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Vol. 51. Núm. 5.
Páginas 303-307 (Mayo 2004)
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Vol. 51. Núm. 5.
Páginas 303-307 (Mayo 2004)
DOI: 10.1016/S1575-0922(04)74620-3
Acceso a texto completo
Tiroiditis posparto
Postpartum thyroiditis
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12901
A.M. Lucas
Autor para correspondencia
alucas@ns.hugtip.scs.es

Correspondencia: Dra. A.M. Lucas. Servei d'Endocrinologia i Nutrició. Hospital Universitari Germans Trias i Pujol. Ctra. del Canyet, s/n. 08916 Badalona. Barcelona. España.
Servei d'Endocrinologia i Nutrició. Hospital Universitari Germans Trias i Pujol. Badalona. Barcelona. España
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Información del artículo

El 50-60% de los hipertiroidismos transitorios posparto se deben a una tiroiditis posparto (TPP). Es una tiroiditis subaguda silente y autoinmunitaria, que cursa con una fase inicial de hipertiroidismo y otra, posterior, de hipotiroidismo transitorio o permanente. El hipertiroidismo pocas veces requiere tratamiento y el hipotiroidismo se trata con tiroxina libre de forma transitoria o definitiva.

La densidad de incidencia de TPP en un grupo de mujeres no seleccionadas fue del 7,8% y el mejor momento para diagnosticar la mayor parte de las TPP fue el sexto mes posparto. En el 58% de las TPP existió hipertiroidismo analítico que se siguió de hipotiroidismo. Los síntomas clínicos fueron muy poco orientativos. De 45 pacientes con TPP, tras un seguimiento medio de 64 ± 37,7 meses, 14 (31,1%) han desarrollado hipotiroidismo definitivo (el 40% de las pacientes que presentaron hipotiroidismo durante la TPP y el 2,3% de todas las mujeres).

Destaca la frecuencia de TPP hallada en la población general, su curso clínico silente, el porcentaje elevado de casos que presentan hipotiroidismo transitorio y la probabilidad alta de evolución a hipotiroidismo definitivo; todo ello, unido a las repercusiones negativas que el hipotiroidismo (clínico y subclínico) durante el embarazo tiene tanto para la madre como para el feto y el recién nacido, obliga a replantearse las recomendaciones sobre el cribado universal para la TPP. Así, parece razonable recomendarlo en todas las mujeres a los 6 meses posparto mediante la determinación de tirotropina basal.

Palabras clave:
Disfunción tiroidea posparto
Tiroiditis posparto
Enfermedad autoinmunitaria tiroidea
Depresión posparto.

Fifty to sixty per cent of postpartum transitory hypothyroidisms are produced by postpartum thyroiditis (PPT). This is an autoimmune silent subacute thyroiditis that curses with an initial thyrotoxic phase and other, subsequent, of transitory or permanent hypothyroidism. The hyperthyroidism few times requires treatment and hypothyroidism could be treated with L-T4 in a transitory or definitive way.

The PPT density of incidence in a group of not selected women was of 7.8% and the best moment to diagnose most of the PPT was the sixth month after delivery. In the 58% of PPT existed analytic hyperthyroidism that was followed of hypothyroidism. The clinical symptoms were very scarce. Fourteen of 45 patients with PPT (31.1%) developed definitive hypothyroidism after a follow-up of 64 ± 37.7 months (the 40% of patients that presented hypothyroidism during PPT and the 2,3% of all the women).

We consider the frequency of PPT found in the general population, its silent clinical course, the high percentage of cases with transitory hypothyroidism and the high probability of evolution to definitive hypothyroidism; these facts and the negative repercussions that the hypothyroidism (clinical and subclinical) during the pregnancy could have either for the mother or for the fetus or for the new born force us to reconsider the recommendations on the universal screening for PPT. In this way, it seems reasonable to recommend the screening in all women in the 6 months postpartum by means of basal TSH determination.

Key words:
Postpartum thyroid dysfunction
Postpartum thyroiditis
Autoimmune thyroid disease
Postpartum depression
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Copyright © 2004. Sociedad Española de Endocrinología y Nutrición
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