Assessment Of Thyroid Status Research Articles

Thyroid disorders in pregnancy

ABSTRACT Thyroid disease is the second most common endocrine disorder encountered in pregnant women with substantial maternal and fetal implications. Therefore, assessing thyroid status during pregnancy is essential for initiating treatment in newly diagnosed individuals and adjusting doses for those already under treatment. To initiate proper and timely treatment evidence-based recommendations are required for clinical decisionmaking in managing thyroid disorders in pregnant and postpartum women. Keeping this in mind, task force consisted of experts in the fields of endocrinology and thyroid disease was constituted and various published data and guidelines were explored to address screening, diagnosis, and management of hypothyroidism, thyrotoxicosis, GD, thyroid nodules, and post-partum thyroiditis and their related complications during pregnancy. This document provides much-required insights and useful, practical, and accurate guidance that aids a practicing clinician.

Thyroid Dysfunction and Kidney Dysfunction.

ObjectivesThe incidence and prevalence of chronic kidney disease (CKD) are rising worldwide. It is becoming more common in the developing world with the increasing impact of non-communicable diseases in these countries. Also, autoimmune disorders, including thyroid dysfunction are more common and may worsen the clinical status of patients with CKD. We sought to determine the thyroid status in patients with CKD and explore the clinical, biochemical, immunological, and hematological parameters that can be affected by thyroid dysfunction among CKD patients.MethodsWe conducted a cross-sectional observational study at the Royal Hospital, Muscat. The data was progressively collected for all newly diagnosed CKD patients with no known history of thyroid disease from January 2018 to December 2019. Assessment of thyroid status was performed at their initial diagnosis.ResultsDuring the study period, 121 females (40.3%) and 179 males (59.7%) were diagnosed with CKD with no prior thyroid diseases. The mean age for females and males were 53.6±16.5 and 49.5±16.5 years, respectively. There were 35 patients with thyroid dysfunction with a prevalence of 11.7%. Of these, 22 patients (62.9%) had subclinical hypothyroidism, and 13 (37.1%) had subclinical hyperthyroidism. Total cholesterol and low-density lipoprotein were higher in hypothyroid patients. Urea was higher in hyperthyroid patients with CKD, and hemoglobin level was significantly lower.ConclusionsThyroid dysfunction was not uncommon among CKD patients, with subclinical hypothyroidism more common than subclinical hyperthyroidism. Thyroid dysfunctions coexisted with kidney dysfunction. These hormonal axis dysfunctions may not be apparent at first presentation; and therefore, may require close clinical and laboratory evaluations.

Thyroid Function at Left Ventricular Assist Device (LVAD) Implantation Predicts Prognosis During LVAD Support

<h3>Purpose</h3> The purpose of this study was to assess thyroid status before and during left ventricular assist device (LVAD) support and to estimate an impact of thyroid status at LVAD implantation on survival. <h3>Methods</h3> We retrospectively analyzed thyroid function profile including thyroid- stimulating hormone (TSH), free triiodothyronine (fT₃), and free thyroxine (fT₄) in a group of all consecutive 147 patients (93.2%- male, BMI-26.7 ±5.6, mean and median INTERMACS profile- 3; 53% -ischemic etiology of heart failure) implanted with continuous-flow LVAD in our institution within years 2009-2021 (54%-HeartMate3; 40%- HeartWare; 6%- Heart Mate II). One year survival was 78.3%. Fifteen percent of patients received amiodarone, whereas 20.4%- supplementation of levothyroxine and 2% - thyreostatic treatment during LVAD support. Statistical methods used were: ROC curves, when Youden factor > 0.27- Chi 2 test, analysis of variance, Bonferroni test. <h3>Results</h3> Mean values of TSH, fT₃ and fT₄ were respectively 2.33 ± 1.69 uIU/ml; 2.14± 0.56 pg/ml; 1.25 ± 0.36 ng/dl before, 2.95 ± 3.18 uIU/ml; 2.47±1.35 pg/ml; 1.11 ±0.27 uIU/ml and 2.0 ±1.27 ng/dl; 2.43 ±0.42 pg/ml; 1.22 ± 0.25 ng/dl at 3 months and at 12 months post LVAD implantation. Mortality risk was 2.8 times lower for patients presenting TSH ≥ 1.29 uIU/ml (p= 0.01) and 3.8 times lower for patients presenting fT₃ ≥ 1.93 uIU/ml (p=0.003) at LVAD implantation. TSH significantly decreased between 3 and 12 months of LVAD support (Bonferroni test, p<0.009), whereas fT3 increased significantly after 3 and 12 months as compared to values before LVAD implantation (Bonferroni test, p < 0.039 and p<0.041 respectively). <h3>Conclusion</h3> Thyroid function may have an impact on survival in patients with end-stage heart failure implanted with LVAD. Thyroid status surveillance and its corrections could improve the overall prognosis in this group of patients. Further studies are needed to confirm this thesis.

