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Turkal R, Turan CA, Elbasan O, Aytan S, Çakmak B, Gözaydınoğlu B, Takır DC, Ünlü O, Bahramzada G, Tekin AF, Çevlik T, Büyükbayrak EE, Şirikçi Ö, Gözü H, Haklar G. Accurate interpretation of thyroid dysfunction during pregnancy: should we continue to use published guidelines instead of population-based gestation-specific reference intervals for the thyroid-stimulating hormone (TSH)? BMC Pregnancy Childbirth 2022; 22:271. [PMID: 35361138 PMCID: PMC8973886 DOI: 10.1186/s12884-022-04608-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Considering the changes in thyroid physiology associated with pregnancy and poor outcomes related to abnormal maternal thyroid function, international guidelines recommend using population-based trimester-specific reference intervals (RIs) for thyroid testing. If these RIs are not available in the laboratory, implementing recommended fixed cut-off values globally is still controversial. To address this issue, we aimed to establish appropriate RI of thyroid-stimulating hormone (TSH) in pregnant Turkish women for our laboratory and compare the prevalence of thyroid dysfunction based on the established and recommended criteria. Methods Of 2638 pregnant women, 1777 women followed in the obstetric outpatient were enrolled in the reference interval study after applying exclusion criteria related to medical and prenatal history. A retrospective study was conducted by collecting data from July 2016 to March 2019. Serum TSH was measured by UniCel DxI 800 Immunoassay System (Beckman Coulter Inc., Brea, CA, USA). The study design relied on two approaches in order to classify pregnant women: trimester-specific and subgroup-specific; the latter involved dividing each trimester into two subgroups: T1a, T1b, T2a, T2b, T3a, T3b. The lower and upper limits of the RIs were derived by the parametric method after normalizing the data distribution using the modified Box-Cox power transformation method. Results The lowest TSH value was detected at 8-12 weeks in early pregnancy, and the median value of TSH in the T1b subgroup was significantly lower than the T1a subgroup (P < 0.05). TSH levels showed a gradual trend of increase along with the pregnancy and increased significantly in the T2a, T2b, and T3b subgroups compared to the preceding subgroups (P < 0.05). Compared to the diagnostic criteria recommended by American Thyroid Association (ATA), the prevalence of thyroid dysfunction was significantly different from the established trimester- and subgroup-specific RIs throughout the pregnancy (P < 0.001). Conclusions We conclude that establishing gestation- and laboratory-specific RIs, especially for TSH, is essential for diagnosing thyroid disorders in pregnancy, and the recommended universal cut-off values, which may contribute to the risk of a misdiagnosis or a missed diagnosis, should be taken with caution in the clinical setting. However, regarding the fluctuation of thyroid function tests throughout pregnancy, trimester-specific RIs are insufficient, and implementing split phases is required.
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Affiliation(s)
- Rana Turkal
- Biochemistry Laboratory, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey.
| | - Cem Armağan Turan
- Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Onur Elbasan
- Subdepartment of Endocrinology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Serenay Aytan
- Medical Student, School of Medicine, Marmara University, Istanbul, Turkey
| | - Burcu Çakmak
- Medical Student, School of Medicine, Marmara University, Istanbul, Turkey
| | - Büşra Gözaydınoğlu
- Medical Student, School of Medicine, Marmara University, Istanbul, Turkey
| | - Duygu Ceyda Takır
- Medical Student, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ozan Ünlü
- Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey
| | - Günel Bahramzada
- Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ahmet Faruk Tekin
- Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey
| | - Tülay Çevlik
- Biochemistry Laboratory, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | - Esra Esim Büyükbayrak
- Department of Gynecology and Obstetrics, School of Medicine, Marmara University, Istanbul, Turkey
| | - Önder Şirikçi
- Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey
| | - Hülya Gözü
- Subdepartment of Endocrinology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Goncagül Haklar
- Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey
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David UE, Asiwe JN, Fasanmade AA. Maternal hypothyroidism prolongs gestation period and impairs glucose tolerance in offspring of Wistar rats. Horm Mol Biol Clin Investig 2021; 43:323-328. [PMID: 34907695 DOI: 10.1515/hmbci-2021-0068] [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: 08/01/2021] [Accepted: 12/03/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Pregnancy is a critical period keenly regulated by both maternal and foetal factors and a shift in these factors could result in severe complications manifesting in foetal and adult life. However, maternal hypothyroidism before and/or during pregnancy is a critical factor. This study investigated the effect of maternal hypothyroidism on glucose tolerance and thyroid function in male and female offspring. METHODS Fifteen adult female Wistar rats were divided into three groups: Group 1 (sham-control), Group 2 (thyrodectomized) and Group 3 (thyroidectomised + L-thyroxine treated). Blood thyroxine (T4) level was measured on the day 10 after thyroidectomy in Groups 1 and 2, and day 35 in Group 3. Males were introduced to the female rats after T4 measurement. At PND-112, T4 levels of their offspring were measured. Oral Glucose Tolerance Test (OGTT) was measured in offspring at PND-133. RESULTS Thyroxine reduced significantly in Group 2 and their offspring (male and female) compared to Group 3 while gestation period was prolonged significantly in Group 2 compared to Group 1. Hypothyroid male offspring showed depressed glucose tolerance, however, no effect was observed in female offspring. CONCLUSIONS This study suggests that maternal hypothyroidism prolonged gestation period, induced foetal hypothyroidism in both genders and depressed glucose tolerance in male offspring.
