Ramakrishna S, Scott-Coombes DM (2007) Thyroiditis. Surgery 25(11): 479-481.
- Landek-Salgado MA, Gutenberg A, Lupi Ic, Kimura H, Mariotti S, et al. (2010) Pregnancy, postpartum autoimmune thyroiditis, and autoimmune hypophysitis: Intimate relationships. Autoimmunity Reviews 9(3): 153-157
- Pearce EN (2015) Thyroid disorders during pregnancy and postpartum. Best Practice & Research Clinical Obstetrics and Gynaecology 29(5): 700-706.
- Jansson R, Tötterman, TH Sällström, J Dahlberg PA (1984) Intrathyroidal and circulating lymphocyte subsets in different stages of autoimmune postpartum thyroiditis. J Clin Endocrinol Metab 58(5): 942-946.
- Iwatani Y, Amino N, Tamaki H, Aozasa M, Kabutomori O, et al. (1988) Increase in peripheral large granular lymphocytes in postpartum autoimmune thyroiditis. Endocrinol Jpn 35(3): 447-453.
- Stagnaro-Green A, Roman SH, Cobin RH, El-Harazy E, Wallenstein S, et al. (1992) A prospective study of lymphocyte-initiated immunosuppression in normal pregnancy: evidence of a T-cell etiology for postpartum thyroid dysfunction. J Clin Endocrinol Metab 74(3): 645-653.
- Parkes AB, Othman S, Hall R, John R, Lazarus JH (1995) Role of complement in the pathogenesis of postpartum thyroiditis: relationship between complement activation and disease presentation and progression. Eur J Endocrinol 133(2): 210-215.
- Lervang HH, Pryds O, Ostergaard Kristensen HP (1987) Thyroid dysfunction after delivery: incidence and clinical course. Acta Med Scand 222(4): 369-374.
- Hayslip CC, Fein HG, O’Donnell VM, Friedman DS, Klein TA, et al. (1988) The value of serum antimicrosomal antibody testing in screening for symptomatic postpartum thyroid dysfunction. Am J Obstet Gynecol 159(1): 203-209.
- Walfish PG, Meyerson J, Provias JP, Vargas MT, Papsin FR (1992) Prevalence and characteristics of post-partum thyroid dysfunction: results of a survey from Toronto, Canada. J Endocrinol Invest 15(4): 265-272.
- Jansson R, Thompson PM, Clark F, McLachlan SM (1986) Association between thyroid microsomal antibodies of subclass IgG-1 and hypothyroidism in autoimmune postpartum thyroiditis.Clin Exp Immunol 63(1): 80-86.
- Ahmed RG (2017) Developmental thyroid diseases and GABAergic dysfunction. EC Neurology 8(1): 2-4.
- Ahmed RG, Abdel-Latif M, Ahmed F (2015) Protective effects of GM-CSF in experimental neonatal hypothyroidism. International Immunopharmacology 29: 538-543.
- Ahmed RG, Abdel-Latif M, Mahdi E, El-Nesr K (2015) Immune stimulation improves endocrine and neural fetal outcomes in a model of maternofetal thyrotoxicosis. Int Immuno pharmacol 29(2): 714-721.
- Ahmed RG, El-Gareib AW (2014) Lactating PTU exposure: I- Alters thyroid-neural axis in neonatal cerebellum. Eur J of Biol and Medical Sci Res 2(1): 1-16.
- Ahmed RG, Incerpi S (2013) Gestational doxorubicin alters fetal thyroid-brain axis. Int J Devl Neuroscience 31(2): 96-104.
- Ahmed RG, Walaa GH, Asmaa FS (2018) Suppressive effects of neonatal bisphenol A on the neuroendocrine system. Toxicology and Industrial Health Journal (in press).