Significance of changes in general clinical analysis of blood and thyroid status in people with neoplasm of the thyroid gland

Background. One of the major challenges of modern medicine is prevention and early detection of diseases, especially malignant tumors, since the stage does influence the prognosis and treatment costs. Thyroid involvement is currently one of the leading endocrine disorders in terms of overall morbidity and prevalence in the world. Thyroid cancer is one of the localizations, which being timely detected and properly treated, has a favorable prognosis, when 20–30-year survival rate exceeds 90 %. Therefore, the search for simple, minimally invasive, but highly informative techniques for optimizing the algorithms for diagnosis, differential diagnosis and monitoring of this disease remains a priority.&#x0D; Purpose – to determine and substantiate the diagnostic value of comprehensive assessment of the thyroid status and full blood count values in patients with thyroid nodules.&#x0D; Materials and methods. The study involved 60 patients with thyroid nodules, which according to ultrasonography (US) of the thyroid were classified as TR-4 category of thyroid nodules, TIRADS scale (4–6 points, suspected malignant thyroid changes). The examination included the following: questionnaire, ultrasound examination with fine-needle aspiration puncture biopsy, cytological examination, counting the thyroid hormone concentration, full blood count. The study was carried out at the premises of State Institution “Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine”.&#x0D; Results. Assessment of thyroid status of patients with thyroid nodules showed a significant correlation between the severity of thyroid malignancy and TSH levels (according to Kruskal – Wallis test, H = 7.30, p &lt; 0.05), FT4 (H = 17.64, p &lt; 0.001) and FT3 (H = 12.41, p &lt; 0.01). Patients of Group I with benign thyroid process showed significant (p &lt; 0.05) decrease in total hemoglobin along with significantly frequent (p &lt; 0.05) microcytic anemia. According to the studies, Group II had a significant (p &lt; 0.05) decrease in total platelet count and plateletcrit, as well as an increased average platelet volume and the percentage of large platelets compared to Group I. The blood values in malignant thyroid process (Group III) are characterized by increased levels of leukocytes and the proportion of eosinophils and basophils in the leukocyte formula compared to Group II (p &lt; 0.05).&#x0D; Conclusions. The outcomes of comprehensive assessment of thyroid status and full blood count values in patients with thyroid nodules can be used in preoperative diagnosis as a differential prognostic tool to assess their malignant potential.

Thyroid cancer: retrospective study of patients with surgical treatment (a single-center experience)

Introduction. Nodular goiter is one of the most common endocrine disorder, and thyroid cancer takes a leading place among malignancy of the endocrine system. The aim of our study is to evaluate the prevalence and risk factors of thyroid cancer. Materials and methods: this is a retrospective case-control study that included 140 patients operated with suspected thyroid cancer according to a cytological study of fine needle aspirates in single center in 2018. All patients underwent preoperative cytological examination with interpretation of the results according to the Bethesda system, thyroid ultrasound examination, thyroid status assessment. The results of the cytological examination, as well as clinical and laboratory data were compared with the data of histological analysis. Results: According to the preoperative cytological study, 76 nodules were reported as Bethesda IV, 4 – Bethesda III, 32 – Bethesda VI, 28 – Bethesda V. According to the results of a histological examination, thyroid cancer was confirmed in 70% of patients: in 89,3% of Bethesda V and 100% in the Bethesda VI group, 52,6% of Bethesda IV, 25% of the Bethesda III. The risk of nodule malignancy was associated with such ultrasound signs as hypoechoicity, calcifications and irregular contours. Conclusions: the improvement of the methods of preoperative diagnosis of thyroid cancer should help to choose the optimal surgical strategy, reduce the number of diagnostic and repeated thyroidectomy.