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Affiliation(s)
- Ubong Edem David
- Department of Physiology, University of Ibadan, Ibadan, Nigeria.,Department of Physiology, Ajayi Crowther University, Oyo, Nigeria
| | - Jerome Ndudi Asiwe
- Department of Physiology, University of Ibadan, Ibadan, Nigeria.,Department of Physiology, PAMO University of Medical Sciences, Port Harcourt, Rivers State, Nigeria
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The prevalence of thyroid dysfunction and its relationship with perinatal outcomes in pregnant women in the third trimester. North Clin Istanb 2019; 6:267-272. [PMID: 31650114 PMCID: PMC6790929 DOI: 10.14744/nci.2018.51422] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 07/02/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE In this study, we aimed to investigate the prevalence of thyroid dysfunction in pregnant women in their third trimester and assess its relationship with perinatal outcomes. METHODS A total of 796 women who delivered babies at the Haydarpaşa Numune Training and Research Hospital between January 2014 and January 2015 were evaluated retrospectively. Women with complete data and relevant results from thyroid functions tests were included in the study (n=573). Serum levels of thyroid stimulating hormone (TSH), free triiodothyronine (T3), free thyroxine (T4) were studied for all patients. Patients were classified according to thyroid function test results as having hypothyroidism, subclinical hypothyroidism, hyperthyroidism, or euthyroid state. The perinatal outcomes (Apgar score, birth type and birth weight) were compared. RESULTS A total of 86.7% of pregnant woman (492/573) showed normal thyroid function tests. Out of the remaining participants,0.5% had hypothyroidism, 8.9% had subclinical hypothyroidism, and 2.8% had hyperthyroidism. TSH levels correlated with maternal age. The perinatal outcomes were insignificant between groups. CONCLUSION The prevalence of thyroid dysfunction was 13.2% in our population. Subclinical hypothyroidism and hyperthyroidism had no adverse effects on birth weight, cesarean section rates, and Apgar scores.
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Drover SSM, Villanger GD, Aase H, Skogheim TS, Longnecker MP, Zoeller RT, Reichborn-Kjennerud T, Knudsen GP, Zeiner P, Engel SM. Maternal Thyroid Function During Pregnancy or Neonatal Thyroid Function and Attention Deficit Hyperactivity Disorder: A Systematic Review. Epidemiology 2019; 30:130-144. [PMID: 30299402 PMCID: PMC6359926 DOI: 10.1097/ede.0000000000000937] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder in children, yet its etiology is poorly understood. Early thyroid hormone disruption may contribute to the development of ADHD. Disrupted maternal thyroid hormone function has been associated with adverse neurodevelopmental outcomes in children. Among newborns, early-treated congenital hypothyroidism has been consistently associated with later cognitive deficits. METHODS We systematically reviewed literature on the association between maternal or neonatal thyroid hormones and ADHD diagnosis or symptoms. We searched Embase, Pubmed, Cinahl, PsycInfo, ERIC, Medline, Scopus, and Web of Science for articles published or available ahead of print as of April 2018. RESULTS We identified 28 eligible articles: 16 studies of maternal thyroid hormones, seven studies of early-treated congenital hypothyroidism, and five studies of neonatal thyroid hormones. The studies provide moderate evidence for an association between maternal thyroid hormone levels and offspring ADHD, some evidence for an association between early-treated congenital hypothyroidism and ADHD, and little evidence for an association between neonatal thyroid hormone levels and later ADHD. CONCLUSIONS The reviewed articles suggest an association between maternal thyroid function and ADHD, and possibly between early-treated congenital hypothyroidism and ADHD. Study limitations, however, weaken the conclusions in our systematic review, underlining the need for more research. Importantly, there was much variation in the measurement of thyroid hormone function and of ADHD symptoms. Recommendations for future research include using population-based designs, attending to measurement issues for thyroid hormones and ADHD, considering biologically relevant covariates (e.g., iodine intake), and assessing nonlinear dose-responses.
