Thyroid Dysfunction In Pregnant Women Research Articles

9396 Deciphering The Enigma: A Case Report On New-onset Graves Disease Presenting As Thyroid Storm In The First Trimester Of Pregnancy, Managed In The Intensive Care Setting

Abstract Disclosure: M. Zeb: None. S.W. Salari: None. A. Tiwari: None. A. Vadher: None. A. Dabaja: None. S. Kambhatla: None. Graves' disease, an autoimmune disorder characterized by hyperthyroidism, presents unique challenges when manifesting as thyroid storm during pregnancy. We report a case of a 27-year-old African American woman at 9 weeks gestation who presented with palpitations, agitation, and fever. On examination, she exhibited fever, tachycardia, tremors in hands, and mild bilateral exophthalmos. Thyroid function tests revealed markedly elevated free thyroxine and suppressed thyroid-stimulating hormone levels. Thyroid ultrasound confirmed diffuse thyroid enlargement with increased vascularity, consistent with Graves' disease. Pelvic ultrasound estimated the gestational age at 9 weeks and 2 days, with a serum β-hCG level of 135,037 mIU/mL. An electrocardiogram revealed sinus tachycardia, and a complete metabolic panel indicated mild hypokalemia. The Thyroid Stimulation Immunoglobulin (TSI) and Thyrotropin receptor antibodies were tested positive. The Burch-Warsofsky point score of 45, supported the diagnosis of thyroid storm. The patient received intensive care treatment including intravenous fluids, hydrocortisone, beta-blockers, Lugol’s iodine, propylthiouracil, and potassium replacement. Following treatment, thyroid function stabilized within 48 hours, and her hyperthyroid symptoms resolved. The patient was discharged on oral labetalol and propylthiouracil. Thyroid storm, characterized by severe manifestations of hyperthyroidism, is a rare but potentially life-threatening condition, especially during pregnancy. Prompt recognition and intervention are crucial due to associated maternal and fetal morbidity and mortality. A multidisciplinary approach, involving endocrinology, obstetrics, and critical care, is essential to optimize outcomes. The unique physiologic changes of pregnancy, such as increased thyroid hormone production and altered thyroid hormone-binding globulin levels, can complicate the diagnosis and management of hyperthyroidism. Our case underscores the importance of vigilance for thyroid dysfunction in pregnant women, even in the absence of prior thyroid disease. Additionally, the potential impact of hyperthyroidism and thyroid storm on pregnancy outcomes highlights the need for early recognition and intervention. Long-term management of Graves' disease during pregnancy may also require adjustment of antithyroid medication dosage and monitoring of thyroid function to maintain euthyroidism while minimizing fetal exposure to medication. Further research is warranted to refine diagnostic criteria, treatment protocols, and long-term management strategies for thyroid storm in pregnancy. Increased awareness among healthcare providers about the risks and management strategies for this rare but serious complication is also necessary. Presentation: 6/3/2024

Thyroid functions and insulin resistance in pregnant Sudanese women

BackgroundThe thyroid function test (free triiodothyronine [FT3], free thyroxine [FT4], and thyroid-stimulating hormone [TSH]) is one of the key determinant of glucose homeostasis by regulating the balance of insulin. Thyroid dysfunction alters glucose metabolism, leading to insulin resistance (IR). This study aimed to assess the association between thyroid function and IR in pregnant Sudanese women.MethodA cross-sectional study was conducted in Saad Abuelela Hospital, Khartoum-Sudan, from January to April 2021. Obstetric/sociodemographic characteristics were gathered through questionnaires. Serum TSH, FT3, FT4, fasting plasma glucose (FPG), and fasting insulin levels were measured and evaluated, and IR was estimated using the homeostatic model assessment for insulin resistance (HOMA-IR) equation.ResultsIn total, the study included 127 pregnant women with a median age of 27.0 years (interquartile range [IQR] 23.0‒31.2) and a median gestational (IQR) age of 25.0 (IQR 25.0‒27.0) weeks. The medians (IQRs) of the TSH, FT3, and FT4 were 1.600 (1.162‒2.092) IU/ml, 2.020(1.772‒2.240) nmol/l, and 10.70 (9.60‒11.90) pmol/l, respectively. The median (IQR) of the FPG and fasting blood insulin level was [69.0 (62.00‒78.00) mg/dl] and [5.68(2.99‒11.66) IU/ml], respectively. The median (IQR) of the HOMA-IR level was 0.9407 (0.4356‒2.1410). There was a positive correlation between HOMA -IR and FT3 levels (r = 0.375; P < 0.001) and a negative correlation with FT4 levels (r= -0.312; P < 0.001). Also, a significant positive correlation was found between fasting insulin levels and FT3 levels (r = 0.438; P < 0.001) and a negative correlation with FT4 levels (r= -0.305; P < 0.001).ConclusionsThis study indicated that FT3 has positive correlation with HOMA-IR, while FT4 has negative correlation among healthy pregnant women without a history of thyroid dysfunction. This may indicate screening of euthyroid pregnant women for thyroid dysfunction and IR. Further studies are needed.

