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KMID : 0371919890020010109
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Journal of Wonju College of Medicine
1989 Volume.2 No. 1 p.109 ~ p.119
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The Influence of Parturition, Puerperium and Lactation on Thyroid Function
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Abstract
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It is well recognized that thyroid normally demonstrates an increased activity during pregnancy, and at times, painless thyroiditis, transient thyrotoxicosis without true hyperthyroidism, may occur with some frequency (approximately 5%) during the postpartum period. And the incidence of Graves´ disease is two in 1000 pregnancies. Maternal thyroid disorders must be continuously and carefully monitored because maternal hyperthyroidism results in thyroid storm and neonatal hypothyroidism as well as maternal hypothyroidism effects on developing fetus. But, the diagnosis of true hyperthyroidism in pregnancy is not easy because prgnancy and hyperthyroidism have many features in common. As a result, early identification and management of thyroid disorders in pregnancy are mandatory to promote maternal and fetal wellbeing.
But, thyroid function during parturition and puerperium is seldom studies in Korea. Moreover, the reported results of thyroid function test have been variable. Thus it is felt to be necessary to evaluate the thyroid function in normal pregnancy, in Korea. The change of thyroid function influenced by lactation during puerperium was also studied.
During the period from March 1988 to Febrary 1989, a total of 120 blood samples from pregnant women of Wonju christian Hospital were collected and tested by RIA. The following results were obtained.
1) The serum concentrations of T₃ and T₄ during parturition and puerperium show increased levels compared with control group. And serum T₄ level was significantly increased (p<0.01). Both of them showed the lowest level in 2 days after parturition and maintained stable level throughtout puerperium period.
2) Compared with control group, FT₄ level was significantly decreased, being lowest in second days after parturition. Then, it should be a tendency to increase slowly till the late puerperium period (p<0.01).
3) The TSH seemed to be increased was not significantly different from the control group. Also it showed the highest level in the second day after parturition.
4) The concentration of TGAG was not significantly different from the normal group.
5) In the groups suppressing lactation by bromocriptine, serum prolactin level was markedly decreased compared with nursing group. And there was no significant difference of thyroid function test between two groups.
It was concluded in view of thes studies that T₃, T₄ and TSH levels were increased, while thyroglobulin antigen was not changed and FT₄ was decreased in normal puerperium. The levels of thyroid homones strikingly changed at 2 days after parturition and it required 8 weeks for the complete recovery of thyroid functional changes induced by pregnancy.
It was also concluded that changes of thyroid function in normal pregnancy would mainly induce biochemical hyperthyroidism, but not a clinically apparent hyperthyroidism. Also, the regulation of throid hormones seemed not to be affected by lactation irrespective of the use of bromocriptine.
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