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Chen A, Luo Z, Zhang J, Cao X. Emerging research themes in maternal hypothyroidism: a bibliometric exploration. Front Immunol 2024; 15:1370707. [PMID: 38596686 PMCID: PMC11002152 DOI: 10.3389/fimmu.2024.1370707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/12/2024] [Indexed: 04/11/2024] Open
Abstract
Background Hypothyroidism, a prevalent endocrine disorder, carries significant implications for maternal and infant health, especially in the context of maternal hypothyroidism. Despite a gradual surge in recent research, achieving a comprehensive understanding of the current state, focal points, and developmental trends in this field remains challenging. Clarifying these aspects and advancing research could notably enhance maternal-infant health outcomes. Therefore, this study employs bibliometric methods to systematically scrutinize maternal hypothyroidism research, serving as a reference for further investigations. Objective Through bibliometric analysis, this study seeks to unveil key research focus areas, developmental trends, and primary contributors in Maternal Hypothyroidism. The findings offer insights and recommendations to inform future research endeavors in this domain. Methods Literature metrics analysis was performed on data retrieved and extracted from the Web of Science Core Collection database. The analysis examined the evolution and thematic trends of literature related to Maternal Hypothyroidism. Data were collected on October 28, 2023, and bibliometric analysis was performed using VOSviewer, CiteSpace, and the Bibliometrix software package, considering specific characteristics such as publication year, country/region, institution, authorship, journals, references, and keywords. Results Retrieved from 1,078 journals, 4,184 articles were authored by 18,037 contributors in 4,580 institutions across 113 countries/regions on six continents. Maternal Hypothyroidism research publications surged from 44 to 310 annually, a 604.54% growth from 1991 to 2022. The USA (940 articles, 45,233 citations), China Medical University (82 articles, 2,176 citations), and Teng, Weiping (52 articles, 1,347 citations) emerged as the most productive country, institution, and author, respectively. "Thyroid" topped with 233 publications, followed by "Journal of Clinical Endocrinology & Metabolism" (202) with the most citations (18,513). "Pregnancy" was the most cited keyword, with recent high-frequency keywords such as "outcome," "gestational diabetes," "iodine intake," "preterm birth," "guideline," and "diagnosis" signaling emerging themes in Maternal Hypothyroidism. Conclusions This study unveils developmental trends, global collaboration patterns, foundational knowledge, and emerging frontiers in Maternal Hypothyroidism. Over 30 years, research has predominantly focused on aspects like diagnosis, treatment guidelines, thyroid function during pregnancy, and postpartum outcomes, with a central emphasis on the correlation between maternal and fetal health.
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Affiliation(s)
- Ailing Chen
- Research Institute for Reproductive Health and Genetic Diseases, Women’s Hospital of Jiangnan University, Wuxi Maternity and Child Health Care Hospital, Wuxi, China
| | - Zouqing Luo
- Department of Obstetrics, Women’s Hospital of Jiangnan University, Wuxi Maternity and Child Health Care Hospital, Wuxi, China
| | - Jinqiu Zhang
- Department of Pathology, Women’s Hospital of Jiangnan University, Wuxi Maternity and Child Health Care Hospital, Wuxi, China
| | - Xiaohui Cao
- Department of Obstetrics, Women’s Hospital of Jiangnan University, Wuxi Maternity and Child Health Care Hospital, Wuxi, China
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Herman T, Török P, Laganà AS, Chiantera V, Venezia R, Jakab A. Hashimoto's Thyroiditis Negatively Influences Intracytoplasmic Sperm Injection Outcome in Euthyroid Women on T4 Substitution Therapy: A Retrospective Study. Gynecol Obstet Invest 2024; 89:150-158. [PMID: 38368857 DOI: 10.1159/000537836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/10/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE The objective of this study was to analyze the impact of thyroid autoimmunity (TAI) on reproductive outcome parameters of intracytoplasmic sperm injection (ICSI) cycles as compared to TAI-negative ICSI cycles. DESIGN In this single in vitro fertilization (IVF) center retrospective study, 86 infertile women with elevated thyroid peroxidase or TGAb levels, but euthyroid after thyroxine replacement (study group), were compared to 69 female patients with no thyroid abnormalities (controls). Following ICSI treatment fertilization rate (FR), clinical pregnancy rate (CPR), miscarriage rate (MR), and live birth rate (LBR) were analyzed. MATERIALS, SETTING, METHODS All subjects with various infertility factors were treated with ICSI in university-based IVF center. Patients in the study group received thyroxine replacement and were euthyroid at IVF treatment. Before the IVF cycles, endocrinological parameters were uniformly assessed: thyroid function and antibodies, reproductive hormones (anti-Müllerian hormone [AMH], follicular stimulating hormone [FSH], luteinizing hormone, E2, PRL, testosterone, DHEAS, 17-OHP, AD) and OGTT (0-60-120 min glucose and insulin). Following descriptive comparison of laboratory parameters, age-adjusted analyses of FR, CPR, MR, and LBR were performed. RESULTS TAI-positive women were older (mean age 35.31 ± 4.95 vs. 32.15 ± 4.87 years; p = 0.002), had higher FSH (8.4 ± 3.4 vs. 7.4 ± 2.32 U/L; p = 0.024), higher E2 (53.94 ± 47.61 vs. 42.93 ± 18.92 pg/mL; p = 0.025) levels, while AMH (2.88 ± 2.62 vs. 3.61 ± 1.69 ng/mL; p = 0.0002) was lower. There were no differences in TSH levels (1.64 ± 0.96 vs. 1.66 ± 0.65 µIU/mL; p = 0.652) between the two groups. FT3 (2.63 ± 0.58 vs. 2.98 ± 0.55 pg/mL; p = 0.002) was lower and FT4 (1.3 ± 0.29 vs. 1.13 ± 0.21 ng/dL; p = 0.0002) was higher in the TAI-positive group, reflecting clinically irrelevant differences. Egg cell counts (6 ± 3.8 vs. 7.5 ± 3.95; p = 0.015) were lower in TAI and remained so following age adjustment. Although the overall ICSI FR did not differ (62.9% vs. 69.1%, p = 0.12), it was lower for patients under 35 with TAI showing decreasing differences in line with age. The CPR (36.04% vs. 69.56%; p < 0.001) and LBR (23.25% vs. 60.86%; p < 0.001) were lower, the MR (35.48% vs. 12.5%; p = 0.024) was higher in the TAI group, and these differences remained after age adjustment. LIMITATIONS Since the higher age of the study group may interfere with the effect of TAI, age adjustment calculations were necessary to perform to eliminate this confounding factor. CONCLUSION Despite optimal thyroid supplementation in clinical or subclinical hypothyroidism, the presence of TAI negatively influences CPR and is connected to a higher MR, thus resulting in a lower LBR after ICSI. Decreased FR with ICSI in TAI patients may also contribute to poorer outcomes, especially in younger women.
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Affiliation(s)
- Tünde Herman
- Assisted Reproduction Center, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Péter Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Renato Venezia
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Attila Jakab
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Zhang J, Song Z, Yuan H, Cai ZH. The effects of metabolic indicators and immune biomarkers on pregnancy outcomes in women with recurrent spontaneous abortion: a retrospective study. Front Endocrinol (Lausanne) 2024; 14:1297902. [PMID: 38298186 PMCID: PMC10827934 DOI: 10.3389/fendo.2023.1297902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024] Open
Abstract
Background The etiology of recurrent spontaneous abortion (RSA) remains elusive despite specific investigations affirming the association between RSA and thyroid autoimmunity (TAI). This study explores the immunological and metabolic profiles of RSA patients exhibiting positive thyroid antibodies and their connection with the rates of first-trimester miscarriage and live births. The aim is to provide further guidance for clinical interventions. Methods A retrospective analysis included 478 women with RSA. Thyroid profile, thyroid peroxidase antibodies, and anti-thyroglobulin antibodies were measured in all participants. The clinical characteristics and pregnancy outcomes of RSA women were compared between thyroid autoimmunity (TAI)-positive and TAI-negative patients. Significant factors associated with adverse pregnancy outcomes and risk prediction models were explored in TAI-positive patients. Correlation analysis was used to identify specific metabolic or immune biomarkers associated with thyroid autoantibodies. Results The prevalence of TAI was 18.6%. Compared with women without TAI, the thyroid-stimulating hormone (TSH) concentration of TAI-positive RSA was significantly higher (2.80 ± 2.98 vs 1.89 ± 1.17, p=0.006). After 28 weeks, the live birth rate of the TAI-positive group was lower than that of the TAI-negative group, with statistical significance (p<0.05). The immune biomarkers that differed between RSA women with live births and those with first-trimester miscarriages were complement C4 and interleukin-6, respectively, in TAI-negative and TAI-positive women. Then, a risk prediction model for first-trimester miscarriage was constructed for TAI-positive women with an AUC of 0.81. Finally, some factors related to thyroid peroxidase antibody (TPO-Ab) levels were explored, and it was found that TPO-Ab levels were positively correlated with free thyroxine and negatively correlated with 25 hydroxyvitamin D, interleukin-4, and fasting blood glucose in RSA patients. Conclusion TAI-positive RSA patients have higher first-trimester miscarriage rates and a lower live birth rate, which may be related to metabolic immune shifts in TAI-positive RSA patients.
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Affiliation(s)
- Jie Zhang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhan Song
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hui Yuan
- Key Laboratory of Digital Technology in Medical Diagnostics of Zhejiang Province, Dian Diagnostics Group Co., Ltd., Hangzhou, Zhejiang, China
| | - Zhu-Hua Cai
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Zhang S, Yang M, Li T, Yang M, Wang W, Chen Y, Ding Y, Liu J, Xu X, Zhang J, Wang Z, Liu J. High level of thyroid peroxidase antibodies as a detrimental risk of pregnancy outcomes in euthyroid women undergoing ART: A meta-analysis. Mol Reprod Dev 2023; 90:218-226. [PMID: 36922915 DOI: 10.1002/mrd.23677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/27/2022] [Accepted: 02/08/2023] [Indexed: 03/18/2023]
Abstract
Thyroid autoimmunity (TAI) triggered by genetic and epigenetic variation occurs mostly in women of reproductive age. TAI is described mainly by positivity of anti-thyroid peroxidase antibody (TPO-Ab) and/or thyroglobulin antibody (TG-Ab). TPO-Ab, but not TG-Ab, was suggested to be associated with pregnancy outcome in euthyroid women undergoing assisted reproductive technology (ART), but their results are conflicting. This meta-analysis was performed to decide whether the presence of TPO-Ab-in a concentration dependent manner-correlates with the success of ART. A systematic literature search was performed in the PubMed, Web of Science, and EMBASE databases for relevant articles published from January 1999 to April 2022, and these studies focused on the effect of TAI on pregnancy outcomes of women who underwent in vitro fertilization, intracytoplasmic sperm injection and intrauterine insemination and met the inclusion criteria: (i) the studies were prospective or retrospective study; (ii) all patients undergoing ART were tested for thyroid-related antibodies; (iii) the assessed ART outcomes included miscarriage rate (MR) or delivery rate (DR). The exclusion criteria were: (i) female congenital uterine malformation, chromosomal diseases and other infectious diseases; (ii) overt hypothyroidism or pre-existing thyroid disease; (iii) thrombus tendency. We divided the included patients into three groups according to the TPO-Ab threshold they defined: (i) TPO-Ab (-), threshold <34 IU/mL; (ii) TPO-Ab-34, threshold >34 IU/mL; (iii) TPO-Ab-100, threshold >100 IU/mL. We then extracted necessary relevant data, including MR and DR. Egger's test was used to evaluate the risk of publication bias. This meta-analysis included a total of 7 literatures involving 7466 patients with TAI (-) and 965 patients with TAI (+) and revealed that there was no significant difference between group TPO-Ab-34 and group TPO-Ab (-) in MR [risk ratio (RR): 0.61 (0.35, 1.08), p = 0.09] and DR [RR: 0.97 (0.83, 1.13), p = 0.69]. By contrast, compared to TPO-Ab (-) group, TPO-Ab-100 patients showed markedly higher MR [RR: 2.12 (1.52, 2.96), p = 0.0046], and lower DR [RR: 0.66 (0.49, 0.88), p < 0.0001] with high degree of statistical significance. This meta-analysis suggests that, for euthyroid patients, high level of TPO-Ab (>100 IU/mL) could adversely influence the pregnancy outcome of ART.
