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Mulder TA, Korevaar TIM, Peeters RP, van Herwaarden AE, de Rijke YB, White T, Tiemeier H. Urinary Iodine Concentrations in Pregnant Women and Offspring Brain Morphology. Thyroid 2021; 31:964-972. [PMID: 33267727 DOI: 10.1089/thy.2020.0582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Severe maternal iodine deficiency during pregnancy leads to marked intellectual disability in the offspring. Although recent studies showed that even mild-to-moderate maternal iodine deficiency is associated with lower intelligence quotient and attention deficit hyperactivity disorder in offspring, the underlying neurobiological mechanism of these associations remains unknown. The aim of this study was to investigate the association of maternal iodine excretion during pregnancy with offspring brain morphology during pre-adolescence. Methods: This study was embedded within Generation R, a prospective population-based birth cohort in Rotterdam, the Netherlands. We included 990 mother-child pairs with data on urinary iodine concentration (UIC) and creatinine during pregnancy. The UIC was assessed at <18 and/or 18-25 weeks of gestation and offspring brain imaging data were acquired with magnetic resonance imaging (MRI) at age 10 years. We used linear regression to study the association of the iodine-to-creatinine ratio (UI/Creat) with offspring brain MRI outcomes. Results: Maternal UI/Creat during pregnancy was not consistently associated with offspring brain morphology. A low UI/Creat (<150 μg/g) during pregnancy was nominally associated with smaller total gray matter volume, but this did not survive correction for multiple testing. Also, we could not identify a linear association between continuous iodine excretion and offspring brain morphology. Instead, our results suggest a curvilinear association between UI/Creat and brain morphology. In sensitivity analyses using the World Health Organization categorization for UIC values, both low and high UI/Creat were associated with smaller total gray matter volume. Conclusions: The current study provides some but no conclusive evidence for an association of maternal iodine excretion during pregnancy with offspring brain morphology. Our results suggest that the exact definition of the reference group is important because of potential non-linear associations, which could be leveraged in future studies.
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Affiliation(s)
- Tessa A Mulder
- Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tim I M Korevaar
- Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Antonius E van Herwaarden
- Department of Laboratory Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Yolanda B de Rijke
- Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tonya White
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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González-Martínez S, Riestra-Fernández M, Martínez-Morillo E, Avello-Llano N, Delgado-Álvarez E, Menéndez-Torre EL. Nutritional Iodine Status in Pregnant Women from Health Area IV in Asturias (Spain): Iodised Salt Is Enough. Nutrients 2021; 13:nu13061816. [PMID: 34071767 PMCID: PMC8228027 DOI: 10.3390/nu13061816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Iodine deficiency during pregnancy may have adverse effects on the neurodevelopment of the foetus. Recent studies of pregnant women in Asturias (Spain) indicate that nutritional iodine levels are sufficient. The objective of this study was to confirm the appropriate nutritional iodine status and to analyse the influence of the ingestion of iodine on maternal urinary iodine concentration (UIC) and thyroid function. Methods: An observational study was carried out between May and June 2017 on women in the first trimester of pregnancy from Health Area IV in Asturias. The women completed a questionnaire related to their consumption of iodine and samples were taken to analyse UIC and thyroid function. Results: Three hundred and eighteen pregnant women were involved. Of these, 51.10% used iodised salt, 48.90% consumed ≥ 2 servings of dairy products daily and 87.08% took iodine supplements. The median UIC was 171.5 μg/L (116–265 μg/L) and 60.41% of women had UIC ≥ 150 μg/L. Multivariate logistic regression analysis demonstrated that iodised salt had a protective effect on UIC < 150 μg/L (odds ratio (OR) 0.404 (0.237–0.683), p = 0.001), but not iodine supplements (OR 0.512 (0.240–1.085), p = 0.080). The average level of thyroid stimulating hormone (TSH) was 2.26 ± 0.94 mIU/L; 68.40% of pregnant women taking iodine supplements had TSH < 2.5 mIU/L compared to 30.00% of those who were not taking supplements (p = 0.031). Conclusions: The pregnant women in our health area are maintaining appropriate nutritional iodine levels. The consumption of iodised salt protects against iodine deficiency; thus, iodine supplements should be taken on an individualised basis.
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Affiliation(s)
- Silvia González-Martínez
- Endocrinology and Nutrition Service, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (E.D.-Á.); (E.L.M.-T.)
- Endocrinology, Nutrition, Diabetes and Obesity Research Group (ENDO), Health Research Institute of Principado de Asturias (ISPA), 33011 Oviedo, Spain;
- Correspondence:
| | - María Riestra-Fernández
- Endocrinology, Nutrition, Diabetes and Obesity Research Group (ENDO), Health Research Institute of Principado de Asturias (ISPA), 33011 Oviedo, Spain;
- Endocrinology and Nutrition Service, Hospital Universitario de Cabueñes, 33203 Gijón, Spain
| | - Eduardo Martínez-Morillo
- Clinical Biochemistry Service, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (E.M.-M.); (N.A.-L.)
| | - Noelia Avello-Llano
- Clinical Biochemistry Service, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (E.M.-M.); (N.A.-L.)
| | - Elías Delgado-Álvarez
- Endocrinology and Nutrition Service, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (E.D.-Á.); (E.L.M.-T.)
- Endocrinology, Nutrition, Diabetes and Obesity Research Group (ENDO), Health Research Institute of Principado de Asturias (ISPA), 33011 Oviedo, Spain;
- Faculty of Medicine, University of Oviedo, 33011 Oviedo, Spain
| | - Edelmiro Luis Menéndez-Torre
- Endocrinology and Nutrition Service, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (E.D.-Á.); (E.L.M.-T.)
- Endocrinology, Nutrition, Diabetes and Obesity Research Group (ENDO), Health Research Institute of Principado de Asturias (ISPA), 33011 Oviedo, Spain;
- Faculty of Medicine, University of Oviedo, 33011 Oviedo, Spain
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Milczarek-Banach J, Miśkiewicz P. "Small Thyroid Gland" in Reproductive Women without Autoimmune Thyroid Disease-Ultrasonographic Evaluation as a Useful Screening Tool for Hypothyroidism. J Clin Med 2021; 10:jcm10091828. [PMID: 33922363 PMCID: PMC8122801 DOI: 10.3390/jcm10091828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/15/2021] [Accepted: 04/17/2021] [Indexed: 12/02/2022] Open
Abstract
Proper thyroid function is important for women of childbearing age, as hypothyroidism affects fertility, pregnancy and offspring. The upper reference limit for thyrotropin (TSH) in pregnancy was defined as <2.5 mU/L in the first trimester. Recommendations include either universal screening of TSH before pregnancy, or identifying individuals at “high risk” for thyroid illness. “Small thyroid gland” not associated with autoimmune thyroid disease (AITD) seems to be a reason for hypothyroidism and probably should be included in target case finding procedure before pregnancy. The purpose of this cross-sectional study was to analyze relationships between the thyroid volume and its function, and to determine the thyroid volume as a predictive factor for TSH levels above 2.5 µIU/mL in reproductive women without AITD. We included 151 women without AITD, and aged 18–40. Blood and urine samples were analyzed for parameters of thyroid function. Ultrasound examination of the thyroid was performed. The thyroid volume was negatively correlated with TSH. Women with a thyroid volume in the 1st quartile for the study population presented higher TSH levels versus women in the 4th quartile (p = 0.0132). A thyroid volume cut-off point of 9 mL was the predictive factor for TSH levels above 2.5 µIU/mL (p = 0.0037).
