1/30. Postpartum onset of acute heart failure possibly due to postpartum autoimmune myocarditis. A report of three cases.autoimmune diseases, especially autoimmune thyroid disease, frequently develop after delivery due to the immune rebound mechanism. Most cases have transient dysfunction of affected organs. Cardiac dysfunction developed after delivery is called postpartum or peripartum cardiomyopathy. However, the aetiology of the disease is not clarified yet. Here we report three cases that developed acute heart failure in the postpartum period. One was complicated with an atrioventricular block and postpartum autoimmune thyroiditis. All patients recovered to normal cardiac function or pre-attack condition after 1 month of therapy with conventional drugs and bed rest. All three had positive antiheart antibody detected by indirect immunofluorescence assay, and one had antibody to heart myosin detected by enzyme-linked immunosorbent assay. Moreover, one of two patients examined revealed lymphocytic infiltration by endomyocardial biopsy. Antibodies to 26 viruses were not elevated significantly during the first 2 weeks after admission in any case. It is strongly suggested that heart failure is induced by postpartum autoimmune myocarditis, and thus clinicians should be aware of this disease.- - - - - - - - - - ranking = 1keywords = thyroiditis (Clic here for more details about this article) |
2/30. Transient diffuse low thyroid echogenicity in painless postpartum thyroiditis: report of two cases.We report two cases of chronic autoimmune thyroiditis, one patient with recurrent painless thyroiditis and another with recurrent postpartum thyroiditis. In these two patients, the episode of subacute thyroiditis seemed to be immune mediated. Thyroid ultrasonography showed a diffuse, markedly hypoechogenic gland, coinciding with each of the episodes of transient thyroid dysfunction that reverted to a normal echographic appearance with recovery of normal thyroid function. These two cases show that a diffuse low echogenicity of the thyroid, frequently seen in autoimmune thyroid disorders, can be a reversible event and suggest that the transient nature of certain forms of hypothyroidism may be predicted by a follow-up echographic examination. Further studies with a larger number of patients are required to confirm this observation.- - - - - - - - - - ranking = 8keywords = thyroiditis (Clic here for more details about this article) |
3/30. Postpartum proptosis with ophthalmopathy.BACKGROUND: Postpartum thyroid disease presents in two forms: postpartum thyroiditis (PPT) and postpartum Graves' disease (PPGD). CASE REPORT: A case of postpartum thyroid dysfunction with ophthalmopathy is presented. DISCUSSION: In women diagnosed with Graves' disease during the ages of 20 to 35 years, 66% have a postpartum onset; women with a previous history of Graves' disease frequently relapse in the postpartum period. Additionally, up to 25 to 30% of postpartum women can develop permanent hypothyroidism from postpartum thyroiditis. The signs and symptoms of PPT and PPGD may be indefinite after delivery and often go undiagnosed. Because complications can be significant and may become irreversible, proper diagnosis and timely treatment is important.- - - - - - - - - - ranking = 2keywords = thyroiditis (Clic here for more details about this article) |
4/30. postpartum thyroiditis presenting as a cold nodule and evolving to Graves' disease.We describe the case of a 30-year-old woman who, five months after giving birth, was referred with a solitary nodule in her anterior neck. Laboratory analysis, ultrasonography, pertechnetate (Tc99m) thyroid scan and cytological examination of fine needle aspiration biopsy performed on the nodule led us to diagnose postpartum thyroiditis (PPT). Twenty-eight months after parturition, overt hyperthyroidism developed, with raised thyroperoxidase and thyroid stimulating hormone receptor antibody titres, diffuse high uptake of Tc99m at thyroid scan, and high vascular flow throughout the gland at color-Power imaging. The diagnosis of Graves' disease (GD) was established. The differential diagnosis of thyrotoxicosis in the postpartum period, and the possible aetiological relationships between PPT and GD are discussed. To our knowledge, this is the first published report of a PPT presenting as a cold nodule, and evolving to GD.- - - - - - - - - - ranking = 5keywords = thyroiditis (Clic here for more details about this article) |
5/30. Reversible adrenocorticotropin deficiency due to probable autoimmune hypophysitis in a woman with postpartum thyroiditis.The natural history and pathogenesis of lymphocytic hypophysitis remain poorly understood. We describe a 34-yr-old woman with postpartum thyroiditis and ACTH deficiency, studied at monthly intervals for 18 months after pregnancy. A significant titer of thyroid peroxidase autoantibodies was detected at 16 weeks gestation, and she was recruited into a prospective study of postpartum thyroid function. Four months postpartum she developed mild hyperthyroidism [free T4 (fT4), 27 pmol/L; TSH, less than 0.2 mU/L] and showed a rise in thyroid peroxidase and thyroglobulin autoantibodies. At 9 months postpartum, serum fT4 and fT3 levels were low normal (8.0 and 1.7 pmol/L, respectively), but TSH was not raised (0.4 mU/L). Subsequent investigation showed a low basal plasma cortisol level (28 nmol/L) in association with undetectable ACTH, and subnormal cortisol responses to depot Synacthen (535 nmol/L at 6 h) and hypoglycemia (peak, 145 nmol/L). FSH, LH, GH, and PRL function and computerized tomography of the pituitary were normal. Retrospective analysis of serum samples taken throughout the postpartum year showed developing hypocortisolemia between 3-9 months postpartum. Each sample was also tested for pituitary autoantibodies using a specific indirect immunofluorescent assay; none was detected. The ACTH deficiency recovered spontaneously, with normal cortisol responses to depot Synacthen (greater than 1380 at 6 h) and hypoglycemia (peak, 590) 14 and 18 months postpartum, respectively. This case illustrates that postpartum pituitary deficiencies are potentially reversible. The pattern of pituitary deficit and postpartum thyroiditis supported a diagnosis of autoimmune hypophysitis.