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Affiliation(s)
- Samantha S M Drover
- From the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Gro D Villanger
- Norwegian Institute of Public Health, Physical and Mental health, Oslo, Norway
| | - Heidi Aase
- Norwegian Institute of Public Health, Physical and Mental health, Oslo, Norway
| | - Thea S Skogheim
- Norwegian Institute of Public Health, Physical and Mental health, Oslo, Norway
| | - Matthew P Longnecker
- National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - R Thomas Zoeller
- Biology Department, University of Massachusetts-Amherst, Amherst, MA
| | | | - Gun P Knudsen
- Norwegian Institute of Public Health, Physical and Mental health, Oslo, Norway
| | - Pål Zeiner
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Stephanie M Engel
- From the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
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Zhao T, Chen BM, Zhao XM, Shan ZY. Meta-analysis of ART outcomes in women with different preconception TSH levels. Reprod Biol Endocrinol 2018; 16:111. [PMID: 30396353 PMCID: PMC6219175 DOI: 10.1186/s12958-018-0424-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess whether elevated thyroid-stimulating hormone (TSH) levels before conception can predict poor outcomes of assisted reproductive technology (ART). METHODS Prior to July 2018, we searched the PubMed, EMBASE, COCHRANE, Google Scholar, and CNKI databases for studies. Retrospective or prospective reports that compared ART results in patients with subclinical hypothyroidism (SCH) with normal thyroid function were selected. Two reviewers separately reviewed each potential article for qualification, analyzed the quality of the studies according to the Newcastle-Ottawa scale, and extracted the data. The PRISMA guidelines were adopted. RESULTS We selected a total of 18 publications that included 14,846 participants for this meta-analysis. When the TSH cut-off value for SCH was set at 2.5 mIU/L, no significant differences were observed in ART-related outcomes between SCH patients and normal women. The evaluated outcomes included the live birth rate (LBR) (OR: 0.93; 95% CI (0.77,1.12), P = 0.43), clinical pregnancy rate (CPR) (OR:1.02; 95% CI (0.90,1.17); P = 0.74), pregnancy rate (PR) (OR: 1.00; 95% CI (0.89,1.12); P = 0.99), and miscarriage rate (MR) (OR:1.24; 95% CI (0.85, 1.80); P = 0.26). Furthermore, when a higher TSH level was used as the cut-off value to diagnose SCH (i.e., 3.5-5 mIU/L), a significant difference was found in the MR (OR: 1.91; 95% CI (1.09, 3.35); P = 0.02) between the two groups of ART-treated women. However, when a broader cut-off value was used to define SCH, no significant differences were observed in the LBR (OR: 0.72; 95% CI (0.47,1.11); P = 0.14), CPR (OR: 0.82; 95% CI (0.66,1.00); P = 0.052), or PR (OR: 1.07; 95% CI (0.72,1.60); P = 0.74) between the two groups of ART-treated women. CONCLUSION No difference was observed in ART outcomes when a TSH cut-off value of 2.5 mIU/L was used. However, when a broader TSH cut-off value was used, preconception SCH resulted in a higher miscarriage rate than in normal women.
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Affiliation(s)
- T Zhao
- Department of Endocrinology and Metabolism, Institute of Endocrinology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China
| | - B M Chen
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - X M Zhao
- Chengde Medical University, Chengde, Hebei, China
| | - Z Y Shan
- Department of Endocrinology and Metabolism, Institute of Endocrinology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China.