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Huang PC, Kuo PL, Chang WH, Shih SF, Chang WT, Lee CC. Prenatal Phthalates Exposure and Cord Thyroid Hormones: A Birth Cohort Study in Southern Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084323. [PMID: 33921744 PMCID: PMC8074059 DOI: 10.3390/ijerph18084323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The regulation of thyroid hormones in the early stages of gestation plays a crucial role in the outcome of a pregnancy. Furthermore, thyroid hormones are fundamental for the fetal development of all organs, including endocrine hormone changes in uterus. Endocrine disrupting chemicals have been shown to have an effect on thyroid hormone homeostasis in newborns, which affects their later development. Few studies have proposed how phthalates could alter thyroid function through several mechanisms and the possible effects on thyroid hormone homeostasis of phthalates on pregnant women. However, the effects of cord blood phthalates and prenatal phthalate exposure on thyroid hormones in newborns remain unclear. OBJECTIVES We aim to follow up on our previous established subjects and determine the correlation between phthalate exposure and thyroid hormones in pregnant women and newborns. MATERIALS AND METHODS We recruited 61 pregnant women from the Obstetrics and Gynecology Department of a medical hospital in southern Taiwan and followed up. High performance liquid chromatography electrospray ionization tandem mass spectrometry (HPLC-ESI-MS/MS) was used to analyze urine samples for five phthalate metabolites. Serum levels of thyroid hormones were analyzed using electrochemoluminescence immunoassay (ECLIA) method. We used Spearman and Pearson correlation coefficients to evaluate the correlation between each phthalate metabolites in serum and the thyroid hormone levels in fetus and parturient. Finally, multiple logistic regression was used to explore the relationship between hormones and their corresponding phthalate metabolites in cord blood. RESULTS High MBP in cord blood was correlated with negative cord serum TSH in newborns (r = -0.25, p < 0.06). By using multiple linear regression after adjusting for potential confounders (gestational and maternal age), cord serum MBP levels showed a negative association with cord serum TSH (β = 0.217, p < 0.05), cord serum T4 (β = 1.71, p < 0.05) and cord serum T4 × TSH (β = 42.8, p < 0.05), respectively. CONCLUSION We found that levels of cord serum TSH and T4 in newborns was significantly negatively associated with cord serum MBP levels after adjusting for significant covariate. The fall in TSH in newborns may potentially be delaying their development.
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Affiliation(s)
- Po-Chin Huang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli 350, Taiwan; (P.-C.H.); (W.-T.C.)
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 406040, Taiwan
| | - Pao-Lin Kuo
- Department of Obstetrics and Gynecology, Medical College, National Cheng Kung University, Tainan 701, Taiwan;
| | - Wei-Hsiang Chang
- Department of Food Safety/Hygiene and Risk Management, National Cheng Kung University, Tainan 701, Taiwan;
- Research Center of Environmental Trace Toxic Substances, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Shu-Fang Shih
- Department of Health Administration, College of Health Professions, Virginia Commonwealth University, Richmond, VA 23284, USA;
| | - Wan-Ting Chang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli 350, Taiwan; (P.-C.H.); (W.-T.C.)
| | - Ching-Chang Lee
- Research Center of Environmental Trace Toxic Substances, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Department of Environmental and Occupational Health, Medical College, National Cheng Kung University, Tainan 701, Taiwan
- Correspondence: ; Tel.: +886-6-274-4412
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Chen Z, Yang X, Zhang C, Ding Z, Zhang Y, Korevaar TIM, Fan J. Thyroid Function Test Abnormalities in Twin Pregnancies. Thyroid 2021; 31:572-579. [PMID: 32746748 DOI: 10.1089/thy.2020.0348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Compared with singletons, a twin pregnancy is associated with a larger thyroid hormone demand and an increased stimulation of gestational thyroid function due to higher concentrations of human chorionic gonadotropin. However, such effects have been sparsely quantified. The aim of this study was to evaluate thyroid function and thyroid function test abnormalities in twin pregnancies during early and late pregnancy compared with singletons. Methods: We included 1208 twin pregnancies and 46,834 singleton pregnancies with thyroid function tests available. Thyroid function test abnormalities were defined using population-based reference ranges. The analyses were adjusted for potential confounders including maternal age and body mass index. Results: Compared with singletons, a twin pregnancy was associated with a lower thyrotropin (TSH) (β = -0.46 [95% confidence interval, CI -0.49 to -0.44], p < 0.001) and a higher free thyroxine (fT4) (β = 0.91 [CI 0.69-1.16], p < 0.001) during early pregnancy. During late pregnancy, a twin pregnancy was associated with a higher TSH (β = 0.35 [CI 0.29-0.42], p < 0.001) while fT4 did not differ (β = -0.11 [CI -0.22 to 0.01], p = 0.065). During early pregnancy, a twin pregnancy was associated with a higher risk of overt hyperthyroidism (odds ratio, OR = 7.49 [CI 6.02-9.33], p < 0.001), subclinical hyperthyroidism (OR = 5.26 [CI 4.17-6.64], p < 0.001), and isolated hypothyroxinemia (OR = 1.89 [CI 1.43-2.49], p < 0.001), but with a lower risk of subclinical hypothyroidism (OR = 0.27 [CI 0.13-0.54], p < 0.001). In late pregnancy, a twin pregnancy was associated with a higher risk of subclinical hypothyroidism (OR = 4.05 [CI 3.21-5.11], p < 0.001), isolated hypothyroxinemia (OR = 1.48 [CI 1.04-2.10], p = 0.028), and subclinical hyperthyroidism (OR = 1.76 [CI 1.27-2.43], p < 0.001). Conclusions: During early pregnancy, a twin pregnancy was associated with a higher thyroid function and a higher risk of (subclinical) hyperthyroidism, as well as a higher risk of isolated hypothyroxinemia. During late pregnancy, a twin pregnancy was associated with a higher TSH concentration and a higher risk of subclinical hypothyroidism, as well as a persistently higher risk of isolated hypothyroxinemia and subclinical hyperthyroidism. The study was approved by Chinese Clinical Trial Registry (registration no. ChiCTR1800014394).
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Affiliation(s)
- Zhirou Chen
- Department of Obstetrics, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xi Yang
- Department of Obstetrics, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chen Zhang
- Department of Obstetrics, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Zheng Ding
- Department of Obstetrics, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yong Zhang
- Department of Obstetrics, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Tim I M Korevaar
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jianxia Fan
- Department of Obstetrics, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
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Yang Y, Guo T, Fu J, Kuang J, Wang Y, Zhang Y, Zhang H, He Y, Peng Z, Wang Q, Shen H, Zhang Y, Yan D, Ma X, Guan H. Preconception Thyrotropin Levels and Risk of Adverse Pregnancy Outcomes in Chinese Women Aged 20 to 49 Years. JAMA Netw Open 2021; 4:e215723. [PMID: 33847747 PMCID: PMC8044736 DOI: 10.1001/jamanetworkopen.2021.5723] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Maternal thyrotropin levels during gestation have a profound effect on pregnancy outcomes; however, few studies to date have evaluated the importance of preconception thyrotropin levels. OBJECTIVE To investigate the associations between preconception thyrotropin levels and pregnancy outcomes. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study enrolled Chinese women aged 20 to 49 years from the National Free Prepregnancy Checkups Project in China. Participants conceived within 6 months after the thyrotropin examination and completed follow-up for pregnancy outcomes between January 1, 2013, and December 31, 2017. Data were analyzed between May 1, 2019, and March 31, 2020. EXPOSURES Levels of thyrotropin within 6 months before pregnancy, measured as less than 0.10 mIU/L, 0.10 to 0.36 mIU/L, 0.37 to 2.49 mIU/L, 2.50 to 4.87 mIU/L, 4.88 to 9.99 mIU/L, and 10.00 mIU/L or greater. MAIN OUTCOMES AND MEASURES The association of maternal preconception thyrotropin levels with the 4 primary adverse pregnancy outcomes was assessed, including preterm birth (PTB), small for gestational age (SGA), birth defect, and perinatal infant death. Logistic regression analyses were used to evaluate the association between preconception maternal thyrotropin levels and risk of adverse pregnancy outcomes. The dose-response associations were assessed using restricted cubic spline regression. RESULTS This study enrolled 5 840 894 women (mean [SD] age, 26.30 [4.10] years) in the primary analysis. The median (interquartile range [IQR]) thyrotropin level was 1.60 (1.06-2.37) mIU/L. The cumulative incidences for the adverse pregnancy outcomes were as follows: PTB, 6.56%; SGA, 7.21%; birth defect, 0.02%; and perinatal infant death, 0.33%. Compared with the reference group (thyrotropin range, 0.37-2.49 mIU/L), both low (<0.10 mIU/L and 0.10-0.36 mIU/L) and high (4.88-9.99 mIU/L and ≥10.00 mIU/L) maternal preconception thyrotropin levels were associated with higher risk of PTB (low: odds ratio [OR], 1.23 [95% CI, 1.19-1.27] and OR, 1.15 [95% CI, 1.13-1.18] vs high: OR, 1.13 [95% CI, 1.10-1.15] and OR, 1.14 [95% CI, 1.08-1.20]), SGA (low: OR, 1.37 [95% CI, 1.33-1.40] and OR, 1.14 [95% CI, 1.12-1.17] vs high: OR, 1.05 [95% CI, 1.03-1.08] and OR, 1.17 [95% CI, 1.11-1.23]), and perinatal infant death (low: OR, 1.26 [95% CI, 1.10-1.43] and OR, 1.14 [95% CI, 1.05-1.24] vs high: OR, 1.31 [95% CI, 1.20-1.43] and OR, 1.47 [95% CI, 1.21-1.80]). J-shaped associations between preconception thyrotropin levels and PTB (χ2 = 1033.45; nonlinear P < .001), SGA (χ2 = 568.90; nonlinear P < .001), and perinatal infant death (χ2 = 38.91; nonlinear P < .001) were identified. CONCLUSIONS AND RELEVANCE In this cohort study, both low and high maternal thyrotropin levels were associated with a significantly increased risk of adverse pregnancy outcomes. Results suggest that the optimal preconception thyrotropin levels may be between 0.37 mIU/L and 2.50 mIU/L to prevent adverse pregnancy outcomes.
