Subclinical Hypothyroidism In Women Research Articles

Pregnancy outcome in subclinical hypothyroidism with and without thyroid peroxidase antibodies-a prospective cohort study.

Subclinical hypothyroidism (SCH) in pregnancy is associated with adverse foetomaternal outcomes. The literature is scarce with respect to maternal and perinatal outcomes in women with mild SCH (TSH levels between 2.5-4 mIU/L). The primary objective of the study was to compare the pregnancy outcome between SCH and euthyroid women. The secondary objectives were to find out the proportion of women with SCH having thyroid peroxidase antibodies (TPOAb) and to see the effect of TPOAb positivity on foetomaternal outcomes. A total of 178 pregnant women were recruited in the first trimester, and those with TSH between 0.1 and 2.4 mIU/L were considered as euthyroid and 2.5-4mIU/L were labelled as SCH. Women with SCH underwent testing for TPOAb. All women were followed until delivery, and foetomaternal outcomes were assessed. Amongst SCH group, there was a significantly higher proportion of overweight and obese women (76/91 (83.51%) vs 59/87 (68%), p = 0.031). The neonatal intensive care unit (NICU) admission was higher with adjusted odds ratio of 3.24 (1.41-7.43) in women with SCH as compared to euthyroid women. Otherwise, there was no difference in foetomaternal outcomes between the two groups. The proportion of gestational diabetes mellitus, intrauterine growth retardation and still birth were higher in SCH women with TPOAb as compared to euthyroid. Amongst SCH women, the proportion of induced labour was lower (aOR:0.27 (0.08-0.93) whereas the proportion of stillbirth and low APGAR scores were higher in TPOAb-positive women with a statistically significant difference and adjusted odds ratio (aOR:20.18 (1.84-220.83)) and (aOR:4.77 (1.06-21.3)), respectively, when compared to TPOAb-negative women. There appears to be no difference in pregnancy outcomes between women with SCH and euthyroid women except higher NICU admission in SCH group. Future multi-centre large prospective studies are required to understand better about the pregnancy outcomes in these women.

Effect of extra-low dose levothyroxine supplementation on pregnancy outcomes in women with subclinical hypothyroidism undergoing in vitro fertilization and embryo transfer

ObjectiveThis study was undertaken to test the therapeutic effect of extra-low dose of levothyroxine (LT4; 25 mcg/day) to preconception and pregnant women with subclinical hypothyroidism (SCH). Materials and methodsThis is a retrospective study, SCH women who succeeded in their first in vitro fertilization (IVF) cycle between January 1, 2018, to December 31, 2020 were included. SCH is defined as normal serum free thyroxine (T4) level and an elevated serum thyroid stimulating hormone (TSH) level >4 mIU/L. Extra-low dose of levothyroxine (LT4; 25 mcg/day) was prescribed to the SCH women from the establish of diagnosis of SCH to the end of pregnancy. The pregnancy outcomes (miscarriage, live birth, preterm birth, and small for gestational age baby) were compared to the euthyroid pregnant women. ResultsTotally, 589 women were screened, and 317 cases received their first time IVF treatment. 167 women were clinically pregnant after IVF treatment, 155 of them were euthyroid and 12 of these women were diagnosed to have SCH. The average age of the participants was 35 years old. There were no significant differences in age, body mass index (BMI), anti-müllerian hormone (AMH), types of embryo transfer, number of embryos to transfer, or embryo stage during transfer between two groups. The live birth rate, miscarriage rate, and preterm birth rate in women with SCH supplemented with extra-low dose of LT4 were non-inferior to euthyroid patients (miscarriage rate: P = 0.7112; live birth rate: P = 0.7028; preterm delivery: P = 0.2419; small for gestational age: P = 0.2419). ConclusionOur result demonstrated that supplementation with extra-low dose of levothyroxine at 25 mcg/day to SCH women can produce the comparable obstetrical and neonatal outcome as that in euthyroid pregnant women. Accordingly, we suggest extra-low-dose of levothyroxine may be considered as a safe and effective alternative for those SCH pregnant women who were not tolerated to the standard dose of levothyroxine.

