1
|
Salloum-Asfar S, Shin KC, Taha RZ, Khattak S, Park Y, Abdulla SA. The Potential Role of Thyroid Hormone Therapy in Neural Progenitor Cell Differentiation and Its Impact on Neurodevelopmental Disorders. Mol Neurobiol 2024; 61:3330-3342. [PMID: 37991699 PMCID: PMC11087352 DOI: 10.1007/s12035-023-03751-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/28/2023] [Indexed: 11/23/2023]
Abstract
Thyroid hormone (T3) plays a vital role in brain development and its dysregulation can impact behavior, nervous system function, and cognitive development. Large case-cohort studies have associated abnormal maternal T3 during early pregnancy to epilepsy, autism, and attention deficit hyperactivity disorder (ADHD) in children. Recent experimental findings have also shown T3's influence on the fate of neural precursor cells and raise the question of its convergence with embryonic neural progenitors. Our objective was to investigate how T3 treatment affects neuronal development and functionality at the cellular level. In vitro experiments using neural precursor cells (NPCs) measured cell growth and numbers after exposure to varying T3 concentrations. Time points included week 0 (W0) representing NPCs treated with 100 nM T3 for 5 days, and differentiated cortical neurons assessed at weeks 3 (W3), 6 (W6), and 8 (W8). Techniques such as single-cell calcium imaging and whole-cell patch clamp were utilized to evaluate neuronal activity and function. IHC staining detected mature neuron markers, and RNA sequencing enabled molecular profiling. W6 and W8 neurons exhibited higher action potential frequencies, with W6 showing increased peak amplitudes and shortened inter-spike intervals by 50%, indicating enhanced activity. Transcriptomic analysis revealed that W6 T3-treated neurons formed a distinct cluster, suggesting accelerated maturation. Comparison with the whole transcriptome further unveiled a correlation between W6 neurons treated with T3 and neuronal regulatory elements associated with autism and ADHD. These findings provide insights into T3's impact on neuronal development and potential mechanisms of T3 dysregulation and neurodevelopmental disorders.
Collapse
Affiliation(s)
- Salam Salloum-Asfar
- Neurological Disorders Research Center, Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar.
| | - Kyung Chul Shin
- Neurological Disorders Research Center, Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Rowaida Z Taha
- Neurological Disorders Research Center, Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Shahryar Khattak
- BESE and KAUST Smart-Health Initiative (KSHI), King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
| | - Yongsoo Park
- Neurological Disorders Research Center, Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Sara A Abdulla
- Neurological Disorders Research Center, Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar.
| |
Collapse
|
2
|
Abadi KK. "Dynamic Monitoring of Hypothyroidism During Pregnancy" article [Response to Letter]. Int J Womens Health 2023; 15:1711-1712. [PMID: 37954007 PMCID: PMC10638932 DOI: 10.2147/ijwh.s446488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023] Open
|
3
|
Abadi KK, Jama AH, Legesse AY, Gebremichael AK. Prevalence of Hypothyroidism in Pregnancy and Its Associations with Adverse Pregnancy Outcomes Among Pregnant Women in A General Hospital: A Cross Sectional Study. Int J Womens Health 2023; 15:1481-1490. [PMID: 37810201 PMCID: PMC10559790 DOI: 10.2147/ijwh.s429611] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023] Open
Abstract
Background Hypothyroidism affects 3-5% of all pregnant mothers, making it the most common thyroid disorder associated with pregnancy. Furthermore, it is associated with adverse outcomes of pregnancy and newborn. Therefore, this research is aimed at determining the magnitude and pregnancy adverse outcomes associated with hypothyroidism among pregnant women having maternity services in a general hospital in Somalia. Methods A cross-sectional study was conducted on pregnant women who delivered in the hospital between December 2022 and May 2023. Subjects were selected through systematic sampling and data collected through an interviewer-based questionnaire. Adjusted odds ratios (AORs) of P values and 95% confidence intervals (CIs) were used to assess the correlation between variables. Results The prevalence of hypothyroidism was 23.6% (95% CI: [19.4-27.8]). Overt DM (AOR=9.125, CI (3.106-26.812)), History of Recurrent pregnancy loss (AOR=12.938, CI (4.958-33.763), hypertension during pregnancy (AOR=6.718, CI (2.326-19.994)) and preterm delivery (AOR=7.015, CI (3.234-13.958)) were variables associated with hypothyroidism in pregnancy. Conclusion The study has shown a high prevalence of hypothyroidism during pregnancy at Daruxannan Hospital compared to previous studies around the world. This finding highlights the need for national and regional surveys to identify the prevalence and associated factors that contribute to hypothyroidism in pregnancy to set up interventions and determine policy directions.
Collapse
Affiliation(s)
| | - Abdikani Hassan Jama
- Daruxannan General Hospital, Burao, Somaliland, Somalia
- Burao University, Burao, Somaliland, Somalia
| | - Awol Yemane Legesse
- Department of Obstetrics and Gynecology, Mekelle University, Mekelle, Tigray, Ethiopia
| | | |
Collapse
|
4
|
Ge GM, Cheung ECL, Man KKC, Ip P, Leung WC, Li GHY, Kung AWC, Cheung CL, Wong ICK. Association of maternal levothyroxine use during pregnancy with offspring birth and neurodevelopmental outcomes: a population-based cohort study. BMC Med 2022; 20:390. [PMID: 36344981 PMCID: PMC9641874 DOI: 10.1186/s12916-022-02586-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 09/27/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The influence of maternal levothyroxine treatment during pregnancy remains unclear. This study aimed to evaluate the associations of maternal levothyroxine treatment during pregnancy with the birth and neurodevelopmental outcomes in offspring. METHODS This population-based cohort study was conducted among pregnant women using the Hong Kong Clinical Data Analysis and Reporting System. Mother-child pairs in Hong Kong from 2001 to 2015 were included and children were followed up till 2020. We defined the exposure group as mothers who were exposed to levothyroxine during pregnancy. Preterm birth and small for gestational age (SGA) were included as birth outcomes. Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) were included as neurodevelopmental outcomes. Odds ratios (OR) or hazard ratios (HRs) with a 95% confidence interval (CI) were evaluated to assess the association of gestational levothyroxine use with offspring birth and neurodevelopmental outcomes respectively, using propensity score fine-stratification weighting and a Cox proportional hazards regression model. RESULTS Among 422,156 mother-child pairs, 2125 children were born from mothers exposed to levothyroxine during pregnancy. A significantly increased risk of preterm birth was observed in children with maternal levothyroxine exposure during pregnancy, when compared to mothers who had no history of thyroid-related diagnoses or prescriptions (weighted OR [wOR]: 1.22, 95% CI: 1.07, 1.39). Similarly, an increased risk of preterm birth was found among children of gestational levothyroxine users, when compared to children of mothers who had used levothyroxine before but stopped during pregnancy (wOR: 2.16, 95% CI: 1.09, 4.25). Sensitivity analysis, by excluding mothers exposed to psychotropic or antiepileptic medications before or during pregnancy, also indicated a similar increased risk of preterm birth regarding the gestational use of levothyroxine (wOR: 1.26, 95% CI: 1.10, 1.45). No significant association was observed for the risk of SGA, ADHD, and ASD. CONCLUSIONS There is no evidence that gestational use of levothyroxine is associated with SGA, ADHD, or ASD in offspring. Gestational levothyroxine treatment is associated with a higher risk of preterm birth. Such risk might be confounded by the underlying maternal thyroid disease itself, however, we cannot completely exclude the possible effect of gestational L-T4 treatment on offspring preterm birth. Our findings provided support to the current guidelines on the cautious use of levothyroxine treatment during pregnancy.
