分娩後甲状腺機能低下症における乳中ヨード量

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  • Iodine content in milk in postpartum hypothyroidism

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To investigate iodine metabolism in postpartum hypothyroidism and to confirm security of lactation, we examined serum nonhormonal iodine (SNI) and iodine in milk in 10 patients who have experienced transient hypothyroidism 4-7 months after delivery. Age-matched 26 postpartum normal subjects were selected as control. In hypothyroid cases 7 out of 10 had large goiter (III degree) and 9 out of 10 cases possessed high titer of MCHA (?802). High levels of SNI and serum Tg were found in 20% and in 60%, respectively. Whilst iodine contents in milk were high immediately after delivery and decreased gradually during 6 months thereafter in 6 control subjects, those in hypothyroid cases increased remarkably at onset and were significantly high compared with controls. Iodine contents in milk in 80% of hypothyroid cases were more than M+2SD (25.5 μg/dl) of those in controls. Elevated iodine in milk declined within normal limit after 1-2 months. Postpartum hypothyroid patients were divided into 3 stages; first latent hypothyroid stage which was one week after delivery, second overt hypothyroid stage that was 1-2 months after delivery and third euthyroid stage thereafter. Differences of iodine in milk among 3 stages in hypothyroidism were significant (H=13.2, p<0.01). Iodine contents in milk were significantly correlated with serum Tg levels in hypothyroid cases (rs=+0.82, p<0.01) and those in subjects with large goiter tend to be higher than those with small goiter. It was considered that iodine distribution space in whole body may be enlarged in postpartum hypothyroidism and iodine may be markedly excreted out of body through milk as well as urine.<BR>These results suggest that iodine content in milk could be an indicator for the degree of thyroid follicular destruction and breast milk in postpartum hypothyroidism may be harmless to the neonatal thyroid gland.

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