title: Prediction of post-partum Graves' thyrotoxicosis by measurement of thyroid stimulating antibody in early pregnancy.
abstract: OBJECTIVE
  Autoimmune thyroid diseases often occur after delivery. However, it has been difficult to predict who will develop Graves' thyrotoxicosis after delivery. We tried to establish a systematic method for predicting post-partum onset of Graves' thyrotoxicosis.
  
  
  METHODS
  We followed up the pregnant women with antithyroid microsomal antibody (MCAb) from early pregnancy to the post-partum period and analysed the relation between the activities of thyroid stimulating antibodies (TSAb) in early pregnancy and post-partum occurrence of Graves' disease.
  
  
  METHODS
  Seventy-one women with positive MCAb in early pregnancy were studied. They were randomly selected from 262 MCAb-positive subjects found in 3405 consecutive early pregnant women who attended our maternity clinic during the last ten years.
  
  
  METHODS
  MCAb was measured with a commercially available agglutination kit. For 71 MCAb-positive subjects, TSH-binding inhibitory immunoglobulin (TBII) and TSAb were measured in early pregnancy, and serially until 6 months after delivery for the subjects with either positive TBII or TSAb. Thyroid function and goitre size were recorded at every observation.
  
  
  RESULTS
  Among the 71 subjects, 7 showed positive TSAb in early pregnancy without any thyroid dysfunction; all 7 developed thyroid dysfunction in the post-partum period. Five of them (70% of TSAb-positive subjects) developed Graves' disease, two showing persistence and three transiently. None of 64 TSAb-negative subjects developed Graves' thyrotoxicosis, though 44 developed various types of thyroid dysfunction as a result of post-partum autoimmune thyroiditis.
  
  
  CONCLUSIONS
  The individuals at high risk of post-partum onset of Graves' thyrotoxicosis can be found early in their pregnancy by the detection of TSAb. Overall occurrence of post-partum Graves' disease in the general population is estimated above 0.54%, that is, one in 200 post-partum women may develop Graves' thyrotoxicosis, although thyrotoxicosis may be transient in half of the patients.
authors.affiliation: Department of Laboratory Medicine, Osaka University Medical School, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Hidaka
authors.forename: H
authors.initials: H
authors.lastname: Tamaki
authors.forename: Y
authors.initials: Y
authors.lastname: Iwatani
authors.forename: H
authors.initials: H
authors.lastname: Tada
authors.forename: N
authors.initials: N
authors.lastname: Mitsuda
authors.forename: N
authors.initials: N
authors.lastname: Amino
mesh_terms: D001323:Autoantibodies / Q000097:blood*; D005260:Female; D006111:Graves Disease / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D018828:Immunoglobulins, Thyroid-Stimulating; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood*; D011262:Pregnancy Trimester, Second; D011379:Prognosis; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000175:diagnosis* / Q000276:immunology; D013961:Thyroid Gland / Q000276:immunology; D013963:Thyroid Hormones / Q000097:blood; D013971:Thyrotoxicosis / Q000175:diagnosis* / Q000276:immunology
chemical_list: D001323:Autoantibodies; D018828:Immunoglobulins, Thyroid-Stimulating; D013963:Thyroid Hormones; C056626:thyroid microsomal antibodies