Collapse
Affiliation(s)
- Grace Mengqin Ge
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Edmund C L Cheung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kenneth K C Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.,Research Department of Practice and Policy, UCL, School of Pharmacy, London, UK
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Wing Cheong Leung
- Department of Obstetrics and Gynecology, Kwong Wah Hospital, Hong Kong Special Administrative Region, China
| | - Gloria H Y Li
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Annie W C Kung
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ching-Lung Cheung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China. .,Research Department of Practice and Policy, UCL, School of Pharmacy, London, UK. .,Aston Pharmacy School, Aston University, Birmingham, B4 7ET, UK.
| |
Collapse
|
5
|
Das D, Banerjee A, Jena AB, Duttaroy AK, Pathak S. Essentiality, relevance, and efficacy of adjuvant/combinational therapy in the management of thyroid dysfunctions. Biomed Pharmacother 2022; 146:112613. [PMID: 35062076 DOI: 10.1016/j.biopha.2022.112613] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/14/2021] [Accepted: 01/02/2022] [Indexed: 11/02/2022] Open
Abstract
Thyroid dysfunction is the most prevalent endocrine disorder worldwide having an epidemiology of 11% in Indians, 4.6% in the United Kingdom, and 2% in the United States of America among the overall population. The common thyroid disorders include hypothyroidism, hyperthyroidism, Hashimoto's thyroiditis, and thyroid cancer. This review briefly elaborates the molecular regulation and mechanism of thyroid hormone, and its associated thyroid disorders. The thyroid hormones regulate critical biochemical functions in brain development and function. Hypothyroidism is mainly associated with dysregulation of cytokines, increased ROS production, and altered signal transduction in major regions of the brain. In addition, it is associated with reduced antioxidant capacity and increased oxidative stress in humans. Though 70% of thyroid disorders are caused by heredity, environmental factors have a significant influence in developing autoimmune thyroid disorders in people who are predisposed to them. This drives us to understand the relationship between environmental factors and thyroid dysregulated disorders. The treatment option for the thyroid disorder includes antithyroid medications, receiving radioactive iodine therapy, or surgery at a critical stage. However, antithyroid drugs are not typically used long-term in thyroid disease due to the high recurrence rate. Adjuvant treatment of antioxidants can produce better outcomes with anti-thyroid drug treatment. Thus, Adjuvant therapy has been proven as an effective strategy for managing thyroid dysfunction, herbal remedies can be used to treat thyroid dysfunction in the future, which in turn can reduce the prevalence of thyroid disorders.
Collapse
Affiliation(s)
- Diptimayee Das
- Faculty of Allied Health Sciences, Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Chennai 603103, India
| | - Antara Banerjee
- Department of Medical Biotechnology, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Chennai, India
| | | | - Asim K Duttaroy
- Department of Nutrition, Institute of Medical Sciences, Faculty of Medicine, University of Oslo, Norway.
| | - Surajit Pathak
- Department of Medical Biotechnology, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Chennai, India.
| |
Collapse
|
6
|
Abstract
Overt hypothyroidism is a common endocrine disorder affecting 1-2% of women of reproductive age. Optimizing treatment in pregnant women with overt hypothyroidism can reduce adverse fetal and maternal outcomes. Ideally, women who are known to have a history of hypothyroidism or those with risk factors for becoming hypothyroid, should have adequate preconception care to ensure euthyroidism from the onset of pregnancy, with a TSH target of below 2.5mIU/L. On women who are already on levothyroxine, an empirical dose increase of 30-50% as soon as pregnancy is confirmed may be considered. During pregnancy, levothyroxine doses should be titrated against TSH, which have trimester-specific ranges. In women who are known to be hypothyroid but are inadequately treated, we recommend a doubling of levothyroxine dose on at least three days a week to rapidly achieve euthyroidism. In newly diagnosed overt hypothyroidism in pregnancy, starting doses of either 100 or 150 mg daily may be considered safe.
Collapse
Affiliation(s)
- Sarah Weiling Li
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228.
| |
Collapse
|
7
|
Huget-Penner S, Feig DS. Maternal thyroid disease and its effects on the fetus and perinatal outcomes. Prenat Diagn 2020; 40:1077-1084. [PMID: 32181913 DOI: 10.1002/pd.5684] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/06/2020] [Accepted: 03/07/2020] [Indexed: 12/17/2022]
Abstract
Thyroid disease is common in women of childbearing age and can have significant effects on the development of the fetus and perinatal outcomes. Maternal thyroid hormone is critical for proper fetal neurodevelopment, and the fetus relies on thyroid hormone from its mother for the first half of pregnancy. Both overt maternal hypothyroidism and overt maternal hyperthyroidism have been shown to be associated with adverse effects on central nervous system gray matter and neurocognitive development of offspring as well as increased obstetrical risks. Treatment of overt thyroid conditions improves outcomes. Subclinical maternal hypothyroidism may increase adverse neurocognitive and obstetrical outcomes although data are conflicting. To date, treatment of subclinical hypothyroidism has not shown benefit. Subclinical hyperthyroidism is well tolerated in pregnancy. Thyroid autoantibodies alone may also affect neurodevelopment and obstetrical outcomes; however, recent data have shown no improvement with levothyroxine treatment. Several rare maternal genetic thyroid conditions can affect the fetus including a thyroid-stimulating hormone receptor mutation leading to hypersensitivity to human chorionic gonadotropin and thyroid hormone resistance. The thyroid plays a crucial role in fetal health and understanding it is important for optimal care.
Collapse
Affiliation(s)
- Sawyer Huget-Penner
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Endocrinology, Department of Medicine, Fraser Health Authority, New Westminster, British Columbia, Canada
| | - Denice S Feig
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| |
Collapse
|
8
|
Effect of maternal hypothyroidism during pregnancy on insulin resistance, lipid accumulation, and mitochondrial dysfunction in skeletal muscle of fetal rats. Biosci Rep 2018; 38:BSR20171731. [PMID: 29784871 PMCID: PMC6028760 DOI: 10.1042/bsr20171731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 05/06/2018] [Accepted: 05/21/2018] [Indexed: 01/09/2023] Open
Abstract
The present study aimed to investigate the effect of maternal hypothyroidism during pregnancy on thyroid function of the fetal rat. Female Sprague–Dawley rats were randomized into two groups. Propylthiouracil (PTU) group received PTU in drinking water for 6 weeks (n=90), normal group received normal drinking water (n=50). The pregnant rats were obtained and had a cesarean-section to get at gestational ages of 8.5, 13, and 21 days, following blood samples and skeletal muscle were obtained from fetal rats. Levels of thyroid hormone, insulin, mitochondrial protein, and adipokines were detected using ELISA. Western blotting was performed to analyze mitochondria and insulin signal transduction-related protein in fetal rat skeletal muscle. Immunostaining of Periodic Acid-Schiff (PAS) and Oil Red O was used to observe the accumulation of muscle glycogen and lipid in the fetal rat. The results showed that the levels of thyroid hormone, insulin, insulin signal transduction-related protein, mitochondrial, and adipokines increased with the fetus developed, but had no statistical differences in the PTU group compared with the normal group. In conclusion, pregnant rats with hypothyroidism had no influence on insulin resistance (IR), lipid accumulation, and mitochondrial dysfunction in skeletal muscle of the fetal rats.
Collapse
|
9
|
Dhanwal DK, Bajaj S, Rajput R, Subramaniam KAV, Chowdhury S, Bhandari R, Dharmalingam M, Sahay R, Ganie A, Kotwal N, Shriram U. Prevalence of hypothyroidism in pregnancy: An epidemiological study from 11 cities in 9 states of India. Indian J Endocrinol Metab 2016; 20:387-390. [PMID: 27186559 PMCID: PMC4855970 DOI: 10.4103/2230-8210.179992] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A previous hospital based study from Delhi revealed a high prevalence of hypothyroidism in pregnant women. Several other studies with small sample size also indicate a rising trend of prevalence of hypothyroidism during pregnancy in India. OBJECTIVE To assess prevalence of hypothyroidism in pregnant women from various states/cities across India. MATERIALS AND METHODS This was a cross-sectional multicenter study conducted at Allahabad (Uttar Pradesh), Bengaluru (Karnataka), Chennai (Tamil Nadu), Kolkata (West Bengal), Hyderabad (Telangana), Nasik (Maharashtra), Rohtak (Haryana), Pune (Maharashtra), New Delhi (Delhi), Srinagar (Kashmir), and Vizag (Andhra Pradesh) enrolling 2599 pregnant women. Estimation of thyroid stimulating hormone (TSH), free T4, and antithyroid peroxidase (TPO) antibodies was carried out using Roche modular kit using ECLIA technology in a central laboratory. RESULTS We found in our study population that 13.13% of pregnant women have hypothyroidism (n = 388), using a cutoff TSH level of 4.5 μIU/ml. This prevalence was much higher using the American Thyroid Association criteria. Anti-TPO antibodies were positive in 20.74% of all pregnant women (n = 613), whereas 40% (n = 155) of hypothyroid pregnant women were positive for anti-TPO antibodies. CONCLUSION This study concludes that there is a high prevalence of hypothyroidism (13.13%), majority being subclinical in pregnant women during the first trimester from India and universal screening of hypothyroidism may be desirable in our country.
