{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T15:56:47Z","timestamp":1781020607701,"version":"3.54.1"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010101","name":"Taichung Veterans General Hospital","doi-asserted-by":"publisher","award":["1136401\u5e74"],"award-info":[{"award-number":["1136401\u5e74"]}],"id":[{"id":"10.13039\/501100010101","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Emerging evidence links gestational diabetes mellitus (GDM) with thyroid dysfunction, but the long-term risk of clinically diagnosed thyroid diseases after GDM remains unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess the long-term risk of specific thyroid disorders in women with prior GDM compared with those without GDM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a retrospective cohort study using the TriNetX U.S. Collaborative Network, including de-identified records from &amp;gt;80 healthcare organizations. Women aged 16\u201345 years with pregnancies from 2001 to 2015 were eligible; those with pre-existing hypertension, diabetes, thyroid disease, thyroid surgery, or preeclampsia\/eclampsia were excluded. GDM was identified by ICD codes. The primary outcome was first diagnosis of thyroid disorders\u2014hyperthyroidism, hypothyroidism, toxic\/non-toxic goiter, thyroiditis (acute, subacute, Hashimoto\u2019s), benign thyroid neoplasms, and thyroid cancer\u2014after the index pregnancy. Propensity score matching (1:1) accounted for age, race, overweight\/obesity, nicotine dependence, and alcohol abuse. Follow-up extended up to 20 years. Hazard ratios (HRs) were estimated using Cox models; cumulative incidence was compared with Kaplan\u2013Meier analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After matching, GDM was associated with higher risks of hyperthyroidism (HR 1.60, 95% CI 1.30\u20131.99), hypothyroidism (HR 1.33, 95% CI 1.17\u20131.51), thyroiditis (HR 1.55, 95% CI 1.21\u20132.00), Hashimoto\u2019s thyroiditis (HR 1.37, 95% CI 1.02\u20131.83), toxic goiter (HR 1.70, 95% CI 1.19\u20132.44), and non-toxic goiter (HR 1.26, 95% CI 1.10\u20131.45). No association was found for benign neoplasms or thyroid cancer. Risks were greater in women aged 35\u201345 years and those with BMI &amp;gt;25.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>GDM is linked to increased long-term risk of multiple thyroid diseases, warranting extended thyroid monitoring in older and overweight\/obese women.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1656498","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T04:12:01Z","timestamp":1756440721000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Gestational diabetes: a contributor to long-term thyroid dysfunction and disease"],"prefix":"10.3389","volume":"16","author":[{"given":"Yu-Hsiang","family":"Shih","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-Jung","family":"Hsieh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shao-Jing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chien-Hsing","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenn-Jhy","family":"Tseng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"109050","DOI":"10.1016\/j.diabres.2021.109050","article-title":"IDF diabetes atlas: estimation of global and regional gestational diabetes mellitus prevalence for 2021 by international association of diabetes in pregnancy study group's criteria","volume":"183","author":"Wang","year":"2022","journal-title":"Diabetes Res Clin Pract"},{"key":"B2","doi-asserted-by":"publisher","first-page":"3","DOI":"10.4093\/dmj.2021.0335","article-title":"Gestational diabetes mellitus: diagnostic approaches and maternal-offspring complications","volume":"46","author":"Moon","year":"2022","journal-title":"Diabetes Metab J"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1210\/endrev\/bnac003","article-title":"A clinical update on gestational diabetes mellitus","volume":"43","author":"Sweeting","year":"2022","journal-title":"Endocr Rev"},{"key":"B4","doi-asserted-by":"publisher","first-page":"195","DOI":"10.5222\/MMJ.2020.29964","article-title":"Is there any relationship between thyroid function abnormalities, thyroid antibodies and development of gestational diabetes mellitus (GDM) in pregnant women","volume":"35","author":"Sert","year":"2020","journal-title":"Medeni Med J"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12580","article-title":"Evaluation of thyroid dysfunction and autoimmunity in gestational diabetes mellitus and its relationship with postpartum thyroiditis","volume":"32","author":"Maleki","year":"2015","journal-title":"Diabetes Med"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00030.2013","article-title":"Thyroid hormone regulation of metabolism","volume":"94","author":"Mullur","year":"2014","journal-title":"Physiol Rev"},{"key":"B7","doi-asserted-by":"publisher","first-page":"26174","DOI":"10.1038\/srep26174","article-title":"Changes in profile of lipids and adipokines in patients with newly diagnosed hypothyroidism and hyperthyroidism","volume":"6","author":"Chen","year":"2016","journal-title":"Sci Rep"},{"key":"B8","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1210\/er.2018-00163","article-title":"Thyroid