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Postpartum thyroid dysfunction and the long-term risk of hypothyroidism: results from a 12-year follow-up study of women with and without postpartum thyroid dysfunction

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Abstract Background 

The long-term risk of hypothyroidism following postpartum thyroid dysfunction (PPTD) is uncertain. Most previous studies have been small, short-term or have lacked a control group. Objective 

To ascertain the long-term risk of hypothyroidism in women following PPTD. Design and participants 

A 12-year longitudinal study of 409 women (including 71 with PPTD) who previously participated in a PPTD prevalence study. Measurements 

The primary outcome measure was hypothyroidism (defined as TSH greater than 4 mU/l or on thyroxine replacement) at follow-up. Outcomes in women with and without PPTD were compared by logistic regression. Receiver operating characteristic analysis was used to determine the optimal cut-off for baseline TSH as a predictor of hypothyroidism in the cohort. Results 

At follow-up, hypothyroidism was present in 27 of 71 women who had PPTD at baseline (38%) and 14 of 338 women without PPTD (4%). From multivariate analysis, odds ratios (with 95% confidence intervals) for hypothyroidism were – 4·8 (1·6, 14·1) for PPTD; 8·2 (2·8, 24·6) for positive thyroid peroxidase antibodies (TPOAb); 9·7 (2·6, 37·0) for the hypothyroid phase of PPTD and 51·4 (19·2, 137·5) for hypothyroid PPTD with positive TPOAb. A baseline TSH above 2·6 mU/l was the optimal cut-off for predicting hypothyroidism (sensitivity 76%, specificity 86%). Conclusions 

PPTD is a strong predictor of hypothyroidism in the long-term. Women who present with postpartum hypothyroidism or have positive TPOAb are at particularly high risk, suggesting that close long-term follow-up is advisable if thyroxine replacement is not instituted at an early stage.
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Document Type: Research Article

Affiliations: 1: Department of Clinical Biochemistry and Clinical Pharmacology and Toxicology, PathWest Laboratory Medicine, Nedlands, WA, Australia 2: Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA

Publication date: September 1, 2010

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