Collapse
Affiliation(s)
- Dinesh Kumar Dhanwal
- Department of Endocrinology, Consultant Endocrinologist, NMC Specialty Hospital, Abu Dhabi, UAE
| | - Sarita Bajaj
- Department of Medicine, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - Rajesh Rajput
- Department of Endocrinology and Medicine, Pt. B.D.Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - K. A. V. Subramaniam
- Department of Medicine and Endocrinology, King Georges Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Subhankar Chowdhury
- Department of Endocrinology, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | | | - Mala Dharmalingam
- Bangalore Endocrinology and Diabetes Research Centre, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, Telangana, India
| | - Ashraf Ganie
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | | | | |
Collapse
|
10
|
Spencer L, Bubner T, Bain E, Middleton P. Screening and subsequent management for thyroid dysfunction pre-pregnancy and during pregnancy for improving maternal and infant health. Cochrane Database Syst Rev 2015; 2015:CD011263. [PMID: 26387772 PMCID: PMC9233937 DOI: 10.1002/14651858.cd011263.pub2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Thyroid dysfunction pre-pregnancy and during pregnancy (both hyper- and hypothyroidism) is associated with increased risk of adverse outcomes for mothers and infants in the short- and long-term. Managing the thyroid dysfunction (e.g. thyroxine for hypothyroidism, or antithyroid medication for hyperthyroidism) may improve outcomes. The best method of screening to identify and subsequently manage thyroid dysfunction pre-pregnancy and during pregnancy is unknown. OBJECTIVES To assess the effects of different screening methods (and subsequent management) for thyroid dysfunction pre-pregnancy and during pregnancy on maternal and infant outcomes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (14 July 2015) and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials, comparing any screening method (e.g. tool, program, guideline/protocol) for detecting thyroid dysfunction (including hypothyroidism, hyperthyroidism, and/or thyroid autoimmunity) pre-pregnancy or during pregnancy with no screening, or alternative screening methods. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility of studies, extracted and checked data accuracy, and assessed the risk of bias of included studies. MAIN RESULTS We included two randomised controlled trials (involving 26,408 women) - these trials were considered to be at low risk of bias. Universal screening (screening all women) versus case finding (screening only those at perceived increased risk) in pregnancy for thyroid dysfunctionOne trial (4562 women) compared universal screening with case finding for thyroid dysfunction. Before 11 weeks' gestation, women in the universal screening group, and 'high-risk' women in the case finding group had their sera tested for TSH (thyroid stimulating hormone), fT4 (free thyroxine) and TPO-Ab (thyroid peroxidase antibody); women with hypothyroidism (TSH > 2.5 mIU/litre) received levothyroxine; women with hyperthyroidism (undetectable TSH and elevated fT4) received antithyroid medication.In regards to this review's primary outcomes, compared with the case finding group, more women in the universal screening group were diagnosed with hypothyroidism (risk ratio (RR) 3.15, 95% confidence interval (CI) 1.91 to 5.20; 4562 women; GRADE: high quality evidence), with a trend towards more women being diagnosed with hyperthyroidism (RR 4.50, 95% CI 0.97 to 20.82; 4562 women; P = 0.05; GRADE: moderate quality evidence). No clear differences were seen in the risks of pre-eclampsia (RR 0.87, 95% CI 0.64 to 1.18; 4516 women; GRADE: moderate quality evidence), or preterm birth (RR 0.99, 95% CI 0.80 to 1.24; 4516 women; GRADE: high quality evidence) between groups. This trial did not report on neurosensory disability for the infant as a child.Considering this review's secondary outcomes, more women in the universal screening group received pharmacological treatment for thyroid dysfunction (RR 3.15, 95% CI 1.91 to 5.20; 4562 women). No clear differences between groups were observed for miscarriage (RR 0.90, 95% CI 0.68 to 1.19; 4516 women; GRADE: moderate quality evidence), fetal and neonatal death (RR 0.92, 95% CI 0.42 to 2.02; 4516 infants; GRADE: moderate quality evidence), or other secondary outcomes: pregnancy-induced hypertension, gestational diabetes, congestive heart failure, thyroid storm, mode of birth (caesarean section), preterm labour, placental abruption, respiratory distress syndrome, low birthweight, neonatal intensive care unit admission, or other congenital malformations. The trial did not report on a number of outcomes including adverse effects associated with the intervention. Universal screening versus no screening in pregnancy for hypothyroidismOne trial (21,846 women) compared universal screening with no screening for hypothyroidism. Before 15 + 6 weeks' gestation, women in the universal screening group had their sera tested; women who screened 'positive' (TSH > 97.5th percentile, fT4 < 2.5th percentile, or both) received levothyroxine.Considering primary review outcomes, compared with the no screening group, more women in the universal screening screened 'positive' for hypothyroidism (RR 998.18, 95% CI 62.36 to 15,978.48; 21,839 women; GRADE: high quality evidence). No data were provided for the outcome pre-eclampsia, and for preterm birth, the trial reported rates of 5.6% and 7.9% for the screening and no screening groups respectively (it was unclear if these percentages related to the entire cohort or women who screened positive). No clear difference was seen for neurosensory disability for the infant as a child (three-year follow-up IQ score < 85) (RR 0.85, 95% CI 0.60 to 1.22; 794 infants; GRADE: moderate quality evidence).More women in the universal screening group received pharmacological treatment for thyroid dysfunction (RR 1102.90, 95% CI 69.07 to 17,610.46; 1050 women); 10% had their dose lowered because of low TSH, high fT4 or minor side effects. No clear differences were observed for other secondary outcomes, including developmental delay/intellectual impairment at three years. Most of our secondary outcomes, including miscarriage, fetal or neonatal death were not reported. AUTHORS' CONCLUSIONS Based on the existing evidence, though universal screening for thyroid dysfunction in pregnancy increases the number of women diagnosed with hypothyroidism who can be subsequently treated, it does not clearly impact (benefit or harm) maternal and infant outcomes.While universal screening versus case finding for thyroid dysfunction increased diagnosis and subsequent treatment, we found no clear differences for the primary outcomes: pre-eclampsia or preterm birth. No clear differences were seen for secondary outcomes, including miscarriage and fetal or neonatal death; data were lacking for the primary outcome: neurosensory disability for the infant as a child, and for many secondary outcomes. Though universal screening versus no screening for hypothyroidism similarly increased diagnosis and subsequent treatment, no clear difference was seen for the primary outcome: neurosensory disability for the infant as a child (IQ < 85 at three years); data were lacking for the other primary outcomes: pre-eclampsia and preterm birth, and for the majority of secondary outcomes.For outcomes assessed using the GRADE approach the evidence was considered to be moderate or high quality, with any downgrading of the evidence based on the presence of wide confidence intervals crossing the line of no effect.More evidence is needed to assess the benefits or harms of different screening methods for thyroid dysfunction in pregnancy, on maternal, infant and child health outcomes. Future trials should assess impacts on use of health services and costs, and be adequately powered to evaluate the effects on short- and long-term outcomes.