Association Between Thyroid Dysfunction Among Pregnant Women with Bad Obstetric History A Comprehensive Study

Background: Thyroid dysfunction is increasingly prevalent globally, particularly in developing countries where dietary and hygiene practices during pregnancy contribute to its incidence. This condition significantly affects maternal and fetal health, necessitating closer examination, especially in populations with adverse obstetric histories. Objective: To evaluate the prevalence of thyroid dysfunction among pregnant women with a history of adverse obstetric outcomes and to underscore the necessity for targeted screening and management strategies. Methods: A cross-sectional study involved 260 pregnant women aged 18 to 40 with a history of poor obstetric outcomes. Participants were selected through non-probability consecutive sampling. After obtaining informed consent, demographic data were collected, and thyroid function was assessed by measuring TSH, T3, and T4 levels in a hospital laboratory. Data analysis was performed using SPSS version 16.0, utilizing means and standard deviations for quantitative data and frequencies and percentages for qualitative data. Results: The average age of participants was 30.31 ± 3.11 years. Mean thyroid hormone levels were recorded at T4: 1.84 ± 1.12 and TSH: 4.32 ± 0.91. Thyroid dysfunction was identified in 45.4% of the women, with 65.2% having subclinical hypothyroidism and 34.7% exhibiting subclinical hyperthyroidism among those diagnosed. Conclusion: The study highlights a significant prevalence of thyroid dysfunction in pregnant women with poor obstetric histories, indicating a critical need for comprehensive screening and tailored management to improve maternal and fetal health outcomes.

Can Pathological Conditions of the Thyroid Gland During Pregnancy Affect the Course and Outcome of Pregnancy and The Parameters of the Newborn?

Background: To determine the influence of hypothyroidism and hyperthyroidism on the course, outcome of pregnancy and parameters of the newborn.Methods: The cross-sectional epidemiological study was conducted. The study included 319 pregnant women of which 257 had hypothyroidism, and 62 pregnant women had hyperthyroidism. The main parameter was the pathological conditions of the mother’s thyroid gland. Data were collected from the protocol, medical history and discharge letters. The results of the statistical analysis are expressed in absolute and relative frequencies. The significance of the differences was tested with the χ2 test.Main findings: In 2020 and 2021, a total of 3,627 children were born. 318 mothers were included in research, of which 257 (80.82%) had hypothyroidism, and 61 (19.18%) had hyperthyroidism. 91 newborns (35.4%) of mothers suffering from hypothyroidism and 20 newborns (32.79%) of mothers suffering from hyperthyroidism were transferred to the NICU. No statistically significant difference was found in the influence of hypothyroidism and hypothyroidism on newborn parameters. Statistically significant difference was observed in the incidence of pathological conditions during pregnancy. In subjects with hypothyroidism, there was significantly more gestational diabetes (15%) and preeclampsia (3.5%).Principal conclusion:Thyroid dysfunction in pregnant women didn't significantly affect the course and outcome of pregnancy, as well as parameters of the newborn including gestational age or anthropometric measurements.Key words: TSH Deficiency, Primary Hyperthyroidism, Neonate, Perinatal Care, Complications, Pregnancy

Third-Generation Thyrotropin Receptor Antibody (TRAb) assay for predicting neonatal thyroid dysfunction in pregnant women with Graves' disease.