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Banigé M, Estellat C, Biran V, Desfrere L, Champion V, Benachi A, Ville Y, Dommergues M, Jarreau PH, Mokhtari M, Boithias C, Brioude F, Mandelbrot L, Ceccaldi PF, Mitanchez D, Polak M, Luton D. Study of the Factors Leading to Fetal and Neonatal Dysthyroidism in Children of Patients With Graves Disease. J Endocr Soc 2017; 1:751-761. [PMID: 29130077 PMCID: PMC5677510 DOI: 10.1210/js.2017-00189] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/20/2017] [Indexed: 12/27/2022] Open
Abstract
CONTEXT Neonatal hyperthyroidism was first described in 1912 and in 1964 was shown to be linked to transplacental passage of maternal antibodies. Few multicenter studies have described the perinatal factors leading to fetal and neonatal dysthyroidism. OBJECTIVE To show how fetal dysthyroidism (FD) and neonatal dysthyroidism (ND) can be predicted from perinatal variables, in particular, the levels of anti-thyrotropin receptor antibodies (TRAbs) circulating in the mother and child. DESIGN AND PATIENTS This was a retrospective multicenter study of data from the medical records of all patients monitored for pregnancy from 2007 to 2014. SETTING Among 280,000 births, the medical records of 2288 women with thyroid dysfunction were selected and screened, and 417 women with Graves disease and positive for TRAbs during pregnancy were included. RESULTS Using the maternal TRAb levels, the cutoff value of 2.5 IU/L best predicted for FD, with a sensitivity of 100% and specificity of 64%. Using the newborn TRAb levels, the cutoff value of 6.8 IU/L best predicted for ND, with a sensitivity of 100% and a specificity of 94%. In our study, 65% of women with a history of Graves disease did not receive antithyroid drugs during pregnancy but still had infants at risk of ND. CONCLUSIONS In pregnant women with TRAb levels ≥2.5 IU/L, fetal ultrasound monitoring is essential until delivery. All newborns with TRAb levels ≥6.8 IU/L should be examined by a pediatrician with special attention for thyroid dysfunction and treated, if necessary.
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Affiliation(s)
- Maïa Banigé
- Department of Neonatology, Obstetrics and Gynecology, University Hospitals Paris Nord Val de Seine, Assistance Publique Hôpitaux de Paris, Beaujon Hospital, Clichy 92118, France
| | - Candice Estellat
- Department of Epidemiology and Clinical Research, Assistance Publique Hôpitaux de Paris, Bichat Hospital, University Hospitals Paris Nord Val de Seine, UMR 1123 ECEVE/CIC-EC 1425, Inserm, Paris 75184, France
| | - Valerie Biran
- Department of Neonatal Pediatrics and Intensive Care, Assistance Publique Hôpitaux de Paris, Robert Debré Hospital, Paris Diderot University, Paris 75013, France
| | - Luc Desfrere
- Department of Neonatal Pediatrics and Intensive Care, Assistance Publique Hôpitaux de Paris, Louis Mourier Hospital, University Hospitals Paris Nord Val de Seine, Colombes 92700, France
| | - Valerie Champion
- Department of Neonatal Pediatrics, Assistance Publique Hôpitaux de Paris, Armand Trousseau Hospital, Pierre and Marie Curie University (UPMC), Paris 75005, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Paris, Antoine Béclère Hospital, Paris-Sud University, Clamart 92140, France
| | - Yves Ville
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Paris, Necker-Enfants Malades, Paris Descartes University, Paris 75006, France
| | - Marc Dommergues
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Pierre and Marie Curie University (UPMC), Paris 75005, France
| | - Pierre-Henri Jarreau
- Department of Neonatal Pediatrics and Intensive Care, Assistance Publique Hôpitaux de Paris, Port-Royal Hospital, Paris Descartes University, Paris 75006, France
| | - Mostafa Mokhtari
- Department of Neonatal Pediatrics and Intensive Care, Assistance Publique Hôpitaux de Paris, Kremlin Bicêtre Hospital, Bicêtre 94270, France
| | - Claire Boithias
- Department of Neonatal Pediatrics and Intensive Care, Assistance Publique Hôpitaux de Paris, Kremlin Bicêtre Hospital, Bicêtre 94270, France
| | - Frederic Brioude
- Department of Endocrinology Pediatrics, Assistance Publique Hôpitaux de Paris, Armand Trousseau Hospital, Paris 75012, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Paris, Louis Mourier Hospital, University Hospitals Paris Nord Val de Seine, Colombes 92700, France
| | - Pierre-François Ceccaldi
- Department of Neonatology, Obstetrics and Gynecology, University Hospitals Paris Nord Val de Seine, Assistance Publique Hôpitaux de Paris, Beaujon Hospital, Clichy 92118, France
| | - Delphine Mitanchez
- Department of Neonatal Pediatrics, Assistance Publique Hôpitaux de Paris, Armand Trousseau Hospital, Pierre and Marie Curie University (UPMC), Paris 75005, France
| | - Michel Polak
- Department of Paediatric Endocrinology (APHP), Necker-Enfants Malades, Paris Descartes University, Paris 75006, France
| | - Dominique Luton