Frequency of Subclinical Hypothyroidism in Patients with First-Trimester Pregnancy Loss

Objectives: To determine the frequency of subclinical Hypothyroidism in women with first-trimester pregnancy loss. Study Design: Cross-sectional study. Place and Duration of Study: Gynaecology & Obstetrics Department, Combined Military Hospital, Rawalpindi Pakistan,from Jun 2018 to Dec 2018. Methodology: The study included 130 women aged 18-40 years who had first-trimester pregnancy loss. Patients withchronic renal failure, known thyroid disorders and taking medication that can affect thyroid functions were excluded. Venous blood samples were taken to analyse thyroid function tests, and subclinical Hypothyroidism was noted. Results: The mean age of the women was 28.68±4.80 years. Most patients 77(59.23%), were between 18 and 30 years old. The mean BMI was 29.42±2.50 kg/m2. 16(12.31%) women with first-trimester miscarriage had subclinical Hypothyroidism. Conclusion: This study concluded that the frequency of subclinical Hypothyroidism in women with first-trimester pregnancy loss was significant. Proper management protocol for early recognition and management of subclinical Hypothyroidism in women can improve pregnancy outcomes.

Expressions of mitochondria-related genes in pregnant women with subclinical hypothyroidism, and expressions of miRNAs in maternal and cord blood

BackgroundSubclinical hypothyroidism in pregnancy and definition by upper thyrotropin (TSH) cutoff are controversial. As mitochondria are influenced by thyroid hormones, the purpose in this study was to measure expression of mitochondria-related genes in euthyroid and subclinical hypothyroid pregnant women to obtain more knowledge of potential metabolic consequences of maternal subclinical hypothyroidism. In addition, we wished to test if applied TSH-cutoff significantly changed our results of expressed gene-levels. Moreover, we aimed to identify potential microRNA-biomarkers for subclinical hypothyroidism – markers that could be traced to offspring as well.MethodsFrom a cohort of at-term pregnant women undergoing planned cesarean section, 77 women had expression levels of the mitochondria-related genes Peroxisome Proliferator-activated Receptor-γ coactivator-1β (PGC-1β), mitochondrial Transcription Factor A (TFAM), Superoxide Dismutase 2 (SOD2) and Nuclear Respiratory Factor 2 (NRF-2) determined by qPCR from blood sampled in prior to delivery. Two TSH-cutoff levels defining subclinical hypothyroidism (> 3.0 and > 3.7 mIU/L) were applied for the procession of results, generating two data analyses of the same cohort. In 22 pairwise maternal-cord samples (subclinical hypothyroid/euthyroid-rate 0.5, TSH-cutoff > 3.0 mIU/L), microRNA-expressions (miRNA) were analyzed.ResultsAll gene expressions were lower in the subclinical hypothyroid group regardless of applied TSH-cutoff, but insignificant except for PGC-1β at TSH cutoff > 3.0 mIU/L. Two miRNAs (hsa-let-7d-3p and hsa-miR-345-5p) were upregulated in blood from women and offspring (cord blood) with subclinical hypothyroidism.ConclusionsA trend towards decreased mitochondrial gene expressions in subclinical hypothyroidism were demonstrated. The miRNAs hsa-let-7d-3p and hsa-miR-345-5p might be potential markers of maternal subclinical hypothyroidism. However, larger studies are needed to verify the findings.

Effect of levothyroxine treatment on fetal growth among women with mild subclinical hypothyroidism and thyroid peroxidase antibody negative: a cohort study

BackgroundSome clinicians used levothyroxine (LT4) treatment for mild subclinical hypothyroidism (SCH) pregnant women (2.5 < thyroid-stimulating hormone (TSH) ≤ the pregnancy-specific reference range with normal free thyroxine (FT4) level) with thyroid peroxidase antibody negative (TPOAb−), although the recent clinical guideline did not recommend it. It is unknown whether LT4 treatment for pregnant women with mild SCH and TPOAb− have impact on fetal growth. Therefore, the aim of the study was to investigate the effect of LT4 treatment on fetal growth and birth weight among mild SCH pregnant women with TPOAb−.MethodsThis was a birth cohort study including 14,609 pregnant women between 2016 and 2019 in Tongzhou Maternal and Child Health Hospital of Beijing, China. Pregnant women were divided into 3 groups as follows: Euthyroid (n = 14,285, 0.03 ≤ TSH ≤ 2.5mIU/L, normal FT4), TPOAb−; Untreated mild SCH with TPOAb− (n = 248, 2.5 < TSH ≤ 2.9mIU/L, normal FT4, without LT4 treatment); Treated mild SCH with TPOAb− (n = 76, 2.5 < TSH ≤ 2.9mIU/L, normal FT4, with LT4 treatment). The main outcome measures were Z-scores of fetal growth indicators (abdominal circumference (AC), biparietal diameter (BPD), femur length (FL), head circumference (HC), estimated fetal weight (EFW)), fetal growth restriction (FGR) and birth weight.ResultsThere was no difference in fetal growth indicators and birth weight between the untreated mild SCH women with TPOAb− and the euthyroid pregnant women. But the HC Z-score was lower in the LT4 treated mild SCH women with TPOAb−, compared with the euthyroid pregnant women (β = -0.223, 95%CI: -0.422, -0.023). The LT4 treated mild SCH women with TPOAb− had lower fetal HC Z-score (β = -0.236, 95%CI: -0.457, -0.015), compared with the untreated mild SCH women with TPOAb−.ConclusionsWe observed that LT4 treatment for mild SCH with TPOAb− was associated with decreased fetal HC, which was not observed for untreated mild SCH women with TPOAb−. The adverse effect of LT4 treatment for mild SCH with TPOAb− provided new evidence for the recent clinical guideline.