dysfunction and diabetes mellitus: two closely associated disorders","volume":"40","author":"Biondi","year":"2019","journal-title":"Endocr Rev"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa945","article-title":"Testing, monitoring, and treatment of thyroid dysfunction in pregnancy","volume":"106","author":"Lee","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"B10","doi-asserted-by":"publisher","first-page":"ooad035","DOI":"10.1093\/jamiaopen\/ooad035","article-title":"A global federated real-world data and analytics platform for research","volume":"6","author":"Palchuk","year":"2023","journal-title":"JAMIA Open"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2025.1516126","article-title":"A comprehensive review of methodologies and application to use the real-world data and analytics platform TriNetX","volume":"16","author":"Ludwig","year":"2025","journal-title":"Front Pharmacol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-023-02079-3","article-title":"Thyroid dysfunction during gestation and gestational diabetes mellitus: a complex relationship","volume":"46","author":"Pinto","year":"2023","journal-title":"J Endocrinol Invest"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-021-02712-2","article-title":"Association of thyroid disorders with gestational diabetes mellitus: a meta-analysis","volume":"73","author":"Luo","year":"2021","journal-title":"Endocrine"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-023-07137-y","article-title":"The risk of developing gestational diabetes mellitus in maternal subclinical hypothyroidism: a systematic review and meta-analysis","volume":"309","author":"Dincgez","year":"2024","journal-title":"Arch Gynecol Obstet"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e44390","DOI":"10.7759\/cureus.44390","article-title":"Assessment of thyroid dysfunction among pregnant women with pre-existing diabetes mellitus or gestational diabetes mellitus","volume":"15","author":"Alotaibi","year":"2023","journal-title":"Cureus"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.87.2.8182","article-title":"T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III)","volume":"87","author":"Hollowell","year":"2002","journal-title":"J Clin Endocrinol Metab"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2007-1499","article-title":"Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population: implications for the prevalence of subclinical hypothyroidism","volume":"92","author":"Surks","year":"2007","journal-title":"J Clin Endocrinol Metab"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-3275","article-title":"Is age a risk factor for hypothyroidism in pregnancy? An analysis of 5223 pregnant women","volume":"97","author":"Potlukova","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2004-2225","article-title":"Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population","volume":"90","author":"Knudsen","year":"2005","journal-title":"J Clin Endocrinol Metab"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2006.16.73","article-title":"Thyroid function in humans with morbid obesity","volume":"16","author":"Michalaki","year":"2006","journal-title":"Thyroid"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2009-2798","article-title":"Investigations of thyroid hormones and antibodies in obesity: leptin levels are associated with thyroid autoimmunity independent of bioanthropometric, hormonal, and weight-related determinants","volume":"95","author":"Marzullo","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2019.02349","article-title":"The impact of obesity on thyroid autoimmunity and dysfunction: A systematic review and meta-analysis","volume":"10","author":"Song","year":"2019","journal-title":"Front Immunol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1186\/s13098-023-01188-6","article-title":"Maternal pre-pregnancy obesity modifies the association between first-trimester thyroid hormone sensitivity and gestational Diabetes Mellitus: a retrospective study from Northern China","volume":"15","author":"Sun","year":"2023","journal-title":"Diabetol Metab Syndr"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-S014","article-title":"Management of diabetes in pregnancy: standards of medical care in diabetes-2020","volume":"43","year":"2020","journal-title":"Diabetes Care"},{"key":"B25","doi-asserted-by":"publisher","first-page":"2356031","DOI":"10.1080\/14767058.2024.2356031","article-title":"Gestational diabetes mellitus: relationship of adverse outcomes with severity of disease","volume":"37","author":"Karkia","year":"2024","journal-title":"J Matern Fetal Neonatal Med"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1656498\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T04:12:02Z","timestamp":1756440722000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1656498\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,29]]},"references-count":25,"alternative-id":["10.3389\/fendo.2025.1656498"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2025.1656498","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,29]]},"article-number":"1656498"}}