Influence of low free thyroxine on progression of chronic kidney disease

BackgroundHypothyroidism is highly prevalent in patients with chronic kidney disease (CKD) and has been associated with poorer clinical outcomes, including faster decline of kidney function. However, there is no consensus whether low free thyroxin (LFT) affects the rate of estimated glomerular filtration rate (eGFR) decline and how the presence of proteinuria influences the progression of renal dysfunction in hypothyroidism.MethodsWe assessed thyroid status, proteinuria, and progression of eGFR by Modification of Diet in Renal Disease equation and CKD-EPI equation in a cohort of CKD patients followed in general nephrology clinics. We estimated the association of LFT levels, and the degree of proteinuria on progression of eGFR. We adjusted for other covariables: age, gender, body mass index, diabetes, hypertension, HbA1c, uric acid, cholesterol, and triglycerides levels..ResultsOne thousand six hundred ten patients (64 ± 15 years, 46.8% men, 25.3% diabetic) were included. At beggnining of follow up eGFR was between 45 and 60, 30–45 and 15-30 ml/min/1.73m2 in 479 (29.8%), 551(34.2%), and 580(36.0%) patients, respectively. LFT levels were available at initial evaluation in 288(17.9%) patients and 735(48.5%) had assessment of proteinuria (19.6% with LFT vs. 15.4% without LFT, p = 0.032). Median follow-up time was of 21 months, and 1223(76%) had at least 1 year of follow up. Overall, eGFR decline per month was − 0.05(− 0.26, 0.23) ml/min/1.73m2, reaching 1.7(1.3, 2.4) ml/min/1.73m2 by the end of study period. Similar results were obtained using CKD-EPI. Multivariable mixed linear analysis showed that proteinuria and age were independently associated with eGFR decline, with no effect of LFT, and no interaction between proteinuria and LFT. In patients without proteinuria, there was an improvement of eGFR despite the presence of LFT.ConclusionsWe confirmed a faster rate of eGFR declined in patients with proteinuria. However, despite the pathophysiological rational that hypothyroidism can lead to increased rate of CKD progression, we failed to demonstrate an association between LFT and rate of CKD progression. We conclude that the benefit of hypothyroidism treatment in CKD patients needs to be evaluate in prospective studies.

Effects of Environmental Chemicals on the Course of Autoimmune Thyroiditis

Introduction. The relevance of the research is attributed to the increased incidence of autoimmune thyroiditis in children, especially those dwelling in contaminated areas. Our objective was to study effects of environmental exposures to industrial chemicals on the course of autoimmune thyroiditis. Materials and methods. In order to establish the relationship between specific features of the course of autoimmune thyroiditis and adverse environmental exposures, we conducted a comparative study of incidence rates of thyroid diseases including thyroiditis, cytotoxicity testing, thyroid status assessment, antioxidant activity assays, and thyroid ultrasound. The observation group consisted of 98 children living the area with the developed metallurgical industry while the comparison group included 23 children living in a recreation area. The groups were matched by age and socio-economic characteristics. Results. We established that thyroiditis incidence rates in the industrially polluted area were almost thrice as high as those in the relatively clean area. The observation group was characterized by smoothed sexual differentiation, earlier development of the autoimmune thyroiditis, higher (up to 1.6 times) frequency of typical diffuse structural changes, and increased thyroid gland. Blood levels of metals having a direct cytotoxic effect on the thyroid gland were 2.0 to 6.7 times higher than normal in the cases compared to their matched controls. The correlation and regression analysis established contribution of chemicals to the increased incidence of autoimmune thyroiditis in children (zinc), antibodies to thyroid gland tissue (lead), thyroid-stimulating hormone (nickel), and decreased resistive indices (lead). Conclusion. High blood levels of lead, nickel and zinc were among the factors having an adverse effect on the course of AIT and thyroid function.