Collapse
Affiliation(s)
- Laura Spencer
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and Gynaecology72 King William RoadAdelaideSAAustralia5006
| | - Tanya Bubner
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and Gynaecology72 King William RoadAdelaideSAAustralia5006
| | - Emily Bain
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and Gynaecology72 King William RoadAdelaideSAAustralia5006
| | - Philippa Middleton
- The University of AdelaideWomen's and Children's Research InstituteWomen's and Children's Hospital72 King William RoadAdelaideSouth AustraliaAustralia5006
| | | |
Collapse
|
11
|
Ghanbari M, Jeddi S, Bagheripuor F, Ghasemi A. The effect of maternal hypothyroidism on cardiac function and tolerance to ischemia-reperfusion injury in offspring male and female rats. J Endocrinol Invest 2015; 38:915-22. [PMID: 25823371 DOI: 10.1007/s40618-015-0267-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/03/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE Accumulating evidence indicates that intrauterine evolution disturbance can contribute to myocardial ischemia reperfusion (IR) injury; in addition, thyroid hormones (THs) have a crucial role in the development of different systems during fetal life. The aim of this study was to determine the effect of TH deficiency during fetal life on tolerance of isolated heart to ischemia during adulthood in both genders. METHODS Hypothyroidism was induced in pregnant Wistar rats by administrating 0.025 % 6-propyl-2-thiouracil in drinking water throughout pregnancy. Offspring of rats with maternal hypothyroidism (MH) and control groups were tested in adulthood. Isolated hearts were perfused with Langendorff setup and exposed to 30 min of ischemia, followed by 45 min of reperfusion. Baseline values of the left ventricular end-diastolic pressure (LVEDP), left ventricular developed pressure (LVDP), heart rate (HR), and peak rates of positive and negative changes in left ventricular pressure (±dp/dt) were recorded. RESULTS In the MH groups the baseline levels of LVDP (male: 23 %, female: 33 %), HR (male: 31 %, female: 26 %), and ±dp/dt were significantly (p < 0.01) lower, compared to controls. After ischemia, hearts from male rats with MH had less tolerance to IR injury as assessed in terms of reductions in recovery of hemodynamic parameters compared to controls, while in female rats there were no significant differences between MH and controls. CONCLUSIONS MH decreases hemodynamic parameters in the heart of both male and female offspring in adulthood; in addition, hearts of male rats with MH show less tolerance to ischemia, compared to those of females.
Collapse
Affiliation(s)
- M Ghanbari
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Parvaneh Street, Velenjak, 1985717413, Tehran, Iran
| | | | | | | |
Collapse
|
12
|
Mianji FA, Diba JK, Babakhani A. Fetus dose estimation in thyroid cancer post-surgical radioiodine therapy. RADIATION PROTECTION DOSIMETRY 2015; 163:27-36. [PMID: 24723189 DOI: 10.1093/rpd/ncu051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Unrecognised pregnancy during radioisotope therapy of thyroid cancer results in hardly definable embryo/fetus exposures, particularly when the thyroid gland is already removed. Sources of such difficulty include uncertainty in data like pregnancy commencing time, amount and distribution of metastasized thyroid cells in body, effect of the thyroidectomy on the fetus dose coefficient etc. Despite all these uncertainties, estimation of the order of the fetus dose in most cases is enough for medical and legal decision-making purposes. A model for adapting the dose coefficients recommended by the well-known methods to the problem of fetus dose assessment in athyrotic patients is proposed. The model defines a correction factor for the problem and ensures that the fetus dose in athyrotic pregnant patients is less than the normal patients. A case of pregnant patient undergone post-surgical therapy by I-131 is then studied for quantitative comparison of the methods. The results draw a range for the fetus dose in athyrotic patients using the derived factor. This reduces the concerns on under- or over-estimation of the embryo/fetus dose and is helpful for personal and/or legal decision-making on abortion.
Collapse
Affiliation(s)
- Fereidoun A Mianji
- Nuclear Science & Technology Research Institute, End of North Kargar, Tehran, Iran Iran Nuclear Regulatory Authority, End of North Kargar, Tehran, Iran
| | - Jila Karimi Diba
- Iran Nuclear Regulatory Authority, End of North Kargar, Tehran, Iran
| | - Asad Babakhani
- Nuclear Science & Technology Research Institute, End of North Kargar, Tehran, Iran Iran Nuclear Regulatory Authority, End of North Kargar, Tehran, Iran
| |
Collapse
|
13
|
Abstract
The most common thyroid diseases during pregnancy are hyper- and hypothyroidism and their variants including isolated hypothyroxinemia (hypo-T4), autoimmune thyroid disease (AITD) and different types of goiter. AITD represents the main cause of hypothyroidism during pregnancy ranging in prevalence between 5 and 20% with an average of 7.8%. The incidence of isolated hypo-T4 is about 150 times higher compared to congenital hypothyroidism. Prevalence of Graves' disease (GD) ranges between 0.1% and 1% and the Transient Gestational Hyperthyroidism Syndrome between 1 and 3%. Thyroid stimulating hormone (TSH) is a sensitive marker of thyroid dysfunction during pregnancy. Normal values have been modified recently with a downward shift. Thus, the upper normal range is now considered to be 2.5 mUI/mL in the first trimester and 3.0 mUI/mL for the remainder of pregnancy. Most studies have shown that children born to women with hypothyroidism during gestation had significantly lower scores in neuropsychological tests related to intelligence, attention, language, reading ability, school performance and visual motor performance. However, some studies have not confirmed these findings. On the other hand, multiple retrospective studies have shown that the risks of maternal and fetal/neonatal complications are directly related to the duration and inadequate control of maternal thyrotoxicosis. The latter is associated with a risk of spontaneous abortion, congestive heart failure, thyrotoxic storm, preeclampsia, preterm delivery, low birth weight and stillbirth. Despite the lack of consensus among professional organizations, recent studies, which are based on sophisticated analyses, support universal screening in all pregnant women in the first trimester for thyroid diseases.
Collapse
Affiliation(s)
| | - Spyridon N Karras
- Department of Endocrinology, St. Paul Hospital, Thessaloniki, Greece
| | | |
Collapse
|
14
|
Prevalence of overt and subclinical thyroid dysfunction among pregnant women and its effect on maternal and fetal outcome. J Obstet Gynaecol India 2013; 64:105-10. [PMID: 24757337 DOI: 10.1007/s13224-013-0487-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 10/26/2013] [Indexed: 10/26/2022] Open
Abstract
AIM To determine the current prevalence of thyroid dysfunction in normal pregnant women and to study the impact of thyroid dysfunction on maternal and fetal outcome. METHODS 400 pregnant women between 13 and 26 weeks of gestation were registered for the study. Apart from routine obstetrical investigations, TSH tests were done. Free T4 and anti-TPO antibody tests were done in patients with deranged TSH. Patients were followed up till delivery. Their obstetrical and perinatal outcomes were noted. RESULTS The prevalence of hypothyroidism and hyperthyroidism was 12 and 1.25 %, respectively. Adverse maternal effects in overt hypothyroidism included preeclampsia (16.6 vs. 7.8 %) and placental abruption (16.6 vs. 0.8 %). Subclinical hypothyroidism was associated with preeclampsia (22.3 vs. 7.8 %) as compared to the euthyroid patients. Adverse fetal outcomes in overt hypothyroidism included spontaneous abortion (16.6 vs. 2.39 %), preterm birth (33.3 vs. 5.8 %), low birth weight (50 vs. 12.11 %), intrauterine growth retardation (25 vs. 4.9 %), and fetal death (16.6 vs. 1.7 %) as compared to the euthyroid women. Adverse fetal outcomes in subclinical hypothyroidism included spontaneous abortion (5.5 vs. 2.39 %), preterm delivery (11.2 vs. 5.8 %), low birth weight (25 vs. 12.11 %), and intrauterine growth retardation (8.4 vs. 4.9 %) as compared to the euthyroid women. CONCLUSIONS The prevalence of thyroid disorders was high in our study with associated adverse maternal and fetal outcomes. Routine screening of thyroid dysfunction is recommended to prevent adverse fetal and maternal outcome.