Comparison Between Levothyroxine and Lifestyle Intervention on Subclinical Hypothyroidism in Women: A Review.

Subclinical hypothyroidism (SCH) or "mild thyroid failure" is defined as elevated serum thyroid-stimulating hormone (TSH) in the presence of normal free thyroxine (T4). The incidence of SCH is estimated at 4.4-8.5% of the general population and occurs more frequently in women. Given that it falls below the diagnostic threshold, SCH is monitored rather than treated. Its management is a common topic of debate as SCH frequently progresses into overt hypothyroidism and is linked to long-term hyperlipidemia, endothelial dysfunction, cardiovascular disease, heart failure, and cerebrovascular disease. Premature hormone administration and lifestyle interventions have been explored as treatment options to mitigate the symptoms of SCH. Our review compares both modalities' efficacy and potential for standardized clinical practice.A trial of levothyroxine demonstrated significant results in specific SCH demographics, such as patients who are pregnant or trying to conceive, those with goiter, those with thyroid peroxidase (TPO) antibody status, those with steadily increasing TSH, children, and adolescents. All other SCH patients presenting with chronic symptoms may also be reasonably considered for a three- to six-month trial of treatment. Lifestyle modifications through improved sleep hygiene, a diet within the recommended daily allowance (RDA) for iodine and selenium, increased exercise, and smoking cessation also proved efficacious. Our findings indicate that a synergistic approach to treatment is most favorable. Lifestyle modifications neither show adverse effects nor contraindications and can be safely recommended alone or alongside levothyroxine for the treatment of SCH.

A STUDY ON SUBCLINICAL HYPOTHYROIDISM IN FEMALES OVER FIFTY YEARS OF AGE

Subclinical hypothyroidism is dened as patient with normal free T4 but elevated serum TSH level.(1) Various studies have reported the incidence of subclinical hypothyroidism to be 3-15% depending on the population studied.(2,3). Statistical research shows a higher incidence of subclinical hypothyroidism in women and elderly individuals The prevalence of this disorder has increased due to the increased availability of thyroid function testing.

Polycystic Ovary Syndrome, Subclinical Hypothyroidism, the Cut-Off Value of Thyroid Stimulating Hormone; Is There a Link? Findings of a Population-Based Study.

Despite solid evidence regarding the association of over-hypothyroidism with polycystic ovary syndrome (PCOS), the relationship between PCOS and subclinical hypothyroidism (SCH) is still a topic of debate. In the present population-based study, we aimed to assess if there is a difference between PCOS and the control group regarding the upper reference limit of thyroid stimulating hormone (TSH). We also aimed to identify the prevalence of SCH in women with PCOS compared to controls. This study was conducted on data collected in the Iranian PCOS prevalence study and the Khuzestan PCOS prevalence study. Participants that met our eligibility criteria were categorized into two groups: PCOS (n = 207) and control (n = 644). Quantile and logistic regression models were used to explore the effect of PCOS status on TSH cut-off values and SCH, respectively. The 95 percentiles of TSH were not significantly different in the PCOS group compared to control ones (6.12 and 6.56 microU/mL, respectively). There was no statistically significant association between PCOS status and SCH (OR adjusted: 1.40; 95%CI: 0.79, 2.50; p = 0.2). The prevalence of SCH and the upper reference limit of TSH were not significantly different in PCOS and controls. Investigation of SCH in women with PCOS might be questionable.