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Affiliation(s)
- Sudan Zhang
- Department of Reproductive Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Mingdong Yang
- Department of Rheumatology and Immunology, Shouguang People's Hospital, Shouguang, Shandong, China
| | - Teng Li
- Qingdao Branch of SJTU Bio-X Institutes, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,Department of Toxicology, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Min Yang
- Department of Internal Medicine, The People's Hospital of Shinan District, Qingdao, Shandong, China
| | - Wei Wang
- Department of Reproductive Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yunqing Chen
- Department of Reproductive Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yu Ding
- Department of Reproductive Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jianxin Liu
- Department of Reproductive Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiaohui Xu
- Department of Genetics and Cell Biology, Basic Medical College, Qingdao University, Qingdao, Shandong, China
| | - Jian Zhang
- Department of Cell Biology, Yale Stem Cell Center, Yale University, New Haven, Connecticut, USA
| | - Zheng Wang
- Department of Reproductive Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,Department of Genetics and Cell Biology, Basic Medical College, Qingdao University, Qingdao, Shandong, China
| | - Jiane Liu
- Department of Reproductive Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,Department of Genetics and Cell Biology, Basic Medical College, Qingdao University, Qingdao, Shandong, China
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Guo J, Yu X, Liu Y, Lu L, Zhu D, Zhang Y, Li L, Zhang P, Gao Q, Lu X, Sun M. Prenatal hypothyroidism diminished exogenous NO-mediated diastolic effects in fetal rat thoracic aorta smooth muscle via increased oxidative stress. Reprod Toxicol 2022; 113:52-61. [PMID: 35970333 DOI: 10.1016/j.reprotox.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
Abstract
Maternal hypothyroidism is an important problem of modern healthcare and is reported to increase the risk of cardiovascular diseases in the offspring later in life. However, it is unclear whether hypothyroidism during pregnancy causes vascular damage in the fetal period. We established the prenatal hypothyroidism rat model and collected the fetuses at the 21th day of gestation (GD21). Thyroid hormone concentrations in maternal and offspring blood serum were assessed by enzyme-linked immunosorbent assay (ELISA). The thoracic aortas of the fetuses were isolated for microvessel functional testing and histochemical stainings. qPCR and Western blot were performed to access mRNA and protein expression. We found that the concentrations of thyroid hormones in the serum of pregnant rats and fetuses were significantly suppressed at GD21. The responses of the fetal thoracic aortas to SNP were significantly attenuated in the PTU group. However, no statistical difference was found between the two groups when treated with either inhibitor (ODQ) or activator (BAY58-2667) of sGC. The production of O2-• in the arterial wall was significantly increased in hypothyroid fetuses. Moreover, the level of NADPH oxidase (NOX) was increased, while superoxide dismutase 2 (SOD2) was down-regulated in the PTU group, ultimately contributing to the increased production of superoxide. Additionally, decreased SNP-mediated vasodilation found in fetal vessels was improved by either NOX inhibitor (Apocynin) or SOD mimic (Tempol). These results indicate that increased oxidative stress is probably the cause of the diminished diastolic effect of exogenous NO in the thoracic artery of prenatal hypothyroidism exposed fetuses.
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Affiliation(s)
- Jun Guo
- Institute for Fetology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu 215006, China
| | - Xi Yu
- Institute for Fetology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu 215006, China
| | - Yanping Liu
- Institute for Fetology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu 215006, China
| | - Likui Lu
- Institute for Fetology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu 215006, China
| | - Dan Zhu
- Institute for Fetology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu 215006, China
| | - Yingying Zhang
- Institute for Fetology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu 215006, China
| | - Lingjun Li
- Institute for Fetology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu 215006, China
| | - Pengjie Zhang
- Institute for Fetology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu 215006, China
| | - Qinqin Gao
- Institute for Fetology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu 215006, China
| | - Xiyuan Lu
- Institute for Fetology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu 215006, China.
| | - Miao Sun
- Institute for Fetology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu 215006, China.
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Kent NL, Atluri SC, Cuffe JSM. Maternal Hypothyroidism in Rats Reduces Placental Lactogen, Lowers Insulin Levels, and Causes Glucose Intolerance. Endocrinology 2022; 163:6429715. [PMID: 34791119 DOI: 10.1210/endocr/bqab231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Indexed: 11/19/2022]
Abstract
Hypothyroidism increases the incidence of gestational diabetes mellitus (GDM) but the mechanisms responsible are unknown. This study aimed to assess the pathophysiological mechanisms by which hypothyroidism leads to glucose intolerance in pregnancy. Hypothyroidism was induced in female Sprague-Dawley rats by adding methimazole (MMI) to drinking water at moderate (MOD, MMI at 0.005% w/v) and severe (SEV, MMI at 0.02% w/v) doses from 1 week before pregnancy and throughout gestation. A nonpregnant cohort received the same dose for the same duration but were not mated. On gestational day 16 (GD16), or nonpregnant day 16 (NP16), animals were subjected to an intraperitoneal glucose tolerance test. Tissues and blood samples were collected 4 days later. Hypothyroidism induced a diabetic-like phenotype by GD16 in pregnant females only. Pregnant MOD and SEV females had reduced fasting plasma insulin, less insulin following a glucose load, and altered expression of genes involved in insulin signaling within skeletal muscle and adipose tissue. Hypothyroidism reduced rat placental lactogen concentrations, which was accompanied by reduced percentage β-cell cross-sectional area (CSA) relative to total pancreas CSA, and a reduced number of large β-cell clusters in the SEV hypothyroid group. Plasma triglycerides and free fatty acids were reduced by hypothyroidism in pregnant rats, as was the expression of genes that regulate lipid homeostasis. Hypothyroidism in pregnant rats results in a diabetic-like phenotype that is likely mediated by impaired β-cell expansion in pregnancy. This pregnancy-specific phenomenon is likely due to reduced placental lactogen secretion.
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Affiliation(s)
- Nykola Louise Kent
- School of Biomedical Sciences, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Sharat Chandra Atluri
- School of Biomedical Sciences, The University of Queensland, Brisbane, Queensland 4072, Australia
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Hamad A, Alhalabi N, Nmr N, Abbas F, Al-Hammami H, Ibrahim N, Alhalabi M. Impact of Thyroid Autoimmunity in euthyroid women on the outcomes of In Vitro Fertilization. Ann Med Surg (Lond) 2021; 67:102473. [PMID: 34178319 PMCID: PMC8214029 DOI: 10.1016/j.amsu.2021.102473] [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] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Infertility is inadequately acknowledged as a problem in developing countries. Thyroid Autoimmunity (TAI) has been neatly investigated for its association with unfavorable pregnancy and reproductive consequences. We aim to evaluate Clinical Pregnancy Rate (CPR) as a primary outcome following In Vitro Fertilization/Intra Cytoplasmic Sperm Injection (IVF/ICSI) in women with Thyroid Autoimmunity (TAI). METHODS A Retrospective cohort study included 584 women who underwent IVF/ICSI treatment between November 2012 and April 2017 in Orient Hospital, Damascus, Syria. Patients were tested for TAI before IVF/ICSI procedure. RESULTS CPR did not significantly differ between TAI positive and TAI negative groups (p > 0.05). Subgroup analysis for only primary infertility patients showed a statistically significant difference in CPR between TAI positive and TAI negative groups. CONCLUSION Although several arguments were in favor of the relation between IVF/ICSI outcomes and Thyroid autoimmune disease, the presence of TAI positivity did not adversely affect the clinical pregnancy rate.
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Affiliation(s)
- Ahed Hamad
- Faculty of Medicine, Damascus University, Damascus, Syria
- Al-Zahrawi Maternity Hospital, Damascus, Syria
| | - Nawras Alhalabi
- Faculty of Medicine, Damascus University, Damascus, Syria
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Nazht Nmr
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Fatima Abbas
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Hisham Al-Hammami
- Department of Obstetrics and Gynecology, Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Nazir Ibrahim
- Department of Internal Medicine, Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Marwan Alhalabi
- Division of Reproductive Medicine, Embryology and Genetics, Faculty of Medicine, Damascus University, Damascus, Syria
- Assisted Reproduction Unit, Orient Hospital, Damascus, Syria
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Abstract
Both thyrotoxicosis and hypothyroidism are associated with adverse pregnancy outcomes. There also is concern about the effect of overt maternal thyroid disease on fetal development. In addition, medications that affect the maternal thyroid gland can cross the placenta and affect the fetal thyroid gland. This document reviews the thyroid-related pathophysiologic changes that occur during pregnancy and the effects of overt and subclinical maternal thyroid disease on maternal and fetal outcomes. This Practice Bulletin has been updated with information on the diagnosis and the management of thyroid disease in pregnant women and includes a new clinical algorithm on management of thyroid disease in pregnancy.
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Valores de referencia de hormonas tiroideas en la población de gestantes en Lugo. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2020. [DOI: 10.1016/j.gine.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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10
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Abstract
Thyroid autoimmunity (TAI) is prevalent amongst women of reproductive age. TAI describes the presence of circulating anti-thyroid autoantibodies that are targeted against the thyroid, with or without thyroid dysfunction. Thyroid peroxidase antibodies (TPOAb) are the most common anti-thyroid autoantibodies. Around 10% of biochemically euthyroid individuals also have an elevated TPOAb titre. Many studies have linked the presence of TPOAb to adverse maternal and fetal outcomes in pregnancy, in particular miscarriage and pre-term birth, even in the absence of thyroid dysfunction. The causal pathway is poorly understood and few trials have looked to find treatments to reduce adverse outcomes. This review discusses in detail the associated adverse outcomes of TPOAb in pregnancy and the results of trials exploring methods to reduce such outcomes. Recommendations for counselling and monitoring of women with TPOAb and suggested areas for future work are also outlined.
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Affiliation(s)
- R K Dhillon-Smith
- Institute of Metabolism and Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK; Tommy's Centre for Miscarriage Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK; Centre for Women's and Newborn Health, Birmingham Women's and Children's Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK.
| | - A Coomarasamy
- Institute of Metabolism and Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK; Tommy's Centre for Miscarriage Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK; Centre for Women's and Newborn Health, Birmingham Women's and Children's Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK
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Cellini M, Santaguida MG, Stramazzo I, Capriello S, Brusca N, Antonelli A, Fallahi P, Gargano L, Centanni M, Virili C. Recurrent Pregnancy Loss in Women with Hashimoto's Thyroiditis with Concurrent Non-Endocrine Autoimmune Disorders. Thyroid 2020; 30:457-462. [PMID: 31910128 DOI: 10.1089/thy.2019.0456] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: An increased rate of recurrent miscarriage has been described in patients with autoimmune thyroid disease. However, there is a lack of studies that assess the rate of recurrent pregnancy loss (RPL) in patients with Hashimoto's thyroiditis (HT) isolated or with concurrent non-endocrine autoimmune disorders (NEAD). The objective of the study was to assess the rate of RPL in patients with HT isolated or accompanied with non-endocrine autoimmune diseases. Methods: This is a retrospective observational cohort study with a systematic review of the NEAD with concurrent HT in an outpatient Endocrinology Unit at a University Hospital. Among the 3480 consecutively examined women with HT, 87 patients met the criteria of RPL and represented the study group. Sixty-five of them had isolated HT and 22 women had HT+NEAD. Results: The rate of RPL in women with HT was 2.1% versus 5.64% observed in women with HT+NEAD (odds ratio = 2.78 [95% confidence interval 1.70-4.57]; p < 0.0001). On subdivision, this difference was still evident in euthyroid patients (p < 0.0001), while it disappeared in hypothyroid women (p = 0.21). The RPL did not correlate with the autoantibody concentrations nor in women with isolated HT nor in those with HT+NEAD. The presence of antiphospholipid syndrome (APS) explained RPL in 3 out of 22 (14%) patients with HT+NEAD, the remaining being related to different autoimmune disorders. Interestingly, even subtracting the patients with APS, RPL was more frequent in patients with poly-autoimmunity than in patients with isolated HT (p = 0.0013). Conclusions: The co-presence of NEAD is correlated with a higher risk of RPL in women with HT. The association with APS may explain only a fraction of RPL rate in patients with poly-autoimmunity.