Collapse
|
15
|
Abstract
BACKGROUND Women with hyperthyroidism in pregnancy have increased risks of miscarriage, stillbirth, preterm birth, and intrauterine growth restriction; and they can develop severe pre-eclampsia or placental abruption. OBJECTIVES To identify interventions used in the management of hyperthyroidism pre-pregnancy or during pregnancy and to ascertain the impact of these interventions on important maternal, fetal, neonatal and childhood outcomes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2013). SELECTION CRITERIA We planned to include randomised controlled trials, quasi-randomised controlled trials, and cluster-randomised trials comparing antithyroid interventions for hyperthyroidism pre-pregnancy or during pregnancy with another intervention or no intervention (placebo or no treatment). DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility and planned to assess trial quality and extract the data independently. MAIN RESULTS No trials were included in the review. AUTHORS' CONCLUSIONS As we did not identify any eligible trials, we are unable to comment on implications for practice, although early identification of hyperthyroidism before pregnancy may allow a woman to choose radioactive iodine therapy or surgery before planning to have a child. Designing and conducting a trial of antithyroid interventions for pregnant women with hyperthyroidism presents formidable challenges. Not only is hyperthyroidism a relatively rare condition, both of the two main drugs used have potential for harm, one for the mother and the other for the child. More observational research is required about the potential harms of methimazole in early pregnancy and about the potential liver damage from propylthiouracil.
Collapse
Affiliation(s)
- Rachel Earl
- Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, The University of Adelaide, Medical School North Building, Frome Road, Adelaide, Australia, 5005
| | | | | |
Collapse
|
16
|
Altomare M, La Vignera S, Asero P, Recupero D, Condorelli RA, Scollo P, Gulisano A, Magro E, Tumino D, Tumino S, Vicari E, Leanza V, D'Agata R, Calogero AE. High prevalence of thyroid dysfunction in pregnant women. J Endocrinol Invest 2013; 36:407-11. [PMID: 23095459 DOI: 10.3275/8658] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND/AIM Maternal thyroid dysfunction during pregnancy has been associated with adverse obstetric and neonatal outcomes. This prospective study evaluates the prevalence of these disorders in pregnant women. SUBJECTS AND METHODS Serum levels of TSH, free T4 (fT4), and thyroperoxidase antibodies (TPO-Ab) were measured in 951 women at different gestational ages of pregnancy. Trimester-specific reference ranges for TSH were used to classify pregnant women into five groups: 1) Overt hypothyroidism (OH); 2) Subclinical hypothyroidism (SCH); 3) Isolated hypothyroxinemia (IH); 4) Low TSH (isolated or associated with high fT4); and 5) Normal. A classification was made also according to the lower and upper ranges provided by the manufacturer for thyroid hormones. Pregnant women who were at a high risk of developing thyroid disease were identified. RESULTS Altogether, 117 women (12.3%) had hypothyroidism and 25 (2.6%) had low TSH. The prevalence of both OH and SCH was higher in the high-risk group than in the low-risk group, but 17.9% of women with hypothyroidism were classified at low-risk. A family history of thyroid disorders and TPO-Ab positivity increased the risk of SCH. Using non-pregnant reference range for TSH, 10.6% of women were misclassificated. CONCLUSIONS The high prevalence of hypothyroidism observed in this study suggests that accurate thyroid screening with trimester specific reference ranges should be warranted, particularly in areas with mild to moderate iodine deficiencies.
Collapse
Affiliation(s)
- M Altomare
- Section of Endocrinology, Andrology and Internal Medicine, Department of Medical and Paediatric Sciences, University of Catania, Via S. Sofia 78, Catania, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Tirosh D, Benshalom-Tirosh N, Novack L, Press F, Beer-Weisel R, Wiznitzer A, Mazor M, Erez O. Hypothyroidism and diabetes mellitus - a risky dual gestational endocrinopathy. PeerJ 2013; 1:e52. [PMID: 23638390 PMCID: PMC3628609 DOI: 10.7717/peerj.52] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 02/28/2013] [Indexed: 12/11/2022] Open
Abstract
Objectives. Diabetes mellitus (DM) and hypothyroidism are each associated with increased rate of pregnancy complications. However, their combined morbidity during gestation is poorly studied. Therefore, the aims of this study were to determine the prevalence of the combined morbidity of DM & hypothyroidism and whether it is associated with adverse maternal and neonatal outcome. Study design. This population based retrospective cohort study included 87,213 women who had 232,293 deliveries. All deliveries were divided into the following groups: (1) hypothyroidism & DM (n = 171); (2) hypothyroidism (n = 1502); (3) DM (n = 13,324); and (4) deliveries of women with neither endocrinopathy, who served as a control group (n = 217, 296). Results. The prevalence of DM & hypothyroidism in our population was 0.17%. In comparisons to the other study groups, women with DM & hypothyroidism had higher rates of infertility (p < 0.001), preeclampsia (p < 0.001), chronic hypertension (p < 0.001), preterm birth (p < 0.001), and cesarean deliveries (p < 0.001). In Generalized Estimating Equations (GEE) model, hypothyroidism & DM was an independent risk factor for cesarean section (OR 3.46; 95% CI 2.53–4.75) and for preeclampsia (OR 1.82; 95%CI 1.16–2.84). Conclusion. The combination of DM & hypothyroidism is rare, yet it is associated with higher rate of infertility, cesarean sections, preterm deliveries, and hypertensive disorders of pregnancy than the rest of the population. This dual endocrinological combination is an independent risk factor for preeclampsia and cesarean section. These findings suggest that these patients are at risk for perinatal complications and should be followed and delivered as high risk pregnancies.
Collapse
Affiliation(s)
- Dan Tirosh
- Department of Obstetrics & Gynecology, Soroka University Medical Center , Beer Sheva , Israel
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Dhanwal DK, Prasad S, Agarwal AK, Dixit V, Banerjee AK. High prevalence of subclinical hypothyroidism during first trimester of pregnancy in North India. Indian J Endocrinol Metab 2013; 17:281-284. [PMID: 23776903 PMCID: PMC3683205 DOI: 10.4103/2230-8210.109712] [Citation(s) in RCA: 25] [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] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Thyroid dysfunction is a common occurrence in pregnancy and affects both maternal and fetal outcomes. There are limited data on prevalence of hypothyroidism during pregnancy from India. Therefore, this study was designed to evaluate the prevalence of thyroid dysfunction especially hypothyroidism during first trimester in a large public hospital in North India. MATERIALS AND METHODS All the consecutive first trimester pregnant women attending Lok Nayak and Kasturba Hospitals were enrolled in the study after institutional ethics approval and consent from the study subjects. The pregnant women with diagnosed thyroid disease and on thyroid medications were excluded from the study. Morning samples of study participants were analyzed for thyroid hormone profile which included free T3, free T4, TSH, and TPO Ab. In addition, all study participants were tested for CBC, LFT, KFT, and lipid profile. RESULTS A total of 1000 women were enrolled for this prospective observational study. The mean (SD) age of study subjects was 25.6 (11.1) years, and mean (SD) gestational age was 10.3 (3.4) weeks. One hundred and forty-three (14.3%) subjects had TSH values more than 4.5 mIU/L above the cutoff used for definition of hypothyroidism. Out of these, 135 had normal free T4 and therefore labeled as subclinical hypothyroidism and 7 had low free T4 suggestive of overt hypothyroidism. TPO Ab was positive in 68 (6.82%) of total, 25 (18.5%) of subclinical and 5 (71%) of overt hypothyroid patients. CONCLUSION Hypothyroidism, especially subclinical, is common in North Indian women during first trimester. Further countrywide studies are needed to evaluate the prevalence and etiology of hypothyroidism to prevent maternal and fetal adverse effects of hypothyroidism in India.
