donderdag 21 mei 2015

Graves’ hyperthyreoïdie in en rond de zwangerschap

Hyperthyroidism in women of reproductive age is predominantly caused by Graves’ disease. Pregnancy-associated changes in the immune system may influence the onset of disease, but population-based incidence rates in and around pregnancy have not been reported.

The objective of Stine Linding Andersen, Jørn Olsen, Allan Carlé and Peter Laurberg was to estimate the incidence of maternal hyperthyroidism (defined by prescriptions for antithyroid drugs being filled) in and around pregnancy and to compare this with the incidence of other autoimmune diseases, such as rheumatoid arthritis (RA) and inflammatory bowel disease (IBD).


Hyperthyroidism incidence fluctuates widely in and around pregnancy and is at variance with some other autoimmune diseases: a Danish population-based study
Stine Linding Andersen, Jørn Olsen, Allan Carlé, Peter Laurberg

The incidence of Graves’ hyperthyroidism increases in early pregnancy and the late postpartum period
Jorge H. Mestman, analyse en commentaar

Graves’ hyperthyreoïdie, zwangerschap en borstvoeding
Schildkliertje

Methods

Danish nationwide registers provided for a population-based cohort study. In women giving birth to singleton liveborn children in Denmark from 1999 to 2008 (n = 403,958), the main outcome investigated was the incidence rates (IR) of maternal hyperthyroidism during a 4-year period beginning 2 years before and ending 2 years after the date when the mother gave birth for the first time during the study period.

Results

Altogether 3673 women (0.9%) were identified as having the onset of hyperthyroidism from 1997 to 2010. The IR of hyperthyroidism in and around pregnancy varied widely and was high in the first 3 months of pregnancy (incidence rate ratio [IRR] as compared with the remaining study period, 1.50), very low in the last 3 months of pregnancy (0.26), and at the highest level 7 to 9 months post partum (3.80). The incidence variation in and around pregnancy was different for RA and IBD.

Conclusions

The incidence of hyperthyroidism was high in early pregnancy and post partum, whereas this particular pattern was not observed for other diseases of autoimmune origin.

Referenties analyse en commentaar Jorge H Mestman

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  2. R Jansson, PA Dahlberg, B Winsa, O Meirik, J Safwenberg, A Karlsson. The postpartum period constitutes an important risk for the development of clinical Graves’ disease in young women. Acta Endocrinol (Copenh) 1987;116:321-5.
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  6. N Amino, O Tanizawa, H Mori, Y Iwatani, T Yamada, K Kurachi, Y Kumahara, K Miyai. Aggravation of thyrotoxicosis in early pregnancy and after delivery in Graves’ disease. J Clin Endocrinol Metab 1982;55:108-12.
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