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Affiliation(s)
- Miriam Cellini
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | | | - Ilaria Stramazzo
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - Silvia Capriello
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - Nunzia Brusca
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Lucilla Gargano
- Endocrinology Unit, Santa Maria Goretti Hospital, AUSL Latina, Latina, Italy
| | - Marco Centanni
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
- Endocrinology Unit, Santa Maria Goretti Hospital, AUSL Latina, Latina, Italy
| | - Camilla Virili
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
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12
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Min Y, Wang X, Chen H, Yin G. The exploration of Hashimoto's Thyroiditis related miscarriage for better treatment modalities. Int J Med Sci 2020; 17:2402-2415. [PMID: 33029083 PMCID: PMC7532476 DOI: 10.7150/ijms.48128] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/21/2020] [Indexed: 12/25/2022] Open
Abstract
Hashimoto's thyroiditis (HT) is the most prevalent autoimmune thyroid disease (ATD) worldwide and is strongly associated with miscarriage and even recurrent miscarriage (RM). Moreover, with a deepening understanding, emerging evidence has shown that immune dysfunctions caused by HT conditions, including imbalanced subsets of CD4+ T-helper cells, B regulatory (Breg) cells, high expression levels of CD56dim natural killer (NK) cells, and cytokines, possibly play an important role in impairing maternal tolerance to the fetus. In recent years, unprecedented progress has been made in recognizing the specific changes in immune cells and molecules in patients with HT, which will be helpful in exploring the mechanism of HT-related miscarriage. Based on these findings, research investigating some potentially more effective treatments, such as selenium (Se), vitamin D3, and intravenous immunoglobulin (IVIG), has been well developed over the past few years. In this review, we highlight some of the latest advances in the possible immunological pathogenesis of HT-related miscarriage and focus on the efficacies of treatments that have been widely introduced to clinical trials or practice described in the most recent literature.
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Affiliation(s)
- Yu Min
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.74, Linjiang Rd, Yuzhong Dist, Chongqing 404100, China
| | - Xing Wang
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.74, Linjiang Rd, Yuzhong Dist, Chongqing 404100, China
| | - Hang Chen
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.74, Linjiang Rd, Yuzhong Dist, Chongqing 404100, China
| | - Guobing Yin
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.74, Linjiang Rd, Yuzhong Dist, Chongqing 404100, China
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Leduc-Robert G, Iews M, Abdelkareem AO, Williams C, Bloomenthal D, Abdelhafez F, Bedaiwy MA. Prevalence of thyroid autoimmunity and effect of levothyroxine treatment in a cohort of 1064 patients with recurrent pregnancy loss. Reprod Biomed Online 2019; 40:582-592. [PMID: 32160949 DOI: 10.1016/j.rbmo.2019.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/31/2019] [Accepted: 11/26/2019] [Indexed: 01/08/2023]
Abstract
RESEARCH QUESTION Does initiating levothyroxine treatment based on thyroid-stimulating hormone (TSH) >2.5 mIU/l or thyroid autoimmunity improve pregnancy continuation rates in recurrent pregnancy loss (RPL) patients? DESIGN A retrospective cohort study of 1064 RPL patients, in which subjects were classified as either euthyroid (TSH 0.1 to ≤2.5 mIU/l), borderline-subclinical hypothyroid (borderline-SCH, TSH 2.5 to ≤4 mIU/l) or subclinical hypothyroid (SCH, TSH 4 to ≤10 mIU/l). For subjects with ≥2 pregnancy losses and a subsequent pregnancy with known outcome, a comparison was done of the pregnancy continuation rate past 10 weeks of treated and untreated borderline-SCH (n = 98) and untreated euthyroid (n = 279) subjects, and between subjects with positive (n = 18) and negative (n = 206) thyroid peroxidase (TPOAb tests) within the borderline-SCH and euthyroid groups. RESULTS 72.7% were euthyroid (721/992), 19.4% (192/992) were borderline-SCH, and 5.4% (54/992) were subclinically hypothyroid (SCH). Of 401 women with a subsequent pregnancy of known outcome at 10 gestational weeks, 21% received treatment with levothyroxine. 57.7% of subjects had a TPOAb test, which was positive in 9.25% (37/400) in euthyroid, 16.5% (22/133) in borderline-SCH subjects and 35.3% (12/34) in SCH subjects. Treatment did not improve pregnancy continuation rates in borderline-SCH subjects (P = 0.392). There was no difference in pregnancy outcomes based on TPOAb status and treatment for borderline-SCH subjects (P = 0.4214), or based on TPOAb status for euthyroid subjects (P = 0.2668). CONCLUSIONS Treatment of hypothyroidism in pregnancy should be initiated based on a TSH >4 mIU/l. Treatment initiation based on thyroid autoimmunity or a TSH >2.5 mIU/l may result in overtreatment.
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Affiliation(s)
- Geneviève Leduc-Robert
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynaecology, University of British Columbia, BC Women and Children's Hospital, Vancouver BC, Canada
| | - Mahmoud Iews
- Department of Obstetrics and Gynaecology, South Valley University, Qena, Egypt
| | - Amr O Abdelkareem
- Department of Obstetrics and Gynaecology, Sohag University, Sohag, Egypt
| | - Christina Williams
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynaecology, University of British Columbia, BC Women and Children's Hospital, Vancouver BC, Canada
| | - Dena Bloomenthal
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynaecology, University of British Columbia, BC Women and Children's Hospital, Vancouver BC, Canada
| | - Faten Abdelhafez
- Department of Obstetrics and Gynaecology, Assiut University, Assiut, Egypt
| | - Mohamed A Bedaiwy
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynaecology, University of British Columbia, BC Women and Children's Hospital, Vancouver BC, Canada.
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Chen M, Gilbert N, Liu H. Reduced expression of PD-L1 in autoimmune thyroiditis attenuate trophoblast invasion through ERK/MMP pathway. Reprod Biol Endocrinol 2019; 17:86. [PMID: 31656199 PMCID: PMC6816196 DOI: 10.1186/s12958-019-0536-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/16/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Autoimmune thyroiditis (AIT) with euthyroid is associated with miscarriage. But the exact mechanism remains unclear. Studies have shown that the programmed cell death-1 (PD-1)/programmed cell death -ligand 1 (PD-L1) pathway is essential for normal pregnancy. However, the expression of PD-L1 in gestational trophoblasts in mice with autoimmune thyroiditis and the mechanisms leading to miscarriage have not been fully investigated. METHODS Immunofluorescence and Western blot were used to detect the expression of PD-L1, p-ERK, MMP-2 and MMP-9 in embryonic trophoblast cells of pregnant mice with AIT. The expression of PD-L1 in HTR-8/SVneo cells were silenced, and the expression of PD-L1, MMP-2, MMP-9, ERK and p-ERK1/2 was detected by Western blot analyses and immunofluorescence assays. Invasive assays were performed in PD-L1 silenced HTR-8/SVneo cells using a Transwell chamber. RESULTS Compared with normal pregnancy, the expression of PD-L1, ERK, p-ERK, MMP-2 and MMP-9 in embryonic trophoblast cells was significantly lower in pregnant mice with AIT. Compared with the negative control (NC) group (cells transfected with negative control siRNA), phosphorylation of MMP-2, MMP-9 and P-ERK1/2 proteins was significantly reduced in HTR-8/SVneo cells transfected with PD-L1 siRNA, and the number of cells penetrating the membrane was reduced. CONCLUSION AIT inhibits ERK/MMP-2 and MMP-9 pathways through PD-L1 reduction, attenuates embryonic trophoblast invasion and ultimalely induces miscarriage ultimately.
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Affiliation(s)
- Mengya Chen
- grid.452828.1Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Dalian Medical University, 467 Zhongshan Road, Dalian, 116027 Liaoning China
| | - Nduwimana Gilbert
- grid.452828.1Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Dalian Medical University, 467 Zhongshan Road, Dalian, 116027 Liaoning China
| | - Haixia Liu
- grid.452828.1Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Dalian Medical University, 467 Zhongshan Road, Dalian, 116027 Liaoning China
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15
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Aljarad M, Alhalabi N, Hamad A, Nmr N, Abbas F, Alkhatib A, Alhalabi M, Al-Hammami H, Ibrahim N. Prevalence of Thyroid Autoimmune Antibodies in Women Seeking Fertility Care in Damascus, Syria. Cureus 2019; 11:e5315. [PMID: 31592370 PMCID: PMC6773447 DOI: 10.7759/cureus.5315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Thyroid autoimmune (TAI) disease with a prevalence varying between 5 and 15%, represents the most common endocrine disorder in women with reproductive age. Not only is TAI disease five to 10 folds more common in women than men but also TAI diseases is often undiagnosed because it may be present without overt thyroid dysfunction for several years. Studies found an increased prevalence of TAI in women referred to fertility clinics compared with normal population. In this analysis we aimed to study the prevalence of TAI among women seeking fertility care in Damascus, Syria in order to understand its clinical and public health importance in population. Methods This study is a retrospective cross-sectional study on women patients seeking fertility care at Orient Hospital, Damascus city, Syria from April 2011 to March 2018. A total of 2526 women, with available biochemical data of anti-thyroid antibodies (anti-TPO) and anti-thyroglobulin antibodies (anti-TG) were included in our study. Thyroid stimulating hormone (TSH) titers data were also included in the statistical analysis. Results TAI was found positive in 559 patients (22.1%) of our studies population. TAI was more prevalent in patients with abnormal TSH levels. Conclusion Thyroid autoimmunity prevalence in women seeking fertility care in Damascus, Syria was 22.1% which is significantly higher than normal population. Further studies are needed to assess the relation of these antibodies in thyroid, gynecological and other factors for the Syrian population.
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Affiliation(s)
- Mohammad Aljarad
- Miscellaneous, Faculty of Medicine, Syrian Private University, Damascus, SYR
| | - Nawras Alhalabi
- Internal Medicine, Faculty of Medicine, Syrian Private University, Damascus, SYR
| | - Ahed Hamad
- Miscellaneous, Faculty of Medicine, Damascus University, Damascus, SYR
| | - Nazht Nmr
- Miscellaneous, Faculty of Medicine, Damascus University, Damascus, SYR
| | - Fatima Abbas
- Internal Medicine, Faculty of Medicine, Damascus University, Damascus, SYR
| | - Adnan Alkhatib
- Genetics, Clinical Lab Unit, Alkhatib Lab, Damascus, SYR
| | - Marwan Alhalabi
- Obstetrics and Gynecology, Faculty of Medicine, Damascus University, Damascus, SYR
| | - Hisham Al-Hammami
- Obstetrics and Gynecology, Faculty of Medicine, Syrian Private University, Damascus, SYR
| | - Nazir Ibrahim
- Internal Medicine, Faculty of Medicine, Syrian Private University, Damascus, SYR
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16
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Fernández Martínez P, Aguado García R, Barajas Galindo DE, Hernández Moreno A, Alejo Ramos M, García Arias S, Ballesteros Pomar MD, Cano Rodríguez IM. Influence of thyroid peroxidase antibodies on TSH levels of pregnant women and maternal-fetal complications. ACTA ACUST UNITED AC 2018; 65:444-450. [PMID: 29910160 DOI: 10.1016/j.endinu.2018.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/24/2018] [Accepted: 05/03/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION During pregnancy, thyroid peroxidase (TPO) antibodies may increase the risk of developing subclinical hypothyroidism (SCH). Both conditions appear to be associated to maternal-fetal complications. The objectives of this study were to analyze if a relationship exists between TSH and TPO levels during pregnancy and the potential effects on gestational and perinatal complications, and to assess whether detectable, but not positive, TPO levels have an impact on development of gestational SCH. METHODS A prospective study was conducted at the Leon Health Area (CAULE), where universal screening for gestational thyroid dysfunction is performed between weeks 7-13 of pregnancy. Data on TSH and TPO levels and gestational and perinatal complications were collected for all 2016 deliveries. Positive TPO antibodies were defined as values≥35IU/mL. In a previous study, a TSH level>3.72mU/L was established as the cut-off value for gestational SCH. RESULTS Records corresponding to 1,980 deliveries at CAULE, 21 abortions, and 18 deliveries outside the hospital were analyzed. Of the 1,670 pregnant women screened (84.34%), 142 (8.50%) had positive TPO antibodies and their presence was associated to diagnosis of SCH (P<0.01) and to significantly higher mean TSH levels (3.51mU/L vs. 2.46mU/L, P=0.03). There were no significant differences in gestational or neonatal complications. In the group with undetectable TPO antibodies (<10lU/mL), the mean TSH levels was slightly lower than in the group with TPO values ranging from 10-35 IU/mL, but the difference was not significant (P=0.89). CONCLUSION Presence of positive TPO antibodies is associated to higher TSH levels and higher risk of gestational SCH, but does not increase the rate of maternal-fetal complications.