- - - - - - - - - - ranking = 6keywords = thyroiditis (Clic here for more details about this article) |
6/30. Thyroid hemiagenesis with postpartum silent thyroiditis.A 28-year-old woman with thyroid hemiagenesis, who had been diagnosed as having Graves' disease, became pregnant during the course of methimazole treatment. The treatment was terminated in the second trimester. She delivered a normal infant at full term. She became thyrotoxic 3 months after the delivery, hypothyroid 6 months after the delivery, and finally euthyroid 11 months after the delivery without undergoing any treatment. This clinical course indicates that she developed silent thyroiditis after the delivery. A diagnosis of thyroid hemiagenesis was made on the basis of ultrasonography of the thyroid and 99mTc-pertechnetate thyroid scintiscan.- - - - - - - - - - ranking = 5keywords = thyroiditis (Clic here for more details about this article) |
7/30. Papillary carcinoma of the thyroid after postpartum thyroiditis.postpartum thyroiditis is a benign, often self-limited cause of thyroid dysfunction. This report describes the first case of papillary carcinoma arising in a woman with postpartum thyroid disease. Both clinicians and pathologists must keep a high index of suspicion in postpartum patients with persistent thyroid abnormalities, even when a previous biopsy may have disclosed benign disease.- - - - - - - - - - ranking = 5keywords = thyroiditis (Clic here for more details about this article) |
8/30. insulin-dependent diabetes mellitus in which glycemic control was improved during pregnancy but deteriorated after delivery with the occurrence of postpartum thyrotoxicosis: a case report.We report a patient, a twin, with diabetes mellitus whose hyperglycemic state fluctuated during the course of the pregnancy and the subsequent delivery. She was diagnosed as having slowly progressive IDDM because of her clinical course and the findings of serum positive ICA/CF, positive HLA-DR4 and disconcordance of diabetes mellitus with her identical twin. insulin therapy was not initially needed in the first two years because the endogenous insulin secretion was not completely reduced. After two years of insulin therapy the patient became pregnant. Her glycemic control was remarkably improved without changes in dietary intake and insulin dosage. After delivery glycemic control deteriorated after delivery with the occurrence of postpartum thyroiditis. Urinary excretion of CPR was increased during pregnancy but decreased after delivery. ICA/CF in serum were persistently detected in the whole observation period. It seems that the improved glycemic control during pregnancy was caused by the reduction in the autoimmune reaction and the deterioration in glycemic control during the postpartum period was induced by the acceleration of the autoimmune reaction by the same mechanism of postpartum autoimmune thyroiditis.- - - - - - - - - - ranking = 2keywords = thyroiditis (Clic here for more details about this article) |
9/30. Tuberculous thyroiditis and miliary tuberculosis manifested postpartum in a patient with thyroid carcinoma.Right nodular goiter with diffuse miliary shadow on chest roentgenogram was found in a postpartum febrile woman. Transbronchial lung biopsy revealed tuberculous granuloma and acid-fast bacilli were found by aspiration cytology of the thyroid. Although chemotherapy was effective, the thyroid nodule remained palpable and the serum thyroglobulin level remained high. Subtotal thyroidectomy revealed papillary carcinoma associated with tuberculosis and lymph nodes metastasis. This seems to be the first case report of a patient with tuberculous thyroiditis, coexisting with thyroid carcinoma, diagnosed by aspiration cytology and treated prior to surgery.- - - - - - - - - - ranking = 5keywords = thyroiditis (Clic here for more details about this article) |
10/30. Post-partum thyroiditis can be painful.A patient with post-partum thyroiditis is described. She was a 22 year old with a negative family history of autoimmune thyroid disease who was noted to have a high titre of antithyroid microsomal antibody during pregnancy. She developed mild hyperthyroidism 8 weeks post-partum but at 12 weeks she had a mildly painful enlarged thyroid gland. At 20 weeks post-partum she had severe thyroidal pain with dysphagia. The thyroid was exquisitely tender to palpation. She was treated with L-thyroxine and the pain resolved within 4 weeks. This is the first report documenting pain in the thyroid as a feature of post-partum thyroiditis.- - - - - - - - - - ranking = 6keywords = thyroiditis (Clic here for more details about this article) |
| | Next -> |