- Department of Neonatology, Obstetrics and Gynecology, University Hospitals Paris Nord Val de Seine, Assistance Publique Hôpitaux de Paris, Beaujon Hospital, Clichy 92118, France
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Gingold JA, Zafman K, Rodriguez-Purata J, Whitehouse MC, Lee JA, Sandler B, Copperman AB. Do elevated TSH levels predict early pregnancy loss in ART patients? Gynecol Endocrinol 2016; 32:973-976. [PMID: 27426225 PMCID: PMC5145795 DOI: 10.1080/09513590.2016.1200553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION The upper limit of normal TSH has been revised from 5 mIU/L to 2.5 mIU/L. We sought to evaluate IVF patients and the association between abnormal TSH and early pregnancy loss. METHODS A retrospective study of patients who had TSH levels measured within the 2 weeks prior to their fresh autologous IVF cycles (2002-2014). Cohorts were stratified by oocyte age (<35, [35-38), [38-41), [41-43) and ≥43 years), and TSH level [(0-0.5], (0.5-2.5], (2.5-5], and (5-23) mIU/L]. Patients were followed until pregnancy loss or delivery. Model was assessed by chi-square of ANOVA with significance at p < 0.05. RESULTS TSH was abnormally elevated (>5 mIU/L), mildly elevated ((2.5-5] mIU/L) or suppressed (≤0.5 mIU/L) in 46, 317 and 65 of the 1201 total cycles, respectively. Treatment resulted in 630 pregnancies, 524 clinical pregnancies and 409 deliveries. Pregnancy loss rates were increased in patients ≥38 yo (p < 0.001) but not [35-38) yo (p = 0.40) compared with those <35 yo. Early pregnancy loss rate was not associated with TSH level (p > 0.30) compared with euthyroid patients after adjusting for oocyte age. CONCLUSION Early pregnancy loss rate in IVF patients appears to have no relation to recent TSH levels.
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Affiliation(s)
- Julian A. Gingold
- Reproductive Medicine Associates of New York, 635 Madison Ave 10th Floor New York, New York, United States, 10022
- Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, 1176 Fifth Avenue, 9th Floor, New York, New York, United States, 10029
- Obstetrics/Gynecology and Women’s Health Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A81, Cleveland Ohio, 44195
| | - Kelly Zafman
- Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, 1176 Fifth Avenue, 9th Floor, New York, New York, United States, 10029
| | - Jorge Rodriguez-Purata
- Reproductive Medicine Associates of New York, 635 Madison Ave 10th Floor New York, New York, United States, 10022
| | - Michael C. Whitehouse
- Reproductive Medicine Associates of New York, 635 Madison Ave 10th Floor New York, New York, United States, 10022
| | - Joseph A. Lee
- Reproductive Medicine Associates of New York, 635 Madison Ave 10th Floor New York, New York, United States, 10022
| | - Benjamin Sandler
- Reproductive Medicine Associates of New York, 635 Madison Ave 10th Floor New York, New York, United States, 10022
- Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, 1176 Fifth Avenue, 9th Floor, New York, New York, United States, 10029
| | - Alan B. Copperman
- Reproductive Medicine Associates of New York, 635 Madison Ave 10th Floor New York, New York, United States, 10022
- Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, 1176 Fifth Avenue, 9th Floor, New York, New York, United States, 10029
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Maji R, Nath S, Lahiri S, Saha Das M, Bhattacharyya AR, Das HN. Establishment of Trimester-Specific Reference Intervals of Serum TSH & fT4 in a Pregnant Indian Population at North Kolkata. Indian J Clin Biochem 2014; 29:167-73. [PMID: 24757298 PMCID: PMC3990810 DOI: 10.1007/s12291-013-0332-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 04/20/2013] [Indexed: 11/25/2022]
Abstract
Reference intervals (RIs) of serum thyroid stimulating hormone (TSH) and free thyroxine (fT4) were determined in 402 healthy pregnant women by enzyme-linked immunosorbent assay (ELISA) technique after partitioning them into three trimesters. The reference population was chosen from a study population of 610 pregnant females by applying strict inclusion and exclusion criteria. The assays were done using proper quality control measures. RIs were calculated from the central 95 % of the distribution of TSH and fT4 values located between the lower reference limit of 2.5 percentile and upper reference limit of 97.5 percentile value 0.90 confidence intervals for the upper and lower reference limits were also determined. The reference intervals for TSH were 0.25-3.35 μIU/ml for the first trimester; 0.78-4.96 μIU/ml for the second trimester and 0.89-4.6 μIU/ml for the third trimester. Similarly, the reference intervals for fT4 for first, second and third trimesters were 0.64-2.0, 0.53-2.12 and 0.64-1.98 ng/dl respectively. The values thus obtained varied from those provided by the kit literature. In comparison to our derived reference intervals, the reference data from kit manufacturer under-diagnosed both subclinical hypo- and hyper-thyroidism within our pregnant reference population.