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Affiliation(s)
| | - Rocío Aguado García
- Sección de Endocrinología y Nutrición, Complejo Asistencial Universitario de León, León, Spain
| | | | - Ana Hernández Moreno
- Sección de Endocrinología y Nutrición, Complejo Asistencial Universitario de León, León, Spain
| | - Mirian Alejo Ramos
- Sección de Endocrinología y Nutrición, Complejo Asistencial Universitario de León, León, Spain
| | - Sara García Arias
- Sección de Endocrinología y Nutrición, Complejo Asistencial Universitario de León, León, Spain
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Azizi F, Mehran L, Hosseinpanah F, Delshad H, Amouzegar A. Secondary and tertiary preventions of thyroid disease. Endocr Res 2018; 43:124-140. [PMID: 29319359 DOI: 10.1080/07435800.2018.1424720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Secondary and tertiary preventions are concerned with the recognition of the disease process in a very early stage and delay in progression to complete disease and minimization of complications and the impact of illness. METHODS All articles related to secondary and tertiary prevention of thyroid diseases were reviewed. Using related key words, articles published between 2001 and 2015 were evaluated, categorized, and analyzed. RESULTS In secondary prevention, congenital hypothyroidism and subclinical hypo and hyperthyroidism are equally important. Routine screening of patients with multinodular goiter by either ultrasonography or calcitonin is a controversial issue, while calcitonin assessments in medullary cancer and RET in family members are recommended. Screening of thyroid disease in pregnancy is limited to those with risk factors. Views regarding the importance of thyroid autoimmunity in secondary prevention are also presented. In tertiary prevention, prescribing excessive doses of levothyroxine, in the elderly in particular and appropriate care of all patients to avoid progression and complications are the key issues. CONCLUSION Optimization of management of thyroid diseases requires timely screening, prevention of progression to more sever disease, optimal medical care, and avoidance of iatrogenic conditions.
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Affiliation(s)
- Fereidoun Azizi
- a Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Ladan Mehran
- a Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Farhad Hosseinpanah
- b Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Hossein Delshad
- b Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Atieh Amouzegar
- a Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran , Iran
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18
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Leiva P, Schwarze JE, Vasquez P, Ortega C, Villa S, Crosby J, Balmaceda J, Pommer R. There is no association between the presence of anti-thyroid antibodies and increased reproductive loss in pregnant women after ART: a systematic review and meta-analysis. JBRA Assist Reprod 2017; 21:361-365. [PMID: 29043757 PMCID: PMC5714606 DOI: 10.5935/1518-0557.20170057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Women submitted to ART treatments represent a select subgroup of individuals.
Several studies have described the relationship between TAI and pregnancy
outcomes as a result of ART, with contradictory results. The purpose of this
systematic review was to determine the association between TAI and the risk of
miscarriage in pregnancies resulting from ART. MEDLINE via PubMed, LILACS and
Embase were searched for studies published in peer-reviewed journals from 1999
to 2017. The studies were summarized using the fixed effects model and the
Peto's method to calculate RR in order to flesh out the association between TAI
and spontaneous abortion. Only four papers were included in this systematic
review and meta-analysis. Thirty-one miscarriages were observed in 210 clinical
pregnancies of women with antithyroid antibodies; and 158 miscarriages were seen
in 1,371 pregnancies without antithyroid antibodies. The meta-analysis failed to
find an association between TAI and higher risk of reproductive loss, RR=0.94
95% confidence interval: 0.71-1.24; p=0.879. In conclusion, the
presence of antithyroid antibodies was not associated with increased
reproductive loss in patients submitted to ART treatments. It is our opinion
that the presence of antithyroid antibodies should be considered as a secondary
biomarker of autoimmune disease, rather than an actual cause of miscarriage in
patients undergoing ART. Due to the small amount of evidence on the matter, the
determination of TAI before the initiation of ART should be limited to research
contexts.
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Affiliation(s)
- Paz Leiva
- Obstetrics and Gynecology Department at Universidad de Santiago, Chile
| | - Juan Enrique Schwarze
- Obstetrics and Gynecology Department at Universidad de Santiago, Chile.,Reproductive Medicine Unit at Clinica Monteblanco
| | - Pamela Vasquez
- Epidemiology Department, Universidad de los Andes, Chile
| | | | - Sonia Villa
- Reproductive Medicine Unit at Clinica Monteblanco
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Akram FH, Johansson B, Möllerström G, Landgren BM, Stavreus-Evers A, Skjöldebrand-Sparre L. Incidence of Subclinical Hypothyroidism and Hypothyroidism in Early Pregnancy. J Womens Health (Larchmt) 2017; 26:1231-1235. [DOI: 10.1089/jwh.2016.6111] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Frida Hosseini Akram
- Department of Clinical Sciences, Danderyd, Karolinska Institute, Stockholm, Sweden
| | - Bengt Johansson
- Department of Clinical Sciences, Danderyd, Karolinska Institute, Stockholm, Sweden
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20
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Fan JX, Yang S, Qian W, Shi FT, Huang HF. Comparison of the Reference Intervals Used for the Evaluation of Maternal Thyroid Function During Pregnancy Using Sequential and Nonsequential Methods. Chin Med J (Engl) 2017; 129:785-91. [PMID: 26996472 PMCID: PMC4819297 DOI: 10.4103/0366-6999.178954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Maternal thyroid dysfunction is common during pregnancy, and physiological changes during pregnancy can lead to the overdiagnosis of hyperthyroidism and misdiagnosis of hypothyroidism with nongestation-specific reference intervals. Our aim was to compare sequential with nonsequential methods for the evaluation of thyroid function in pregnant women. METHODS We tested pregnant women who underwent their trimester prenatal screening at our hospital from February 2011 to September 2012 for serum thyroid stimulating hormone (TSH) and free thyroxine (FT4) using the Abbott and Roche kits. There were 447 and 200 patients enrolled in the nonsequential and sequential groups, respectively. The central 95% range between the 2.5th and the 97.5th percentiles was used as the reference interval for the thyroid function parameter. RESULTS The nonsequential group exhibited a significantly larger degree of dispersion in the TSH reference interval during the 2nd and 3rd trimesters as measured using both the Abbott and Roche kits (all P < 0.05). The TSH reference intervals were significantly larger in the nonsequential group than in the sequential group during the 3rd trimester as measured with both the Abbott (4.95 vs. 3.77 mU/L, P < 0.001) and Roche kits (6.62 vs. 5.01 mU/L, P = 0.004). The nonsequential group had a significantly larger FT4 reference interval as measured with the Abbott kit during all trimesters (12.64 vs. 5.82 pmol/L; 7.96 vs. 4.77 pmol/L; 8.10 vs. 4.77 pmol/L, respectively, all P < 0.05), whereas a significantly larger FT4 reference interval was only observed during the 2nd trimester with the Roche kit (7.76 vs. 5.52 pmol/L, P = 0.002). CONCLUSIONS It was more reasonable to establish reference intervals for the evaluation of maternal thyroid function using the sequential method during each trimester of pregnancy. Moreover, the exclusion of pregnancy-related complications should be considered in the inclusion criteria for thyroid function tests.
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Affiliation(s)
| | | | | | | | - He-Feng Huang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030; Institute of Embryo-Fetal Original Adult Disease Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
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Nazarpour S, Ramezani Tehrani F, Simbar M, Azizi F. Thyroid autoantibodies and the effect on pregnancy outcomes. J OBSTET GYNAECOL 2017. [PMID: 26203920 DOI: 10.3109/01443615.2014.968110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Thyroid antibody positivity is relatively common in women. While many epidemiological studies have investigated the links between thyroid antibodies and pregnancy complications, evidence regarding the effect of Levothyroxine treatment of euthyroid pregnant women with autoimmune thyroid disease on pregnancy outcome is limited. The objective of this paper is to provide a review on the impact of treatment of euthyroid thyroid antibody-positive pregnant women on adverse pregnancy outcome. This systematic review was conducted with a prospective protocol. PubMed, Science direct, Google scholar, Embase and the Cochrane Library databases were searched through January 2014 to identify studies that met pre-stated inclusion criteria. The search was limited to English manuscripts. We found that there is inadequate data regarding both the adverse effect of thyroid antibody positivity in euthyroid women on pregnancy outcomes and the effects Levothyroxine on these women. It seems that the results of most studies indicate adverse effects of thyroid antibody positivity in euthyroid women on pregnancy outcomes. Further randomised clinical trials are needed to investigate the effects of treating pregnant euthyroid women with positive thyroid antibodies on the maternal and early/late neonatal outcomes.
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Affiliation(s)
- S Nazarpour
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Le Donne M, Mento C, Settineri S, Antonelli A, Benvenga S. Postpartum Mood Disorders and Thyroid Autoimmunity. Front Endocrinol (Lausanne) 2017; 8:91. [PMID: 28522989 PMCID: PMC5415609 DOI: 10.3389/fendo.2017.00091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/06/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Maria Le Donne
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
- *Correspondence: Maria Le Donne,
| | - Carmela Mento
- Department of Cognitive Sciences, Psychology, Educational and Cultural Studies (COSPECS), University of Messina, Messina, Italy
| | - Salvatore Settineri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging (BIOMORF), University of Messina, Messina, Italy
| | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Interdept. Program of Molecular & Clinical Endocrinology and Women’s Endocrine Health, University Hospital Policlinico G. Martino, Messina, Italy
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Busnelli A, Paffoni A, Fedele L, Somigliana E. The impact of thyroid autoimmunity on IVF/ICSI outcome: a systematic review and meta-analysis. Hum Reprod Update 2016; 22:775-790. [PMID: 27323769 DOI: 10.1093/humupd/dmw019] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 05/11/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Thyroid autoimmunity (TAI) is the most frequent autoimmune condition and the first cause of thyroid dysfunction among women of reproductive age. Notably, it has been associated with adverse obstetric outcomes during all trimesters of pregnancy. Furthermore, since most studies show an increased prevalence of TAI among women attending infertility clinics, a detrimental impact of this condition on natural fertility and on the rate of success of assisted reproductive techniques has been suggested. However, to date, the results have been inconsistent. OBJECTIVE AND RATIONALE The objective of this study was to define the relation between TAI per se and the outcome of in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) cycles. SEARCH METHODS A systematic literature review and meta-analysis were conducted. A Medline search was performed to identify all the comparative studies published from January 1990 to November 2015 in the English language literature on IVF/ICSI outcome in women with and without TAI, using combinations of the medical subject heading terms 'thyroid autoimmunity', 'thyroid autoantibodies', 'IVF', 'ICSI', 'pregnancy', 'miscarriage' and 'delivery'. The primary outcome was live birth rate (LBR). Our secondary outcomes were number of oocytes retrieved (NOR), fertilisation rate (FR), implantation rate (IR), clinical pregnancy rate (CPR) and miscarriage rate (MR). We also extracted data on mean age and basal serum concentrations of thyroid stimulating hormone (TSH) and performed a meta-regression analysis to assess the effect of these two covariates on CPR and MR. OUTCOMES We selected 12 studies for the meta-analysis. Six of the included studies were prospective cohort studies, and six were retrospective cohort studies. Compared with women with negative TAI, women with positive TAI had a lower LBR (odds ratio (OR) 0.73; 95% confidence interval (CI) [0.54-0.99]; P = 0.04; 9 studies; 4396 women; I2 = 41%), a higher MR (OR 1.44; 95% CI [1.06-1.95]; P = 0.02; 12 studies; 4876 women; I2 = 35%), a similar CPR (OR 0.90; 95% CI [0.77-1.06]; P = 0.22; 12 studies; 4876 women; I2 = 7%), a similar number of oocytes (standardized mean difference [SMD] 0.10; 95% CI [-0.09 to 0.29]; P = 0.28; 5 studies; 1506 women; I2 = 47%), a similar FR (OR 1.11; 95% CI [0.97-1.27]; P = 0.13; 3 studies; 1082 women; I2 = 0%) and a similar IR (OR 0.98; 95% CI [0.73-1.32]; P = 0.91; 2 studies; 918 women; I2 = 0%). Both mean age (SMD 0.96; 95% CI [0.66-1.27]; P < 0.00001; 9 studies; 3256 women; I2 = 85%) and serum TSH (SMD 0.24; 95% CI [0.15-0.34]; P < 0.00001; 6 studies; 2098 women; I2 = 59%) were higher in women with TAI. However, neither of these two covariates were significantly associated with CPR or MR. WIDER IMPLICATIONS TAI does not impact on IVF/ICSI outcome in terms of NOR and likelihood of fertilisation, implantation and clinical pregnancy. On the contrary, the presence of thyroid autoantibodies may have a detrimental effect on the course of a pregnancy, determining an increased risk of miscarriage and a decreased chance of live birth. However, given the possible modifying effects of age and serum TSH, further evidence is warranted prior to drawing inferences on causality.