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Affiliation(s)
- Ying Yang
- National Research Institute for Family Planning, Haidian District, Beijing, China
- National Human Genetic Resource Center, Haidian District, Beijing, China
- Graduate School of Peking Union Medical College, Dongdan Santiao, Dongcheng District, Beijing, China
| | - Tonglei Guo
- National Research Institute for Family Planning, Haidian District, Beijing, China
- School of Public Health, Hebei Medical University, Changan District, Shijiazhuang, China
| | - Jinrong Fu
- Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Shenyang, China
| | - Jian Kuang
- Department of Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuanyuan Wang
- National Research Institute for Family Planning, Haidian District, Beijing, China
- National Human Genetic Resource Center, Haidian District, Beijing, China
| | - Ya Zhang
- National Research Institute for Family Planning, Haidian District, Beijing, China
- National Human Genetic Resource Center, Haidian District, Beijing, China
| | - Hongguang Zhang
- National Research Institute for Family Planning, Haidian District, Beijing, China
- National Human Genetic Resource Center, Haidian District, Beijing, China
| | - Yuan He
- National Research Institute for Family Planning, Haidian District, Beijing, China
- National Human Genetic Resource Center, Haidian District, Beijing, China
| | - Zuoqi Peng
- National Research Institute for Family Planning, Haidian District, Beijing, China
- National Human Genetic Resource Center, Haidian District, Beijing, China
| | - Qiaomei Wang
- Department of Maternal and Child Health, National Health Commission of the People’s Republic of China, Xicheng District, Beijing, China
| | - Haiping Shen
- Department of Maternal and Child Health, National Health Commission of the People’s Republic of China, Xicheng District, Beijing, China
| | - Yiping Zhang
- Department of Maternal and Child Health, National Health Commission of the People’s Republic of China, Xicheng District, Beijing, China
| | - Donghai Yan
- Department of Maternal and Child Health, National Health Commission of the People’s Republic of China, Xicheng District, Beijing, China
| | - Xu Ma
- National Research Institute for Family Planning, Haidian District, Beijing, China
- National Human Genetic Resource Center, Haidian District, Beijing, China
- Graduate School of Peking Union Medical College, Dongdan Santiao, Dongcheng District, Beijing, China
| | - Haixia Guan
- Department of Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Boggs ASP, Kilpatrick LE, Burdette CQ, Tevis DS, Fultz ZA, Nelson MA, Jarrett JM, Kemp JV, Singh RJ, Grebe SKG, Wise SA, Kassim BL, Long SE. Development of a pregnancy-specific reference material for thyroid biomarkers, vitamin D, and nutritional trace elements in serum. Clin Chem Lab Med 2021; 59:671-679. [PMID: 33098630 PMCID: PMC9972198 DOI: 10.1515/cclm-2020-0977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/06/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Matrix differences among serum samples from non-pregnant and pregnant patients could bias measurements. Standard Reference Material 1949, Frozen Human Prenatal Serum, was developed to provide a quality assurance material for the measurement of hormones and nutritional elements throughout pregnancy. METHODS Serum from non-pregnant women and women in each trimester were bottled into four levels based on pregnancy status and trimester. Liquid chromatography tandem mass spectrometry (LC-MS/MS) methods were developed and applied to the measurement of thyroid hormones, vitamin D metabolites, and vitamin D-binding protein (VDBP). Copper, selenium, and zinc measurements were conducted by inductively coupled plasma dynamic reaction cell MS. Thyroid stimulating hormone (TSH), thyroglobulin (Tg), and thyroglobulin antibody concentrations were analyzed using immunoassays and LC-MS/MS (Tg only). RESULTS Certified values for thyroxine and triiodothyronine, reference values for vitamin D metabolites, VDBP, selenium, copper, and zinc, and information values for reverse triiodothyronine, TSH, Tg, and Tg antibodies were assigned. Significant differences in serum concentrations were evident for all analytes across the four levels (p≤0.003). TSH measurements were significantly different (p<0.0001) among research-only immunoassays. Tg concentrations were elevated in research-only immunoassays vs. Federal Drug Administration-approved automated immunoassay and LC-MS/MS. Presence of Tg antibodies increased differences between automated immunoassay and LC-MS/MS. CONCLUSIONS The analyte concentrations' changes consistent with the literature and the demonstration of matrix interferences in immunoassay Tg measurements indicate the functionality of this material by providing a relevant matrix-matched reference material for the different stages of pregnancy.
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Affiliation(s)
- Ashley S. P. Boggs
- Corresponding author: Ashley S. P. Boggs, PhD, Research Biologist, National Institute of Standards and Technology, 331 Fort Johnson Rd, Charleston, SC 29412, USA, Phone: 843 460 9789, Fax: 843 998 6940,
| | | | | | - Denise S. Tevis
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zachary A. Fultz
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael A. Nelson
- National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Jeffery M. Jarrett
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer V. Kemp
- Division of Clinical Biochemistry and Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ravinder J. Singh
- Division of Clinical Biochemistry and Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Stefan K. G. Grebe
- Division of Clinical Biochemistry and Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stephen A. Wise
- National Institute of Standards and Technology, Gaithersburg, MD, USA; National Institutes of Health, Office of Dietary Supplements, Bethesda, MD, USA
| | - Brittany L. Kassim
- National Institute of Standards and Technology, Hollings Marine Laboratory, Charleston, SC, USA
| | - Stephen E. Long
- National Institute of Standards and Technology, Hollings Marine Laboratory, Charleston, SC, USA
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Chambers T, Anney R, Taylor PN, Teumer A, Peeters RP, Medici M, Caseras X, Rees DA. Effects of Thyroid Status on Regional Brain Volumes: A Diagnostic and Genetic Imaging Study in UK Biobank. J Clin Endocrinol Metab 2021; 106:688-696. [PMID: 33274371 PMCID: PMC7947746 DOI: 10.1210/clinem/dgaa903] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Thyroid hormone is essential for optimal human neurodevelopment and may modify the risk of attention-deficit/hyperactivity disorder (ADHD). However, the brain structures involved are unknown and it is unclear if the adult brain is also susceptible to changes in thyroid status. METHODS We used International Classification of Disease-10 codes, polygenic thyroid scores at different thresholds of association with thyroid traits (PT-values), and image-derived phenotypes in UK Biobank (n = 18 825) to investigate the effects of a recorded diagnosis of thyroid disease and genetic risk for thyroid status on cerebellar and subcortical gray matter volume. Regional genetic pleiotropy between thyroid status and ADHD was explored using the GWAS-pairwise method. RESULTS A recorded diagnosis of hypothyroidism (n = 419) was associated with significant reductions in total cerebellar and pallidum gray matter volumes (β [95% CI] = -0.14[-0.23, -0.06], P = 0.0005 and β [95%CI] = -0.12 [-0.20, -0.04], P = 0.0042, respectively), mediated in part by increases in body mass index. While we found no evidence for total cerebellar volume alterations with increased polygenic scores for any thyroid trait, opposing influences of increased polygenic scores for hypo- and hyperthyroidism were found in the pallidum (PT < 1e-3: β [95% CI] = -0.02 [-0.03, -0.01], P = 0.0003 and PT < 1e-7: β [95% CI] = 0.02 [0.01, 0.03], P = 0.0003, respectively). Neither hypo- nor hyperthyroidism showed evidence of regional genetic pleiotropy with ADHD. CONCLUSIONS Thyroid status affects gray matter volume in adults, particularly at the level of the cerebellum and pallidum, with potential implications for the regulation of motor, cognitive, and affective function.
