A Preventive Trial of Short-Term Immunosuppressive Therapy in Postpartum Thyroid Dysfunction

Autoimmune diseases, once developed, are often hard to control and thus prevention of disease development is obviously of great importance. Postpartum onset of autoimmune diseases, especially autoimmune thyroid disease, is frequently observed and postpartum hypothyroidism is a good candidate for investigation of prediction and a trial of prevention of disease development.
Materials and Methods: In order to clarify the method of prediction of postpartum onset of hypothyroidism, 9 patients who had had previous episodes of postpartum hypothyroidism and high titers (more than 5 x 103) of anti-thyroid microsomal antibodies were examined during the postpartum period of their current pregnancies. Thyroid function, size of goiter and titer of anti-microsomal antibodies were observed every month for 12 months after delivery. The other two patients, who were expected to develop postpartum hypothyroidism after present parturition and had high anti-thyroid microsomal antibody titers of more than 5 x 103, were treated with short-term glucocorticoid therapy.
Results: All 9 patients, who had previous postpartum transient hypothyroidism and had had high anti-thyroid microsomal antibodies, developed recurrence of postpartum hypothyroidism at almost the same postpartum time. A shortterm glucocorticoid therapy was tried for two other cases who were expected to have recurrence of postpartum hypothyroidism. In the first case, occurrence of postpartum hypothyroidism was delayed by 2 months and peak value of TSH was lower than that of the previous episode. In the second case, duration and dose of predonisolone was doubled and development of postpar- tum hypothyroidism was successfully prevented.
Conclusion: Postpartum recurrence of hypothyroidism was predicted in patients who had previous episodes of postpartum transient hypothyroidism and higher titers of anti-thyroid microsomal antibodies. The short-term predonisolone therapy successfully prevented postpartum development of hypothyroidism in one case.