Maternal thyroid status and its relation to ferritin and vitamin B12 in Saudi pregnant women

BackgroundThyroid dysfunction is a worldwide phenomenon in women, and the prevalence increases during pregnancy, with hypothyroidism being the most common. In most developing countries, nutritional deficiencies of nearly all essential nutrients, including iron, vitamin B12, and folic acid, are common in pregnant women. Thyroid disorders and nutritional deficiencies especially of iron and vitamin B12 cause a number of maternofetal complications.ObjectivesTo assess thyroid status in pregnant Saudi women and explore its relation to ferritin and vitamin B12.Patients and methodsThis was a cross-sectional study conducted at antenatal clinics of the Northern Area Armed Forces Hospital, KSA, enrolling 254 Saudi women: 180 pregnant [classified according to gestational age into group A (first trimester) and group B (second trimester)], and 74 age-matched healthy nonpregnant women, as control group (group C). After a detailed obstetrical and medical history, and clinical assessment, participants were subjected to laboratory investigations in the form of thyroid function by measuring thyroid-stimulating hormone (TSH) and free thyroxin, hemoglobin (HB), serum ferritin, and vitamin B12 levels.ResultsTSH level was lower in pregnant than nonpregnant women. Subclinical hypothyroidism (35.5%) was the most common thyroid disorder followed by overt hypothyroidism (10%) and hypothyroxinemia (2.2%) in pregnant women. HB and vitamin B12 levels were significantly lower in first and second trimesters of pregnancy when compared with controls (P=0.001). Serum free thyroxin correlated positively with HB and ferritin, whereas TSH correlated negatively with HB and ferritin.ConclusionHigh prevalence of hypothyroidism in pregnant females and its association with iron and vitamin B12 deficiencies highlight the urgent need for thyroid status to be detected and to evaluate nutritional deficiencies in such group, so as to start early treatment promptly and to prevent the adverse effects of the disorder to both mother and fetus to achieve normal pregnancy outcome.

A Practical Approach for the Verification and Determination of Site- and Trimester-Specific Reference Intervals for Thyroid Function Tests in Pregnancy.

Population-, assay-, and trimester-specific reference intervals for thyroid function tests are necessary to assess thyroid status accurately and manage thyroid disease throughout pregnancy. This study's objective was to verify if the manufacturer's recommended trimester-specific reference intervals for thyroid tests and the American Thyroid Association's recommended total thyroxine (TT4) pregnancy reference intervals were verifiable and appropriate for use in the authors' multicultural population. Blood samples were obtained from the following sources: stored frozen surplus blood from women undergoing routine aneuploidy screening (first- and second-trimester samples, n = 274), women participating in an observational cohort study (second- and third-trimester samples, n = 135), and blood collected from women presenting for assessment to the labor and delivery ward (third-trimester samples, n = 35). Exclusions included thyroid medication or disease and positive thyroid peroxidase antibodies (anti-TPO). Samples were analyzed for thyrotropin (TSH), free T4 (fT4), free triiodothyronine (fT3), TT4, and anti-TPO using the Roche Cobas 8000 Modular e602 electrochemiluminescence immunoassay. Nine percent of the aneuploidy screening samples were excluded prior to thyroid testing due to maternal use of thyroid medication. Six percent of analyzed samples were excluded: 5.9% with positive anti-TPO and one with a TSH >10 mIU/L. The manufacturer's recommended trimester-specific reference intervals for TSH were not verified by described standardized methods. Therefore, 95th percentile reference intervals were determined using a minimum number of samples. Reference intervals for TSH and fT4 were as follows: 9-12 weeks, 0.18-2.99 mIU/L and 11-19.2 pmol/L; second trimester, 0.11-3.98 mIU/L and 10.5-18.2 pmol/L; and third trimester, 0.48-4.71 mIU/L and 9.0-16.1 pmol/L, respectively. The TT4 reference interval after 19 weeks' gestation was 77-186 nmol/L. This study provides a simple approach to verify or establish trimester-specific thyroid function reference intervals in local populations. The TT4 reference interval was lower than the interval proposed by the American Thyroid Association, suggesting the need for further study of TT4 in pregnancy and reliance on locally established fT4 reference intervals after 19 weeks, especially when there are no equivalent reference intervals for TT4.