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Affiliation(s)
- Tom Chambers
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, Cardiff, UK
| | - Richard Anney
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Peter N Taylor
- Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Germany
| | - Robin P Peeters
- Department of Internal Medicine and Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marco Medici
- Department of Internal Medicine and Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Radboud University Medical Center, HB Nijmegen, The Netherlands
| | - Xavier Caseras
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, UK
- Correspondence: D. Aled Rees, FRCP, PhD, Neuroscience and Mental Health Research Institute, Hadyn Ellis Building, School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom.
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Adibi JJ, Xun X, Zhao Y, Yin Q, LeWinn K, Bush NR, Panigrahy A, Peddada S, Alfthan H, Stenman UH, Tylavsky F, Koistinen H. Second-Trimester Placental and Thyroid Hormones Are Associated With Cognitive Development From Ages 1 to 3 Years. J Endocr Soc 2021; 5:bvab027. [PMID: 33928202 PMCID: PMC8064052 DOI: 10.1210/jendso/bvab027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Indexed: 12/25/2022] Open
Abstract
Adequate maternal thyroid hormone (TH) is necessary for fetal brain development. The role of placental human chorionic gonadotropin (hCG) in ensuring the production of TH is less well understood. The objective of the study was to evaluate 1) associations of placental hCG and its subunits, and maternal TH in the second trimester, and 2) the single and joint effects of TH and placental hormones on cognitive development and communication at ages 1 and 3 years. Fifty individuals (5%) were selected from the CANDLE (Conditions Affecting Neurocognitive Development and Early Learning) pregnancy cohort in Memphis, Tennessee, with recruitment from 2006 to 2011, to equally represent male and female fetuses. Participants were 68% Black and 32% White. Hormones measured were maternal thyroid (thyrotropin [TSH] and free thyroxine [FT4]) and placental hormones (hCG, its hyperglycosylated form [hCG-h], and free - [hCG] and -subunits [hCG]) in maternal serum (17-28 weeks). The primary outcome measurement was the Bayley Scales of Infant and Toddler Development. All forms of hCG were negatively associated with FT4 and not associated with TSH. hCG was associated with cognitive development at age 1 year and jointly interacted with TSH to predict cognitive development at age 3 years. This pilot study added insight into the thyrotropic actions of hCG in the second trimester, and into the significance of this mechanism for brain development. More research is warranted to elucidate differences between hCG, hCG, and hCG-h in relation to TH regulation and child brain function.
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Affiliation(s)
- Jennifer J Adibi
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania 15261, USA
| | - Xiaoshuang Xun
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania 15261, USA
| | - Yaqi Zhao
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania 15261, USA
| | - Qing Yin
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania 15261, USA
| | - Kaja LeWinn
- University of California San Francisco, San Francisco, California 94143, USA
| | - Nicole R Bush
- University of California San Francisco, San Francisco, California 94143, USA
| | - Ashok Panigrahy
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15224, USA
| | - Shyamal Peddada
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania 15261, USA
| | - Henrik Alfthan
- HUSLAB, Helsinki University Hospital, 00290 Helsinki, Finland
| | - Ulf-Håkan Stenman
- University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland
| | | | - Hannu Koistinen
- University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland
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Prevalence of Hypothyroidism in Pregnant Women in India: A Meta-Analysis of Observational Studies. J Thyroid Res 2021; 2021:5515831. [PMID: 33680424 PMCID: PMC7910053 DOI: 10.1155/2021/5515831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction This meta-analysis was conducted to estimate the prevalence of hypothyroidism among pregnant women in India. Methods We searched PubMed, Web of Science, Scopus, Google Scholar, and Shodhganga (Indian thesis repository) for observational studies, providing prevalence of hypothyroidism among pregnant women in India. Systematic study selection and data extraction procedures were followed. Quality assessment of each study was done using JBI critical appraisal checklist. The random effects model was used for pooling the effect sizes. Publication bias was assessed using the funnel plot and rank correlation test. I 2 statistics was used to measure heterogeneity across the studies. Heterogeneity in the pooled estimates was further explored with subgroup analyses and meta-regression analysis. Results Sixty-one studies were found eligible and included in this review. The pooled estimate of the prevalence of hypothyroidism in pregnant women was 11.07% (95% CI: 8.79-13.84, I 2 = 99%). Pooled prevalence estimates of subclinical and overt hypothyroidism are 9.51% (95% CI: 7.48-12.04, I 2 = 98%) and 2.74% (95% CI: 2.08-3.58, I 2 = 94%). Conclusion We documented 11.07% pooled prevalence of hypothyroidism in pregnant women in India.
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Andersen SL, Andersen S. Hyperthyroidism in pregnancy: evidence and hypothesis in fetal programming and development. Endocr Connect 2021; 10:R77-R86. [PMID: 33444223 PMCID: PMC7983517 DOI: 10.1530/ec-20-0518] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/06/2021] [Indexed: 12/19/2022]
Abstract
The management of hyperthyroidism in pregnant patients has been a topic of raised clinical awareness for decades. It is a strong recommendation that overt hyperthyroidism of Graves' disease in pregnant women should be treated to prevent complications. The consequences of hyperthyroidism in pregnancy are less studied than hypothyroidism, and a literature review illustrates that the main burden of evidence to support current clinical guidance emerges from early observations of severe complications in Graves' disease patients suffering from untreated hyperthyroidism in the pregnancy. On the other hand, the more long-term consequences in children born to mothers with hyperthyroidism are less clear. A hypothesis of fetal programming by maternal hyperthyroidism implies that excessive levels of maternal thyroid hormones impair fetal growth and development. Evidence from experimental studies provides clues on such mechanisms and report adverse developmental abnormalities in the fetal brain and other organs. Only few human studies addressed developmental outcomes in children born to mothers with hyperthyroidism and did not consistently support an association. In contrast, large observational human studies performed within the last decade substantiate a risk of teratogenic side effects to the use of antithyroid drugs in early pregnancy. Thus, scientific and clinical practice are challenged by the distinct role of the various exposures associated with Graves' disease including the hyperthyroidism per se, the treatment, and thyroid autoimmunity. More basic and clinical studies are needed to extend knowledge on the effects of each exposure, on the potential interaction between exposures and with other determinants, and on the underlying mechanisms.
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Affiliation(s)
- Stine Linding Andersen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Correspondence should be addressed to S L Andersen:
| | - Stig Andersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Geriatrics, Aalborg University Hospital, Aalborg, Denmark
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Reference values and the effect of clinical parameters on thyroid hormone levels during early pregnancy. Biosci Rep 2021; 41:227259. [PMID: 33305315 PMCID: PMC7789803 DOI: 10.1042/bsr20202296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/20/2020] [Accepted: 12/09/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Thyroid dysfunction is a common endocrine problem during pregnancy; correct diagnosis and appropriate treatments are essential to avoid adverse pregnancy outcomes. Besides, it is vital to identify and quantify the major risk factors for gestational thyroid dysfunction, including thyroid autoimmunity, human chorionic gonadotropin (HCG) concentration, body mass index (BMI) and parity. The study objective was to establish reference ranges during early pregnancy and to explore the relationship between risk factors and thyroid stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyroxine (FT3). DESIGN, PATIENTS AND MEASUREMENTS To establish the reference ranges of thyroid hormone during early pregnancy in China and to identify the risk factors for thyroid dysfunction, woman in the first trimester of pregnancy (4-12 weeks gestation) were recruited. After excluding thyroid peroxidase antibody (TPO-Ab) positive and/or thyroglobulin antibody (TG-Ab) positive women, previous thyroid disease, a lack of iodine intake, reference values were calculated by 2.5th to 97.5th percentiles. RESULTS After exclusion of TPO-Ab and/or TG-Ab positive women, reference values were as follows: TSH, 0.11-3.67 mIU/l; FT3, 3.19-5.91 pmol/l; FT4 10.95-16.79 pmol/l. Higher BMI was associated with lower FT4 concentrations (P=0.005). In multiple regression analysis, TSH was significantly and positively associated with TG (P=0.03). Maternal parity and maternal age may be risk factors for the abnormal thyroidal response to hCG concentrations. CONCLUSIONS Our study defined first trimester-specific reference ranges for serum TSH, FT4, FT3 in a Chinese population, and demonstrated that BMI ≥23kg/m2, maternal parity ≥3 and maternal age ≥30 years may increase the risk of thyroid dysfunction.