Collapse
Affiliation(s)
- Dinesh K. Dhanwal
- Department of Medicine and Endocrinology, Maulana Azad Medical College, New Delhi, India
| | - Sudha Prasad
- Department of Gynecology, Maulana Azad Medical College, New Delhi, India
| | - A. K. Agarwal
- Department of ENT Maulana Azad Medical College, New Delhi, India
| | - Vivek Dixit
- Department of Medicine and Endocrinology, Maulana Azad Medical College, New Delhi, India
| | - A. K. Banerjee
- Department of CTVS, G.B. Pant Hospital, New Delhi, India
| |
Collapse
|
19
|
Taylor PN, Vaidya B. Side effects of anti-thyroid drugs and their impact on the choice of treatment for thyrotoxicosis in pregnancy. Eur Thyroid J 2012; 1:176-85. [PMID: 24783017 PMCID: PMC3821480 DOI: 10.1159/000342920] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 08/23/2012] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Hyperthyroidism in pregnancy is a serious condition and its management is complex. Whilst carbimazole/methimazole (CBZ/MMI) and propylthiouracil (PTU) have similar efficacies in controlling hyperthyroidism, their risk of side effects such as major congenital abnormalities and hepatotoxicity are different. METHODS Various combinations of the terms 'anti-thyroid drugs', 'thionamide', 'carbimazole', 'methimazole', 'propylthiouracil', 'pregnancy', 'side effects', 'agranulocytosis', 'birth defects', 'congenital malformations', 'embryopathy', 'aplasia cutis', 'hepatotoxicity', 'hepatic failure', 'maternal' and 'fetus' were used to search MEDLINE and the Cochrane library. The references of retrieved papers were also reviewed. RESULTS There is increasing evidence for a CBZ/MMI embryopathy, whilst data remain lacking for major congenital abnormalities with PTU. In contrast, PTU is associated with increased risk of severe liver injury. Management strategies to reduce these risks by using PTU in the first trimester and CBZ/MMI in the later trimesters remain untested. CONCLUSION More evidence is still needed in defining the relative risks between CBZ/MMI and PTU of major congenital abnormalities and severe liver injury in pregnancy. Studies are also needed to establish the suitability of recent management suggestions in switching from PTU to CBZ/MMI after the first trimester. Major adverse outcomes secondary to CBZ/MMI and PTU are rare, and inadequately treated hyperthyroidism poses a far greater risk.
Collapse
Affiliation(s)
- Peter N. Taylor
- Thyroid Research Group, Institute of Experimental and Molecular Medicine, School of Medicine, Cardiff University, Cardiff, London
- London School of Hygiene and Tropical Medicine, London
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon and Exeter Hospital and Peninsula Medical School, Exeter, UK
- *Dr. B. Vaidya, Department of Endocrinology, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW (UK), E-Mail
| |
Collapse
|
20
|
|
21
|
|
22
|
Cassina M, Donà M, Di Gianantonio E, Clementi M. Pharmacologic treatment of hyperthyroidism during pregnancy. ACTA ACUST UNITED AC 2012; 94:612-9. [DOI: 10.1002/bdra.23012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 02/29/2012] [Accepted: 03/07/2012] [Indexed: 12/15/2022]
|
23
|
Taylor P, Bhatt S, Gouni R, Quinlan J, Robinson T. A Case of Propylthiouracil-Induced Hepatitis during Pregnancy. Eur Thyroid J 2012; 1:41-4. [PMID: 24782996 PMCID: PMC3821452 DOI: 10.1159/000336071] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 12/13/2011] [Indexed: 12/18/2022] Open
Abstract
A 32-year-old with no pre-existing liver disease was diagnosed with Graves' disease at week 4 of pregnancy. Thyroid-stimulating hormone was undetectable with elevated free thyroxine levels and positive thyroid receptor antibodies. She was started on a reducing regime of propylthiouracil (PTU). At week 20 in pregnancy, she became jaundiced. Initial bloods revealed: bilirubin 91 μmol/l, alanine aminotransferase 1,796 IU/l, alkaline phosphatase 200 IU/l, international normalized ratio 1.2, and albumin 33 g/l. A presumptive diagnosis of PTU-induced hepatitis was made. PTU was immediately discontinued and best supportive care instigated. Serum markers for autoimmune and viral hepatitis were negative, abdomen ultrasound, ferritin and caeruloplasmin were normal. Although her alanine aminotransferase began to fall, her bilirubin continued to rise, peaking at 378. Two weeks after PTU cessation she became thyrotoxic and was started on a reducing regime of carbimazole. Her thyroid function stabilized and liver function tests continued to improve with carbimazole stopped at week 32. Growth scans remained normal with delivery of a healthy baby at 38 weeks. This report highlights that good outcomes can be achieved in PTU-induced hepatitis in pregnancy. Patients on PTU should be warned of the potential risk of hepatic failure and advised to seek medical advice immediately if they develop jaundice.
Collapse
Affiliation(s)
- Peter Taylor
- Department of Diabetes and Endocrinology, Royal United Hospital, Bath, Cardiff University School of Medicine, Cardiff, UK
- Department of Centre for Endocrine and Diabetes Sciences, Department of Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Sandip Bhatt
- Department of Gastroenterology, Royal United Hospital, Bath, Cardiff University School of Medicine, Cardiff, UK
| | - Ravi Gouni
- Department of Diabetes and Endocrinology, Royal United Hospital, Bath, Cardiff University School of Medicine, Cardiff, UK
| | - Jonathan Quinlan
- Department of Gastroenterology, Royal United Hospital, Bath, Cardiff University School of Medicine, Cardiff, UK
| | - Tony Robinson
- Department of Diabetes and Endocrinology, Royal United Hospital, Bath, Cardiff University School of Medicine, Cardiff, UK
- *Tony Robinson, Department of Diabetes and Endocrinology, Royal United Hospital, Bath BA1 3NG (UK), E-Mail
| |
Collapse
|
24
|
Abstract
Hyperthyroidism describes the sustained increase in thyroid hormone biosynthesis and secretion by a thyroid gland with increased metabolism. Although the use of radioiodine scanning serves as a useful surrogate that may help characterize the cause of thyrotoxicosis, it only indirectly addresses the underlying physiologic mechanism driving the increase in serum thyroid hormones. In this article, thyrotoxic states are divided into increased or decreased thyroid metabolic function. In addition to the diagnosis, clinical presentation, and treatment of the various causes of hyperthyroidism, a section on functional imaging and appropriate laboratory testing is included.
Collapse
Affiliation(s)
- Stuart C Seigel
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | | |
Collapse
|
25
|
Nambiar V, Jagtap VS, Sarathi V, Lila AR, Kamalanathan S, Bandgar TR, Menon PS, Shah NS. Prevalence and impact of thyroid disorders on maternal outcome in asian-Indian pregnant women. J Thyroid Res 2011; 2011:429097. [PMID: 21789274 PMCID: PMC3140706 DOI: 10.4061/2011/429097] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 05/24/2011] [Accepted: 06/18/2011] [Indexed: 11/20/2022] Open
Abstract
Aims. To establish the prevalence and the effect of thyroid dysfunction on pregnancy outcomes in Asian-Indian population. Subjects and Methods. The study cohort comprised of 483 consecutive pregnant women in the first trimester attending the antenatal clinic of a tertiary center in Mumbai, India. Thyroid hormone levels and thyroid peroxidase antibody were estimated. Patients with thyroid dysfunction were assessed periodically or treated depending on the severity. Subjects were followed until delivery. Results. The prevalence of hypothyroidism, Graves' disease, gestational transient thyrotoxicosis, and thyroid autoimmunity (TAI) was 4.8% (n = 24), 0.6% (n = 3), 6.4 % (n = 31), and 12.4% (n = 60), respectively. Forty percent of the hypothyroid patients did not have any high-risk characteristics. Hypothyroidism and TAI were associated with miscarriage (P = 0.02 and P = 0.001, resp.). Conclusions. The prevalence of hypothyroidism (4.8%) and TAI (12.4%) is high. TAI and hypothyroidism were significantly associated with miscarriage.
Collapse
Affiliation(s)
- Vimal Nambiar
- Department of Endocrinology, Seth G. S. Medical College, Parel, Mumbai, Maharashtra 400012, India
| | | | | | | | | | | | | | | |
Collapse
|
26
|
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.
