Determining the Association between Preeclampsia and the Thyroid Hormone Status in Pregnant Women

Objective: Preeclamptic women are reported to have a higher incidence of thyroid dysfunction that correlates with the severity of preeclampsia. The aim of this study was to assess thyroid hormone profiles in in pregnant women with preeclampsia and gestational hypertension and the risk for thyroid dysfunction. Methods: In this study, age-matched pregnant females in the second trimester of pregnancy, diagnosed with preeclampsia (PE), gestational hypertension (GH), as cases, and apparently healthy normotensive (NT) pregnant woman as controls were recruited. Blood samples were drawn for the assessment of thyroid hormone (TSH, FT3 and FT4) levels and thyroid dysfunction. Results: Out of the total of 133 pregnant women recruited for this study, sub-clinical hypothyroidism was the only thyroid dysfunction common to all study groups, with a prevalence of 3.3% in both PE and NT groups, and 4.3% in the GH group. 1% of women in the PE group had sub-clinical hyperthyroidism, compared to 3.3% in the NT group. Although TSH and FT3 were elevated in normotensives, mean differences between the three groups were not statistically significant. However, mean FT4 levels in the GH group (12.99 ± 1.24) and PE group (12.33 ± 2.26), when compared to the control group (11.55 ± 1.94), were significantly higher (p < 0.05). Conclusion: Undiagnosed subclinical hypothyroidism was found in all the categories of pregnant women studied, which if uncontrolled, could increase the risk of pregnancy-related complications, especially in pregnant women with preeclampsia and gestational hypertension.

Altered thyroid hormone levels affect the capacity for temperature-induced developmental plasticity in larvae of Rana temporaria and Xenopus laevis.

Background: Preeclampsia is one of the commonest complications of pregnancy. It is associated with a state of hypercoagulability. The present study aimed to estimate the plasma fibrinogen and plasma FDP levels in preeclampsia compared to normal pregnancies. Materials and Methods: This is a case-control hospital based study carried in the Department of Biochemistry M.G.M. Medical College and associated M.Y. Hospital, Indore (M.P., India). Normal pregnant women (n=36) and women with preeclampsia (n=64) in their third trimester were included in the study. Preeclamptic group was classified in to mild (n=42) and severe (n=22) preeclampsia. Plasma fibrinogen and FDP levels were analysed, and compared between the groups. Results: Preeclampsia and normal pregnancy groups were comparable for age and body mass index but preeclampsia group had higher blood pressures and less period of gestation (p<0.0001). The levels of plasma fibrinogen (654.5±131.74 vs. 491.52±81.7 mg/dL) and plasma FDP (10.96±2.32 vs. 5.54±0.8 µg/L) were higher in the preeclampsia group as compared to normal pregnancy (p<0.0001). Elevations in fibrinogen and FDP levels were more marked for severe preeclampsia group than mild preeclampsia group. Conclusion: Preeclampsia is associated with high fibrinogen and FDP levels as compared to normal pregnancies. Severe preeclampsia patients have greater elevations as compared to mild preeclampsia patients. Key words: Fibrin degradation products, Fibrinogen, pre-eclampsia.

Effect of preeclampsia and its severity on maternal serum NGAL and KIM-1 levels during pregnancy and the post-pregnancy period

Antidepressant-Resistant Depression in Patients With Comorbid Subclinical Hypothyroidism or High-Normal TSH Levels.

Heart failure (HF) is a major public health and economic problem in Western countries and is one of the most common causes of hospitalization and death. Coronary artery disease is the underlying cause in more than two thirds of chronic HF patients. By 2020, the World Health Organization projects that ischemic heart disease alone will be the most important global cause of morbidity and mortality. The estimated increases in HF-related morbidity and mortality suggest that our understanding of the pathophysiological mechanisms of this syndrome is inadequate. Interest in the role of thyroid hormones (THs) in HF has increased in recent years. The driving considerations can be summarized as follows: (1) the known effects of THs on contractile and relaxation properties of the heart; (2) experimental findings offering strong support for the hypothesis that TH signaling is critical in preserving cardiac structure and performance under normal conditions and after cardiac injury; and (3) evidence that mildly altered TH function is strongly associated with a worsening prognosis in cardiac patients in general and in HF patients in particular. Diastolic function and systolic function are clearly influenced by THs.1 Ventricular contractile function is also influenced by changes in hemodynamic conditions secondary to TH effects on peripheral vascular tone.1 TH homeostasis preserves positive ventricular-arterial coupling, leading to a favorable balance for cardiac work. A study in rats demonstrated that chronic hypothyroidism alone can eventually lead to HF.2 Other studies suggest reduced cardiac tissue triiodothyronine (T3) levels after myocardial infarction (MI) or with development of hypertension by upregulating type 3 deiodinase (D3), which leads to deactivation of T3 and T4 (thyroxine).3–6 This review highlights a growing body of evidence from animal studies and small-scale clinical trials suggesting that low cellular thyroid activity at the cardiac tissue level may adversely affect HF …