Thyroid Status and Mortality Risk in Older Adults With Normal Thyrotropin: Sex Differences in the Milan Geriatrics 75+ Cohort Study

Thresholds of optimal thyroid status in old age are controversial. We investigated the longitudinal association between thyroid parameters and 10-year all-cause mortality risk in older outpatients with normal thyrotropin (TSH) and modification by sex and age. Baseline TSH, free thyroxine (fT4), and free triiodothyronine (fT3) were assessed in the Milan Geriatrics 75+ Cohort Study. 324 men and 609 women older than 75 years had normal TSH. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for the associations between thyroid parameters and mortality risk using Cox regression. Sex-stratified analyses were adjusted for sociodemographic factors and comorbidities. 233 men and 367 women died during follow-up. After adjustment, each 1-mU/L higher TSH was associated with decreased mortality risk in men (HR 0.83, 95% CI 0.69-0.98), but not in women (HR 1.09, 95% CI 0.95-1.24) (p for sex interaction = .006). Each 1-ng/L higher fT4 was associated with increased mortality risk in men (HR 1.11, 95% CI 1.02-1.22), but not in women (HR 0.98, 95% CI 0.93-1.04) (p for sex interaction = .013). Each 1-pg/mL higher fT3 was associated with decreased mortality risk in women (HR 0.77, 95% CI 0.60-0.98), but not in men (HR 0.80, 95% CI 0.57-1.13). The inverse association between TSH and mortality was most pronounced in men older than 85 years. Among older outpatients with normal TSH, higher TSH and lower fT4 were associated with decreased mortality risk in men but not in women. When assessing thyroid status, sex and age should be taken into account.

Assessment of thyroid status during pregnancy with perinatal outcome

Objectives: To assess and compare the maternal and fetal outcome of Euthyroid, Hypothyroid and Hyperthyroid women during 1 st trimester of pregnancy. Methods:It is a prospective cross sectional study Conducted on 1200 pregnant women who were enrolled between January 2011 to December 2012.Result: Out of 1200 pregnant women were studied between 5-13 weeks of gestation of which 50(4.16%) were diagnosed to be hypothyroid, were treated with Thyroxine and 1150(95.83%) were euthyroid. and all the women were followed upto delivery .Conclusion:The above study concludes that the frequency of hypothyroidism during pregnancy is 4.16%..

Maternal Hypothyroxinemia During Pregnancy and Growth of the Fetal and Infant Head

Severe maternal thyroid dysfunction during pregnancy affects fetal brain growth and corticogenesis. This study focused on the effect of maternal hypothyroxinemia during early pregnancy on growth of the fetal and infant head. In a population-based birth cohort, we assessed thyroid status in early pregnancy (median 13.4, 90% range 10.8-17.2), in 4894 women, and measured the prenatal and postnatal head size of their children at 5 time points. Hypothyroxinemia was defined as normal thyroid-stimulating hormone levels and free thyroxine-4 concentrations below the 10th percentile. Statistical analysis was performed using linear generalized estimating equation. Maternal hypothyroxinemia was associated with larger fetal and infant head size (overall estimate β: 1.38, 95% confidence interval 0.56; 2.19, P = .001). In conclusion, in the general population, even small variations in maternal thyroid function during pregnancy may affect the developing head of the young child.

Thyroid status two decades after salt iodization: country‐wide data in school children from India

Country-wide evaluation of thyroid disorders in school children following two decades of universal salt iodization (USI) has not been carried out till date. This study was planned with aim to assess thyroid status of school children two decades after the launch of USI programme. Population survey. We collected data from 25 schools in 19 cities across five different geographical zones of India. Those children who were evaluated for anthropometry, and goitre status by palpation formed 'total population'. Children who consented to give blood samples were defined as 'study population'. Serum free T3, free T4, TSH, anti-TPO antibody and thyroid ultrasound. A total of 38,961 children aged 5-15 years formed total population. Goitre rate was 15.5% while thyroid hypoechogenicity was found in 4404 (11.3%) children. In the study population (13,790 children), 2258 (16.4%) had goitre, 505 (3.7%) had positive anti-TPO antibody titres, 1001 (7.3%) had hypothyroidism (TSH > 5.2 μIU/ml) and 41 (0.3%) had thyrotoxicosis (TSH < 0.1 μIU/ml). Among goitrous children, 203 (9.0%) had anti-TPO positivity, 365 (16.1%) had hypoechogenicity of thyroid and either of these were present in 488 (21.6%) children. Endemic goitre in school children persisted nationwide, despite more than two decades of USI programme. Thyroid autoimmunity only partially explains the increase in goitre prevalence.

