Abstract
BackgroundDerangements in thyroid hormone levels can cause multiple complications in the mother and the foetus. Thyroid stimulating hormone (TSH) and free thyroxine (free T4 or FT4) levels are used to screen for maternal thyroid dysfunction; these should be compared with population based trimester-specific reference ranges. Our goal was: to determine the prevalence of various thyroid derangements, in early pregnancy, according to the current reference ranges available; to determine the need for trimester specific reference ranges for the local population.MethodsA multi-centric, cross sectional population survey was conducted in Lahore, Pakistan. Serum TSH and FT4 levels were measured at the hormone lab of the Pathology department of Combined Military Hospital (CMH) Lahore. The results were entered and analysed using Statistical Package for the Social Sciences (SPSS) version 23. ResultsIn the 293 women sampled, mean FT4 and TSH levels were 15.03 (±5.62) pmol/L and 2.53 (±6.82) mIU/L respectively. According to the laboratory specific reference ranges, the prevalence of overt hyperthyroidism was 4.10%, (mean TSH= 0.03mIU/L); subclinical hyperthyroidism was 16.38%, (mean TSH= 0.17mIU/L); normal 70.65%, (mean TSH = 1.29mIU/L); subclinical hypothyroidism 4.44%, (mean TSH= 15.11mIU/L); overt hypothyroidism 4.44%, (mean TSH = 20.60mIU/L).ConclusionOur study showed a significant prevalence of thyroid dysfunction in the first trimester of pregnancy, and therefore highlights the need for more rigorous thyroid screening of women, in early pregnancy. There is a need to monitor these women in order to reduce maternal and foetal complications. Trimester specific reference ranges for thyroid hormones need to be developed in Pakistan.
Highlights
Pregnancy induces a great demand on the maternal thyroid gland, as it has to adapt to the multiple physiological changes taking place in the body during this time
Thyroid stimulating hormone (TSH) and free thyroxine levels are used to screen for maternal thyroid dysfunction; these should be compared with population based trimester-specific reference ranges
This study aims to evaluate the current status of thyroid derangements in the city of Lahore by: 1) establishing the prevalence of the various forms of thyroid derangements in the area 2) by determining the number of women already diagnosed with a thyroid derangement and receiving supplementation, 3) by evaluating if women who are already receiving hormone therapy are adequately supplemented, 4) determining if there is a need for more universal thyroid screening of pregnant women in the area and 5) to determine the need for trimester specific reference ranges based on the local population
Summary
Pregnancy induces a great demand on the maternal thyroid gland, as it has to adapt to the multiple physiological changes taking place in the body during this time. It has to produce adequate amounts of thyroid hormone in order to meet the demands of the mother and the fetus, as up till the 12th week of gestation, the fetus is completely dependent on the mother for its supply of thyroid hormones [1]. Thyroid stimulating hormone (TSH) and free thyroxine (free T4 or FT4) levels are used to screen for maternal thyroid dysfunction; these should be compared with population based trimester-specific reference ranges. Our goal was: to determine the prevalence of various thyroid derangements, in early pregnancy, according to the current reference ranges available; to determine the need for trimester specific reference ranges for the local population
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