The aim is to validate the third generation Thyrotropin receptor antibody (TRAb) assay for predicting neonatal thyroid dysfunction and adverse pregnancy outcomes in pregnant women with Graves' disease. This prospective cohort study was conducted in TRAb positive pregnant women with Graves' disease and their off springs. The primary outcome was to assess different forms of neonatal thyroid dysfunction in relation to maternal and neonatal TRAb levels. The secondary outcome was to predict adverse pregnancy outcomes by using maternal TRAb levels. Serum T3, FT4, TSH, TRAb levels were measured using electrochemiluminescence immunoassay. 51 pregnant women were included. Five women had adverse pregnancy outcomes, TRAb levels of > 19.06 IU/L (10.9 times the upper limit of normal (ULN)) predicted adverse pregnancy outcomes with 100% sensitivity and 93.5% specificity. Among the 46 successful live births, 13 (28.3%) had neonatal thyroid dysfunction. Out of 13 neonates, 7 (32%) had neonatal thyrotoxicosis, 4 (18%) had primary hypothyroidism, and 2 (9%) had central hypothyroidism. Third trimester maternal TRAb levels of > 7.99 IU/L (4.6 times the ULN)and day three neonatal TRAb levels of > 5.03 IU/L (2.9 times the ULN), predicted the neonatal thyrotoxicosis with 100% sensitivity and 97.4% specificity. Very high maternal third generation TRAb levels strongly predicted the adverse pregnancy outcomes and neonatal thyroid dysfunction in pregnant women with Graves' disease. Neonatal thyroid function test along with the TRAb levels strongly correlated with different forms of neonatal thyroid dysfunction and is very useful in avoiding inadvertent treatment to neonates.

Структурні зміни тa зміни гормонпродукуючої функції щитоподібної зaлози при перебігу вагітності в природньому циклі і при застосуванні додаткових репродуктивних технологій

Purpose - to evaluate changes in thyroid function that occur during normal pregnancy and in the use of assisted reproductive technologies, various disorders with their consequences for the mother and fetus, laboratory diagnosis and the best ways to treat these conditions. Common abnormalities of thyroid function, such as hypothyroidism, thyrotoxicosis and benign thyroid neoplasms, which disrupt menstrual cycles and female fertility, are considered, which, in turn, directly affect the course of pregnancy, and can lead to pregnancy termination, placental abruption, pre-eclampsia, preterm labor, neonatal morbidity, including reduced fetal neurological development. It has been suggested that the harmful effects of thyroid dysfunction may also extend not only to pregnancy and childbirth, but also affect the neuro-intellectual development of a child at an early age. Early diagnosis of thyroid dysfunction in pregnant women and treatment of thyroid dysfunction during pregnancy is an important and cost-effective aspect aimed at avoiding the occurrence of secondary complications in both the fetus and the mother caused by thyroid dysfunction. No conflict of interests was declared by the authors.

Prevalence of overt and subclinical thyroid dysfunction in pregnant women and outcome in a tertiary care centre

Aim: To know the prevalence of overt and subclinical thyroid disorders in Indian pregnant women and to know the effect of overt and subclinical thyroid dysfunction on maternal and fetal outcome.&#x0D; Materials and methods: This study was conducted at the Government Maternity Hospital, sultan bazaar, Osmania medical college, Hyderabad over a period of 15 months from august 2016 to October 2017. 1000 pregnant women who attended the antenatal clinic were screened for the thyroid dysfunction. Serum TSH level estimated. fT3, fT4 and anti TPO Ab levels were estimated if the TSH level was abnormal. Patients were managed accordingly and followed till the delivery. Maternal and fetal outcome recorded.&#x0D; Results: It was a prospective study done on 1000 antenatal women. Prevalence of thyroid disorder in this study was 11.3%. Prevalence of subclinical, overt hypothyroidism, subclinical and overt hyperthyroidism was 9.4%, 1.4%, 0.4% and 0.1% respectively. Subclinical hypothyroidism was associated with complications like preeclampsia (13.8%), Anaemia (15.95%), preterm delivery (6.38%), Intrauterine growth restriction (4.25%), low birth weight (12.76%) and Intrauterine fetal death)(2.12%). Overt hypothyroidism was associated with complications like Preeclampsia (14.28%), anaemia (21.4%), Preterm delivery (14.28%), intrauterine growth restriction (14.28%), low birth weight (21.4%) and Intrauterine fetal death (7.14%). Incidence of CD was 18.05% in women with hypothyroidism. Subclinical hyperthyroidism was associated with complications like Preeclampsia, Preterm delivery, Intrauterine growth restriction, Intrauterine fetal death.&#x0D; Conclusion: Thyroid disorders in pregnancy are significantly associated with both maternal and fetal complications and adversely affect the outcome of pregnancy. Hence, early identification of thyroid disorders and timely initiation of treatment is essential