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Fu J, Zhang G, Xu P, Guo R, Li J, Guan H, Li Y. Seasonal Changes of Thyroid Function Parameters in Women of Reproductive Age Between 2012 and 2018: A Retrospective, Observational, Single-Center Study. Front Endocrinol (Lausanne) 2021; 12:719225. [PMID: 34539571 PMCID: PMC8443767 DOI: 10.3389/fendo.2021.719225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/13/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Thyroid function can be influenced by external stimuli such as light and temperature. However, it is currently unknown whether there is seasonal variation of thyroid function in women of reproductive age. Adequate thyroid function in reproductive-aged women is necessary for optimal fetal-maternal outcomes. Therefore, this study aims to evaluate the seasonal changes in levels of thyrotropin (TSH), free triiodothyronine (FT3), free thyroxine (FT4), and TSH index (TSHI) in women of reproductive age. METHODS A large retrospective study was conducted that included women aged 20-49 years who visited our outpatient or checkup center between 2012 and 2018. Thyroid function was measured using the automated immunochemiluminescent assay kit. Subjects with overt thyroid dysfunction, pregnancy, thyroid disease, cancer, and severe infectious or psychological disease were excluded. Seasonal differences of thyroid function were analyzed using the Kruskal-Wallis test or the analysis of means with transformed ranks. Spearman's correlation was performed to evaluate the association between thyroid function parameters and age. A subset of 181 subjects was included in the longitudinal analyses. Differences in thyroid function between summer and winter were analyzed using the Wilcoxon signed-rank test. RESULTS A total of 48,990 women with a median age of 39 years were included. The prevalence of subclinical hypothyroidism was lower in summer but higher in winter (5.6% vs. 7.0%, p < 0.05). The TSH, FT3, and FT4 levels and TSHI reached a peak in winter, while they declined to trough in summer. The TSH concentrations (r = 0.044, p < 0.001) and TSHI (r = 0.025, p < 0.001) were positively correlated with age, whereas FT3 (r = -0.073, p < 0.001) and FT4 (r = -0.059, p < 0.001) were negatively correlated with age. The associations of thyroid parameters with age were similar between subjects with positive thyroid peroxidase antibody (TPOAb) and those with negative TPOAb. In the matched longitudinal analysis of 181 subjects, no differences were detected in the thyroid parameters between summer and winter. CONCLUSIONS This retrospective single-center study showed that thyroid hormone levels and central sensitivity to thyroid hormones are influenced by age and seasonal fluctuations among women of reproductive age, while their impact on reproductive health remains to be elucidated in future studies.
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Affiliation(s)
- Jinrong Fu
- Department of Endocrinology and Metabolism, Institute of Endocrinology, National Health Commission (NHC) Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, Shenyang, China
- Department of Endocrinology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guofeng Zhang
- Department of Endocrinology and Metabolism, Institute of Endocrinology, National Health Commission (NHC) Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Pei Xu
- Department of Endocrinology and Metabolism, Institute of Endocrinology, National Health Commission (NHC) Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Rui Guo
- Department of Endocrinology and Metabolism, Institute of Endocrinology, National Health Commission (NHC) Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jiarong Li
- Department of Endocrinology and Metabolism, Institute of Endocrinology, National Health Commission (NHC) Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Haixia Guan
- Department of Endocrinology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- *Correspondence: Haixia Guan, ; Yushu Li,
| | - Yushu Li
- Department of Endocrinology and Metabolism, Institute of Endocrinology, National Health Commission (NHC) Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, Shenyang, China
- *Correspondence: Haixia Guan, ; Yushu Li,
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Zhao S, Xia Y, Huang Y, Zou H, Wang X, Chen Z, Zhou H, Han Y, Tang H, Yan R, Yao Z, Lu Q. The Correlation Between Thyroid Function, Frontal Gray Matter, and Executive Function in Patients With Major Depressive Disorder. Front Endocrinol (Lausanne) 2021; 12:779693. [PMID: 34887837 PMCID: PMC8649711 DOI: 10.3389/fendo.2021.779693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
The present study was aimed to investigate the relationships between serum thyroid hormones (THs), frontal gray matter volume, and executive function in selected patients with major depressive disorder (MDD). One hundred and four MDD patients and seventy-five healthy controls (HCs) were subjected to thyroid-stimulating hormone (TSH), free Triiodothyronine (fT3), free Thyroxine (fT4), and executive function tests and underwent structural magnetic resonance imaging (MRI). Voxel-based morphometry (VBM) analysis was performed to compare group differences in the gray matter for the frontal lobe. Furthermore, mediation analysis was used to investigate whether gray matter volumes of the frontal gyrus mediated the relationship between serum THs and executive function in MDD patients. MDD patients exhibited significant gray matter volume reduction in several brain regions, including the left rectus, right middle frontal cortex, and left middle frontal cortex. Serum TSH levels are positively associated with altered regional gray matter volume patterns within MFG and executive function. Importantly, gray matter in the right MFG was a significant mediator between serum TSH levels and executive function. These findings expand our understanding of how thyroid function affects brain structure changes and executive function in MDD patients.
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Affiliation(s)
- Shuai Zhao
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yi Xia
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yinghong Huang
- Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, China
| | - Haowen Zou
- Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xumiao Wang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Zhilu Chen
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Hongliang Zhou
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yinglin Han
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Tang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Rui Yan
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Zhijian Yao
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
- Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, China
- *Correspondence: Zhijian Yao, ; Qing Lu,
| | - Qing Lu
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China
- Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China
- *Correspondence: Zhijian Yao, ; Qing Lu,
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Luo J, Wang X, Yuan L, Guo L. Iron Deficiency, a Risk Factor of Thyroid Disorders in Reproductive-Age and Pregnant Women: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:629831. [PMID: 33716980 PMCID: PMC7947868 DOI: 10.3389/fendo.2021.629831] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/21/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Iron deficiency (ID) is concerned as the most common nutritional deficiency worldwide. The effects of ID on thyroid function and autoimmunity in pregnant women and reproductive-age women are controversial. The aim of the current study was to summarize the evidences and evaluate the relationship between ID and thyroid disorders. METHODS In this systematic review and meta-analysis, studies published on the Cochrane, Embase, Medline, and PubMed databases by October 2020 were searched. A total of 636 studies which discussed the correlation between ID and thyroid disorders were eligible in the initial search. Pooled mean differences (MD) and 95% confidence intervals (CI) were calculated for the assessment of thyrotropin (TSH) and free thyroxine (FT4) levels. Combined odd ratios (OR) and 95% CI were calculated for the assessment of the prevalence of overt and subclinical hypothyroidism, positive thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb). RESULTS For women of reproductive age, ID could significantly increase the risk of positive TPOAb (OR: 1.89; 95% CI: 1.17, 3.06: P = 0.01) and both positive TPOAb and TgAb (OR: 1.48; 95% CI: 1.03, 2.11: P = 0.03). The meta-analysis of pregnant women showed that pregnant women with ID had increased serum TSH levels (MD: 0.12; 95% CI: 0.07, 0.17; P < 0.00001) and decreased FT4 levels (MD: -0.73; 95% CI: -1.04, -0.41; P < 0.00001). Meanwhile, the prevalence of overt (OR: 1.60; 95% CI: 1.17, 2.19; P = 0.004) and subclinical (OR: 1.37; 95% CI: 1.13, 1.66; P = 0.001) hypothyroidism in pregnant women with ID was significantly increased. CONCLUSIONS ID may adversely affect thyroid function and autoimmunity of pregnant and reproductive-age women and it is very necessary for monitoring iron nutritional status and early treatment of ID for them.
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Affiliation(s)
- Jingyi Luo
- Department of Endocrinology, Beijing Hospital, The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoxia Wang
- Department of Endocrinology, Beijing Hospital, The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Li Yuan
- The Savaid School of Medicine, University of Chinese Academy of Sciences, Beijing, China
- *Correspondence: Lixin Guo, ; Li Yuan,
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Lixin Guo, ; Li Yuan,
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Sauer UG, Asiimwe A, Botham PA, Charlton A, Hallmark N, Jacobi S, Marty S, Melching-Kollmuss S, Palha JA, Strauss V, van Ravenzwaay B, Swaen G. Toward a science-based testing strategy to identify maternal thyroid hormone imbalance and neurodevelopmental effects in the progeny - part I: which parameters from human studies are most relevant for toxicological assessments? Crit Rev Toxicol 2020; 50:740-763. [PMID: 33305658 DOI: 10.1080/10408444.2020.1839380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The 2018 European Food Safety Authority/European Chemicals Agency Guidance on the Identification of Endocrine Disruptors lacks clarity on how the presence or absence of substance-induced maternal thyroid hormone imbalance, or the potential for subsequent deleterious consequences in child neurodevelopment, should be established by toxicological assessments. To address these uncertainties, this narrative review evaluates human evidence on how altered maternal thyroid function may be associated with child neurodevelopmental outcomes; and seeks to identify parameters in human studies that appear most relevant for toxicological assessments. Serum levels of free thyroxine (fT4) and thyroid stimulating hormone (TSH) are most frequently measured when assessing thyroid function in pregnant women, whereas a broad spectrum of neurodevelopmental parameters is used to evaluate child neurodevelopment. The human data confirms an association between altered maternal serum fT4 and/or TSH and increased risk for child neurodevelopmental impairment. Quantitative boundaries of effects indicative of increased risks need to be established. Moreover, it is unknown if altered serum levels of total T4, free or total triiodothyronine, or parameters unrelated to serum thyroid hormones might be more relevant indicators of such effects. None of the human studies established a link between substance-mediated liver enzyme induction and increased serum thyroid hormone clearance, let alone further to child neurodevelopmental impairment. This review identifies research needs to contribute to the development of toxicity testing strategies, to reliably predict whether substances have the potential to impair child neurodevelopment via maternal thyroid hormone imbalance.