Relationship of vitamin A and thyroid function in Arctic residents

At the present time the prevalence of thyroid diseases keeps growing, so knowledge of the factors affecting thyroid activity is very important. Vitamin A (retinol) is a fat-soluble vitamin with a hormone-like effect that can influence both the expression of thyroidstimulating hormone in the pituitary gland and the synthesis of thyroid hormones. The aim of the research was to study vitamin A serum level and its relationship with the thyroid profile in residents of the Arctic zone of the Russian Federation, depending on gender. Material and methods. In the course of a single-center observational cross-sectional study, 304 apparently healthy residents of villages in the Arkhangelsk region (103 men and 201 women) were examined. The serum concentration of vitamin A was determined by the fluorometric method, and the content of thyroid parameters was determined by the enzyme immunoassay. The integral thyroid index (ITI) and the index of peripheral conversion of iodothyronines (IPC) were calculated. The subjects were divided into 4 groups depending on the quartile of vitamin A. The relative risk of developing subclinical hypothyroidism was calculated with a reduced concentration of vitamin A. Results. The content of vitamin A was 1.97 (1.18; 2.97) μmol/l. Retinol levels in the female population were significantly lower than in the male population (1.85 vs 2.27 μmol/l, p<0.0001). Women in group 1 compared with group 4 showed significantly higher levels of thyrotropin (2.33 vs 1.40 μIU/ml, p=0.0002) and thyroxin (109.8 vs 99.4 nmol/l, p=0.010), while the ITI values, on the contrary, were the lowest (8.12 and 13.85 c.u., p=0.0002). The relative risk calculation showed that vitamin A levels below 1.39 μmol/L increase the risk of subclinical hypothyroidism in women by 2.01 times [95% confidence interval 1.07-3.78]. Men in group 4 compared with group 1 showed a lower content of thyroxin (83.0 vs 109.2 nmol/l, p=0.009) against the background of higher IPC values (0.019 vs 0.016 c.u., p=0.046). Conclusion. In the inhabitants of the Arctic, the content of vitamin A is within the reference values, however, in 24.3% of men, its level is above the norm. In women, the concentration of retinol is significantly lower, and its level of less than 1.39 μmol/l increases the risk of developing subclinical hypothyroidism by 2.0 times. Increased values of vitamin A in the inhabitants of the North cause lower levels of thyroxine and an increase in the peripheral conversion of iodothyronines, which is more pronounced in men.

Comparison of reproductive outcomes in subclinical hypothyroidism women with high-normal versus low-normal thyroid-stimulating hormone levels after treatment with levothyroxine.

Reproductive outcomes in euthyroid women with high-normal thyroid-stimulating hormone (TSH) levels are comparable to those in euthyroid women with low TSH levels; however, few studies have investigated whether strictly controlled TSH levels after levothyroxine (LT4) treatment impair reproductive outcomes in infertile women with subclinical hypothyroidism (SCH). This study aimed to investigate the impact of high-normal versus low-normal TSH levels on reproductive outcomes in women undergoing their first in vitro fertilisation and embryo transfer (IVF-ET) cycle. This was a retrospective cohort study. Patients were divided into low-normal (TSH < 2.5 mIU/L, and ≥0.27 mIU/L) and high-normal (TSH ≥ 2.5 mIU/L, and <4.2 mIU/L) groups based on TSH levels after LT4 treatment. TSH levels after LT4 treatment and before ovarian stimulation were recorded. Reproductive outcomes were compared between the low-normal and high-normal TSH groups and between the euthyroid and LT4-treated groups. A total of 6002 women, 548 of whom were LT4-treated women, were finally included in this study. Among the LT4-treated women, 129 women had low-normal TSH levels, and 167 women had high-normal TSH levels. The clinical pregnancy rate, miscarriage rate, and live birth rate were comparable between the low-normal and high-normal groups (all p > .05). When adjusted by age, anti-Mullerian hormone (AMH) levels, infertility duration, transferred embryos, and dose and duration of LT4 treatment, high-normal TSH levels neither significantly decreased miscarriage (adjusted odds ratio [aOR] = 2.27, 95% confidence interval [CI] = 0.77-6.69, p = .14) nor increased clinical pregnancy (aOR = 1.15, 95% CI = 0.70-1.89, p = .57 or live birth (aOR = 0.97, 95% CI = 0.60-1.59, p = .92). Similar obstetric outcomes were observed between the low-normal and high-normal TSH groups after LT4 treatment and between the euthyroid and LT4-treated groups (all p ≥ .05). High-normal TSH levels did not have adverse effects on clinical and obstetric outcomes when compared with low-normal TSH levels after LT4 treatment. However, whether it is appropriate to set 2.5 mIU/L as the goal of treatment before IVF/ICSI remains to be determined in further well-designed studies.

