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Value of Combined Clinical Information and Thyroid Peroxidase Antibodies in Pregnancy for the Prediction of Postpartum Thyroid Dysfunction

Authors

  • Sheila Mamede da Costa,

    1. Faculdade de Medicina/Serviços de Endocrinologia e Núcleo de Estudo em saúde coletiva (NESC), Hospital Universitário Clementino Fraga Filho (HUCFF) – UFRJ, Rio de Janeiro, Brazil
    2. Serviços de Clínica Médica e Pré-Natal do Hospital Geral de Nova Iguaçu (HGNI), UNIG, Nova Iguaçu, Brazil
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  • Lino Sieiro Netto,

    1. Serviços de Clínica Médica e Pré-Natal do Hospital Geral de Nova Iguaçu (HGNI), UNIG, Nova Iguaçu, Brazil
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  • Claudia Medina Coeli,

    1. Faculdade de Medicina/Serviços de Endocrinologia e Núcleo de Estudo em saúde coletiva (NESC), Hospital Universitário Clementino Fraga Filho (HUCFF) – UFRJ, Rio de Janeiro, Brazil
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  • Alexandru Buescu,

    1. Faculdade de Medicina/Serviços de Endocrinologia e Núcleo de Estudo em saúde coletiva (NESC), Hospital Universitário Clementino Fraga Filho (HUCFF) – UFRJ, Rio de Janeiro, Brazil
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  • Mario Vaisman

    1. Faculdade de Medicina/Serviços de Endocrinologia e Núcleo de Estudo em saúde coletiva (NESC), Hospital Universitário Clementino Fraga Filho (HUCFF) – UFRJ, Rio de Janeiro, Brazil
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Sheila Mamede da Costa, Getúlio de Moura, 173, Apartment 705, Olinda, Nilópolis, Rio de Janeiro, RJ, Brazil.
E-mail: drasheila@terra.com.br

Abstract

Problem

To investigate the utility of thyroid peroxidase antibodies (TPOAb) in early pregnancy combined with clinical information for prediction of postpartum thyroid dysfunction (PPTD) within 1 year postpartum.

Method of study

We studied 98 pregnant women by determining their TPOAb levels in early pregnancy, as well as their serum thyrotropin and free thyroid (fT4) levels at 6 and 12 months postpartum. Furthermore, they answered a questionnaire and physical examination was performed by only one examiner.

Results

Of the 98 women, 10 were positive TPOAb in early pregnancy. The overall risk of PPTD within 1 year of follow-up was 10.2% (95% CI 4.1–16.3). Risk of PPTD was significantly higher among women with a family history of thyroid disease, TPOAb positive and presenting goiter in early pregnancy. The sensitivity, specificity and positive predictive value of TPOAb in PPTD prediction were 60.0%, 95.5% and 60%. Restricting screening to women with a family history of thyroid disease or presenting goiter increases the positive predictive value from 60% to 82.4%.

Conclusion

Our results suggest that TPOAb could be used as a screening test for PPTD prediction at least among women who present a high risk of developing PPTD.

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