Evaluation of thyroid dysfunctions frequency in the first trimester

Aim: The aim of the study is to determine the frequency of first-trimester thyroid dysfunction in pregnant women and to investigate the effect of thyroid dysfunction on some perinatal outcomes.&#x0D; Material and Method: In the study, first-trimester Thyroid stimulating hormone (TSH), free T4 and free T3 hormone values of pregnant women who applied to our outpatient clinic were retrospectively scanned and recorded. As a result, 3224 pregnant women were included in the study. Pregnant women were evaluated as overt hypothyroidism, subclinical hypothyroidism, overt hyperthyroidism, subclinical hyperthyroidism and euthyroid according to TSH and fT4 values. Results of thyroid function tests of pregnant women and some perinatal results (age, gestational week, delivery type, baby gender, birth weight, gravida, parity, abortion) were compared&#x0D; Results: In our study, the mean age of the pregnant women for screening was 28.6±3.1, the mean birth week was 38.7±2.1, and the mean birth weight was 3037±324.73.6% (n=2369) of the pregnant women were normal euthyroid, 0.71% (n=23) were subclinical hyperthyroidism, 0.65% (n=23) were overt hyperthyroidism, while 15.6% (n=507) were overtly hypothyroid and 9.4% 3 (n=304) were found to be subclinical hypothyroidism. A significant statistical difference was not found between thyroid outcome test results and perinatal outcomes (age, gravida, parity, abortion, birth strength, gestational age, delivery type, babies) (p&gt; 0.05).&#x0D; Conclusion: In our study, a high prevalence of thyroid disease, especially hypothyroidism, was observed in pregnant women. More studies should be done to evaluate the effect of thyroid functions on pregnancy outcomes.

Thyroglobulin as an evolving biomarker of iodine reserve in thyroid dysfunction assessment in pregnancy

Background: Despite the use of routine thyroid function tests, thyroid dysfunction is often missed in pregnant women, who may have fluctuating iodine reserves and this may be associated with an increased risk of adverse maternal and fetal outcomes due to thyroid dysfunction. Therefore, thyroglobulin (Tg) as a marker of iodine reserve may be added to improve the diagnostic value of the thyroid testing panel. Materials and Methods: This study was a multicenter descriptive cross-sectional study with 501 healthy pregnant women, carried out over 9 months, in which blood and urine (spot) specimens were collected and analysed for serum thyroid-stimulating hormone, free thyroxine, free triiodothyronine, and Tg using enzyme-linked immunosorbent assay, and urinary iodine concentration by modified Sandell–Kolthoff reaction. Results: The prevalence of thyroid dysfunction in pregnant women using thyroid function tests alone was 12.4% (62) with 9.6% (48) being hypothyroid and 2.0% (10) hyperthyroid. The addition of Tg was able to identify more participants with thyroid dysfunction who were iodine deficient, and initially missed using thyroid function tests alone. This newly added biomarker to routine thyroid function tests profile increased the prevalence of thyroid disorders in this study population from 12.4% (62) to 17.6% (88) (P < 0.01), whereas urine iodine concentration was adequate for each trimester falling within the WHO range of 150–249 μg/l. Conclusion: The true prevalence of thyroid dysfunction in pregnant women in Makurdi was 17.6%. The addition of Tg had an impact on thyroid function tests by identifying more participants with iodine-related thyroid dysfunction, who were missed in the initial assessment of the thyroid. The mean urine iodine concentration was adequate, falling within the WHO range of 150–249 μg/l.

Establishment of an iodine model for prevention of iodine-excess-induced thyroid dysfunction in pregnant women.