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Affiliation(s)
- Andrea Busnelli
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy .,Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Alessio Paffoni
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy
| | - Luigi Fedele
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy.,Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Edgardo Somigliana
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy
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Mandal RC, Bhar D, Das A, Basunia SR, Kundu SB, Mahapatra C. Subclinical hypothyroidism in pregnancy: An emerging problem in Southern West Bengal: A cross-sectional study. J Nat Sci Biol Med 2016; 7:80-4. [PMID: 27003976 PMCID: PMC4780174 DOI: 10.4103/0976-9668.175080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Prevalence of subclinical hypothyroidism (SCH) in pregnancy varies widely in different parts of our country, but it has multiple adverse outcomes in both the mother and fetus. Objectives: This study was conducted to evaluate the prevalence of SCH in pregnant women during the first trimester and to identify the prevalence of thyroid autoimmunity in pregnant women. Materials and Methods: This cross-sectional study (March 2014 to February 2015) was conducted among the pregnant women attending antenatal clinic in their first trimester at a tertiary care center. Morning samples of study participants were analyzed for free thyroxin (FT4), thyroid stimulating hormone (TSH), and thyroid peroxidase antibody (TPO Ab). Data expressed as mean ± standard deviation and percentage (%) as applicable. Results: Of the 510 subjects, 168 had TSH value >2.5 μIU/ml (32.94%) with normal FT4 and they were diagnosed as SCH. TSH level >4.5 μIU/ml was estimated in 13.92% (71) of the subjects. TPO Ab was positive in 57 (33.93%) of subclinical hypothyroid and 5 (1.47%) of normal subjects. 70.42% (50) of the subjects with TSH >4.5 μIU/ml had positive TPO Ab. Conclusions: Prevalence of SCH is high in South Bengal and routine thyroid screening at the first antenatal visit should be done to reduce the social and financial burden caused by SCH.
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Affiliation(s)
- Ratan Chandra Mandal
- Department of Gynaecology and Obstetrics, Midnapore Medical College and Hospital, Kolkata, West Bengal, India
| | - Debasish Bhar
- Department of Anaesthesiology, Midnapore Medical College and Hospital, Kolkata, West Bengal, India
| | - Anjan Das
- Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Sandip Roy Basunia
- Department of Anaesthesiology, Midnapore Medical College and Hospital, Kolkata, West Bengal, India
| | | | - Chinmay Mahapatra
- Department of Gynaecology and Obstetrics, Midnapore Medical College and Hospital, Kolkata, West Bengal, India
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Aghajanian P, Spencer CA, Wilson ML, Lee RH, Goodwin TM, Mestman JH. Evaluation of risk-factor-based screening for thyroid peroxidase antibody positivity in pregnancy. Clin Endocrinol (Oxf) 2016; 84:417-22. [PMID: 25823873 DOI: 10.1111/cen.12782] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 03/02/2015] [Accepted: 03/24/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine whether risk-factor-based screening for thyroid dysfunction in pregnancy performs well for detecting thyroid peroxidase antibodies (TPOAb), a marker for autoimmune thyroid disease. STUDY DESIGN We prospectively evaluated pregnant women for thyroid dysfunction using The Endocrine Society's eleven screening questions. Serum was analysed for TPOAb. RESULT We enrolled 546 women. TPOAb positivity was higher in women with a personal (odds ratio (OR) = 8·0; 95% confidence interval (CI) = 1·7-37·4; P = 0·02) or family history of thyroid disease (OR = 2·7; 95% CI = 1·3-5·7; P = 0·02). There was no association between the number of positive responses and TPOAb positivity (P = 0·41). Risk-factor-based screening missed 18 women (33%) with TPOAb. CONCLUSION One-third of women with TPOAb were missed by the case-finding method. A personal or family history of thyroid disease was most strongly associated with TPOAb positivity.
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Affiliation(s)
- Paola Aghajanian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Carole A Spencer
- Department of Endocrinology, Keck School of Medicine, University Southern California, Los Angeles, CA, USA
| | - Melissa L Wilson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University Southern California, Los Angeles, CA, USA
| | - Richard H Lee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University Southern California, Los Angeles, CA, USA
| | - Thomas M Goodwin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University Southern California, Los Angeles, CA, USA
| | - Jorge H Mestman
- Department of Endocrinology, Keck School of Medicine, University Southern California, Los Angeles, CA, USA
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Caccavo D, Pellegrino NM, Nardelli C, Vergine S, Leone L, Marolla A, Vacca MP, Depalo R. Anti-laminin-1 antibodies in serum and follicular fluid of women with Hashimoto's thyroiditis undergoing in vitro fertilization. Int J Immunopathol Pharmacol 2016; 29:280-7. [PMID: 26813862 DOI: 10.1177/0394632015627281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 12/22/2015] [Indexed: 11/15/2022] Open
Abstract
The aim of this study is to evaluate the presence of anti-laminin-1 antibodies (aLN-1) in sera and follicular fluid (FF) of infertile women affected by Hashimoto's thyroiditis (HT) undergoing in vitro fertilization (IVF) and its impact on oocyte maturation and IVF outcome. aLN-1 were measured by a home-made enzyme linked immunosorbent assay (ELISA) in: (1) sera and FF from 44 infertile women affected by HT (HTIW) with tubal factor or male factor as primary cause of infertility; (2) in sera and FF from 28 infertile women without HT, with tubal factor or male factor as cause of infertility (infertile controls-ICTR); and (3) in sera from 50 fertile women (FW). aLN-1 serum levels were significantly higher in HTIW when compared with both fertile women and ICTR (P <0.001and P <0.01, respectively). Assuming as cutoff the 99th percentile of values obtained in sera of FW, 43.2% of HTIW and 3.6% of ICTR were aLN-1 positive (P = 0.0001). Also aLN-1 detected in FF from HTIW were significantly higher in comparison with those found in FF of ICTR (P = 0.006). In HTIW, metaphase II oocyte count showed inverse correlation with both serum and FF aLN-1 levels (r = 0.34, P = 0.02 and r = 0.33, P = 0.03, respectively). Implantation and pregnancy rates were significantly lower in HTIW (7.9% and 9.1%, respectively) when compared with ICTR (23% and 31.1%, respectively) (P = 0.015 and P = 0.03, respectively). Our results demonstrated for the first time the presence of aLN-1 in a relevant percentage of HTIW and suggest that these auto-antibodies may impair IVF outcome.
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Affiliation(s)
- Domenico Caccavo
- Department of Biomedical Sciences and Human Oncology, Section of Immunology, University of Bari "Aldo Moro", University Hospital, Italy
| | - Nelly M Pellegrino
- Department of Biomedical Sciences and Human Oncology, Section of Immunology, University of Bari "Aldo Moro", University Hospital, Italy
| | - Claudia Nardelli
- Department of General Surgery, Gynecology, Obstetrics and Anesthesiology, Unit of Pathophysiology of Human Reproduction and Gametes Cryopreservation, University Hospital, Bari, Italy
| | - Silvia Vergine
- Department of General Surgery, Gynecology, Obstetrics and Anesthesiology, Unit of Pathophysiology of Human Reproduction and Gametes Cryopreservation, University Hospital, Bari, Italy
| | - Luca Leone
- Department of General Surgery, Gynecology, Obstetrics and Anesthesiology, Unit of Pathophysiology of Human Reproduction and Gametes Cryopreservation, University Hospital, Bari, Italy
| | - Alessandra Marolla
- Department of General Surgery, Gynecology, Obstetrics and Anesthesiology, Unit of Pathophysiology of Human Reproduction and Gametes Cryopreservation, University Hospital, Bari, Italy
| | - Margherita P Vacca
- Department of General Surgery, Gynecology, Obstetrics and Anesthesiology, Unit of Pathophysiology of Human Reproduction and Gametes Cryopreservation, University Hospital, Bari, Italy
| | - Raffaella Depalo
- Department of General Surgery, Gynecology, Obstetrics and Anesthesiology, Unit of Pathophysiology of Human Reproduction and Gametes Cryopreservation, University Hospital, Bari, Italy
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Nazarpour S, Tehrani FR, Simbar M, Tohidi M, AlaviMajd H, Azizi F. Comparison of universal screening with targeted high-risk case finding for diagnosis of thyroid disorders. Eur J Endocrinol 2016; 174:77-83. [PMID: 26510839 DOI: 10.1530/eje-15-0750] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 10/28/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Debate about the need for universal screening of thyroid dysfunction in pregnancy is ongoing. The present study aimed to compare universal screening with targeted high-risk case findings for early diagnosis of thyroid disorders in Iranian pregnant women. STUDY DESIGN This cross-sectional prospective study was carried out on 1600 pregnant women in their first trimester. A checklist, including all related risk factors recommended by The American Thyroid Association, was completed for all participants. Serum concentrations of thyroxine (T4), T-uptake, TSH and thyroid peroxidase antibody (TPOAb) were measured and thyroid status was documented, based on hormonal measurements and clinical examinations. RESULTS There were 656 women (44.3%) that had at least one risk factor for thyroid diseases and were eligible for the targeted high-risk case finding (high-risk group) approach, while 55.7% had no risk factors (low-risk group). Using the universal screening approach, there were 974 women (65.8%) with normal thyroid status and 506 participants (34.2%) with thyroid disturbances, including overt hyperthyroidism (0.7%), overt hypothyroidism (1.1%), subclinical hypothyroidism (30.1%; positive TPOAb (5.5%) and negative TPOAb (24.6%); and euthyroid and positive TPOAb (2.3%). Of women with thyroid dysfunction, 64.4% were in the high-risk group and 35.6% were in the low-risk group (P<0.0001). CONCLUSIONS The targeted high-risk case finding approach overlooks about one-third of pregnant women with thyroid dysfunction. If ongoing prospective trials provide evidence on the efficacy of treating subclinical hypothyroidism in pregnancy, in populations with a low prevalence of presumed risk factors, the targeted high-risk case finding approach will be proven inefficient.
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Affiliation(s)
- Sima Nazarpour
- Department of Reproductive Health and MidwiferyFaculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, IranReproductive Endocrinology Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranPrevention of Metabolic Disorders Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranDepartment of BiostatisticsFaculty of Paramedicine, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, IranEndocrine Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Department of Reproductive Health and MidwiferyFaculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, IranReproductive Endocrinology Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranPrevention of Metabolic Disorders Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranDepartment of BiostatisticsFaculty of Paramedicine, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, IranEndocrine Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Simbar
- Department of Reproductive Health and MidwiferyFaculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, IranReproductive Endocrinology Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranPrevention of Metabolic Disorders Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranDepartment of BiostatisticsFaculty of Paramedicine, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, IranEndocrine Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Tohidi
- Department of Reproductive Health and MidwiferyFaculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, IranReproductive Endocrinology Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranPrevention of Metabolic Disorders Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranDepartment of BiostatisticsFaculty of Paramedicine, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, IranEndocrine Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid AlaviMajd
- Department of Reproductive Health and MidwiferyFaculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, IranReproductive Endocrinology Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranPrevention of Metabolic Disorders Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranDepartment of BiostatisticsFaculty of Paramedicine, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, IranEndocrine Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Department of Reproductive Health and MidwiferyFaculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, IranReproductive Endocrinology Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranPrevention of Metabolic Disorders Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranDepartment of BiostatisticsFaculty of Paramedicine, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, IranEndocrine Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Nazarpour S, Ramezani Tehrani F, Simbar M, Tohidi M, Azizi F. Thyroid and Pregnancy in Tehran, Iran: Objectives and Study Protocol. Int J Endocrinol Metab 2016; 14:e33477. [PMID: 27279833 PMCID: PMC4895998 DOI: 10.5812/ijem.33477] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/14/2015] [Accepted: 12/19/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Thyroid dysfunction is the second most common endocrine disease in females of reproductive age. There are controversial data on the adverse effect of subclinical thyroid dysfunctions on adverse feto-maternal outcomes. OBJECTIVES The current study aimed to identify the prevalence of thyroid dysfunction during pregnancy and to assess the effectiveness of treatment with levothyroxine on pregnancy outcomes of females with thyroid autoimmunity with or without subclinical thyroid dysfunction in Tehran, Iran. PATIENTS AND METHODS The study encompassed two phases: 1) a population based cross sectional study using a cluster sampling method that screened first trimester pregnant females for thyroid disorders, 2) a double-blind randomized clinical trial to determine the effectiveness of levothyroxine on adverse pregnancy outcomes in females with thyroid autoimmunity with or without subclinical thyroid dysfunction. Pregnant females were assessed at their first prenatal visit for serum TSH, T4, T-uptake, TPOAb and urinary iodine following which they were classified as: 1) normal, 2) subclinical TPOAb negative and 3) subclinical/euthyroid TPOAb positive. Females in groups two and three were randomly divided into two groups: group A was treated with levothyroxine (LT4), and group B did not receive any treatment. There was a follow-up program for participants and rates of adverse pregnancy outcomes in the treated and untreated groups were measured. RESULTS Results of the study provided reliable information regarding the prevalence of thyroid dysfunction among females in Tehran using universal thyroid screening, along with identification of the iodine status of their community. The study aimed to determine whether LT4 treatment exerts beneficial effects in females without overt thyroid dysfunction.