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Affiliation(s)
- Rituparna Maji
- />Department of Biochemistry, R.G.Kar Medical College and Hospital, Kolkata, West Bengal India
- />23/2/1 D.P.P Road, P.O Naktala, Kolkata, 700047 West Bengal India
| | - Sukla Nath
- />Department of Biochemistry, R.G.Kar Medical College and Hospital, Kolkata, West Bengal India
| | - Surajit Lahiri
- />Department of Community Medicine, R.G.Kar Medical College and Hospital, Kolkata, West Bengal India
| | - Mita Saha Das
- />Department of Biochemistry, R.G.Kar Medical College and Hospital, Kolkata, West Bengal India
| | - Ajit Ranjan Bhattacharyya
- />Department of Gynaecology and Obstetrics, R.G.Kar Medical College and Hospital, Kolkata, West Bengal India
| | - Harendra Nath Das
- />Department of Biochemistry, R.G.Kar Medical College and Hospital, Kolkata, West Bengal India
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Hull K, Montgomery KS, Vireday P, Kendall-Tackett K. Maternal obesity from all sides. J Perinat Educ 2012; 20:226-32. [PMID: 22942626 DOI: 10.1891/1058-1243.20.4.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This column features excerpts from a recent series of articles from the Lamaze International research blog, Science & Sensibility. The eight-part series examined the issue of maternal obesity from various perspectives, incorporating writings from Kimmelin Hull, a physician assistant, a Lamaze Certified Childbirth Educator, and the community manager of Science & Sensibility; Kristen Montgomery, a nursing professor at the University of North Carolina-Charlotte; Pamela Vireday, a childbirth educator and blogger; and Kathleen Kendall-Tackett, a health psychologist, lactation consultant, and writer/speaker. The authors of the blog series, titled "Maternal Obesity from All Sides," reviewed current research about risks associated with maternal obesity as well as the humanistic issues and lived experiences of pregnant women of size.
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Lazarus JH. Screening for thyroid dysfunction in pregnancy: is it worthwhile? J Thyroid Res 2011; 2011:397012. [PMID: 21765989 PMCID: PMC3134289 DOI: 10.4061/2011/397012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 04/13/2011] [Indexed: 12/15/2022] Open
Abstract
There is a high incidence of thyroid dysfunction during pregnancy resulting in adverse maternal (miscarriages, anaemia in pregnancy, preeclampsia, abruptio placenta and post-partum haemorrhage) and fetal effects (premature birth, low birth weight, increased neonatal respiratory distress) which may justify screening for thyroid function during early pregnancy with interventional levothyroxine therapy for thyroid hypofunction. There is a greater prevalence of subclinical hypothyroidism in women with delivery before 32 weeks and there is even an association between thyroid autoimmunity and adverse obstetric outcome, which is independent of thyroid function. Higher maternal TSH levels even within the normal reference range are associated with an increased risk of miscarriages, fetal and neonatal distress and preterm delivery. There are few prospective randomised trials to substantiate the benefit of screening and the recently reported CATS study did not show a benefit in child IQ at age 3 years. Nevertheless there seems to be a case for screening to prevent adverse obstetric outcomes. The clinical epidemiological evidence base does not justify universal screening at the present time. However, it is probable that more evidence will be produced which may alter this view in the future.