Evaluation of Anemia Frequency and Types in Patients with Subclinical and Clinical Hypothyroidism in the Endemic Goiter Region

ABSTRACT&#x0D; Objective: Hypothyroidism is a disease that occurs as a result of thyroid hormone deficiency or rarely, due to ineffectiveness at the tissue level. While the prevalence of clinical hypothyroidism is reported to be 2-5% worldwide, of subclinical hypothyroidism it is 4-8.5%, with the prevalence of subclinical hypothyroidism in women over 60 years of age being 14-20%. Hypothyroidism affects many organs and systems in the body, one of which is the hematopoietic system. Thyroid hormone deficiency plays a role in the development of microcytic, normocytic and macrocytic anemia. The frequency of anemia in patients with hypothyroidism varies between 20-60%. In this study, our aim was to determine the regional prevalence of subclinical and clinical hypothyroidism in adult patients in our region and to evaluate the frequency and types of anemia in patients with hypothyroidism.&#x0D; &#x0D; Method and Material: This study was prospectively conducted between 01.12.2012 and 01.05.2013 at the outpatient clinic of Recep Tayyip Erdogan University Faculty of Medicine Endocrinology. Included in the study were 96 patients who had subclinical hypothyroidism, 30 patients who had clinical hypothyroidism, and 100 healthy controls. Normal fT4 and fT3, high TSH values were used for the diagnosis of subclinical hypothyroidism, and low fT4 and/or fT3, high TSH values were used for the diagnosis of clinical hypothyroidism. The diagnosis of anemia was based on subclinical hypothyroidism, clinical hypothyroidism, and control group Hb value

Subclinical Hypothyroidism in Perimenopausal Abnormal Uterine Bleeding Patients.

Background Abnormal uterine bleeding (AUB) can be very troublesome and is common in women with thyroid dysfunction. The current study aimed to assess the incidence of subclinical hypothyroidism in women with perimenopausal AUB.Methodology A cross-sectional study was conducted at Hayatabad Medical Complex (HMC), Peshawar, Pakistan, between September 2020 to February 2021. All outdoor female patients with complications in the obstetrics and gynecology department, aged between 40 to 55 years of age, and no obvious cervical and genital lesions were included in the study. Patients with a history of suspected inflammatory disease, use of oral contraceptives, and malignant lesions of the cervix were excluded from the study. All cases were evaluated for AUB and their thyroid profile was evaluated. Data regarding menstrual irregularities were recorded in a pre-defined proforma and clinical examination was performed.ResultsA total of 500 women were enrolled with a mean age of 47.2 ± 7.3 years. Of these, 234 (46.8%) women were overweight and the mean levels of the thyroid-stimulating hormone were 4.4 ± 2.5 mIU/L. The mean triiodothyronine and thyroxine were 3.2 ± 1.9 and 1.5 ± 0.7 pmol/L, respectively. The rate of subclinical hypothyroidism was 33%. It was shown that the body mass index was significantly correlated with subclinical hypothyroidism (p=0.03). Furthermore, the rate of oligomenorrhea was significantly higher in patients with subclinical hypothyroidism (p=0.05).Conclusion This study highlights the association between thyroid dysfunction in women with menstrual disorders. Screening and surveillance of thyroid-related abnormalities are warranted in patients with menstrual irregularities to avoid complications of the disease.

Evaluation of Ovarian Reserve among Newly Diagnosed Hashimoto’s Thyroiditis Related Subclinical and Overt Hypothyroid Reproductive Women: A Cross-sectional Study