This study aims to explore the relationship between the iodine status and thyroid dysfunction (TD) in pregnant women and establish a model to guide them to prevent excessive iodine intake. A total of 515 pregnant women were enrolled in the study. Urinary iodine concentration (UIC), thyroid hormones, and thyroid autoantibodies were measured, and then a logistic regression model was established. The median UIC of pregnant women was 174 ± 120 μg/L. Multivariate logistic regression analysis indicated that multivitamin supplements containing iodine and frequent seafood consumption were risk factors for excessive iodine (UIC ≥500 μg/L). Besides, excessive iodine was a risk factor for TD. Iodine excess was associated with a high prevalence of TD in pregnant women, especially TPOAb-positive women (P < 0.05). A logistic regression model based on potential risk factors was established to predict the risk of excessive iodine intake among pregnant women and provide guidance to minimize the risk of excessive iodine intake, thus reducing the risk of TD.

Frequency and characteristics of thyroid dysfunction in pregnant women – screening of 547 women in Bulgaria

The Recommendations of the European Thyroid Association’2014 have been widespread among the medical community for many years. In them as well as in the latest Recommendations of the American Thyroid Association’2017 the first recommendation is related to the development of population-based reference limits based on data from the local population. The aim is to study the current functional thyroid status in pregnant Bulgarian women and to carefully assess in the light of modern understandings the specific diagnostic and therapeutic approach for our population. Material and Methods: The study was conducted as a cross-sectional multicenter population-based study, which included 547 pregnant women, mean age 30 ± 5 years. Fasting morning venous blood (TSH, FT4, TPOAb - determined by ECLIA method) and fresh morning urine sample (to determine urine iodine concentration) was taken, ultrasound examination of the thyroid gland was performed. Results: Based on the accepted cut-off for TSH according to the Recommendations of ETA’2014, the studied pregnant women were divided into six groups: Subclinical and Clinical hypothyroidism; Subclinical and Clinical hyperthyroidism; Euthyroid; Low T4 syndrome. Almost 2/3 of pregnant women have TSH &lt; 2.5 mIU / L. Undiagnosed hypothyroidism is present in 121 pregnant women (22%), which is a bad feature of our health system. The data were analyzed in two TSH cut-offs (ETA’2014 and ATA’2017) and it was found that the increase in TSH cut-off for the first trimester did not change the absolute number of undiagnosed and untreated pregnant women with Clinical hypothyroidism, increasing 2.5 times its relative share, from 25.6% reaching 63.3% of all undiagnosed cases of hypothyroidism. Conclusion: Increasing the cut-off of TSH would unrealistically calm and neglect the follow-up of the pregnant women which is very dangerous. Efforts should focus on early screening for verbally identified risk factors. Of course, it is necessary to develop a national standard for TSH, which would serve more accurately to assess the thyroid status of pregnant women in the Bulgarian population.

ISOLATED MATERNAL HYPOTHYROXINEMIA AND ITS PERINATAL OUTCOME IN NORTH MACEDONIA.

SUMMARYIsolated maternal hypothyroxinemia (IMH) is defined as the presence of low maternal total thyroxine (TT4) level in conjunction with normal maternal thyroid-stimulating hormone (TSH) level. The aim was to investigate whether IMH is associated with adverse pregnancy outcome in North Macedonia. Dried blood spot samples were obtained from 359 pregnant women meeting the inclusion criteria and analyzed for TT4 and TSH. Postpartum data were entered from their medical histories. Out of 359 women, 131 (37.42%) belonged to IMH group. There were statistically significant differences in birth weight (p=0.043), intrauterine growth restriction (IUGR) (p=0.028), Apgar score at 1 min <7 (p=0.018) and cesarean section for dystocia/disproportion (p=0.024) between the IMH and normal thyroid function (NTF) groups. In regression analysis, TSH was a significant variable predicting Apgar score (βst=0.05597, p=0.047), body mass index predicting birth weight (βst=0.02338, p=0.045) and TT4 predicting small for gestational age/IUGR (βst=-0.089834, p=0.029) in IMH group. TT4 was a strong predictor of birth weight (βst=-0.004778, p=0.003) and premature delivery (βst=0.028112, p=0.004) in NTF group. The impact of IMH in pregnancy remains controversial. IMH was associated with an increased maternal BMI and higher birth weight of neonates. Overweight could be a potential risk factor for thyroid dysfunction in pregnant women, and specifically IMH. The worst fetal outcome was seen in IMH mothers examined in second trimester. We found TSH, TT4 and BMI to be strong predictors of perinatal outcomes.