Collapse
Affiliation(s)
- R L Kennedy
- James Cook University School of Medicine, Queensland, Australia.
| | | | | | | | | | | |
Collapse
|
27
|
Negro R, Beck-Peccoz P, Chiovato L, Garofalo P, Guglielmi R, Papini E, Tonacchera M, Vermiglio F, Vitti P, Zini M, Pinchera A. Hyperthyroidism and pregnancy. An Italian Thyroid Association (AIT) and Italian Association of Clinical Endocrinologists (AME) joint statement for clinical practice. J Endocrinol Invest 2011; 34:225-31. [PMID: 21427528 DOI: 10.1007/bf03347071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- R Negro
- Division of Endocrinology, V Fazzi Hospital, Piazza F Muratore, 73100 Lecce, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Du S, Sandoval F, Trinh P, Umeda E, Voskuhl R. Estrogen receptor-β ligand treatment modulates dendritic cells in the target organ during autoimmune demyelinating disease. Eur J Immunol 2010; 41:140-50. [PMID: 21182085 DOI: 10.1002/eji.201040796] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 09/30/2010] [Accepted: 10/29/2010] [Indexed: 11/10/2022]
Abstract
Estrogens act upon nuclear estrogen receptors (ER) to ameliorate cell-mediated autoimmune disease. As most immunomodulatory effects of estrogens in EAE have been attributed to the function of ER-α, we previously demonstrated that ER-β ligand treatment reduced disease severity without affecting peripheral cytokine production or levels of CNS inflammation, suggesting a direct neuroprotective effect; however, the effect of ER-β treatment on the function of immune cells within the target organ remained unknown. Here, we used adoptive transfer studies to show that ER-β ligand treatment was protective in the effector, but not the induction phase of EAE, as shown by decreased clinical disease severity with the preservation of axons and myelin in spinal cords. The analysis of the immune cell infiltrates in the CNS revealed that while ER-β ligand treatment did not reduce overall levels of CNS inflammation, there was a decrease in the DC percentage, and these CNS DC had decreased TNF-α production. Finally, experiments using DC deficient in ER-β revealed that the expression of ER-β on DC was essential for protective effects of ER-β ligand treatment in EAE. Our results demonstrate for the first time an effect of ER-β ligand treatment in vivo on DC in the target organ of a prototypic cell-mediated autoimmune disease.
Collapse
Affiliation(s)
- Sienmi Du
- UCLA Department of Physiological Sciences, Los Angeles, CA 90095, USA
| | | | | | | | | |
Collapse
|
29
|
Abstract
Via its interaction in several pathways, normal thyroid function is important to maintain normal reproduction. In both genders, changes in SHBG and sex steroids are a consistent feature associated with hyper- and hypothyroidism and were already reported many years ago. Male reproduction is adversely affected by both thyrotoxicosis and hypothyroidism. Erectile abnormalities have been reported. Thyrotoxicosis induces abnormalities in sperm motility, whereas hypothyroidism is associated with abnormalities in sperm morphology; the latter normalize when euthyroidism is reached. In females, thyrotoxicosis and hypothyroidism can cause menstrual disturbances. Thyrotoxicosis is associated mainly with hypomenorrhea and polymenorrhea, whereas hypothyroidism is associated mainly with oligomenorrhea. Thyroid dysfunction has also been linked to reduced fertility. Controlled ovarian hyperstimulation leads to important increases in estradiol, which in turn may have an adverse effect on thyroid hormones and TSH. When autoimmune thyroid disease is present, the impact of controlled ovarian hyperstimulation may become more severe, depending on preexisting thyroid abnormalities. Autoimmune thyroid disease is present in 5-20% of unselected pregnant women. Isolated hypothyroxinemia has been described in approximately 2% of pregnancies, without serum TSH elevation and in the absence of thyroid autoantibodies. Overt hypothyroidism has been associated with increased rates of spontaneous abortion, premature delivery and/or low birth weight, fetal distress in labor, and perhaps gestation-induced hypertension and placental abruption. The links between such obstetrical complications and subclinical hypothyroidism are less evident. Thyrotoxicosis during pregnancy is due to Graves' disease and gestational transient thyrotoxicosis. All antithyroid drugs cross the placenta and may potentially affect fetal thyroid function.
Collapse
Affiliation(s)
- G E Krassas
- Department of Endocrinology, Diabetes, and Metabolism, Panagia General Hospital, N. Plastira 22, N. Krini, 55132 Thessaloniki, Greece.
| | | | | |
Collapse
|
30
|
Abstract
BACKGROUND Women with hyperthyroidism in pregnancy have increased risks of miscarriage, stillbirth, preterm birth, and intrauterine growth restriction; and they can develop severe pre-eclampsia or placental abruption. OBJECTIVES To assess the effects of interventions for preventing or treating hyperthyroidism in pregnant women. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 July 2010). SELECTION CRITERIA We intended to include randomised controlled trials comparing antithyroid treatments in pregnant women with hyperthyroidism. DATA COLLECTION AND ANALYSIS Two review authors would have assessed trial eligibility and risk of bias, and extracted data. MAIN RESULTS No trials were located. AUTHORS' CONCLUSIONS As we did not identify any eligible trials, we are unable to comment on implications for practice, although early identification of hyperthyroidism before pregnancy may allow a woman to choose radioactive iodine therapy or surgery before planning to have a child. Designing and conducting a trial of antithyroid drugs for pregnant women with hyperthyroidism presents formidable challenges. Not only is hyperthyroidism a relatively rare condition, both of the two main drugs used have potential for harm, one for the mother and the other for the child. More observational research is required about the potential harms of methimazole in early pregnancy and about the potential liver damage from propylthiouracil.
Collapse
Affiliation(s)
- Rachel Earl
- Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia
| | - Caroline A Crowther
- ARCH: Australian Research Centre for Health of Women and Babies, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, Australia
| | - Philippa Middleton
- ARCH: Australian Research Centre for Health of Women and Babies, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, Australia
| |
Collapse
|
31
|
Abstract
Improvements in the sensitivity of the serum TSH assay have revolutionized our strategies for investigating thyroid function and firmly established TSH as the first-line thyroid function test for most clinical situations, including pregnancy. As a single hormone determination, serum TSH provides the most sensitive index to reliably detect thyroid function abnormalities. Normal thyroid function is important to ensure the best possible pregnancy outcome; in addition, disorders of the thyroid gland are relatively frequent in women of childbearing age. The aim of this article is, therefore, to present relevant information on analytical, as well as clinical, aspects regarding serum TSH determination and its usefulness to detect subtle thyroid function abnormalities associated with the pregnant state, namely overt and subclinical hypothyroidism and hyperthyroidism. As these disorders are associated with poor pregnancy outcome, the authors of the present article are in favor of serum TSH measurement for all pregnant women.
Collapse
Affiliation(s)
- Daniel Glinoer
- Department of Internal Medicine, University Hospital Saint-Pierre, Université Libre de Bruxelles, Rue Haute 322, B-1000 Brussels, Belgium.
| | | |
Collapse
|
32
|
Abstract
The pros and cons of population screening for thyroid disease have been hotly debated over the past several decades. This article addresses the issue from the point of view of the potential benefit of screening, that is, disease detection. Earlier diagnoses of hypothyroidism, hyperthyroidism, thyroid nodules, thyroid cancer and so on, with implementation of the indicated diagnostic and therapeutic interventions, avoid the adverse consequences of unrecognized and untreated progressive disease. Arguments against screening and case-finding often focus on cost considerations. To achieve the greatest yield at the lowest cost, our emphasis is on vulnerable populations with associated risk factors, and special situations such as pregnancy.
Collapse
Affiliation(s)
| | - Leonard Wartofsky
- b Washington Hospital Center, 110 Irving Street, Northwest, Washington, DC 20010-22975, USA.
| |
Collapse
|
33
|
Mansourian AR. Thyroid function tests during first-trimester of pregnancy: a review of literature. Pak J Biol Sci 2010; 13:664-673. [PMID: 21848058 DOI: 10.3923/pjbs.2010.664.673] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This literature review was conducted to summarize the main points of maternal thyroid function tests, with particular attention in the first trimester of pregnancy which accompanied with significant biochemical and metabolic alteration. The evaluation of thyroid function of either hyperthyroidism and hypothyroidism should be assessed by determination of serum Thyroid Stimulating Hormone (TSH), Thyroxine (T4), Triiodothyronine (T3), Iodine and Thyroid Autoantibodies. Glomerular filtration rate is increased during pregnancy; therefor iodine deficiency should be evaluated during the pregnancy to prevent hypothyroidism. The role which can be played by Human Chronic Gonadotropin (hCG) on stimulating the thyroid gland to become over-active was investigated. Serum level ofthyroglobulin (Tg) and Thyroxin Binding Globulin (TBG) should be assessed for proper assessments of thyroid gland during pregnancy. Thyroid function tests during first-trimester of pregnancy and particularly the reference interval for thyroid function tests for pregnant women in each region has to be established, to prevent mis-diagnosis and irreversible mental and physical adverse affect for growing fetus.