Intervalos de referencia para tirotropina sérica durante los primeros 14 días de vida

Early detection of congenital hypothyroidism (CH) prevents impaired cognitive and motor development at problems. To increase the screening program specificity, we defined reference intervals for serum TSH in newborns between 2 and 14 days of life. Newborn infants from our neonatal screening program between 2001 and 2007. Serum TSH was determined by electrochemiluminescence. There were excluded neonates who died before the first month of life or with less than 1500 grams at birth, samples with TSH <0,01 µU/ml., processed after 14 days of life and from other medical centers. Statistical tools: Student t-tests, measures of centrality and dispersion, and logarithmic transformations. Studied population: 6772 newborn infants out of 7869, 50.49% were males. The male/ female ratio was similar during the 14 days. The mean age at testing was 5.85 days (± 2.58), and the mean of TSH value was 4.42 µU/ml (± 4.17). Inverse relationship was found between age and TSH (mean TSH at days 2 and 14 was 5.82 µU/ ml and 2.58 respectively). We found statistical evidence on an inverse relationship between TSH and age in newborn infants with 14 days of age. Reference intervals for TSH contribute to a better assessment of thyroid status in neonates and to define an appropriate conduct for individual therapy.

THE EFFECT OF COMBINED ANTIHYPERTENSIVE THERAPY ON THE BASIC PARAMETERS OF THE LEFT VENTRICLE MYOCARDIUM STRUCTURE AND FUNCTION IN WOMEN WITH METABOLIC SYNDROME AND HYPOTHYROIDISM

Aim. To study the effect of combined antihypertensive therapy on the basic parameters of the left ventricle (LV) myocardium structure and function in women with arterial hypertension (HT), metabolic syndrome (MS) and hypothyroidism. Material and methods. Women (n=196) with HT grade 2–3 and MS were included into the study. Standard clinical examination including an assessment of thyroid status, ambulatory blood pressure (BP) monitoring and echocardiography was performed at baseline and after 6 months. The patients were split into 3 groups: control (without hypothyroidism) with subclinical and manifested (symptomatic) hypothyroidism (SH and MH). Depending on baseline heart rate (HR) patients of each group received a combination of amlodipine+losartan (A+L) in HR <85/min or a combination of amlodipine+moxonidine (A+M) in) in HR ≥85/min. Results. The significant antihypertensive effect was found in patients of the control group due to both A+L and A+M combination (target BP was reached in 85.7 and 88.2%, respectively). In patients with hypothyroidism significant antihypertensive effects was observed only during A+M therapy (target BP in SH and MH was achieved in 82.8 and 82.4%, respectively). In the control group A+L and A+M combinations increased a number of patients with normal LV geometry (85.7 and 86.7, respectively) and diastolic function (78.6 and 80%, respectively). In hypothyroidism A+M therapy resulted in more prominent increase in a number of patients with normal LV geometry (75% in both SH and MH) and diastolic function (in SH and MH 83.3 и 85.7%, respectively) than these in A+L therapy (р<0.05). Conclusion. The combination of A+M has advantages over A+L combination in antihypertensive efficacy as well as in the effect on the structural and functional state of the LV myocardium in women with HT and MS associated with hypothyroidism.

Management of hypothyroidism in pregnancy

Examine recent studies on the assessment of thyroid status in pregnancy, approach to thyroid testing, the spectrum of hypothyroidism in pregnancy, and strategies for thyroid replacement in women with known hypothyroidism. Trimester-specific references range for thyroid-stimulating hormone (TSH) and free thyroxine in pregnancy must take into account iodine and thyroid autoantibody status, race, BMI, as well as other factors. Thyroid testing of only those pregnant women at increased risk for thyroid disease, case finding, will miss 30-80% of women with thyroid disease. Subclinical hypothyroidism is associated with an increasing number of adverse effects including infertility, miscarriage, preterm delivery, and breech presentation at birth. Many pregnant women with known hypothyroidism have an out-of-range TSH at the time of confirmed pregnancy. A variety of strategies are effective at keeping serum TSH normal during pregnancy including preconception increase in thyroxine, increase in thyroxine dose at the time pregnancy is confirmed, or making adjustments based on serum TSH monitoring. Evaluation of thyroid status in pregnancy requires an understanding of pregnancy-associated changes in thyroid function tests and how they vary by trimester. The spectrum of hypothyroidism in pregnancy includes isolated thyroid peroxidase antibody positivity, isolated hypothyroxinemia, subclinical and overt hypothyroidism. These patterns, in some situations, may be related to iodine status, selenium status, or underlying thyroid disease. There are a variety of approaches to management of thyroxine replacement in known hypothyroid women at the time of pregnancy that are all effective at maintaining a normal range during pregnancy.

