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Incidence of Postpartum Thyroid Dysfunction in Patients with Type I Diabetes Mellitus

Hertzel C. Gerstein, MD, MSc
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From McMaster University, Hamilton, Ontario. Requests for Reprints: H. C. Gerstein, MD, MSc, McMaster Medical Clinics, Third Floor, Henderson General Hospital, 711 Concession Street, Hamilton, Ontario, Canada, L8V 1C3. Acknowledgments: The author thanks nurse-educators Edi Zimmerman, Audrey Moroso, Margaret Ford, and Peggy Rowsell for data collection; Drs. J.D. Booth, C.J. Toews, D. Hunter, and R. Burrows for clinical support; M. Donahoe, Dr. G. Luxton, and Dr. A. Luxton for help with biochemical assessments; Ivey Levie, David St. Amant, and the Diabetes Day Care Centre at McMaster University Medical Centre for administrative support; and Dr. G. Browman and Professor R. Roberts for helpful comments. Kits for the measurement of thyroid microsomal antibodies were provided by Miles Canada Inc.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1993;118(6):419-423. doi:10.7326/0003-4819-118-6-199303150-00004
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Objective: To assess the incidence of postpartum thyroid dysfunction in women with type I diabetes.

Design: Cohort study of consecutive patients, with clinical and biochemical assessments of thyroid dysfunction and glycemic control done during the first postpartum week and 3 and 6 months after delivery.

Setting: University medical center providing obstetric care for more than 90% of the pregnant women in the region with type I diabetes.

Patients: Fifty-one patients with type I diabetes who resided in the Hamilton, Ontario, catchment area and who delivered babies between May 1989 and June 1991, were not taking thyroid medication or thyroactive or immunosuppressive medications. Forty patients completed follow-up.

Main Outcome Measures: Postpartum thyroid dysfunction was defined on the basis of thyroid function test results.

Results: Postpartum thyroid dysfunction occurred in 10 of 40 patients (25%; 95% CI, 12.7% to 41.2%); postpartum thyroiditis developed in 9 patients and postpartum Graves disease developed in 1 patient during the first 6 months after delivery. The incidence could have varied between 19.6% and 41.2%, depending on whether none or all of the 11 nonparticipating eligible patients developed thyroid dysfunction. Glycemic control was not affected by thyroid dysfunction.

Conclusions: Women with type I diabetes are at a high risk for symptomatic postpartum thyroid dysfunction and therefore may benefit from routine thyroid function screening at postpartum visits.


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Figure 1.
Change in symptom score from baseline in patients with and without thyroid dysfunction.P

The change in symptom score for euthyroid patients at each postpartum visit is indicated by circles (bars represent 95% CIs). The change in symptom score for each patient who had thyroid dysfunction at either the 3- or 6-month visit is indicated by an “X.” values were determined using the Mann-Whitney U test. Patients who developed hypothyroidism by the 6-month postpartum visit had a greater change in hypothyroid symptom score than did the euthyroid patients at this time. Patients who had thyroid dysfunction (either hypothyroidism or thyrotoxicosis) had a greater change in total symptom score than did the euthyroid patients at both the 3- and 6- month visits.

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