Collapse
Affiliation(s)
- Azad R Mansourian
- Biochemistry and Metabolic Disorder Research Center, Gorgan Medical School, Golestan University of Medical Sciences, Gorgan, Iran
| |
Collapse
|
34
|
Galofre JC, Davies TF. Autoimmune thyroid disease in pregnancy: a review. J Womens Health (Larchmt) 2010; 18:1847-56. [PMID: 19951221 DOI: 10.1089/jwh.2008.1234] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The maternal physiological changes that occur in normal pregnancy induce complex endocrine and immune responses. During a normal pregnancy, thyroid gland volume may enlarge, and thyroid hormone production increases. Hence, the interpretation of thyroid function during gestation needs to be adjusted according to pregnancy-specific ranges. The elevated prevalence of gestation-related thyroid disorders (10%-15%) and the important repercussions for both mother and fetus reported in multiple studies throughout the world denote, in our opinion, the necessity for routine thyroid function screening both before and during pregnancy. Once thyroid dysfunction is suspected or confirmed, management of the thyroid disorder necessitates regular monitoring in order to ensure a successful outcome. The aim of treating hyperthyroidism in pregnancy with antithyroid drugs is to maintain serum thyroxine (T(4)) in the upper normal range of the assay used with the lowest possible dose of drug, whereas in hypothyroidism, the goal is to return serum thyroid-stimulating hormone (TSH) to the range between 0.5 and 2.5 mU/L.
Collapse
Affiliation(s)
- Juan C Galofre
- Thyroid Research Unit, Mount Sinai School of Medicine, The Mount Sinai Hospital and the James J. Peters VA Medical Center, New York, New York, USA
| | | |
Collapse
|
35
|
Chadha G, Goel M. Hypothyroidism in Pregnancy. APOLLO MEDICINE 2009. [DOI: 10.1016/s0976-0016(11)60082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
|
36
|
Guía clínica para el diagnóstico y el tratamiento de la disfunción tiroidea subclínica en la gestación. ACTA ACUST UNITED AC 2009; 56:85-91. [DOI: 10.1016/s1575-0922(09)70556-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 12/01/2008] [Indexed: 10/20/2022]
|
37
|
Halperin Rabinovich I, Obiols Alfonso G, Soto Moreno A, Torres Vela E, Tortosa Henzi F, Català Bauset M, Gilsanz Peral A, Girbés Borràs J, Moreno Esteban B, Picó Alfonso A, Del Pozo Picó C, Zugasti Murillo A, Lucas Morante T, Páramo Fernández C, Varela da Sousa C, Villabona Artero C. Clinical practice guideline for hypotalamic-pituitary disturbances in pregnancy and the postpartum period. ACTA ACUST UNITED AC 2008; 55:29-43. [PMID: 22967849 DOI: 10.1016/s1575-0922(08)70633-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 10/22/2007] [Indexed: 12/12/2022]
Abstract
During pregnancy, the body undergoes a major adaptation process as a result of the interaction between mother, placenta and fetus. Major anatomical and histological changes are produced in the pituitary, with an increase of up to 40% in the size of the gland. There are wide variations in the function of the hypothalamus-pituitary-thyroid axis that effect iodine balance, the overall activity of the gland, as well as transport of thyroid hormones in plasma and peripheral metabolism of thyroid hormones. The incidence of goiter and thyroid nodules increases throughout pregnancy. The management of differentiated thyroid carcinoma should be individually tailored according to tumoral type and pregnancy stage. Given the effects of hypothyroidism on fetal development, both the diagnosis and appropriate therapeutic management of thyroid hypofunction are essential. The most important modification to the hypothalamus-pituitary-adrenal axis during pregnancy is the rise in serum cortisol levels due to an increase in cortisol-binding proteins. Although Cushing's syndrome during pregnancy is infrequent, both diagnosis and treatment of this disorder are especially difficult. Adrenal insufficiency during pregnancy does not substantially differ from that occurring outside pregnancy. However, postpartum pituitary necrosis (Sheehan's syndrome) is a well-known complication that occurs after delivery and, together with lymphocytic hypophysitis, constitutes the most frequent cause of adrenal insufficiency. The management of prolactinoma during pregnancy requires suppression of dopaminergic agonists and their reintroduction if there is tumoral growth. Notable among the neuropituitary disorders that can occur throughout pregnancy is diabetes insipidus, which occurs as a consequence of increased vasopressinase activity.
Collapse
|
38
|
Fux Otta C, Szafryk de Mereshian P, Iraci GS, Ojeda de Pruneda MR. Pregnancies associated with primary adrenal insufficiency. Fertil Steril 2008; 90:1199.e17-20. [DOI: 10.1016/j.fertnstert.2007.08.079] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Revised: 08/31/2007] [Accepted: 08/31/2007] [Indexed: 11/25/2022]
|
39
|
Jaén Díaz JI, de Castro FL, Cordero García B, Santillana Balduz F, Sastre Marcos J, dal Gesso CM. Enfermedad tiroidea y estado de yodación en el primer trimestre del embarazo. ACTA ACUST UNITED AC 2008; 55:196-201. [DOI: 10.1016/s1575-0922(08)70668-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 01/21/2008] [Indexed: 11/25/2022]
|
40
|
Kyriazopoulou V, Michalaki M, Georgopoulos N, Vagenakis AG. Recommendations for thyroxin therapy during pregnancy. Expert Opin Pharmacother 2008; 9:421-7. [DOI: 10.1517/14656566.9.3.421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
41
|
|
42
|
Abstract
Thyrotoxicosis is a condition resulting from elevated levels of thyroid hormone. In this article, the authors review the presentation, diagnosis, and management of various causes of thyrotoxicosis.
Collapse
Affiliation(s)
- Bindu Nayak
- Division of Endocrinology and Metabolism, Georgetown University Hospital, 4000 Reservoir Road, Building D, Suite 232, Washington, DC 20007, USA.
| | | |
Collapse
|
43
|
Chan GW, Mandel SJ. Therapy Insight: management of Graves' disease during pregnancy. ACTA ACUST UNITED AC 2007; 3:470-8. [PMID: 17515891 DOI: 10.1038/ncpendmet0508] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Accepted: 01/24/2007] [Indexed: 11/09/2022]
Abstract
The diagnosis of Graves' disease in pregnancy can be complex because of normal gravid physiologic changes in thyroid hormone metabolism. Mothers with active Graves' disease should be treated with antithyroid drugs, which impact both maternal and fetal thyroid function. Optimally, the lowest possible dose should be used to maintain maternal free thyroxine levels at or just above the upper limit of the normal nonpregnant reference range. Fetal thyroid function depends on the balance between the transplacental passage of thyroid-stimulating maternal antibodies and thyroid-inhibiting antithyroid drugs. Elevated levels of serum maternal anti-TSH-receptor antibodies early in the third trimester are a risk factor for fetal hyperthyroidism and should prompt evaluation of the fetal thyroid by ultrasound, even in women with previously ablated Graves' disease. Maternal antithyroid medication can be modulated to treat fetal hyperthyroidism. Serum TSH and either total or free thyroxine levels should be measured in fetal cord blood at delivery in women with active Graves' disease, and those with a history of (131)I-mediated thyroid ablation or thyroidectomy who have anti-TSH-receptor antibodies. Neonatal thyrotoxicosis can occur in the first few days of life after clearance of maternal antithyroid drug, and can last for several months, until maternal antibodies are also cleared.
Collapse
Affiliation(s)
- Grace W Chan
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | |
Collapse
|