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Affiliation(s)
- John H. Lazarus
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, University Hospital of Wales, Heath Park, Wales, Cardiff CF14 4XN, UK
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Abstract
Advances in understanding the physiology of thyroid function in normal pregnancy have highlighted the importance of the consequences of abnormal function on obstetric outcome and foetal well-being. Pubmed search was done using the terms thyroid and pregnancy. Areas of agreement are the following: gestational normative reference ranges for thyroid function tests are required for proper interpretation of any abnormalities. Measurement of thyroid-stimulating antibodies and antithyroid peroxidase antibodies is useful for diagnosis of thyroid disease in pregnancy. Treatment of Graves' hyperthyroidism should be done with propylthiouracil for first trimester only, then carbimazole or methimazole. Patients on levothyroxine require an increase in dosage during gestation. Areas of controversy are the following: total thyroxine (TT4) versus Free T4 (FT4) assays in pregnancy. Screening for thyroid function in early gestation: should it be routinely performed on everyone? What tests are appropriate? Growing points are the following: physiology of thyroxine delivery to the foetus. Establishment of gestational thyroid hormone reference ranges. Evaluation of strategies to screen thyroid function in early pregnancy. Areas timely for developing research are the following: placental thyroid hormone physiology, thyroid hormone therapy and screening thyroid function.
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Affiliation(s)
- John H Lazarus
- Centre for Endocrine and Diabetes Sciences, Cardiff University School of Medicine, University Hospital of Wales, Heath Park, UK.
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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.
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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
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Hamm MP, Cherry NM, Martin JW, Bamforth F, Burstyn I. The Impact of Isolated Maternal Hypothyroxinemia on Perinatal Morbidity. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009; 31:1015-1021. [DOI: 10.1016/s1701-2163(16)34345-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Buscicchio G, Gentilucci L, Baldini E, Giannubilo SR, Tranquilli AL. Computerized analysis of heart rate in fetuses from mothers under levothyroxin treatment. Gynecol Endocrinol 2009; 25:679-82. [PMID: 19544116 DOI: 10.1080/09513590903015452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To investigate fetal heart rate (FHR) of fetuses whose mothers are under levothyroxin treatment for chronic hypothyroidism. STUDY DESIGN Sixty women under chronic therapy with levothyroxin and 180 controls at 37-39 weeks' gestation were studied by Sonycaid Sistem 8002(R) computerized cardiotocography (cCTG) for 30 min. cCTG parameters were expressed as mean and SD and the differences tested for statistics by Student t-test. Furthermore, cCTG parameters were related to levothyroxin dose by regression analysis. Significance was assessed at p < 0.05. RESULTS Computerized cardiotocographic tracings of fetuses from mothers under levothyroxin treatment revealed: significant reduction of baseline FHR (130.1 +/- 9.47 vs. 134.9 +/- 4.68 bpm); increased number of FHR decelerations greater than 20 bpm (0.2 +/- 0.41 vs. 0.05 +/- 0.22); reduction of body movements per hour (6.68 +/- 11.72 vs. 10.65 +/- 11.74); and increased uterine contraction peaks (5.15 +/- 4.69 vs. 2.7 +/- 2.57). Those fetuses also showed significantly reduced neonatal weight (2668.2 +/- 766.65 vs. 3215.44 + 523.88 g) and lower 1-min Apgar score (8.6 +/- 0.95 vs. 9.3 +/- 1.11). Regression analysis showed a significant correlation between levothyroxin dose and baseline FHR (r = 0.60; p < 0.0001) and fetal body movements per hour (r = 0.52; p < 0.0001), and an inverse relationship with uterine contraction peaks (r = -0.35; p < 0.006), whilst no correlation was found with the number of FHR decelerations greater than 20 bpm. CONCLUSIONS Maternal hypothyroidism and levothyroxin treatment influence FHR and cCTG is a sensible tool to reveal that influence.