Thyroid bone disease

Serum S100B in pregnancy complicated by preeclampsia: A case-control study

To study thyroid hormone changes in women with pre-eclampsia patients, the characteristics of thyroid disease and its relationship with pre-eclampsia. From May 2011 to December 2012 171 patients with pre-eclampsia who delivered in Shengjing Hospital of China Medical University were recruited as pre-eclampsia(PE) group, among which 114 cases were defined as early onset pre-eclampsia (EP) group and 57 cases were defined as late onset pre-eclampsia (LP) group. And 171 healthy women with same age and same stage of pregnancy were selected as the control group. Their blood pressures were normal and they had no obstetrical complications. Serum thyrotropin (TSH), free triiodothyronine (FT3) and free thyroxine(FT4) levels were determined by solid-phase chemiluminescent enzyme immunoassay method (CMIA). Thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) were measured by electro-chemiluminescent assay (ECLIA). The positive rate was calculated (TPOAb > 5.6 U/L, TGAb > 4.1 U/L were defined as positive result). The relationship between TSH, FT3, FT4 level and blood pressure was analyzed in women with pre-eclampsia. (1) The median values of TSH, FT4 and FT3 in PE group were 3.4 mU/L, (12.0 ± 3.0) pmol/L and (3.9 ± 0.9) pmol/L. In the control group, they were 1.9 mU/L, (13.4 ± 2.4) and (5.0 ± 1.3) pmol/L. There were statistically significant differences between the two groups(P < 0.01). In EP group, the median values of TSH, FT4 and FT3 were 3.3 mU/L, (12.1 ± 3.4) pmol/L and (3.8 ± 0.9) pmol/L. The differences between EP group and the control group were statistically significant (P < 0.01). In LP group, the median values of TSH, FT4 and FT3 were 3.4 mU/L, (11.9 ± 3.1) pmol/L and (3.9 ± 1.0)pmol/L. There were statistically significant differences compared to the control group(P < 0.01). While there was no difference between EP group and LP group (P > 0.05). (2) The positive rate of TPOAb and TGAb in PE group were 15.2% (26/171) and 21.6% (37/171), and were 12.3% (21/171) and 14.6% (25/171) in the control group. There was statistically significant difference in the TGAb positive rate (P < 0.01), but the difference in TPOAb positive rate was not statistically different (P > 0.05). The TPOAb positive rates in EP group and LP group were 12.3% (14/114) and 21.1% (12/57), respectively, with no statistically significant difference (P > 0.05). And the positive rates of TGAb in EP group and LP group were 21.9% (25/114) and 21.1% (12/57) , respectively, with no statistically significant difference (P > 0.05). The positive rate of TPOAb in LP group and in the control group had statistically significant difference (P < 0.01). (3) The morbidity of thyroid disease in PE group and in the control group were 47.4% (81/171) and 16.4% (28/171) , with statistically significant difference (P < 0.01). (4) The morbidity of subclinical hypothyroidism or hypothyroidism in PE group and in the control group were 45.0% (77/171) and 16.4% (28/171) , with statistically significant difference(P < 0.01). (5) The morbidity of subclinical hyperthyroidism in PE group and in the control group were 2.3% (4/171) and 1.8% (3/171) , with no statistically significant difference (P > 0.05). (6) In PE group, women with TSH level of 0.3-3.3 mU/L had systolic pressure of (170 ± 21) mmHg (1mmHg = 0.133 kPa) and diastolic pressure of (112 ± 15) mmHg; women with TSH > 3.3 mU/L had systolic pressure of (166 ± 21) mmHg and diastolic pressure of (109 ± 13) mmHg. There was no statistically significant difference (P > 0.05). But the diastolic pressure in EP group and LP group had statistically significant difference (P < 0.01). In PE group, no correlation was found among TSH, FT4 levels and systolic pressure, diastolic pressure (P > 0.05). FT3 level was negatively correlated to diastolic pressure (r = -0.172, P = 0.023) . It is common that pre-eclampsia is complicated with thyroid dysfunction, mainly subclinical hypothyroidism. Thus it is nessesary to test thyroid hormone and thyroid antibodies in women with pre-eclampsia. The decrease of FT3 and FT4, the increase of TSH and the presence of TPOAb and TGAb are related with the presence of pre-eclampsia.

