Increased thyroid autoimmunity among women with multiple sclerosis in the postpartum setting

Abstract

Background:

Multiple sclerosis (MS) patients are predisposed to thyroid abnormalities, but the risk for pregnancy-related thyroid pathology among MS patients has not been evaluated.

Objectives:

The objectives of this research are to prospectively evaluate the prevalence of thyroid autoimmunity among MS patients in relation to pregnancy, and to investigate its impact on pregnancy outcome, postpartum depression and fatigue.

Methods:

Forty-six pregnant MS patients underwent repeat testing for serum thyroid antibodies (Abs), clinical evaluation and thyroid hormone measurement. Results were compared to 35 age-matched healthy mothers.

Results:

At six months postpartum 35.3% of MS patients presented elevated levels of thyroid Abs compared to 5.7% of controls, p = 0.01. Mean thyroid Ab concentrations among MS patients were significantly reduced during pregnancy and returned to maximal levels at six months postpartum. The proportion of individuals with postpartum thyroid dysfunction did not differ significantly between MS patients and healthy controls (3.4% vs 2.9%, p = 1.00). Elevated thyroid Ab levels did not increase the risk for adverse pregnancy outcome, fatigue or postpartum depression.

Conclusions:

Considering the tendency of MS mothers to develop thyroid autoimmunity postpartum and in association to treatments, we recommend screening MS patients for thyroid dysfunction (TSH) during early pregnancy and after delivery.

Keywords

Multiple sclerosis pregnancy thyroid antibodies postpartum thyroiditis

Get full access to this article

View all access options for this article.

References

Disanto

Morahan

Barnett

. The evidence for a role of B cells in multiple sclerosis. Neurology 2012; 78: 823–832.

Orton

Herrera

Yee

. Sex ratio of multiple sclerosis in Canada: A longitudinal study. Lancet Neurol 2006; 5: 932–936.

Cotsapas

Voight

Rossin

. Pervasive sharing of genetic effects in autoimmune disease. PLoS Genet 2011; 7: e1002254.

Broadley

Deans

Sawcer

. Autoimmune disease in first-degree relatives of patients with multiple sclerosis. Brain 2000; 123: 1102–1111.

Somers

Thomas

Smeeth

. Are individuals with an autoimmune disease at higher risk of a second autoimmune disorder? Am J Epidemiol 2009; 169: 749–755.

Monzani

Caraccio

Dardano

. Thyroid autoimmunity and dysfunction associated with type I interferon therapy. Clin Exp Med 2004; 3: 199–210.

Jones

IL-21 drives secondary autoimmunity in patients with multiple sclerosis, following therapeutic lymphocyte depletion with alemtuzumab (campath-1H). J Clin Invest 2009; 119: 2052–2061.

Coles

Wing

Smith

. Pulsed monoclonal antibody treatment and autoimmune thyroid disease in multiple sclerosis. Lancet 1999; 354: 1691–1695.

Airas

Jalkanen

Alanen

. Breast-feeding, postpartum and prepregnancy disease activity in multiple sclerosis. Neurology 2010; 75: 474–476.

10.

Gaberšček

Zaletel

. Thyroid physiology and autoimmunity in pregnancy and after delivery. Expert Rev Clin Immunol 2011; 7: 697–707.

11.

Stagnaro-Green

. Approach to the patient with postpartum thyroiditis. J Clin Endocrinol Metab 2012; 97: 334–342.

12.

Abalovich

Gutierrez

Alcaraz

. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid 2002; 12: 63–68.

13.

Allan

Haddow

Palomaki

. Maternal thyroid deficiency and pregnancy complications: Implications for population screening. J Med Screen 2000; 7: 127–130.

14.

Benhadi

Wiersinga

Reitsma

. Higher maternal TSH levels in pregnancy are associated with increased risk for miscarriage, fetal or neonatal death. Eur J Endocrinol 2009; 160: 985–991.

15.

Prummel

Wiersinga

. Thyroid autoimmunity and miscarriage. Eur J Endocrinol 2004; 150: 751–755.

16.

Casey

. Subclinical hypothyroidism and pregnancy. Obstet Gynecol Surv 2006; 61: 415–420.

17.

Haddow

McClain

Palomaki

. Thyroperoxidase and thyroglobulin antibodies in early pregnancy and placental abruption. Obstet Gynecol 2011; 117: 287–292.

18.

Haddow

Palomaki

Allan

. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 1999; 341: 549–555.

19.

Abbassi-Ghanavati

. Thyroid autoantibodies and pregnancy outcomes. Clin Obstet Gyn 2011; 54: 499–505.

20.

Jalkanen

Alanen

Airas

. Pregnancy outcome in women with multiple sclerosis: Results from a prospective nationwide study in Finland. Mult Scler 2010; 16: 950–955.

21.

Valko

Bassetti

Bloch

. Validation of the fatigue severity scale in a Swiss cohort. Sleep 2008; 31: 1601–1607.

22.

Hansen

Brix

Iachine

. The relative importance of genetic and environmental effects for the early stages of thyroid autoimmunity: A study of healthy Danish twins. Eur J Endocrin 2006; 154: 29–38.

23.

Jensen

Hyltoft Petersen

Blaabjerg

. Establishment of a serum thyroid stimulating hormone (TSH) reference interval in healthy adults. The importance of environmental factors, including thyroid antibodies. Clin Chem Lab Med 2004; 42: 824–832.

24.

Jensen

Petersen

Blaabjerg

. Improved sensitivity of a thyrotropin receptor antibody assay. Clin Chem 2005; 51: 2186–2187.

25.

Thangaratinam

Tan

Knox

. Association between thyroid autoantibodies and miscarriage and preterm birth: Meta-analysis of evidence. BMJ 2011; 9: 342: d2616.

26.

Szmyrka-Kaczmarek

Pokryszko-Dragan

Pawlik

. Antinuclear and antiphospholipid antibodies in patients with multiple sclerosis. Lupus 2012; 21, 412–420.

27.

Garg

Zivadinov

Ramanathan

. Clinical and MRI correlates of autoreactive antibodies in multiple sclerosis patients. J Neuroim 2007; 187: 159–165.

28.

Poppe

Velkeniers

Glinoer

. The role of thyroid autoimmunity in fertility and pregnancy. Nat Clin Pract Endocrinol Metab 2008; 4: 394–405.

29.

Weetman

. Immunity, thyroid function and pregnancy: Molecular mechanisms. Nat Rev Endocrin 2010; 6: 311–331.

30.

Klajnbard

Szecsi

Colov

. Laboratory reference intervals during pregnancy, delivery and the early postpartum period. Clin Chem Lab Med 2010; 48: 237–248.

31.

Caraccio

Dardano

Manfredonia

. Long-term follow-up of 106 multiple sclerosis patients undergoing interferon-b 1a or 1b therapy: Predictive factors of thyroid disease development and duration. J Clin Endocrin Metab 2005; 90: 4133–4137.

32.

Polman

Kappos

Dahlke

. Interferon beta-1b treatment does not induce autoantibodies. Neurology 2005; 64: 996–1000.

33.

Muller

Drexhage

Berghout

. Postpartum thyroiditis and autoimmune thyroiditis in women of childbearing age: Recent insights and consequences for antenatal and postnatal care. Endocr Rev 2001; 22: 605–630.

34.

Atzeni

Doria

Ghirardello

. Anti-thyroid antibodies and thyroid dysfunction in rheumatoid arthritis: Prevalence and clinical value. Autoimmunity 2008; 41: 111–115.

35.

Stagnaro-Green

Abalovich

Alexander

. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 2011; 21: 1081–1125.