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Affiliation(s)
- G Buscicchio
- Department of Clinical Sciences, Polytechnic University Marche, Ancona, Italy
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15
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Sahu MT, Das V, Mittal S, Agarwal A, Sahu M. Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and fetal outcome. Arch Gynecol Obstet 2009; 281:215-20. [PMID: 19437026 DOI: 10.1007/s00404-009-1105-1] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 04/23/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Thyroid disorders are among the common endocrine problems in pregnant women. It is now well established that not only overt, but subclinical thyroid dysfunction also has adverse effects on maternal and fetal outcome. There are few data from India about the prevalence of thyroid dysfunction in pregnancy. With this background, this study aims to find prevalence of thyroid dysfunction in pregnancy and its impact on obstetrical outcome in Indian population. METHODS Six hundred and 33 pregnant women in second trimester were registered. Detailed history and examination was done. Apart from routine obstetrical investigations, TSH level estimation was done. If TSH level was deranged then free T4 and thyroperoxidase antibody level estimation were done. Patients were managed accordingly and followed till delivery. Their obstetrical and perinatal outcomes were noted. RESULTS Prevalence of thyroid dysfunction was high in this study, with subclinical hypothyroidism in 6.47% and overt hypothyroidism in 4.58% women. Overt hypothyroids were prone to have pregnancy-induced hypertension (P=0.04), intrauterine growth restriction (P=0.01) and intrauterine demise (P=0.0004) as compared to control. Cesarean section rate for fetal distress was significantly higher among pregnant subclinical hypothyroid women (P=0.04). Neonatal complications and gestational diabetes were significantly more in overt hyperthyroidism group (P=0.03 and P=0.04, respectively). CONCLUSIONS Prevalence of thyroid disorders, especially overt and subclinical hypothyroidism (6.47%) was high. Significant adverse effects on maternal and fetal outcome were seen emphasizing the importance of routine antenatal thyroid screening.
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Affiliation(s)
- Meenakshi Titoria Sahu
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
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17
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Schlienger JL, Langer B. Hypothyroïdie fruste et grossesse. ACTA ACUST UNITED AC 2007; 36:688-93. [PMID: 17597307 DOI: 10.1016/j.jgyn.2007.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Revised: 04/19/2007] [Accepted: 05/14/2007] [Indexed: 10/28/2022]
Abstract
Pregnancy has an important impact on thyroid homeostasis. The main hormonal criteria of the thyroid function are modified particularly in case of low iodine supply. Subclinical hypothyroidism is defined by a slight elevation of TSH (with a cut-off still under discussion near to 4 mU/l) although serum thyroxine and triiodothyronine levels are within the normal range. Maternal morbidity as well as prenatal morbidity and consequences on the neuropsychological development of the child are fairly well established in subclinical hypothyroidism. However, to date, there are no convincing trials assessing the efficacy levothyroxine in subclinical hypothyroidism all the more when TSH levels are between 3 and 4 mU/l. Therefore routine screening for and treatment of subclinical hypothyroidism during pregnancy are unwarranted.
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Affiliation(s)
- J-L Schlienger
- Service de médecine interne, hôpital de Hautepierre, 67098 Strasbourg cedex, France.
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Casey BM, Dashe JS, Wells CE, McIntire DD, Leveno KJ, Cunningham FG. Subclinical Hyperthyroidism and Pregnancy Outcomes. Obstet Gynecol 2006; 107:337-41. [PMID: 16449121 DOI: 10.1097/01.aog.0000197991.64246.9a] [Citation(s) in RCA: 258] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Subclinical hyperthyroidism has long-term sequelae that include osteoporosis, cardiovascular morbidity, and progression to overt thyrotoxicosis or thyroid failure. The objective of this study was to evaluate pregnancy outcomes in women with suppressed thyroid-stimulating hormone (TSH) and normal free thyroxine (fT(4)) levels. METHODS All women who presented to Parkland Hospital for prenatal care between November 1, 2000, and April 14, 2003, underwent thyroid screening by chemiluminescent TSH assay. Women with TSH values at or below the 2.5th percentile for gestational age and whose serum fT(4) levels were 1.75 ng/dL or less were identified to have subclinical hyperthyroidism. Those women screened and delivered of a singleton infant weighing 500 g or more were analyzed. Pregnancy outcomes in women identified with subclinical hyperthyroidism were compared with those in women whose TSH values were between the 5th and 95th percentiles. RESULTS A total of 25,765 women underwent thyroid screening and were delivered of singleton infants. Of these, 433 (1.7%) were considered to have subclinical hyperthyroidism, which occurred more frequently in African-American and/or parous women. Pregnancies in women with subclinical hyperthyroidism were less likely to be complicated by hypertension (adjusted odds ratio 0.66, 95% confidence interval 0.44-0.98). All other pregnancy complications and perinatal morbidity or mortality were not increased in women with subclinical hyperthyroidism. CONCLUSION Subclinical hyperthyroidism is not associated with adverse pregnancy outcomes. Our results indicate that identification of subclinical hyperthyroidism and treatment during pregnancy is unwarranted. LEVEL OF EVIDENCE II-2.
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Affiliation(s)
- Brian M Casey
- Department of Obstetrics and Gynecology, the University of Texas Southwestern Medical Center, Dallas, 75390, USA.
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