The post partum period and the onset of Graves’ disease: an overestimated risk factor

Objective: Aggravation of autoimmune diseases due to a rebound reaction to the pregnancyassociated immune changes is common during the post-partum (PP). Previous studies demonstrated that 45% of women with Graves’ disease (GD) in the childbearing age had a PP onset. Thus, the PP period was identified as a major risk factor for GD onset. Such a figure seems high and justifies further investigation. Design: The aim of this study was to evaluate the role of the PP period as a risk factor for GD occurrence. Methods: Reproductive history of 291 consecutive GD patients (165 patients in childbearing age and 126 in non-childbearing age) were retrospectively collected. Results: The rate of PP onset of GD in patients with at least 1 successful pregnancy was 9.8% in the entire cohort of women and 20.0% among patients in childbearing age and as low as 7.2% in the entire cohort of GD patients independently of their age and their parity status. The relative frequencies of the rate of PP onset of GD did not change in relation with increasing parity. The positive predictive value of PP period for GD onset calculated for all parous patients was less than 10%. Conclusions: The results of the current study would not support a role for the PP period as a major risk factor for de novo occurrence of GD.