Overweight and obesity may be a risk factor for thyroid dysfunction in pregnant women: a systematic review and meta-analysis

Overweight and obesity may be a risk factor for thyroid dysfunction in pregnant women: a systematic review and meta-analysis

Study of thyroid function in pregnancy, its feto-maternal outcome; a prospective observational study

BackgroundPregnancy is a stress test of maternal thyroid function. The prevalence of thyroid dysfunction in pregnant women is high. Subclinical hypothyroidism occurs in 10% of all pregnancies. Effects of hypothyroidism in pregnancy are anemia, low birth weight and mental retardation in neonate. This study is aimed to evaluate maternal and fetal outcomes in pregnant women with deranged thyroid profile. The relevance of this study is to document the association of hypothyroidism and its adverse effects on mother and fetus.MethodsThis prospective observational study was carried out at R.D. Gardi Medical College, Ujjain, India. Subjects of this study were 198 antenatal women in third trimester with singleton pregnancy admitted in the obstetric ward, and informed consent was obtained. Women were chosen irrespective of age, parity, residence and socioeconomic status. Women with multiple pregnancy, a known case of thyroid disorder, or any pre-existing medical disorder were excluded. Routine hematological parameters and estimation of T3, T4 and TSH was conducted. Patients with deranged thyroid profile were subsequently assessed for maternal and fetal complications. History of infertility, family history of thyroid disease, menstrual pattern, recurrent abortion, hemoglobin level and fetal outcome were the main study variables. Data was analysed in SPSS software for statistical co-relation.ResultsPrevalence of thyroid disorder is 11%; with subclinical hypothyroidism, overt hypothyroidism and subclinical hyperthyroidism occurring in 5.6, 3.5 and 1.5% of subjects respectively. In women with subclinical and overt hypothyroidism, anemia was present in 26.3% being significantly associated with hypothyroidism (p = 0.008). With respect to fetal outcome, LBW 31.6% (p = 0.001), NICU admission 42.1%, (p = 0.000) and low APGAR Score (21.1%, p = 0.042) were statistically associated with hypothyroidism. Risk of anemia, Low Birth weight, NICU admissions, and low APGAR score was 4.8, 6.3, 0.14 and 3.64 times higher respectively in women with hypothyroidism than in women who are euthyroid.ConclusionPrevalence of subclinical hypothyroidism is 5.6% in 3rd trimester of pregnancy. Anemia, pre-eclampsia, high caesarean rates and neonatal morbidities is significantly associated with hypothyroidism.

Thyroid Dysfunction in Pregnant Women with Gestational Diabetes Mellitus

Investigation thyroid dysfunction and autoimmunity in pregnant women with gestational diabetes mellitus. This article was written to evaluate the thyroid function and anti-thyroid peroxidase (anti- TPO) antibodies in pregnant women with gestational diabetes mellitus (GDM). A total of 252 women with GDM and 252 healthy pregnant women were enrolled. Thyroid tests, including TSH, FreeT3, Free T4, and anti-TPO were performed for all women at 24-28 weeks of gestation. Data analysis was then carried out using SPSS ver. 22. There was a significant difference between the experimental group (38.4%) and the control group (14.06%) in terms of the prevalence of subclinical hypothyroidism (p= 0.016). The frequency of anti-TPO was higher in the experimental group than the control group and positive anti-TPO was observed in 18.6% of women with GDM and 10.3% of healthy pregnant women (P= 0.008). Thyroid disorders are observed in pregnant women with GDM more frequently than healthy individuals and it may be thus reasonable to perform thyroid tests routinely.

Assessment of Thyroid Function in Pregnant Females Attending Suez Canal University Hospital

contribute to these changes. These factors could contribute to thyroid dysfunction during pregnancy especially when adeficiency of iodine intake exists and when thyroid reserve is not sufficient.Aim: To study thyroid functions in pregnant women avoiding maternal and fetal complications associated with thyroiddysfunctions.Materials and Methods: A cross-sectional study was carried out on 100 pregnant women attending Obstetrics OutpatientClinic in Suez-Canal University Hospitals were invited to enroll in the study. At the end of study, the blood samples wereassessed for free T3, free T4 and TSH.Results: This study revealed that most of the pregnant women had normal thyroid functions (51%), while subclinicalhypothyroidism (39%) was the most prevalent disorder followed by clinical hypothyroidism (6%) and isolatedhypothyroxinemia (4%).Conclusion: The most prevalent pattern of thyroid dysfunction in pregnant women was subclinical hypothyroidism.