Background: Hypertensive disorders of pregnancy are the most common medical problems affecting pregnancy. Off late, the incidence of the disease has increased and laboratory investigations become part of management. Core pathophysiology in hypertensive disorders of pregnancy is endothelial damage, which triggers platelet consumption. Aim and Objectives: This was to study platelet count in normal pregnancy, preeclampsia, and eclampsia groups. Materials and Methods: The study was done in S N Medical College, Bagalkot, Karnataka. Retrospective analysis of data was done. Platelet count in lakhs/mm3 in normal pregnancy (n = 30), preeclampsia (n = 30), and eclampsia (n = 20) groups was noted. Normal pregnancy group was matched with respect to age and parity with the other two groups. Data were tabulated and analysis was done by the analysis of variance and post-hoc tests. P < 0.05 was taken as statistically significant. Results: Mean platelet count in normal pregnancy, preeclampsia, and eclampsia was 259066.7 ± 29752.93, 210533 ± 12721.78, and 157200 ± 36464.26, respectively. Platelet count was found to be significantly less in preeclampsia and eclampsia groups when compared to normal pregnancy (F = 86.96 and P = 0.0001). There was a significant reduction in platelet count in the preeclampsia group when compared to normal pregnancy and in the eclampsia group when compared to the preeclampsia group. Conclusion: Platelet count being easily performable test and economical to the patient can be used as an indicator of preeclampsia and eclampsia. Reduction in platelet count is proportionate to the severity of disease.

Association between mercury exposure and thyroid hormones levels: A meta-analysis

Objective: To observe and analyze the difference of serum immunoglobulin IgA, IgG, IgM, β2-microglobulin and transferrin in pre-eclampsia (PE) and pregnancies complicated with chronic kidney disease. Methods: Totally 46(40.0%) pregnancies with PE (PE group), 36(31.3%) pregnancies with chronic kidney disease (chronic kidney disease group) and 33(28.7%) normal pregnancies with normal blood pressure and proteinuria without any complication (control group) delivered in Renji Hospital were recruicted in this study from February 2017 to July 2017. Serum IgA, IgG, IgM, β2-microglobulin and transferrin levels were detected. Correlation tests were conducted between these indicators and blood pressure, 24 hours proteinuria value and delivery weeks. Results: (1) Comparison of general situation of pregnancies in the 3 groups: there were no significant difference in the age and child bearing history between the 3 groups (all P>0.05), while there was a significant difference in the blood pressure and deliver week (all P<0.01). There was no significant difference in 24 hours proteinuria values between PE group and chronic kidney disease group (Z=-0.187, P=0.852). (2) Comparison of serum immunoglobulin, β2-microglobulin and transferrin levels in pregnant women with three groups: serum IgA level in chronic kidney disease group was significantly higher than those in PE and control groups [(2.4±0.9) vs (1.8±0.9) vs (1.6±0.6) g/L; F=9.959, P<0.01]. The serum IgG and IgM values had no significant difference between the 3 groups (all P>0.05). Serum β2-microglobulin in chronic kidney disease group was significantly higher than those in PE and control groups [(4.0±2.6) vs (2.7±0.7) vs (2.0±0.5) mg/L; F=15.892, P<0.01]. Serum transferrin in chronic kidney disease group was significantly lower than those in PE and control groups [(3.0±0.8) vs (3.7±1.1) vs (3.6±0.6) g/L; F=6.284, P<0.01]. (3) The correlation between serum immunoglobulin, β2-microglobulin, transferrin and blood pressure, proteinuria value and delivery weeks in PE group: the blood pressure level was not correlated with serum IgA, β2-microglobulin and transferrin values in PE group (all P> 0.05). So, 24 hours proteinuria value was positively correlated with β2-microglobulin (r=0.557, P<0.01), which was negatively correlated with transferrin (r=-0.442, P<0.01) and was not correlated with IgA(r=0.089, P=0.556). There was a negative correlation between delivery weeks and β2-microglobulin (r=-0.328, P=0.026), and positive correlation with transferrin (r=0.315, P=0.035) and no correlation with IgA (r=-0.169, P=0.260). (4) The correlation between serum immunoglobulin, β2-microglobulin, transferrin and blood pressure, proteinuria value and delivery weeks in chronic kidney disease group: the blood pressure level was positively correlated with β2- microglobulin (systolic pressure: r=0.598, P<0.01; diastolic pressure:r=0.557, P<0.01), which was not correlated with IgA and transferrin in chronic kidney disease group (all P>0.05). So, 24 hours proteinuria value was positively correlated with β2-microglobulin and IgA (r=0.568, r=0.330, both P<0.05), and not correlated with transferrin (r=0.255, P=0.133). Delivery weeks had a negative correlation with β2-microglobulin (r=-0.574, P<0.01), while it had a positive correlation with transferrin (r=0.369, P=0.027). No correlation was found between delivery weeks and IgA values (r=-0.257, P=0.131). Conclusion: The serum levels of IgA, β2-microglobulin and transferrin in PE and pregnancies with chronic kidney disease are significantly different, which may provide clinical value for the diagnosis of PE and pregnancies with chronic kidney disease in future.