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Affiliation(s)
- Sima Nazarpour
- Department of Reproductive Health and Midwifery, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Fahimeh Ramezani Tehrani, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2122439982, Fax: +98-2122439784, E-mail:
| | - Masoumeh Simbar
- Department of Reproductive Health and Midwifery, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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Huang C, Liang P, Diao L, Liu C, Chen X, Li G, Chen C, Zeng Y. Thyroid Autoimmunity is Associated with Decreased Cytotoxicity T Cells in Women with Repeated Implantation Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:10352-61. [PMID: 26308040 PMCID: PMC4586615 DOI: 10.3390/ijerph120910352] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 01/30/2023]
Abstract
Thyroid autoimmunity (TAI), which is defined as the presence of autoantibodies against thyroid peroxidase (TPO) and/or thyroglobulin (TG), is related to repeated implantation failure (RIF). It is reported that TAI was involved in reproductive failure not only through leading thyroid function abnormality, but it can also be accompanied with immune imbalance. Therefore, this study was designed to investigate the association of thyroid function, immune status and TAI in women with RIF. Blood samples were drawn from 72 women with RIF to evaluate the prevalence of TAI, the thyroid function, the absolute numbers and percentages of lymphocytes. The prevalence of thyroid function abnormality in RIF women with TAI was not significantly different from that in RIF women without TAI (c(2) = 0.484, p > 0.05). The absolute number and percentage of T cells, T helper (Th) cells, B cells and natural killer (NK) cells were not significantly different in RIF women with TAI compared to those without TAI (all p > 0.05). The percentage of T cytotoxicity (Tc) cells was significantly decreased in RIF women with TAI compared to those without TAI (p < 0.05). Meanwhile, Th/Tc ratio was significantly increased (p < 0.05). These results indicated that the decreased Tc percentage and increased Th/Tc ratio may be another influential factor of adverse pregnancy outcomes in RIF women with TAI.
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Affiliation(s)
- Chunyu Huang
- Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, China.
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen 518045, China.
- Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Shenzhen 518045, China.
| | - Peiyan Liang
- Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, China.
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen 518045, China.
- Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Shenzhen 518045, China.
| | - Lianghui Diao
- Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, China.
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen 518045, China.
- Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Shenzhen 518045, China.
| | - Cuicui Liu
- Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, China.
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen 518045, China.
- Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Shenzhen 518045, China.
| | - Xian Chen
- Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, China.
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen 518045, China.
- Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Shenzhen 518045, China.
| | - Guangui Li
- Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, China.
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen 518045, China.
- Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Shenzhen 518045, China.
| | - Cong Chen
- Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, China.
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen 518045, China.
- Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Shenzhen 518045, China.
| | - Yong Zeng
- Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, China.
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen 518045, China.
- Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Shenzhen 518045, China.
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Abstract
OBJECTIVE To assess attitudes and perceptions of U.S. survey respondents regarding prevalence, causes, and emotional effects of miscarriage. METHODS We used a questionnaire consisting of 33 questions administered in January of 2013 to men and women aged 18-69 years across the United States. RESULTS Participants from 49 states completed the questionnaire: 45% male and 55% female (N=1,084). Fifteen percent reported they or their partner experienced at least one miscarriage. Fifty-five percent of respondents believed that miscarriage occurred in 5% or less of all pregnancies. Commonly believed causes of miscarriage included a stressful event (76%), lifting a heavy object (64%), previous use of an intrauterine device (28%), or oral contraceptives (22%). Of those who had a miscarriage, 37% felt they had lost a child, 47% felt guilty, 41% reported feeling that they had done something wrong, 41% felt alone, and 28% felt ashamed. Nineteen percent fewer people felt they had done something wrong when a cause for the miscarriage was found. Seventy-eight percent of all participants reported wanting to know the cause of their miscarriage, even if no intervention could have prevented it from occurring. Disclosures of miscarriages by public figures assuaged feelings of isolation for 28% of respondents. Level of education and gender had a significant effect on perceptions and understanding of miscarriage. CONCLUSION Respondents to our survey erroneously believed that miscarriage is a rare complication of pregnancy, with the majority believing that it occurred in 5% or less of all pregnancies. There were also widespread misconceptions about causes of miscarriage. Those who had experienced a miscarriage frequently felt guilty, isolated, and alone. Identifying a potential cause of the miscarriage may have an effect on patients' psychological and emotional responses. LEVEL OF EVIDENCE II.
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Gaberšček S, Zaletel K, Schwetz V, Pieber T, Obermayer-Pietsch B, Lerchbaum E. Mechanisms in endocrinology: thyroid and polycystic ovary syndrome. Eur J Endocrinol 2015; 172:R9-21. [PMID: 25422352 DOI: 10.1530/eje-14-0295] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Thyroid disorders, especially Hashimoto's thyroiditis (HT), and polycystic ovary syndrome (PCOS) are closely associated, based on a number of studies showing a significantly higher prevalence of HT in women with PCOS than in controls. However, the mechanisms of this association are not as clear. Certainly, genetic susceptibility contributes an important part to the development of HT and PCOS. However, a common genetic background has not yet been established. Polymorphisms of the PCOS-related gene for fibrillin 3 (FBN3) could be involved in the pathogenesis of HT and PCOS. Fibrillins influence the activity of transforming growth factor beta (TGFβ). Multifunctional TGFβ is also a key regulator of immune tolerance by stimulating regulatory T cells (Tregs), which are known to inhibit excessive immune response. With lower TGFβ and Treg levels, the autoimmune processes, well known in HT and assumed in PCOS, might develop. In fact, lower levels of TGFβ1 were found in HT as well as in PCOS women carrying allele 8 of D19S884 in the FBN3 gene. Additionally, vitamin D deficiency was shown to decrease Tregs. Finally, high estrogen-to-progesterone ratio owing to anovulatory cycles in PCOS women could enhance the immune response. Harmful metabolic and reproductive effects were shown to be more pronounced in women with HT and PCOS when compared with women with HT alone or with controls. In conclusion, HT and PCOS are associated not only with respect to their prevalence, but also with regard to etiology and clinical consequences. However, a possible crosstalk of this association is yet to be elucidated.
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Affiliation(s)
- Simona Gaberšček
- Department of Nuclear MedicineUniversity Medical Centre Ljubljana, Zaloška 7, 1525 Ljubljana, SloveniaFaculty of MedicineUniversity of Ljubljana, Vrazov trg 2, 1104 Ljubljana, SloveniaDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria Department of Nuclear MedicineUniversity Medical Centre Ljubljana, Zaloška 7, 1525 Ljubljana, SloveniaFaculty of MedicineUniversity of Ljubljana, Vrazov trg 2, 1104 Ljubljana, SloveniaDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Katja Zaletel
- Department of Nuclear MedicineUniversity Medical Centre Ljubljana, Zaloška 7, 1525 Ljubljana, SloveniaFaculty of MedicineUniversity of Ljubljana, Vrazov trg 2, 1104 Ljubljana, SloveniaDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Verena Schwetz
- Department of Nuclear MedicineUniversity Medical Centre Ljubljana, Zaloška 7, 1525 Ljubljana, SloveniaFaculty of MedicineUniversity of Ljubljana, Vrazov trg 2, 1104 Ljubljana, SloveniaDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Thomas Pieber
- Department of Nuclear MedicineUniversity Medical Centre Ljubljana, Zaloška 7, 1525 Ljubljana, SloveniaFaculty of MedicineUniversity of Ljubljana, Vrazov trg 2, 1104 Ljubljana, SloveniaDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Barbara Obermayer-Pietsch
- Department of Nuclear MedicineUniversity Medical Centre Ljubljana, Zaloška 7, 1525 Ljubljana, SloveniaFaculty of MedicineUniversity of Ljubljana, Vrazov trg 2, 1104 Ljubljana, SloveniaDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Elisabeth Lerchbaum
- Department of Nuclear MedicineUniversity Medical Centre Ljubljana, Zaloška 7, 1525 Ljubljana, SloveniaFaculty of MedicineUniversity of Ljubljana, Vrazov trg 2, 1104 Ljubljana, SloveniaDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
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Ahmed IZ, Eid YM, El Orabi H, Ibrahim HR. Comparison of universal and targeted screening for thyroid dysfunction in pregnant Egyptian women. Eur J Endocrinol 2014; 171:285-91. [PMID: 24842727 DOI: 10.1530/eje-14-0100] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare universal vs targeted screening for thyroid dysfunction and to estimate the prevalence of hypothyroidism in pregnant Egyptian women. SUBJECTS AND METHODS A total of 168 of pregnant women who attended the outpatient obstetric clinic at Ain Shams University Hospital (Cairo, Egypt) for antenatal care between September 2011 and December 2011 were enrolled. Based on the detailed data collection and results of laboratory testing, they were subdivided into the high- and low-risk group for thyroid disease according to the most recent Endocrine Society clinical practice guidelines, as well as into groups by trimester for application of American Thyroid Association guidelines. The group values were subjected to statistical analysis for estimating the prevalence of clinical and subclinical hypothyroidism and for identifying significant differences. RESULTS Of the 168 patients, 104 were classified into the low-risk group and 64 into the high-risk group. Using the trimesteric and normal population cutoff values for thyroid functions, the prevalence of hypothyroidism was found to be 56% (n=94) and 44.6% (n=75) respectively. No statistically significant differences were found between the high- and low-risk group regarding prevalence of either clinical or subclinical hypothyroidism, and no significant differences were found regarding the prevalence of hypothyroidism in the first, second, or third trimester. CONCLUSION Use of the most recent Endocrine Society clinical practice guidelines led to missed detection of clinical or subclinical hypothyroidism in 34.5% of pregnant women. Universal screening of pregnant women for thyroid dysfunction should thus be adopted throughout Egypt.
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Affiliation(s)
- Iman Z Ahmed
- Endocrinology and Metabolism UnitInternal Medicine DepartmentAin Shams University Hospital, Abbassia square, Ramsis street, Cairo 11591, EgyptMatarya Teaching HospitalCairo, Egypt
| | - Yara M Eid
- Endocrinology and Metabolism UnitInternal Medicine DepartmentAin Shams University Hospital, Abbassia square, Ramsis street, Cairo 11591, EgyptMatarya Teaching HospitalCairo, Egypt
| | - Hussein El Orabi
- Endocrinology and Metabolism UnitInternal Medicine DepartmentAin Shams University Hospital, Abbassia square, Ramsis street, Cairo 11591, EgyptMatarya Teaching HospitalCairo, Egypt
| | - Hani Refat Ibrahim
- Endocrinology and Metabolism UnitInternal Medicine DepartmentAin Shams University Hospital, Abbassia square, Ramsis street, Cairo 11591, EgyptMatarya Teaching HospitalCairo, Egypt
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Brenta G, Vaisman M, Sgarbi JA, Bergoglio LM, Andrada NCD, Bravo PP, Orlandi AM, Graf H. Clinical practice guidelines for the management of hypothyroidism. ACTA ACUST UNITED AC 2014; 57:265-91. [PMID: 23828433 DOI: 10.1590/s0004-27302013000400003] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 04/01/2013] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Hypothyroidism has long been known for its effects on different organ systems, leading to hypometabolism. However, subclinical hypothyroidism, its most prevalent form, has been recently related to cardiovascular risk and also to maternal-fetal complications in pregnant women. OBJECTIVES In these clinical practice guidelines, several aspects of this field have been discussed with the clear objectives of helping physicians treat patients with hypothyroidism, and of sharing some of our Latin American-based clinical experience. MATERIALS AND METHODS The Latin American Thyroid Society commissioned a Task Force on Hypothyroidism to develop evidence-based clinical guidelines on hypothyroidism. A systematic review of the available literature, focused on the primary databases of MedLine/PubMed and Lilacs/SciELO was performed. Filters to assess methodological quality were applied to select the best quality studies. The strength of recommendation on a scale from A-D was based on the Oxford Centre for Evidence--based Medicine, Levels of Evidence 2009, allowing an unbiased opinion devoid of subjective viewpoints. The areas of interest for the studies comprised diagnosis, screening, treatment and a special section for hypothyroidism in pregnancy. RESULTS Several questions based on diagnosis, screening, treatment of hypothyroidism in adult population and specifically in pregnant women were posed. Twenty six recommendations were created based on the answers to these questions. Despite the fact that evidence in some areas of hypothyroidism, such as therapy, is lacking, out of 279 references, 73% were Grade A and B, 8% Grade C and 19% Grade D. CONCLUSIONS These evidence-based clinical guidelines on hypothyroidism will provide unified criteria for management of hypothyroidism throughout Latin America. Although most of the studies referred to are from all over the world, the point of view of thyroidologists from Latin America is also given.