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Affiliation(s)
- Ursula G Sauer
- Scientific Consultancy - Animal Welfare, Neubiberg, Germany
| | | | | | | | | | | | - Sue Marty
- The Dow Chemical Company, Midland, MI, USA
| | | | - Joana A Palha
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimaraes, Portugal.,Clinical Academic Center, Braga, Portugal
| | | | | | - Gerard Swaen
- Department of Complex Genetics, Maastricht University, Maastricht, The Netherlands
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Iodine Status and Thyroid Function in a Group of Seaweed Consumers in Norway. Nutrients 2020; 12:nu12113483. [PMID: 33202773 PMCID: PMC7697291 DOI: 10.3390/nu12113483] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/05/2020] [Accepted: 11/11/2020] [Indexed: 12/13/2022] Open
Abstract
Seaweeds, or macroalgae, may be a good dietary iodine source but also a source of excessive iodine intake. The main aim in this study was to describe the iodine status and thyroid function in a group of macroalgae consumers. Two urine samples were collected from each participant (n = 44) to measure urinary iodine concentration (UIC) after habitual consumption of seaweed. Serum thyroid stimulating hormone (TSH), free thyroxine (fT4), free triiodothyronine (fT3), and peroxidase autoantibody (TPOAb), were measured in a subgroup (n = 19). A food frequency questionnaire and an iodine-specific 24 h recall were used to assess iodine intake and macroalgae consumption. The median (p25–p75) UIC was 1200 (370–2850) μg/L. Median (p25–p75) estimated dietary iodine intake, excluding macroalgae, was 110 (78–680) μg/day, indicating that seaweed was the major contributor to the iodine intake. TSH levels were within the reference values, but higher than in other comparable population groups. One third of the participants used seaweeds daily, and sugar kelp, winged kelp, dulse and laver were the most common species. Labelling of iodine content was lacking for a large share of the products consumed. This study found excessive iodine status in macroalgae consumers after intake of dietary seaweeds. Including macroalgae in the diet may give excessive iodine exposure, and consumers should be made aware of the risk associated with inclusion of macroalgae in their diet.
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Andersen SL, Andersen S. Turning to Thyroid Disease in Pregnant Women. Eur Thyroid J 2020; 9:225-233. [PMID: 33088790 PMCID: PMC7548846 DOI: 10.1159/000506228] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/28/2020] [Indexed: 12/14/2022] Open
Abstract
Thyroid disease in pregnant women needs attention from a clinical and scientific standpoint due to the potential severe adverse consequences. It is well-established that overt thyroid disease in pregnant women should be treated to prevent maternal and fetal complications, but routine testing for overt thyroid function test abnormalities has not been implemented. In contrast, the scientific focus has shifted towards smaller aberrations in maternal thyroid function including subclinical thyroid disease and isolated deviations in maternal thyroxine. In this focused review, we touch upon the assessment of maternal thyroid function in pregnancy and how the historical advancements in thyroid function tests parallel with the thyroid function test abnormalities described. Furthermore, we discuss how the scientific focus has evolved and how the field could turn in view of the existing discrepancies between results of observational studies and randomized controlled trials.
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Affiliation(s)
- Stine Linding Andersen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- *Stine Linding Andersen, Department of Clinical Biochemistry, Aalborg University Hospital, Hobrovej 18–22, DK–9000 Aalborg (Denmark),
| | - Stig Andersen
- Department of Geriatrics, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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69
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Aimuzi R, Luo K, Huang R, Huo X, Nian M, Ouyang F, Du Y, Feng L, Wang W, Zhang J. Perfluoroalkyl and polyfluroalkyl substances and maternal thyroid hormones in early pregnancy. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 264:114557. [PMID: 32388293 DOI: 10.1016/j.envpol.2020.114557] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND The development of the embryo and fetal brain depends on maternal transfer of thyroid hormones (THs) in early pregnancy. Perfluoroalkyl and polyfluoralkyl substances (PFAS) may disrupt maternal TH homeostasis in pregnancy, but findings from epidemiologic studies were inconsistent. We aimed to assess this relationship in early pregnancy in a large prospective cohort study. METHODS A total of 1885 pregnant women enrolled in the Shanghai Birth Cohort were used. Ten PFAS, free thyroxine (FT4), free triiodothyronine (FT3), thyroid stimulating hormone (TSH) and thyroid peroxidase antibody (TPOAb) were measured in maternal blood collected prior to 16 weeks of gestation. Multiple linear regression accompanied by restricted cubic spline was used to examine the association and the exposure-response relationship between each PFAS and TH in separate models. Possible effect modification by TPOAb status was also investigated. RESULTS Perfluorooctanoic acid [PFOA, β = 0.121, 95% confidence interval (CI): 0.015, 0.227] and perfluorohexane sulfonate (PFHxS, β = 0.123, 95% CI: 0.024, 0.222) were positively associated with FT4. Perfluorononanoic acid (PFNA, β = 0.179, 95% CI: 0.047, 0.311) and PFHxS (β = 0.197, 95% CI: 0.054, 0.339) were positively associated with FT3, while PFHxS was negatively associated with TSH (β = -0.115, 95%CI: 0.216, -0.014). TPOAb-positivity appeared to modify the associations between PFAS and THs. In TPOAb-positive women, several long-chain PFAS were positively associated with FT4 and/or FT3 and tended to be negatively associated with TSH. CONCLUSIONS Several long-chain PFAS were associated with disrupted TH homeostasis in Chinese pregnant women, especially among TPOAb-positive women.
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Affiliation(s)
- Ruxianguli Aimuzi
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China; School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Kai Luo
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China; School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Rong Huang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China
| | - Xiaona Huo
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China
| | - Min Nian
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China; School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Fengxiu Ouyang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China
| | - Yatao Du
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China
| | - Liping Feng
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China
| | - Weiye Wang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China; School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China.
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70
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Demeneix B, Vandenberg LN, Ivell R, Zoeller RT. Thresholds and Endocrine Disruptors: An Endocrine Society Policy Perspective. J Endocr Soc 2020; 4:bvaa085. [PMID: 33834149 PMCID: PMC8010901 DOI: 10.1210/jendso/bvaa085] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/07/2020] [Indexed: 12/16/2022] Open
Abstract
The concept of a threshold of adversity in toxicology is neither provable nor disprovable. As such, it is not a scientific question but a theoretical one. Yet, the belief in thresholds has led to traditional ways of interpreting data derived from regulatory guideline studies of the toxicity of chemicals. This includes, for example, the use of standard “uncertainty factors” when a “No Adverse Effect Level” (or similar “benchmark dose”) is either observed, or not observed. In the context of endocrine-disrupting chemicals (EDCs), this approach is demonstrably inappropriate. First, the efficacy of a hormone on different endpoints can vary by several orders of magnitude. This feature of hormone action also applies to EDCs that can interfere with that hormone. For this reason, we argue that the choice of endpoint for use in regulation is critical, but note that guideline studies were not designed with this in mind. Second, the biological events controlled by hormones in development not only change as development proceeds but are different from events controlled by hormones in the adult. Again, guideline endpoints were also not designed with this in mind, especially since the events controlled by hormones can be both temporally and spatially specific. The Endocrine Society has laid out this logic over several years and in several publications. Rather than being extreme views, they represent what is known about hormones and the chemicals that can interfere with them.
