Postpartum period: When the thyroid might bring the blues
Postpartum thyroiditis is a relatively common form of autoimmune
thyroid dysfunction during pregnancy.
There is a mysterious link between thyroid autoimmunity and pregnancy
outcomes (higher risk of miscarriage)and a higher propensity for
postpartum depression.
In 30% of patients with post-partum thyroiditis, the thyroid goes through
a transient period of hyperthyroidism, which could be confused with a
manic episode of bipolar disorder, the thyroid might sometimes evolve into
frank hypothyroidism, which could also manifest as depression among other
symptoms.
If one doesn't think or measure thyroid function in the postpartum
period especially in women with goiter and symptoms suggestive of anxiety
and or depression, it would be very easy to miss the diagnosis.
Based on this association, I recommend thyroid function test (thyroid
stimulating hormone and free thyroxine) and thyroid perxidase (TPO)
antibodies in all my postpartum patients who are being evaluated for
depression. Since vitamin B12 deficiency is common in patients with
autoimmune thyroid disease and that this vitamin deficiency could cause
depression, I also check vitamin B12 level during this period.
Before diagnosing depression or bipolar disease in the postpartum period,
one should ascertain that autoimmune thyroid disease is not the culprit.
References:
1. Charles Musters, Elizabeth McDonald, and Ian Jones
Management of postnatal depression
BMJ 2008; 337: a736
3. Amino, N., Mori, H., Iwatani, Y., et al. High prevalence of
transient post-partum thyrotoxicosis and hypothyroidism. N. Engl. J. Med.
1982, 306, 849-52.
4. Pedersen CA, Johnson JL, et al.
Psychoneuroendocrinology 2007 Apr;32(3):235-45
Antenatal thyroid correlates of postpartum depression.
5. Kuijpens JL, Vader HL, et al.
Thyroid peroxidase antibodies during gestation are a marker for subsequent
depression postpartum. Eur J Endocrinol. 2001:145(5):579-84.
6. Harris, B, Othman, S, et al
Association between postpartum thyroid dysfunction and thyroid
antibodies and depression.
BMJ 1992; 305:152.
7. Pedersen, CA.
Postpartum mood and anxiety disorders: a guide for the nonpsychiatric
clinician with an aside on thyroid associations with postpartum mood.
Thyroid 1999; 9:691.
8. Kent, GN, Stuckey, BG, Allen, JR, et al. Postpartum thyroid
dysfunction: clinical assessment and relationship to psychiatric affective
morbidity. Clin Endocrinol (Oxf) 1999; 51:429.
Competing interests:
On the Speakers' Bureau Abbott Pharmaceutical
Rapid Response:
Postpartum period: When the thyroid might bring the blues
Postpartum thyroiditis is a relatively common form of autoimmune
thyroid dysfunction during pregnancy.
There is a mysterious link between thyroid autoimmunity and pregnancy
outcomes (higher risk of miscarriage)and a higher propensity for
postpartum depression.
In 30% of patients with post-partum thyroiditis, the thyroid goes through
a transient period of hyperthyroidism, which could be confused with a
manic episode of bipolar disorder, the thyroid might sometimes evolve into
frank hypothyroidism, which could also manifest as depression among other
symptoms.
If one doesn't think or measure thyroid function in the postpartum
period especially in women with goiter and symptoms suggestive of anxiety
and or depression, it would be very easy to miss the diagnosis.
Based on this association, I recommend thyroid function test (thyroid
stimulating hormone and free thyroxine) and thyroid perxidase (TPO)
antibodies in all my postpartum patients who are being evaluated for
depression. Since vitamin B12 deficiency is common in patients with
autoimmune thyroid disease and that this vitamin deficiency could cause
depression, I also check vitamin B12 level during this period.
Before diagnosing depression or bipolar disease in the postpartum period,
one should ascertain that autoimmune thyroid disease is not the culprit.
References:
1. Charles Musters, Elizabeth McDonald, and Ian Jones
Management of postnatal depression
BMJ 2008; 337: a736
3. Amino, N., Mori, H., Iwatani, Y., et al. High prevalence of
transient post-partum thyrotoxicosis and hypothyroidism. N. Engl. J. Med.
1982, 306, 849-52.
4. Pedersen CA, Johnson JL, et al.
Psychoneuroendocrinology 2007 Apr;32(3):235-45
Antenatal thyroid correlates of postpartum depression.
5. Kuijpens JL, Vader HL, et al.
Thyroid peroxidase antibodies during gestation are a marker for subsequent
depression postpartum. Eur J Endocrinol. 2001:145(5):579-84.
6. Harris, B, Othman, S, et al
Association between postpartum thyroid dysfunction and thyroid
antibodies and depression.
BMJ 1992; 305:152.
7. Pedersen, CA.
Postpartum mood and anxiety disorders: a guide for the nonpsychiatric
clinician with an aside on thyroid associations with postpartum mood.
Thyroid 1999; 9:691.
8. Kent, GN, Stuckey, BG, Allen, JR, et al. Postpartum thyroid
dysfunction: clinical assessment and relationship to psychiatric affective
morbidity. Clin Endocrinol (Oxf) 1999; 51:429.
Competing interests:
On the Speakers' Bureau Abbott Pharmaceutical
Competing interests: No competing interests