Introduction: Thyroid autoimmunity is amore common autoimmune disease among reproductive women. It is proposed that, thyroid peroxidase antibodies pass through the blood follicle barrier during follicular development which damages the growing follicles and oocytes. Previous studies have demonstrated the association between thyroid autoimmunity and ovarian failure. Serum Anti-Müllerian Hormone (AMH) levels are used as a marker of ovarian reserve in clinical practice. Aim: To evaluate ovarian reserve among newly diagnosed Hashimoto’s Thyroiditis (HT) related subclinical and overt hypothyroid women. Materials and Methods: A cross-sectional study was conducted at the Department of Biochemistry, Government Medical College Nalgonda, Telangana, India, from August 2020 to July 2021. The study included 180 subjects, 60 in each Overt Hypothyroid (OH group), Subclinical Hypothyroid (SCH group) and Euthyroid subjects (EU group). Socio-demographic details and other parameters age, Body Mass Index (BMI), AMH, Thyroid Stimulating Hormone (TSH), free T4 (fT4), Thyroid Peroxidase Antibodies (TPOAb), Follicular Stimulating Hormone (FSH), Luteinizing Hormone (LH), Estradiol (E2), Antral Follicular Count (AFC) were evaluated and compared in all the three groups. The above data were recorded and analysed using Statistical Package for Social Sciences (SPSS) version 20.0 and the Analysis of Variance (ANOVA) test, Chi-square test, and Spearman’s correlation test were performed for statistical analysis. Results: The median age, BMI, and total AFC were not statistically significant (p-value &gt;0.05). Serum TPOAb levels were significantly (p-value &lt;0.001) high in the OH group and SCH group when compared to the EU group. The AMH levels were significantly (p-value=0.015) high inthe EU group compared to the OH group, but there were no statistically significant differences among other groups. The AMH values were negatively correlated with age among all the three groups. There was no significant correlation between AMH and other parameters analysed among different groups. Conclusion: The AMH levels were significantly low in the OH group when compared to the EU group. There were no statistically significant differences among other groups. Age was found to be an independent factor for low AMH levels among all the three groups.

Differential lipids in pregnant women with subclinical hypothyroidism and their correlation to the pregnancy outcomes

Subclinical hypothyroidism (SCH) has become a prevalent complication in pregnancy. Recent research links SCH to disturbed thyroid lipid profile; however, it is unclear how lipid metabolism disorders contribute to the pathogenesis of SCH during pregnancy. Thus, we used nontargeted lipidomics to identify and compare the lipids and metabolites expressed by pregnant women with SCH and healthy pregnant women. Multivariate analysis revealed 143 lipid molecules differentially expressed between the SCH group and the control group. Based on fold change, 30 differentially expressed lipid metabolites are potential biomarkers. KEGG pathway enrichment analysis showed that the differentially expressed metabolites participate in several pathways, including response to pathogenic Escherichia coli infection, regulation of lipolysis in adipocytes, metabolic pathways, glycerophospholipid metabolism, and fat digestion and absorption pathways. Correlation analyses revealed sphingomyelin (SM) and phosphatidylcholine (PC) positively correlate to tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and interleukin-6 (IL-6), while phosphatidylglycerol (PG), and phosphatidylinositol (PI) negatively correlate with them. In addition, PG positively correlates to birth weight. Thus, the lipid profile of pregnant women with SCH is significantly different from that of healthy pregnant women. Lipid molecules associated with the differential lipid metabolism, such as SM, phosphatidylethanolamine (PE), and PI, should be further investigated for their roles in the pathogenesis of SCH in pregnancy, as they might be targets for reducing the incidence of adverse pregnancy outcomes.

Frequency of Subclinical Hypothyroidism in Women With Polycystic Ovary Syndrome.

Introduction: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder characterized by hyperandrogenism and chronic anovulation. It may also influence thyroid hormones. Increasing evidence suggests that PCOS is linked with an increased prevalence of thyroid diseases such as nodular goiter, autoimmune thyroiditis, and subclinical hypothyroidism (SCH). Due to very limited global and regional data related to the prevalence of SCH in women with PCOS, we will determine the association between the two.Methods: This case-control study was conducted in the endocrinology ward of a tertiary care hospital in Pakistan from March 2020 to April 2021. We enrolled 200 females between the ages of 18 and 30 years, with documented evidence of PCOS in the study. Further 200 females without PCOS were enrolled as the case group. After demographics were noted, blood was drawn from their cubital vein via phlebotomy and sent to the laboratory to assess for thyroid-stimulating hormone, free thyroxine, and free triiodothyronine.Results: SCH was found to be more prevalent in participant with PCOS compared to participants without PCOS (43.5% vs. 20.5%; p-value: <0.00001). Increased weight (65.12 ± 5.62 kg vs. 60.02 ± 4.41 kg; p-value: <0.0001) and BMI (25.12 ± 2.51 kg/m2 vs. 22.51 ± 2.01 kg/m2; p-value: <0.0001) was significantly more in participants with PCOS compared to participants without PCOS.Conclusion: Based on our findings, this study demonstrated the strong association of SCH in women with PCOS as compared to their normal counterparts. Therefore, the clinical implication is to maintain a high index of suspicion for signs and symptoms of SCH, and awareness is needed for such women to enhance the reproductive and clinical pregnancy outcomes.

