Zhang H, Lu SM, Deng MM, Dong N, Ji KK. Letter to the Editor: Re-evaluating fixed thyroid thresholds in postpartum depression risk stratification. World J Psychiatry 2026; 16(9): 118509 [DOI: 10.5498/wjp.118509]
Corresponding Author of This Article
Kang-Kang Ji, PhD, College of Biomedicine and Health, Huazhong Agricultural University, No. 1 Shizishan Street, Wuhan 430070, Hubei Province, China. kyrie@mail.ustc.edu.cn
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Obstetrics & Gynecology
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letter
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Zhang H, Lu SM, Deng MM, Dong N, Ji KK. Letter to the Editor: Re-evaluating fixed thyroid thresholds in postpartum depression risk stratification. World J Psychiatry 2026; 16(9): 118509 [DOI: 10.5498/wjp.118509]
World J Psychiatry. Sep 19, 2026; 16(9): 118509 Published online Sep 19, 2026. doi: 10.5498/wjp.118509
Letter to the Editor: Re-evaluating fixed thyroid thresholds in postpartum depression risk stratification
Huan Zhang, Sheng-Mei Lu, Miao-Miao Deng, Na Dong, Kang-Kang Ji
Huan Zhang, Department of Obstetrics and Gynecology, Jianhu County People’s Hospital, Yancheng 224700, Jiangsu Province, China
Sheng-Mei Lu, Miao-Miao Deng, Na Dong, Department of Neurology, Jianhu County People’s Hospital, Yancheng 224700, Jiangsu Province, China
Kang-Kang Ji, College of Biomedicine and Health, Huazhong Agricultural University, Wuhan 430070, Hubei Province, China
Co-corresponding authors: Na Dong and Kang-Kang Ji.
Author contributions: Ji KK and Dong N conceived the theme of this letter; Zhang H completed the drafting with the assistance of Lu S and Deng M; Ji KK and Zhang H made significant contributions in gathering expert opinions. All authors have read and approved the final manuscript. Both Ji KK and Dong N are designated as co-corresponding authors due to their distinct and essential contributions. Ji KK conceived the study's theme, coordinated expert consultations, and provided senior oversight from an academic institution. Dong N, as the clinical lead, conceived the theme, supervised the neurological perspective, and ensured the manuscript’s clinical relevance and accuracy. Their combined expertise- Ji KK’s in biomedical research and Dong N’s in clinical neurology-was indispensable for developing this interdisciplinary critique on thyroid function in postpartum depression.
Conflict-of-interest statement: No conflict-of-interest to declare.
Corresponding author: Kang-Kang Ji, PhD, College of Biomedicine and Health, Huazhong Agricultural University, No. 1 Shizishan Street, Wuhan 430070, Hubei Province, China. kyrie@mail.ustc.edu.cn
Received: January 4, 2026 Revised: February 12, 2026 Accepted: March 31, 2026 Published online: September 19, 2026 Processing time: 230 Days and 16.7 Hours
Abstract
We commend Chen et al recently published a study in World Journal of Psychiatry, for investigating maternal thyroid-stimulating hormone (TSH)/thyroid peroxidase antibody (TPOAb), associations with postpartum depression (PPD) and adverse pregnancy outcomes (APOs) in their retrospective analysis. However, the reliance on universal biomarker thresholds (TSH ≥ 3 mIU/L, TPOAb ≥ 7 U/mL) as independent APO predictors warrants scrutiny. Thyroid physiology exhibits significant inter-individual variability during pregnancy, and fixed thresholds may overlook subclinical dysfunction in women with TSH or TPOAb levels below these cutoffs. The study’s exclusion of participants with overt thyroid dysfunction introduces a selection bias, potentially underestimating the true risk spectrum. Moreover, the use of single-timepoint measurements at 6-7 weeks postpartum ignores dynamic fluctuations in thyroid autoimmunity across gestation, which recent evidence links to the course of PPD symptoms. We urge future studies to adopt individualized, trimester-specific reference ranges and serial biomarker assessments to better capture nonlinear relationships between thyroid dysfunction, PPD, and APOs. This approach will help optimize clinical risk prediction models for diverse populations.
Core Tip: Chen et al identified thyroid-stimulating hormone ≥ 3 mIU/L and thyroid peroxidase antibody ≥ 7 U/mL as independent predictors for adverse pregnancy outcomes (APOs) in postpartum depression (PPD). While this underscores the thyroid-PPD link, reliance on universal, fixed thresholds is problematic. Pregnancy induces profound, individualized thyroid physiological changes, making static cut-offs potentially misleading for risk stratification. Future research must prioritize trimester-specific reference ranges and longitudinal biomarker profiling to capture dynamic thyroid-autoimmune interactions and refine personalized prediction models for PPD and APOs.