Valores de referencia de hormonas tiroideas en la población de gestantes en Lugo

Background and objectiveThe complex physiology of thyroid function during pregnancy requires a hormonal evaluation according to reference values for each trimester, each area, and with the techniques of each laboratory. The objectives of this study were to analyse thyroid function in the three trimesters of pregnancy and to establish the reference values of hormones in pregnant women in this health area (Lugo). MethodsA total of 831 pregnant women were included in the study (median age: 33years, age range: 16-47years). Once the exclusion criteria were applied, the sample consisted of 641 pregnant women, a size that can be considered representative of the reference population. ResultsThe reference intervals were as follows: TSH first trimester, 0.10-3.74mIU/L; second trimester, 0.45-3.77mIU/L; and third trimester, 0.36-4.15mIU/L. For Free T4 in the first trimester, 0.87-1.34ng/dL; second trimester, 0.78-1.20ng/dL; and third trimester, 0.78-1.23ng/dL. For Free T3 in the first trimester, 2.52-3.78pg/mL; second trimester, 2.22-3.21pg/mL; and third trimester, 2.17-3.14pg/mL. The presence of thyroid autoimmunity was confirmed in 109 women (13.1%), who presented with higher TSH values than pregnant women without thyroid autoimmunity. ConclusionThe reference intervals for TSH, Free T4, and Free T3 obtained in this study are below those used in the non-pregnant adult population in this laboratory. This should help to identify more accurately a possible thyroid dysfunction in pregnant women in the study area, avoiding an underdiagnosis of subclinical hypothyroidism and reducing the possible associated perinatal complications.

Association of Preeclampsia and Thyroid Dysfunction in Pregnant Women and Perinatal Outcome

Introduction: In preeclampsia, there is failure of estrogen production due to placental dysfunction resulting in lowering of TBG, TT3, TT4 along with growth retardation of the foetus. It has been shown that individuals with subclinical hypothyroidism have impaired endothelium derived vasodilatation from diminished nitric oxide secretion that is restored after thyroxine (T4) replacement. The present study is proposed to evaluate the association of preeclampsia and thyroid dysfunction in pregnant women and perinatal outcome. Methods: The present study was carried out on pregnant women with preeclampsia admitted to or attending the Outpatient Department of Obstetrics and Gynecology GSL medical college and hospital, between June 1st 2018 to May 31st 2019. Similar number of age &amp; parity-matched normotensive pregnant women served as controls. Battery of investigations focusing on thyroid hormones were performed and both groups were compared in terms of thyroid status, perinatal outcome and complications. Results: Incidence of hypothyroidism is high but mostly subclinical.Women with preeclampsia had higher TT3, TT4 levels as compared to non pregnant women. TSH levels were higher significantly higher in preeclamptic women than normotensive pregnant women. A significant negative correlation was observed between birth weight and TSH levels serum albumin and TSH levels in preeclamptic women. Conclusion: These findings indicate that there is state of hypothyroxinemia in normal pregnancy and in preeclampsia. Identification of changes in thyroid hormones in preeclampsia might be of help in preventing the occurrence of preeclampsia.

Interventions to prevent women from developing gestational diabetes mellitus: an overview of Cochrane Reviews.

Interventions to prevent women from developing gestational diabetes mellitus: an overview of Cochrane Reviews.

TSHβX1 Splice Variant Expression and D2 Thr92Ala Polymorphism Analysis in Pregnant Women with Thyroid Diseases

Thyroid diseases are pathologies that frequently affect pregnant women. The objective was to find out whether the expression of TSHβX1 splice variant and D2 Thr92Ala polymorphism in the DIO2 gene are associated with thyroid disease in pregnant women. It was a comparative, prospective clinical, and cross-sectional study. Ninety-two pregnant patients, of which 38 were normothyroid and 54 had thyroid disease, were included. The expression of the TSHβX1 splice variant was quantified by real-time PCR and the D2 Thr92Ala (rs225014 CT) polymorphism was genotyped using TaqMan probes. The TSHβX1 splice variant was detected in both groups without significant differences in the relative expression. The T allele was associated with the thyroid dysfunction (OR = 2.117, p = 0.0339). We confirmed the presence of the predicted TSHβX1, and our results suggest that 92Thr (rs225017T) allele is a risk factor to thyroid dysfunction in pregnant women.