Altered Thyroid Function amongst the Infertile Insulin Resistant Women with Polycystic Ovarian Syndrome

Background: Polycystic ovarian syndrome (PCOS) is a hormonal disorder common among women of the child-bearing age. Likewise, women with PCOS are more likely to be obese or overweight, which may be due to their higher Insulin resistance and TSH levels.&#x0D; Aim: The study's objectives were to assess the prevalence of subclinical hypothyroidism in infertile PCOS, distribution of insulin resistant in PCOS women with subclinical hypothyroidism, and the efficacy of Metformin treatment in these women.&#x0D; Methods: It was a single-center study which included all infertile patients who visited the Department of Obstetrics and Gynecology at a Karachi hospital between January 2019 and September 2019. The infertile PCOS patients were then divided into two groups: Group A (Insulin Resistant with Subclinical Hypothyroidism) and Group B. (Non-Insulin Resistant with Subclinical Hypothyroidism). Following the written consent, both the treatment groups received Metformin 500mg T.D. for three months.&#x0D; Results: The infertile PCOS patients showed a higher prevalence of subclinical hypothyroidism. Insulin resistance was found to be 63.3% among subclinical hypothyroid PCOS women. Finally, three months of Metformin treatment resulted in a significant reduction in TSH levels in Insulin resistant PCOS women.&#x0D; Conclusion: We identified a positive link between TSH levels and insulin resistance in PCOS women, both in terms of incidence and treatment.

Comparison of Maternal Outcomes between Clinical and Subclinical Hypothyroid Pregnant Women admitted in a Subspecialty Department of a Tertiary Hospital

Background: Women with Hypothyroidism have higher pregnancy complication rates.&#x0D; Objective: The purpose of the present study was to compare the effects of clinical and subclinical hypothyroidism on maternal outcomes.&#x0D; Methodology: This cohort study was conducted in the Feto-Maternal Department of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from a period of 6 months dated from September 2019 to February 2020 for a period of 6 months. All cases of the clinical and sub-clinical hypothyroid pregnant women admitted in this department. Maternal outcomes of both groups during pregnancy were recorded. Findings of the cases recorded carefully.&#x0D; Result: This study was conducted among 75 patients, which was 14.79% of the total admitted cases during study period. Maximum (62.79%) number was found in the age group of 25 to 44 years in group I and 65.62% cases in group II. (p&lt;0.05). Severe Pre Eclampsia was observed 2(4.65%) cases and 6(18.75%) Group II. Abruptio placenta was observed 5(15.62%) cases in group II and none in group I. However Preterm delivery are three times more 39.5% in group I cases. Uterine rupture, abortion are observed only in group II patients (p&lt;0.05).&#x0D; Conclusion: In conclusion maternal outcomes are significantly varied in clinical and subclinical hypothyroidism women during pregnancy.&#x0D; Journal of Current and Advance Medical Research, January 2021;8(1):7-11

Effect of Clinical and Subclinical Hypothyroidism on Fetal Outcomes among Pregnant Women: A Sub-Specialty Department Experience

Background: Hypothyroidism can effect on the fetal outcomes during pregnancy.&#x0D; Objective: The purpose of the present study was to compare the effects of clical and subclinical hypothyroidism on fetal outcomes among pregnant women.&#x0D; Methodology: This cohort study was conducted in the Feto-Maternal Department of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from a period of 6 months dated from September 2019 to February 2020. All cases of the clinical and sub-clinical hypothyroid pregnant women admitted in this department. Fetal outcomes of clinical and sub-clinical hypothyroid pregnant women during delivery were recorded. Findings of the cases recorded carefully.&#x0D; Result: A total number of 75 patients were recruited for this study who were divided in to two group designated as group I or sub clinical hypothyroidism and group II or clinical hypothyroidism. Fetal distress was 22(51.1%) cases in group I and 9(33.3%) cases in group II. The fetal outcome of the study patients had observed that 8(27.6%) and 12(80.0%) of the baby had low (&lt;2.5 kg) birth weight in group I and group II' respectively. In group I most (62.1%) of the baby APGAR score was &gt;7 and 11(73.3%) cases had &lt; 6 APGAR score at 1st minute. Majority of the study patients had &gt;7 APGAR score at 5 min in both groups which was 25(86.2%) and 12(80.0%) in group I and group II respectively.&#x0D; Conclusion: In conclusion there is a significant difference found in overt and sub-clinical hypothyroidism considering fetal stress, IUD and prematurity.&#x0D; Journal of National Institute of Neurosciences Bangladesh, January 2021, Vol. 7, No. 1, pp. 29-32