To investigate the association between the leptin, leptin receptor and hormone levels and hyperemesis gravidarum, and to determine whether these two parameters may be early markers for hyperemesis gravidarum. The study group consisted of 18 pregnant women with hyperemesis gravidarum and the control group consisted of 18 healthy pregnant women. Demographic characteristics were recorded and body mass index (BMI) values were calculated for all the pregnant women. Serum leptin, leptin receptor, insulin, cortisol, thyroid hormone and human chorionic gonadotrophin (hCG) levels were measured. When the two groups were compared with respect to leptin levels, the group with hyperemesis gravidarum was found to have significantly higher leptin levels (P = 0.037). No intergroup differences were observed in serum cortisol, insulin, hCG, thyroid hormone levels or BMI values. In the group with hyperemesis gravidarum, an inverse correlation was detected between cortisol and leptin (r = -0.762, P < 0.01), and hCG and thyroid-stimulating hormone (r = -0.503, P < 0.05), whereas a significant correlation was detected between insulin and leptin (r = 0.538, P < 0.05), leptin and BMI (r = 0.711, P < 0.01), and between TT3 and hCG (r = 0.605, P < 0.01). It was concluded that leptin could play a role in, and be defined as, a marker of hyperemesis gravidarum.

The aim of this study was to investigate the urine iodine concentration in women with severe preeclampsia and in healthy women in Erzurum, Turkey. Urine specimens were obtained from 40 severe preeclampsia and 18 healthy pregnant women. Urinary iodine levels were determined by the Foss method based on the Sandell-Kolthoff reaction. The urinary iodine level for women with severe preeclampsia was 4.25 +/- 2.7 microg/dL, lower than 20.89 +/- 6.4 microg/dL of urinary iodine for healthy pregnant women (p < 0.001). Blood magnesium concentration was found to be 1.63 +/- 0.05 mg/dL for women with severe preeclampsia, which is lower than that of healthy pregnant women (1.87 +/- 0.05 mg/dL; p < 0.001). There was a positive correlation between urinary iodine level and blood magnesium level in pregnant women with preeclampsia (Pearson correlation coefficient = 0.43; p < 0.01). However, there was no correlation between urinary iodine level and blood magnesium level in healthy pregnant women. There was no difference in thyroid hormone levels (T4, TSH, FT4) between women with severe preeclampsia and healthy pregnant women. However, there was a difference in T3 thyroid hormone levels between women with severe preeclampsia (1.86 +/- 0.4 microg/dL) and healthy pregnant women (1.45 +/- 0.3 microg/dL; p < 0.001). There was also a difference in FT3 between women with severe preeclampsia (2.77 +/- 0.4 pg/mL) and healthy pregnant women (2.41 +/- 0.5 microg/dL; p < 0.01). Urinary iodine excretion is currently the most convenient laboratory marker of iodine deficiency. The method is useful for the rapid and low-cost assessment of iodine deficiency. Our results suggested that urinary iodine concentration might be a useful marker for prediagnosing preeclamptic women. In addition, iodine supplementation may also be considered for preeclamptic therapy.

Environmental variation induced by natural and anthropogenic processes including climate change may threaten species by causing environmental stress. Anuran larvae experiencing environmental stress may display altered thyroid hormone (TH) status with potential implications for physiological traits. Therefore, any capacity to adapt to environmental changes through plastic responses provides a key to determining species vulnerability to environmental variation. We investigated whether developmental temperature (T dev), altered TH levels and whether the interactive effect of both affect standard metabolic rate (SMR), body condition (BC), survival and thermal tolerance in larvae of the African clawed frog (Xenopus laevis) reared at five temperatures with experimentally altered TH levels. At metamorphosis, SMR, BC and survival were significantly affected by T dev, TH status and their interaction with the latter often intensified impacts. Larvae developing at warmer temperatures exhibited significantly higher SMRs and BC was reduced at warm T dev and high TH levels suggesting decreased ability to acclimate to variation in temperature. Accordingly, tadpoles that developed at warm temperatures had higher maximum thermal limits but more narrow thermal tolerance windows. High and low TH levels decreased and increased upper thermal limits, respectively. Thus, when experiencing both warmer temperatures and environmental stress, larvae may be less able to compensate for changes in T dev. Our results demonstrate that physiological traits in larvae of X. laevis are strongly affected by increased TH levels and warmer temperatures. Altered TH levels and increasing T dev due to global change may result in a reduced capacity for physiological plasticity. This has far reaching consequences since the energetic requirement at the onset of metamorphosis is known to determine metamorphic success and thus, is indirectly linked to individual fitness in later life stages.