Assessment of thyroid function during pregnancy: first‐trimester (weeks 9–13) reference intervals derived from Western Australian women

Gilbert and colleagues report thyroid function test results in a large number of pregnant women in Western Australia during the first trimester. While assessment of thyroid status is increasingly important in pregnancy, they do not present a strong enough argument for their reference ranges to be adopted. Their controls consisted of only 100 blood donors, and it is not clear whether these were age-matched with patients. Differences between pregnant and non-pregnant thyroid hormone ranges were too small to justify use of separate ranges. We assume from the article that the controls were not screened for thyroid antibodies. Prevalence of thyroid autoimmunity is high in women of reproductive age, whether or not they are pregnant.

A study of thyroid status in hyperemesis gravidarum

Study was undertaken to assess thyroid status in hyperemesis gravidarum. 150 women pregnant with <20 weeks of gestation were selected randomly and out of these 100 women presenting with hyperemesis formed study group while 50 normal pregnant women served as controls. 53% of hyperemetic pregnant women were primigravidae and 82% of pregnant women presented with vomiting at less than 12 weeks of gestation. Statistically significant, 22% of hyperemetic women had increased serum T(3) levels while T(4) levels were increased in 67% of women in study group as compared to 8% and 16% respectively in control group. TSH levels were decreased in 18% of hyperemetic women as compared to 8% in control group with decrease in mean TSH level statistically significant. 22% of hyperemetic women had electrolyte disturbances and 7% were ketonuric. In clinically euthyroid women, biochemically altered thyroid function can attribute to vomiting and its prolongation to second trimester.

Self-reported thyroid disease and mental disorder prevalence in the general population

Objective Community studies have failed to confirm that biochemically assessed thyroid status is significantly associated with psychopathology. However, it has been reported that self-reported thyroid disease is associated with symptoms of depression and anxiety. The objective of the current study was to determine whether self-reported thyroid disease is associated with elevated mental disorder prevalence in the general population. Method Data from the Canadian Community Health Survey (CCHS) 1.2: Mental Health and Well-being were used. The CCHS 1.2 included the World Mental Health version of the Composite International Diagnostic Interview and collected self-report data about professionally diagnosed chronic medical conditions, including thyroid disease. Results Twelve-month and lifetime mental disorder prevalence was higher in subjects with thyroid disease than in subjects reporting no chronic conditions. For each condition examined (major depressive disorder, bipolar disorder, panic disorder/agoraphobia and social phobia), the 12-month and lifetime prevalence in subjects with thyroid disease resembled that of an aggregate category of subjects having other chronic conditions. After adjustment for age, sex and other chronic conditions, only social phobia was found to be associated with thyroid disease. Conclusions People with thyroid disease are not a particularly high-need group for mental disorder screening or intervention, at least not in the community population.

TSH au cordon élevées au Maroc : hypothyroïdie iatrogène ?

A short prospective study was conducted to assess thyroid status in healthy full term newborns (n=90) of a large maternity of Marrakech (Morocco), as part of the validation of a national salt iodisation program. High TSH (>5mU/l) was detected in 89% of infants tested; urinary iodine excretion was measured in 35 of the mothers, and was found to be normal (100-200microg/l) or high (>200microg/l)(n=27) in all of them. Milk iodine concentration was measured in 315 lactating women from the same area. Low values (<41microg/l) were found in 60% of them. The common use of iodinated disinfectants during delivery could be responsible for the high urine iodine values of mothers; however iodine deficiency seems to remain a widespread problem in this population and justifies a large scale survey of iodine status.