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Affiliation(s)
- Barbara Demeneix
- UMR 7221, Muséum National d´Histoire Naturelle, Département Régulation Développement et Diversité Moléculaire, Paris, France
| | - Laura N Vandenberg
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts-Amherst, Amherst, Massachusetts
| | - Richard Ivell
- School of Biosciences, University of Nottingham, Sutton Bonington, UK
| | - R Thomas Zoeller
- Morrill Science Center, Department of Biology, University of Massachusetts-Amherst, Amherst Massachusetts.,School of Science and Technology, Örebro University, Örebro Sweden
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71
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Psychiatric Disorders in the Adolescent Offspring of Mothers with Thyroid Problems During Pregnancy. Child Psychiatry Hum Dev 2020; 51:461-470. [PMID: 32008126 DOI: 10.1007/s10578-020-00957-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Maternal thyroid problems during pregnancy have been linked to neurocognitive impairments in children. While studies suggest that disorders of maternal thyroid function during pregnancy are associated with symptoms of mental health problems in children, little is known about the risk of clinically significant psychiatric disorders in adolescence. A sample of 2451 Canadian adolescents enrolled in the Ontario Child Health Study completed the Mini International Neuropsychiatric Interview for Children and Adolescents at 12-17 years of age. Their mothers self-reported thyroid problems during pregnancy. Gestational thyroid problems were associated with offspring oppositional defiant disorder (ODD; OR 3.73; 95% CI 1.69-8.24), conduct disorder (CD; OR 12.95; 95% CI 5.12-32.75), and social anxiety disorder (SAD; OR 6.25; 95% CI 2.53-15.47). Neither sex nor gestational age moderated associations between prenatal thyroid dysfunction and the majority of outcomes. School performance mediated 8% of the association between thyroid problems and SAD, 21% for CD and 53% for ODD.
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Huget-Penner S, Feig DS. Maternal thyroid disease and its effects on the fetus and perinatal outcomes. Prenat Diagn 2020; 40:1077-1084. [PMID: 32181913 DOI: 10.1002/pd.5684] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/06/2020] [Accepted: 03/07/2020] [Indexed: 12/17/2022]
Abstract
Thyroid disease is common in women of childbearing age and can have significant effects on the development of the fetus and perinatal outcomes. Maternal thyroid hormone is critical for proper fetal neurodevelopment, and the fetus relies on thyroid hormone from its mother for the first half of pregnancy. Both overt maternal hypothyroidism and overt maternal hyperthyroidism have been shown to be associated with adverse effects on central nervous system gray matter and neurocognitive development of offspring as well as increased obstetrical risks. Treatment of overt thyroid conditions improves outcomes. Subclinical maternal hypothyroidism may increase adverse neurocognitive and obstetrical outcomes although data are conflicting. To date, treatment of subclinical hypothyroidism has not shown benefit. Subclinical hyperthyroidism is well tolerated in pregnancy. Thyroid autoantibodies alone may also affect neurodevelopment and obstetrical outcomes; however, recent data have shown no improvement with levothyroxine treatment. Several rare maternal genetic thyroid conditions can affect the fetus including a thyroid-stimulating hormone receptor mutation leading to hypersensitivity to human chorionic gonadotropin and thyroid hormone resistance. The thyroid plays a crucial role in fetal health and understanding it is important for optimal care.
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Affiliation(s)
- Sawyer Huget-Penner
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Endocrinology, Department of Medicine, Fraser Health Authority, New Westminster, British Columbia, Canada
| | - Denice S Feig
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
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73
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Korevaar TI. Levothyroxine Overtreatment During Pregnancy Is Associated with a Higher Risk of Adverse Child Mental Health Outcomes. Thyroid 2020. [DOI: 10.1089/ct.2020;32.20-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Tim I.M. Korevaar
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus University, Medical Center, Rotterdam, The Netherlands
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74
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Chen GD, Pang TT, Lu XF, Li PS, Zhou ZX, Ye SX, Yang J, Shen XY, Lin DX, Fan DZ, Lu DM, Liu ZP. Associations Between Maternal Thyroid Function and Birth Outcomes in Chinese Mother-Child Dyads: A Retrospective Cohort Study. Front Endocrinol (Lausanne) 2020; 11:611071. [PMID: 33613448 PMCID: PMC7892893 DOI: 10.3389/fendo.2020.611071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/10/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Although research suggests a close association between maternal thyroid function and birth outcomes, no clear conclusion has been reached. We aimed to explore this potential association in a retrospective cohort study. METHODS This study included 8985 mother-child dyads. The maternal serum free tetraiodothyronine (FT4), thyroid-stimulating hormone (TSH), and thyroid peroxidase antibody (TPO Ab) concentrations and birth outcome data were reviewed from medical records. Subjects with TPO Ab concentrations of >34 and ≤34 IU/ml were classified into the TPO Ab positivity (+) and TPO Ab negativity (-) groups, respectively. RESULTS Compared with subjects in the normal group (0.1 ≤ TSH < 2.5 mIU/L and TPO Ab-), those with TSH concentrations of 2.5-4.0 mIU/L and TPO Ab- had a 0.65-fold lower risk of low birth weight (LBW). In contrast, those with TSH concentrations of >4.0 mIU/L, regardless of the TPO Ab status, had a 2.01-fold increased risk of LBW. Subclinical hypothyroidism, regardless of the TPO Ab status, was associated with a 1.94-fold higher risk of LBW when compared with that in subjects with euthyroidism and TPO Ab-. No other significant associations were observed. CONCLUSION A maternal TSH concentration of 2.5-4.0 mIU/L was associated with a lower risk of LBW when combined with TPO Ab-, whereas subjects with a TSH concentration of >4.0 mIU/L had an increased risk of LBW. Subclinical hypothyroidism appears to be associated with a higher risk of LBW.
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Affiliation(s)
- Geng-Dong Chen
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity and Child Healthcare Hospital, Southern Medical University, Foshan, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Ting-Ting Pang
- Department of Medical Records, Affiliated Foshan Maternity and Child Healthcare Hospital, Southern Medical University, Foshan, China
| | - Xia-Fen Lu
- Department of Obstetrics, Affiliated Foshan Maternity and Child Healthcare Hospital, Southern Medical University, Foshan, China
| | - Peng-Sheng Li
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity and Child Healthcare Hospital, Southern Medical University, Foshan, China
| | - Zi-Xing Zhou
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity and Child Healthcare Hospital, Southern Medical University, Foshan, China
| | - Shao-Xin Ye
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity and Child Healthcare Hospital, Southern Medical University, Foshan, China
| | - Jie Yang
- Department of Obstetrics, Affiliated Foshan Maternity and Child Healthcare Hospital, Southern Medical University, Foshan, China
| | - Xiu-Yin Shen
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity and Child Healthcare Hospital, Southern Medical University, Foshan, China
| | - Dong-Xin Lin
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity and Child Healthcare Hospital, Southern Medical University, Foshan, China
| | - Da-Zhi Fan
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity and Child Healthcare Hospital, Southern Medical University, Foshan, China
| | - De-Mei Lu
- Department of Obstetrics, Affiliated Foshan Maternity and Child Healthcare Hospital, Southern Medical University, Foshan, China
- *Correspondence: De-Mei Lu, ; Zheng-Ping Liu,
| | - Zheng-Ping Liu
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity and Child Healthcare Hospital, Southern Medical University, Foshan, China
- *Correspondence: De-Mei Lu, ; Zheng-Ping Liu,
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75
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Milczarek-Banach J, Rachoń D, Bednarczuk T, Myśliwiec-Czajka K, Wasik A, Miśkiewicz P. Exposure to Bisphenol A Analogs and the Thyroid Function and Volume in Women of Reproductive Age-Cross-Sectional Study. Front Endocrinol (Lausanne) 2020; 11:587252. [PMID: 33542704 PMCID: PMC7851079 DOI: 10.3389/fendo.2020.587252] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 12/01/2020] [Indexed: 12/24/2022] Open
Abstract
Bisphenols (BPs) are commonly known plastifiers that are widely used in industry. The knowledge about the impact of BPs on thyroid function is scarce. Proper thyroid functioning is especially important for women of reproductive age, as hypothyroidism affects fertility, pregnancy outcomes and the offspring. There are no studies analyzing the influence of BPs on thyroid function and volume in non-pregnant young women. The aim of this cross-sectional study was to evaluate the relationship between bisphenol A and its 10 analogs (BPS, BPC, BPE, BPF, BPG, BPM, BPP, BPZ, BPFL, and BPBP) on thyroid function and volume in women of reproductive age. Inclusion criteria were: female sex, age 18-40 years. Exclusion criteria were history of any thyroid disease, pharmacotherapy influencing thyroid function, pregnancy or puerperium, and diagnosis of autoimmune thyroid disease during this study. Venous blood was drawn for measurement of thyrotropin (TSH), free thyroxine, thyroid peroxidase antibodies, thyroglobulin antibodies, BPs. Urine samples were analyzed for: ioduria and BPs. Ultrasound examination of thyroid gland was performed. One hundred eighty participants were included into the study. A negative correlation was found between urine BPC and the thyroid volume (R = -0.258; p = 0.0005). Patients with detected urine BPC presented smaller thyroid glands than those with not-detected urine BPC (p = 0.0008). A positive correlation was found between TSH and urine BPC (R = 0.228; p = 0.002). Patients with detected urine BPC presented higher concentrations of TSH versus those with not-detected urine BPC (p = 0.003). There were no relationships between any of serum BPs as well as the other urine BPs and thyroid function and its volume. The only BP that demonstrated the relationship between thyroid function and its volume was BPC, probably because of its chemical structure that most resembles thyroxine. Exposure to this BP may result in the development of hypothyroidism that could have a negative impact on pregnancy and the offspring.