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Bozic Antic I, Macut D, Popovic B, Isailovic T, Petakov M, Ognjanovic S, Damjanovic S. Recurrent spontaneous abortions, Hashimoto thyroiditis and alopecia totalis: response to anticoagulation and intravenous immunoglobulin therapy. Gynecol Endocrinol 2014; 30:100-2. [PMID: 24308767 DOI: 10.3109/09513590.2013.864271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Although numerous studies indicated a link between antithyroid antibodies and recurrent spontaneous abortions (RSA), consensus on the treatment of this condition is still lacking. CASE REPORT We present a case of a 35-year-old pregnant woman (gestation week 4) with primary hypothyroidism, total alopecia, high level of positive antithyroid antibodies, and history of two recurrent spontaneous abortions in early pregnancy. Along with L-thyroxin substitution, intravenous human immunoglobulin (IVIg) combined with anticoagulation and antiaggregation therapy was introduced. During pregnancy her scalp hair completely re-grew, and following gestation week 39 she delivered healthy female child. CONCLUSION Thyroid antibodies could contribute to previous recurrent abortions in our patient. It is suggested that in older primiparas with Hashimoto thyroiditis and history of RSA, a combined treatment with IVIg, anticoagulation and antiaggregation therapy should be considered.
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Affiliation(s)
- Ivana Bozic Antic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia and
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Aktas A, Berberoglu Z, Fidan Y, Yazıcı AC, Koc G, Aral Y, Ademoglu E, Bekdemir H, Alphan Z. Higher levels of circulating CXCL-9 and CXCL-11 in euthyroid women with autoimmune thyroiditis and recurrent spontaneous abortions. Gynecol Endocrinol 2014; 30:157-60. [PMID: 24351073 DOI: 10.3109/09513590.2013.871514] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We aimed to measure serum CXCL-9 and CXCL-11 levels in patients with autoimmune thyroiditis (AIT) and recurrent spontaneous abortions (RSA). METHODS Forty-one euthyroid, non-pregnant women with AIT and a history of unexplained first trimester RSA, 35 euthyroid women with AIT, and 29 healthy controls matched for age and body mass index were enrolled. Serum CXCL-9 and CXCL-11 were measured. RESULTS Serum CXCL-9 and -11 levels were significantly higher (p < 0.001 for both) in the antibody-positive women with a history of abortions than in both control groups. Additionally, CXCL-9 levels were higher in patients with AIT without RSA than in healthy controls. No significant differences were found in CXCL-9 and -11 levels in subjects with a history of RSA in relation to the number of previous abortions. In multiple linear regression analyses, abortions were significantly related to CXCL-9 (β-coefficient = 0.174, p < 0.001), CXCL-11 (β-coefficient = 0.490, p < 0.001). CONCLUSION Higher circulating levels of CXCL-9 and -11 have been shown in non-pregnant AIT patients with a history of RSA as compared to both control groups, suggesting that this subgroup produce a more dominant Th-1 cytokine profile.
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Affiliation(s)
- Aynur Aktas
- Department of Endocrinology and Metabolism and
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Impact of maternal thyroperoxidase status on fetal body and brain size. J Thyroid Res 2014; 2014:872410. [PMID: 24624307 PMCID: PMC3929063 DOI: 10.1155/2014/872410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 11/05/2013] [Accepted: 11/23/2013] [Indexed: 11/30/2022] Open
Abstract
The obstetric consequences of abnormal thyroid function during pregnancy have been established. Less understood is the influence of maternal thyroid autoantibodies on infant outcomes. The objective of this study was to examine the influence of maternal thyroperoxidase (TPO) status on fetal/infant brain and body growth. Six-hundred thirty-one (631) euthyroid pregnant women were recruited from prenatal clinics in Tampa Bay, Florida, and the surrounding area between November 2007 and December 2010. TPO status was determined during pregnancy and fetal/infant brain and body growth variables were assessed at delivery. Regression analysis revealed maternal that TPO positivity was significantly associated with smaller head circumference, reduced brain weight, and lower brain-to-body ratio among infants born to TPO+ white, non-Hispanic mothers only, distinguishing race/ethnicity as an effect modifier in the relationship. No significant differences were noted in body growth measurements among infants born to TPO positive mothers of any racial/ethnic group. Currently, TPO antibody status is not assessed as part of the standard prenatal care laboratory work-up, but findings from this study suggest that fetal brain growth may be impaired by TPO positivity among certain populations; therefore autoantibody screening among high-risk subgroups may be useful for clinicians to determine whether prenatal thyroid treatment is warranted.
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Grossmann M, Hoermann R, Francis C, Hamilton EJ, Tint A, Kaitu’u-Lino T, Kuswanto K, Lappas M, Sikaris K, Zajac JD, Permezel M, Tong S. Measuring thyroid peroxidase antibodies on the day nulliparous women present for management of miscarriage: a descriptive cohort study. Reprod Biol Endocrinol 2013; 11:40. [PMID: 23672306 PMCID: PMC3655833 DOI: 10.1186/1477-7827-11-40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 05/08/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND There has been recent evidence suggesting the presence of anti-thyroid peroxidase antibodies (TPOAb) increases the risk of miscarriage, and levothyroxine can rescue miscarriages associated with TPOAb. We propose the most clinically pragmatic cohort to screen for TPOAb are women presenting for management of a missed miscarriage and have never birthed a liveborn. We measured serum TPOAb among nulliparous women presenting for management of miscarriage, and compared levels with women who have had 2 or more livebirths (and never miscarried). Given its potential role in immunomodulation, we also measured Vitamin D levels. METHODS We performed a prospective descriptive cohort study at a tertiary hospital (Mercy Hospital for Women, Victoria, Australia). We measured TPOAb and Vitamin D levels in serum obtained from 118 nulliparous women presenting for management of miscarriage, and 162 controls with 2 or more livebirths (and no miscarriages). Controls were selected from a serum biobank prospectively collected in the first trimester at the same hospital. RESULTS Nulliparous women with 1 or more miscarriages had higher thyroid peroxidase antibody (TPOAb) levels than those with 2 or more livebirths; TPOAb in miscarriage group was 0.3 mIU/L (interquartile range [IR]: 0.2-0.7) vs 0.2 mIU/L among controls (IR 0.0-0.5; p < 0.0001). We confirmed TPOAb levels were not correlated with serum human chorionic gonadotrophin (hCG) concentrations in either the miscarriage or control groups. In contrast, thyroid stimulating hormone, fT3 and fT4 levels (thyroid hormones) either trended towards a correlation, or were significantly correlated with serum hCG levels in the two groups. Of the entire cohort that was predominantly caucasian, only 12% were Vitamin D sufficient. Low Vitamin D levels were not associated with miscarriage. CONCLUSIONS We have confirmed the association between miscarriage and increased TPOAb levels. Furthermore, it appears TPOAb levels in maternal blood are not influenced by serum hCG levels. Therefore, we propose the day nulliparous women present for management for miscarriage is a clinically relevant, and pragmatic time to screen for TPOAb.
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Affiliation(s)
- Mathis Grossmann
- Department of Medicine, Austin Health, University of Melbourne, Studley Road, Heidelberg, Victoria 3084, Australia
| | - Rudolf Hoermann
- Department of Medicine, Austin Health, University of Melbourne, Studley Road, Heidelberg, Victoria 3084, Australia
| | - Claire Francis
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Studley Road, Heidelberg, Victoria 3084, Australia
| | - Emma J Hamilton
- Department of Medicine, Austin Health, University of Melbourne, Studley Road, Heidelberg, Victoria 3084, Australia
| | - Aye Tint
- Department of Medicine, Austin Health, University of Melbourne, Studley Road, Heidelberg, Victoria 3084, Australia
| | - Tu’uhevaha Kaitu’u-Lino
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Studley Road, Heidelberg, Victoria 3084, Australia
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Studley Road, Heidelberg, Victoria 3084, Australia
| | - Kent Kuswanto
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Studley Road, Heidelberg, Victoria 3084, Australia
| | - Martha Lappas
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Studley Road, Heidelberg, Victoria 3084, Australia
| | - Ken Sikaris
- Melbourne Pathology, 103 Victoria Parade, Collingwood, Victoria 3066, Australia
| | - Jeffery D Zajac
- Department of Medicine, Austin Health, University of Melbourne, Studley Road, Heidelberg, Victoria 3084, Australia
| | - Michael Permezel
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Studley Road, Heidelberg, Victoria 3084, Australia
| | - Stephen Tong
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Studley Road, Heidelberg, Victoria 3084, Australia
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Studley Road, Heidelberg, Victoria 3084, Australia
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Management of thyroid peroxidase antibody euthyroid women in pregnancy: comparison of the american thyroid association and the endocrine society guidelines. J Thyroid Res 2013; 2013:542692. [PMID: 23738229 PMCID: PMC3666229 DOI: 10.1155/2013/542692] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 03/27/2013] [Indexed: 01/27/2023] Open
Abstract
The presence of thyroid autoantibodies is relatively high in women of childbearing age. There is evidence that positive thyroperoxidase antibody even in euthyroid women may increase the risk of spontaneous and recurrent pregnancy loss and preterm delivery. However, the evidence is not enough to justify recommendation on the screening of pregnant women for thyroid autoantibodies or LT4 supplementation for reducing maternal or fetal complications. In this paper we reviewed the related evidence and compared the new guidelines of the American Thyroid Association and Endocrine Society with respect to the screening and management of positive thyroperoxidase antibody in euthyroid pregnant women. As there was no major contradiction or disagreement between the two guidelines, either one of two guidelines may be used by clinicians for the appropriate management of thyroid autoimmunity during pregnancy.
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Artini PG, Uccelli A, Papini F, Simi G, Di Berardino OM, Ruggiero M, Cela V. Infertility and pregnancy loss in euthyroid women with thyroid autoimmunity. Gynecol Endocrinol 2013; 29:36-41. [PMID: 22835333 DOI: 10.3109/09513590.2012.705391] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Thyroid autoimmunity is the most prevalent autoimmune state that affects up to 5-20% of women during the age of fertility. Prevalence of thyroid autoimmunity is significantly higher among infertile women, especially when the cause of infertility is endometriosis or polycystic ovary syndrome. Presence of thyroid autoimmunity does not interfere with normal embryo implantation and have been observed comparable pregnancy rates after assisted reproduction techniques in patients with or without thyroid autoimmunity. Instead, the risk of early miscarriage is substantially raised with the presence of thyroid autoimmunity, even if there was a condition of euthyroidism before pregnancy. Furthermore the controlled ovarian hyperstimulation, used as preparation for assisted reproduction techniques, can severely impair thyroid function increasing circulating estrogen levels. Systematic screening for thyroid disorders in women with a female cause of infertility is controversial but might be important to detect thyroid autoimmunity before to use assisted reproduction techniques and to follow-up these parameters in these patients after controlled ovarian hyperstimulation and during pregnancy.
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Affiliation(s)
- Paolo Giovanni Artini
- Division of Obstetrics and Gynecology, Department of Reproductive Medicine and Child Development, University of Pisa, Pisa, Italy
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Le Donne M, Settineri S, Benvenga S. Early pospartum alexithymia and risk for depression: relationship with serum thyrotropin, free thyroid hormones and thyroid autoantibodies. Psychoneuroendocrinology 2012; 37:519-33. [PMID: 22047958 DOI: 10.1016/j.psyneuen.2011.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 08/01/2011] [Accepted: 08/02/2011] [Indexed: 10/15/2022]
Abstract
Most psychometric evaluations in the postpartum (PP) target depression (PPD) and show an association with thyroid autoantibodies (TAb), not with thyroid function. Three studies evaluated PP alexithymia, but none its relationship with thyroid indices. We tested 74 women aged 31.8±4.64 years, on day 3 PP, by the Edinburgh Postnatal Depression Scale (EPDS), the Montgomery and Asberg Depression Rating Scale (MADRS), and the Toronto Alexithymia Scale (TAS). Concurrently, we measured serum thyrotropin (TSH), free T3 (FT3), free T4 (FT4), thyroperoxidase and thyroglobulin antibodies (TPOAb, TgAb). Using cut-off scores of ≥12 (EPDS), ≥15 (MADRS) and ≥61 (TAS), rates of women with abnormal EPDS and MADRS scores were similar (31%, 30% and 28.4%, respectively). TAS scores were higher and proportions of alexithymics were greater in the abnormal EPDS group or in the abnormal MADRS group than in the normal EPDS or MADRS group. EPDS correlated significantly with TAS. Compared to nonalexithymics, alexythimics had lower FT4, higher FT3, lower FT4:FT3 ratio, and insignificantly higher TPOAb or TgAb levels. Only TPOAb and TgAb were significantly higher in women at risk for PPD compared to women not at risk for PPD, but solely at EPDS cut-off values of ≥13 or ≥14. TAS correlated directly with TPOAb and FT3, and inversely with FT4:FT3 ratio, while EPDS correlated only with TPOAb. Comparing women at risk for depression but nonalexithymics or women alexithymics but not at risk for depression vs. women normal on all scales, the former had lower FT3 and higher FT4:FT3 ratio while the latter had lower both FT4 and FT4:FT3 ratio. We conclude that PPD risk and alexithymia (i) are partly comorbid and directly associated with thyroid autoimmunity; (ii) their association with serum free thyroid hormones and with FT4:FT3 ratio goes in opposite directions.