Evaluation of Leptin and HOMA-Adiponectin in Hypothyroid Infertile Females

Introduction:Thyroid hormones and leptin is a perfect pair that maintains homeostasis of metabolic profile and abnormality in thyroid hormone levels potentiates insulin resistant state.The intriguing relationship between obesity and hypothyroidism is related by the key element leptin leading to consequent clinical implications. The severity of insulin resistance in hypothyroid and adipocytokine levels relate to the chance of pregnancy in infertile women. Aim:To assess the Leptin, insulin resistance and HOMA-adiponectin in Hypothyroid infertile women. Settings and Design:It is an Observational Cross-sectional work conducted in women with 20 to 40 years of age. About 180 infertile females were screened at the Obstetric&amp; Gynecology OPD. 86 married women were categorized as groups: Euthyroid (A) –included fertile women who had TSH and FT4 within normal reference range. Subclinical Hypothyroidism (B) - infertile women with raised TSH ranging from 4.6 – 20 mIU/ml and normal FT4 Overt hypothyroid (C)- includedinfertile women with elevated TSH greater than 20 mIU/ml and decreased free T4 level. Methods and Material:Measurement of adiposity indices that includes calculated parameters such as BMI, WHR, waist circumference / height ratio and body roundness index. Fasting serum sample was collected and analysed for FT3, FT4, TSH, prolactin, insulin. Using Biovendor and DRG Human kit based on ELISA; Adiponectin and Leptin levels was estimated respectively. HOMA-IR and HOMA-adiponectin were calculated. Results:Mean Leptin concentrations and HOMA-adiponectin were significantly increased (p &lt; 0.01) in Overt hypothyroid infertile women as compared to euthyroid and subclinical hypothyroid infertile women. Leptin had significantly positive correlation with TSH, FT3/FT4 ratio whereas negatively correlated with FT4. Significant positive correlation was observed with HOMA-IR and HOMA- adiponectin in hypothyroid infertile women. Conclusions:The study concludes that in hypothyroid infertile women having high leptin levels with reduced insulin sensitivity as related with increased HOMA-adiponectin. Analysis of thyroid profile, insulin sensitivity state along with leptin is mandatory to regulate ovulatory process in infertile women.

Subclinical hypothyroidism in women at the stage of natural pregnancy planning and with the use of assisted reproductive technologies in the iodine deficiency region

The problem of infertility does not lose its relevance and is global in nature. According to state statistics, in 2016, 38,998 cases of female infertility were registered in Ukraine. During 2006—2015, the number of started treatment cycles by methods of assisted reproductive technologies increased by 3.5 times. Despite the rapid development of reproductive medicine in Ukraine and all around the world, many questions about the mechanisms that ensure the onset of pregnancy in assisted reproductive technology programs remain relevant. In Ukraine, almost 25 % of women of reproductive age have pathology of the thyroid gland, which affects the state of the neuroendocrine and immune systems, which play a significant role in the pathogenesis of infertility and the effectiveness of assisted reproductive technologies. There is a close interaction between thyroid hormones and the normal action and secretion of steroids, which is necessary for normal ovarian function and, consequently, fertility. Thus, the multilateral mechanism of influence of thyroid pathology on menstrual and reproductive functions of the woman is accurately defined. The prevalence and incidence of thyroid disease vary in different regions of the country depending on the influence of environmental factors and their combination, one of which is iodine deficiency. Iodine deficiency is an important medical and social problem in many countries around the world. The most common consequences of iodine deficiency in pregnancy planning are subclinical hypothyroidism. Therefore, the study of the pecu­­liarities of the course of subclinical hypothyroidism at the stage of pregnancy planning and with the use of assisted reproductive technologies in the iodine-deficient region today remains an urgent problem. The article presents an analysis of publications of PubMed and Medline databases for the last decades.