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Affiliation(s)
| | - Dominik Rachoń
- Department of Clinical and Experimental Endocrinology, Medical University of Gdańsk, Gdańsk, Poland
| | - Tomasz Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | | | - Andrzej Wasik
- Department of Analytical Chemistry, Chemical Faculty, Gdańsk University of Technology, Gdańsk, Poland
| | - Piotr Miśkiewicz
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
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76
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Korevaar TIM, Derakhshan A, Taylor PN, Meima M, Chen L, Bliddal S, Carty DM, Meems M, Vaidya B, Shields B, Ghafoor F, Popova PV, Mosso L, Oken E, Suvanto E, Hisada A, Yoshinaga J, Brown SJ, Bassols J, Auvinen J, Bramer WM, López-Bermejo A, Dayan C, Boucai L, Vafeiadi M, Grineva EN, Tkachuck AS, Pop VJM, Vrijkotte TG, Guxens M, Chatzi L, Sunyer J, Jiménez-Zabala A, Riaño I, Murcia M, Lu X, Mukhtar S, Delles C, Feldt-Rasmussen U, Nelson SM, Alexander EK, Chaker L, Männistö T, Walsh JP, Pearce EN, Steegers EAP, Peeters RP. Association of Thyroid Function Test Abnormalities and Thyroid Autoimmunity With Preterm Birth: A Systematic Review and Meta-analysis. JAMA 2019; 322:632-641. [PMID: 31429897 PMCID: PMC6704759 DOI: 10.1001/jama.2019.10931] [Citation(s) in RCA: 188] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 07/08/2019] [Indexed: 01/27/2023]
Abstract
Importance Maternal hypothyroidism and hyperthyroidism are risk factors for preterm birth. Milder thyroid function test abnormalities and thyroid autoimmunity are more prevalent, but it remains controversial if these are associated with preterm birth. Objective To study if maternal thyroid function test abnormalities and thyroid autoimmunity are risk factors for preterm birth. Data Sources and Study Selection Studies were identified through a search of the Ovid MEDLINE, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, and Google Scholar databases from inception to March 18, 2018, and by publishing open invitations in relevant journals. Data sets from published and unpublished prospective cohort studies with data on thyroid function tests (thyrotropin [often referred to as thyroid-stimulating hormone or TSH] and free thyroxine [FT4] concentrations) or thyroid peroxidase (TPO) antibody measurements and gestational age at birth were screened for eligibility by 2 independent reviewers. Studies in which participants received treatment based on abnormal thyroid function tests were excluded. Data Extraction and Synthesis The primary authors provided individual participant data that were analyzed using mixed-effects models. Main Outcomes and Measures The primary outcome was preterm birth (<37 weeks' gestational age). Results From 2526 published reports, 35 cohorts were invited to participate. After the addition of 5 unpublished data sets, a total of 19 cohorts were included. The study population included 47 045 pregnant women (mean age, 29 years; median gestational age at blood sampling, 12.9 weeks), of whom 1234 (3.1%) had subclinical hypothyroidism (increased thyrotropin concentration with normal FT4 concentration), 904 (2.2%) had isolated hypothyroxinemia (decreased FT4 concentration with normal thyrotropin concentration), and 3043 (7.5%) were TPO antibody positive; 2357 (5.0%) had a preterm birth. The risk of preterm birth was higher for women with subclinical hypothyroidism than euthyroid women (6.1% vs 5.0%, respectively; absolute risk difference, 1.4% [95% CI, 0%-3.2%]; odds ratio [OR], 1.29 [95% CI, 1.01-1.64]). Among women with isolated hypothyroxinemia, the risk of preterm birth was 7.1% vs 5.0% in euthyroid women (absolute risk difference, 2.3% [95% CI, 0.6%-4.5%]; OR, 1.46 [95% CI, 1.12-1.90]). In continuous analyses, each 1-SD higher maternal thyrotropin concentration was associated with a higher risk of preterm birth (absolute risk difference, 0.2% [95% CI, 0%-0.4%] per 1 SD; OR, 1.04 [95% CI, 1.00-1.09] per 1 SD). Thyroid peroxidase antibody-positive women had a higher risk of preterm birth vs TPO antibody-negative women (6.6% vs 4.9%, respectively; absolute risk difference, 1.6% [95% CI, 0.7%-2.8%]; OR, 1.33 [95% CI, 1.15-1.56]). Conclusions and Relevance Among pregnant women without overt thyroid disease, subclinical hypothyroidism, isolated hypothyroxinemia, and TPO antibody positivity were significantly associated with higher risk of preterm birth. These results provide insights toward optimizing clinical decision-making strategies that should consider the potential harms and benefits of screening programs and levothyroxine treatment during pregnancy.
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Affiliation(s)
- T I M Korevaar
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Arash Derakhshan
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Peter N Taylor
- Thyroid Research Group, Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, England
| | - Marcel Meima
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Liangmiao Chen
- Department of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Sofie Bliddal
- Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - David M Carty
- Department of Diabetes, Endocrinology, and Clinical Pharmacology, Glasgow Royal Infirmary, Glasgow, Scotland
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Margreet Meems
- Departments of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, University of Exeter Medical School, Exeter, England
| | - Beverley Shields
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, England
| | - Farkhanda Ghafoor
- National Health Research Complex, Shaikh Zayed Medical Complex, Lahore, Pakistan
| | - Polina V Popova
- Almazov National Medical Research Centre, St Petersburg, Russia
- Department of Internal Diseases and Endocrinology, St Petersburg Pavlov State Medical University, St Petersburg, Russia
| | - Lorena Mosso
- Department of Endocrinology, Pontificia Universidad Catolica de Chile, Santiago
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
- Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Eila Suvanto
- Department of Obstetrics and Gynecology and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Aya Hisada
- Center for Preventive Medical Science, Chiba University, Chiba, Japan
| | - Jun Yoshinaga
- Faculty of Life Sciences, Toyo University, Gunma, Japan
| | - Suzanne J Brown
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Judit Bassols
- Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute, Dr Josep Trueta Hospital, Girona, Spain
| | - Juha Auvinen
- Medical Research Center Oulu, Oulu University Hospital, Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Wichor M Bramer
- Medical Library, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Abel López-Bermejo
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute, Dr Josep Trueta Hospital, Girona, Spain
| | - Colin Dayan
- Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, England
| | - Laura Boucai
- Division of Endocrinology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell University, New York, New York
| | - Marina Vafeiadi
- Department of Social Medicine, University of Crete, Heraklion, Greece
| | - Elena N Grineva
- Almazov National Medical Research Centre, St Petersburg, Russia
- Department of Internal Diseases and Endocrinology, St Petersburg Pavlov State Medical University, St Petersburg, Russia
| | - Alexandra S Tkachuck
- Almazov National Medical Research Centre, St Petersburg, Russia
- Department of Internal Diseases and Endocrinology, St Petersburg Pavlov State Medical University, St Petersburg, Russia
| | - Victor J M Pop
- Departments of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
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Vermiglio F, Moleti M. Maternal thyroid function and brain development: time for preconception screening? Lancet Diabetes Endocrinol 2019; 7:589-590. [PMID: 31262705 DOI: 10.1016/s2213-8587(19)30185-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Francesco Vermiglio
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy.
| | - Mariacarla Moleti
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
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