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Serum pituitary antibodies in normal pregnancy and in patients with postpartum thyroiditis: a nested case-control study

L Manetti, Department of Endocrinology, University of Pisa, Pisa, Italy
A Parkes, Center for Endocrine and Diabetes Sciences, Cardiff University School of Medicine, Cardiff, United Kingdom
I Lupi, Department of Endocrinology, University of Pisa, Pisa, Italy
G Di Cianni, Department of Endocrinology, University of Pisa, Pisa, Italy
F Bogazzi, Department of Endocrinology, University of Pisa, Pisa, Italy
S Albertini, Department of Endocrinology, University of Pisa, Pisa, Italy
L Morselli, Department of Endocrinology, University of Pisa, Pisa, Italy
V Raffaelli, Department of Endocrinology, University of Pisa, Pisa, Italy
D Russo, Department of Endocrinology, University of Pisa, Pisa, Italy
G Rossi, Istituto di Fisiologia Clinica, C.N.R., Pisa, Italy
M Gasperi, Chair of Endocrinology, University of Molise, Campobasso, Italy
J Lazarus, Center for Endocrine and Diabetes Sciences, Cardiff University School of Medicine, Cardiff, United Kingdom
E Martino, Department of Endocrinology, University of Pisa, Pisa, Italy

Correspondence: Luca Manetti, Email: lmanetti{at}endoc.med.unipi.it

Abstract

Objectives: The aim of this study was to evaluate antipituitary antibody (APA) prevalence in a series of patients with postpartum thyroiditis (PPT) during pregnancy and in the postpartum.

Design: We conducted a nested case-control study on consecutive PPT and normal pregnant women at the Centre for Endocrine and Diabetes Sciences in Cardiff and at the Department of Endocrinology in Pisa.

Methods: We enrolled thirty women with PPT: 17 were hypothyroid (Hypo), 7 with hyperthyroidism (Hyper) and 6 with a transient hyperthyroidism followed by hypothyroidism (Biphasic). Twenty-one healthy pregnant women served as Control. APA (measured by indirect immunofluorescence), free thyroxine (FT4), free triiodiothyronine (FT3), TSH, anti-thyroid autoantibodies and thyroid ultrasound were performed during pregnancy and postpartum. The stored sera have been sent in Pisa, where serum APA, IGF-I and cortisol were measured.

Results: APA were found in 8/30 PPT patients (26.7%) and in 1 normal pregnancy (4.7%, p=0.063). Three/17 Hypo with PPT (17.6%), 3/7 Hyper PPT (42.8%) and 2/6 Biphasic PPT (33.3%) were positive for APA. APA prevalence was not significantly different in the PPT subgroups (p=0.453). With one exception, APA all increased in the postpartum period (87.5%, p<0.016). Basal serum IGF-I and cortisol were in the normal range with the exception of two patients with positive APA that presented low serum IGF-I levels (36 and 45 ng/ml).

Conclusions: APA are frequently present in the postpartum period in patients affected by PPT. Further studies are necessary to evaluate if APA in PPT patients are associated with pituitary function impairment.