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Affiliation(s)
- Maria Le Donne
- Department of Gynecological, Obstetric Sciences and Reproductive Medicine, University of Messina, Messina, Italy.
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Perricone C, de Carolis C, Perricone R. Pregnancy and autoimmunity: A common problem. Best Pract Res Clin Rheumatol 2012; 26:47-60. [DOI: 10.1016/j.berh.2012.01.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 01/12/2012] [Indexed: 12/15/2022]
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Klubo-Gwiezdzinska J, Burman KD, Van Nostrand D, Wartofsky L. Levothyroxine treatment in pregnancy: indications, efficacy, and therapeutic regimen. J Thyroid Res 2011; 2011:843591. [PMID: 21876837 PMCID: PMC3163038 DOI: 10.4061/2011/843591] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 05/30/2011] [Accepted: 05/30/2011] [Indexed: 01/15/2023] Open
Abstract
The prevalence of overt and subclinical hypothyroidism during pregnancy is estimated to be 0.3–0.5% and 2–3%, respectively. Thyroid autoantibodies are found in 5–18% of women in the childbearing age. The aim of this review is to underscore the clinical significance of these findings on the health of both the mother and her offspring. Methods of evaluation of thyroid function tests (TFTs) during pregnancy are described as are the threshold values for the diagnosis of overt and subclinical hypothyroidism or hypothyroxinemia. Anticipated differences in TFTs in iodine-sufficient and iodine-deficient areas are discussed and data are provided on potential complications of hypothyroidism/hypothyroxinemia and autoimmune thyroid disease during pregnancy and adverse effects for the offspring. The beneficial effects of levothyroxine therapy on pregnancy outcomes and offspring development are discussed with a proposed treatment regimen and follow up strategy.
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Affiliation(s)
- Joanna Klubo-Gwiezdzinska
- Section of Endocrinology, Department of Medicine, Washington Hospital Center, Washington, DC 20010, USA
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THYROID FUNCTION IN PREGNANCY: MATERNAL AND FETAL OUTCOMES WITH HYPOTHYROIDISM AND SUBCLINICAL THYROID DYSFUNCTION. ACTA ACUST UNITED AC 2011. [DOI: 10.1017/s096553951100009x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Thyroid hormones are important in the development of the fetus and the placenta as well as in maintaining maternal wellbeing. Thyroid disorders are common in the population as a whole, particularly in women, and therefore are common during pregnancy and the puerperium. Biochemical derangement of thyroid function tests are present in approximately 2.5–5% of pregnant women.
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Thyroid hormone receptors and reproduction. J Reprod Immunol 2011; 90:58-66. [PMID: 21641659 DOI: 10.1016/j.jri.2011.02.009] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 02/13/2011] [Accepted: 02/14/2011] [Indexed: 11/20/2022]
Abstract
Thyroid disorders have a great impact on fertility in both sexes. Hyperthyroidism and hypothyroidism cause changes in sex hormone-binding globulin (SHBG), prolactin, gonadotropin-releasing hormone, and sex steroid serum levels. In females, thyroid hormones may also have a direct effect on oocytes, because it is known that specific binding sites for thyroxin are found on mouse and human oocytes. There is also an association between thyroid dysfunction in women and morbidity and outcome in pregnancy. In males, hyperthyroidism causes a reduction in sperm motility. The numbers of morphologically abnormal sperm are increased by hypothyroidism. When euthyroidism is restored, both abnormalities improve or normalize. In women, the alterations in fertility caused by thyroid disorders are more complex. Hyper- and hypothyroidism are the main thyroid diseases that have an adverse effect on female reproduction and cause menstrual disturbances--mainly hypomenorrhea and polymenorrhea in hyperthyroidism, and oligomenorrhea in hypothyroidism. In recent studies, it has become evident that it is not only changes in serum levels of SHBG and sex steroids that are responsible for these disorders, but also alterations in the metabolic pathway. Adequate levels of circulating thyroid hormones are of primary importance for normal reproductive function. This review presents an overview of the impact of thyroid disorders on reproduction.
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Ticconi C, Giuliani E, Veglia M, Pietropolli A, Piccione E, Di Simone N. Thyroid autoimmunity and recurrent miscarriage. Am J Reprod Immunol 2011; 66:452-9. [PMID: 21623997 DOI: 10.1111/j.1600-0897.2011.01021.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PROBLEM To investigate the role of antithyroid autoantibodies (ATA) in recurrent miscarriage (RM). METHODS In this case-control study, a total of 160 women with RM and 100 healthy women were investigated for the presence of serum ATA directed against thyreoglobulin (TG-Ab), thyroid peroxidase (TPO-Ab) and TSH receptor (TSHr-Ab), which were determined by either chemiluminescence or radioimmunoassay. RESULTS Antithyroid autoantibodies were detected in 46 (28.75%) women with RM and in 13 (13%) women of the control group (P < 0.05). The frequencies for TG-Ab and TPO-Ab were higher in RM than in control women. Among the women of RM group, 91.3% of ATA+ women were positive also for other autoantibodies. The majority of study women were euthyroid. CONCLUSIONS Antithyroid autoantibodies, particularly TG-Ab, are associated with RM and could be an expression of a more general maternal immune system abnormality leading to RM. ATA could have a role in RM irrespective of thyroid hormone status.
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Affiliation(s)
- Carlo Ticconi
- Section of Gynecology and Obstetrics, Department of Surgical Sciences, University Tor Vergata, Rome, Italy.
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Thangaratinam S, Tan A, Knox E, Kilby MD, Franklyn J, Coomarasamy A. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. BMJ 2011; 342:d2616. [PMID: 21558126 PMCID: PMC3089879 DOI: 10.1136/bmj.d2616] [Citation(s) in RCA: 309] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To evaluate the association between thyroid autoantibodies and miscarriage and preterm birth in women with normal thyroid function. To assess the effect of treatment with levothyroxine on pregnancy outcomes in this group of women. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, Embase, Cochrane Library, and SCISEARCH (inception-2011) without any language restrictions. We used a combination of key words to generate two subsets of citations, one indexing thyroid autoantibodies and the other indexing the outcomes of miscarriage and preterm birth. STUDY SELECTION Studies that evaluated the association between thyroid autoantibodies and pregnancy outcomes were selected in a two stage process. Two reviewers selected studies that met the predefined and explicit criteria regarding population, tests, and outcomes. DATA SYNTHESIS Odds ratios from individual studies were pooled separately for cohort and case-control studies with the random effects model. RESULTS 30 articles with 31 studies (19 cohort and 12 case-control) involving 12,126 women assessed the association between thyroid autoantibodies and miscarriage. Five studies with 12,566 women evaluated the association with preterm birth. Of the 31 studies evaluating miscarriage, 28 showed a positive association between thyroid autoantibodies and miscarriage. Meta-analysis of the cohort studies showed more than tripling in the odds of miscarriage with the presence of thyroid autoantibodies (odds ratio 3.90, 95% confidence interval 2.48 to 6.12; P < 0.001). For case-control studies the odds ratio for miscarriage was 1.80, 1.25 to 2.60; P = 0.002). There was a significant doubling in the odds of preterm birth with the presence of thyroid autoantibodies (2.07, 1.17 to 3.68; P = 0.01). Two randomised studies evaluated the effect of treatment with levothyroxine on miscarriage. Both showed a fall in miscarriage rates, and meta-analysis showed a significant 52% relative risk reduction in miscarriages with levothyroxine (relative risk 0.48, 0.25 to 0.92; P=0.03). One study reported on the effect of levothyroxine on the rate of preterm birth, and noted a 69% relative risk reduction (0.31, 0.11 to 0.90). CONCLUSION The presence of maternal thyroid autoantibodies is strongly associated with miscarriage and preterm delivery. There is evidence that treatment with levothyroxine can attenuate the risks.
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Affiliation(s)
- Shakila Thangaratinam
- Centre for Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AD, UK
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Kennedy RL, Malabu UH, Jarrod G, Nigam P, Kannan K, Rane A. Thyroid function and pregnancy: before, during and beyond. J OBSTET GYNAECOL 2011; 30:774-83. [PMID: 21126112 DOI: 10.3109/01443615.2010.517331] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Thyroid disturbances are common in women during the reproductive years of their lives. Autoimmunity and altered iodine status together account for a high proportion of the abnormalities. Autoimmune thyroid disease is present in around 4% of young females, and up to 15% are at risk because they are thyroid antibody-positive. There is a strong relationship between thyroid immunity on the one hand and infertility, miscarriage, and thyroid disturbances in pregnancy and postpartum on the other hand. Suboptimal iodine status affects a large proportion of the world's population, and pregnancy further depletes iodine stores. There is controversy surrounding the degree to which iodine should be supplemented and the duration of supplementation. Recent studies have helped to clarify the relationship between maternal thyroid status and neuropsychological development of the child. The role of other environmental factors including smoking and selenium status is also now recognised. Universal screening for thyroid hormone abnormalities is not routinely recommended at present. However, measurement of thyroid function and autoantibodies should certainly be considered in those who are at high risk of thyroid disease and in those whose pregnancy is otherwise high risk. The practicing clinician needs to be aware of the thyroid changes which accompany pregnancy.
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Affiliation(s)
- R L Kennedy
- James Cook University School of Medicine, Queensland, Australia.
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Dal Lago A, Vaquero E, Pasqualetti P, Lazzarin N, De Carolis C, Perricone R, Moretti C. Prediction of early pregnancy maternal thyroid impairment in women affected with unexplained recurrent miscarriage. Hum Reprod 2011; 26:1324-30. [DOI: 10.1093/humrep/der069] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Abstract
Both diabetes mellitus and thyroid disorders are common diseases. According to epidemiologic studies the prevalence of specific thyroid disorders in diabetic subjects is two times higher. Risk factors are age, female gender and autoimmune diabetes mellitus. However, thyroid disorders are diagnosed only half of the cases in diabetic population. The review briefly summarizes the association of autoimmune diabetes mellitus and thyreoiditis, the risk of thyroid disorders in type 1 diabetic pregnant women. Furthermore, the influence of obesity in the risk on thyroid cancer and the effect of glucagon-like peptide 1 analogue on thyroid medullary C-cells are discussed. Orv. Hetil., 2011, 152, 516–519.
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Affiliation(s)
- Péter Reismann
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088
| | - Anikó Somogyi
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088
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Recent thoughts on management and prevention of recurrent early pregnancy loss. Curr Opin Obstet Gynecol 2011; 22:446-51. [PMID: 20724930 DOI: 10.1097/gco.0b013e32833e124e] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To provide an overview of the latest views and evidence available to clinicians managing couples with recurrent early pregnancy loss (RPL). RECENT FINDINGS RPL is a heterogeneous condition associated with many pathologies, none of which is found in more than 50% of couples after routine investigations. The recommended treatment of low-dose aspirin and heparin in women with antiphospholipid syndrome has a weak evidence base. Recent randomized controlled trials (RCTs) of low-dose aspirin and heparin have failed to find an improvement in live birth rates, even in the presence of thrombophilia. Although parental karyotypic abnormalities are associated with RPL, conservative management of such couples may be optimal. Observational studies of hysteroscopic metroplasty have promising results, but evidence from RCTs is awaited. Progestogen therapy may improve pregnancy outcomes, but further RCTs are needed. Immunological factors are thought to be important in idiopathic RPL. Research is focused on natural killer cells and cytokines in influencing implantation as potential therapeutic treatments. Currently, RCTs have not substantiated a benefit for immunotherapy. SUMMARY Management of RPL remains challenging, with many controversial issues regarding the underlying pathophysiology. Improvements in live birth rates in subsequent pregnancies have not been found in RCTs of treatment for most of the associated conditions. All women can be offered supportive care in subsequent pregnancies. Empirical treatment is widely used in idiopathic RPL. A better option may be to encourage women to participate in high-quality and methodologically sound studies to guide optimal management.
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