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Su GY, Yeh CC, Yang SJ, Yang CC, Hwu CM, Wang FF, Huang CJ. Assessment of iodine nutritional status and gestational thyroid function reference ranges during the first trimester of pregnancy in Taiwan. J Chin Med Assoc 2024; 87:590-596. [PMID: 38651854 DOI: 10.1097/jcma.0000000000001099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Iodine nutrition is critical for fetal neurodevelopment in the first trimester of pregnancy, a period associated with dramatic changes in thyroid function. The aim of this study was to evaluate iodine nutritional status and thyroid function reference ranges in the first trimester in Taiwan. METHODS Pregnant women aged 20 years and above in the first trimester were recruited in Taipei Veterans General Hospital, Taiwan from March 2019 to July 2022. Each participant provided a spot urine sample for measurement of urinary iodine concentration (UIC) and a blood sample for checkup of thyroid function and thyroid autoantibodies. A simple food frequency questionnaire was also completed. RESULTS A total of 209 women with a mean age of 32.9 ± 4.4 years were enrolled. The median UIC was 160.9 μg/L (interquartile range [IQR]: 105.0-246.2 μg/L), indicating overall iodine sufficiency. The gestational thyroid function reference ranges were: thyroid stimulating hormone (TSH) (median: 0.93 [0.007-2.9] µIU/mL), free T4 (1.3 [0.93-2.2] ng/dL), free T3 (3.0 [2.3-5.0] ng/dL), total T4 (9.9 [6.4-16.9] ng/dL), and total T3 (135 [88-231] ng/dL). If the nonpregnant reference range of serum TSH was used, eight women (4.8%) would be misclassified as having subclinical hyperthyroidism, and two women (1.2%) with subclinical hypothyroidism would be missed. In multivariate analysis, nulliparous (adjusted odds ratio [OR] from model 1-3: 2.02, 2.05, 2.02; 95% CI, 1.08-3.77, 1.10-3.81, 1.11-3.66; p = 0.027, 0.023, 0.022, respectively) and multivitamin nonusers (adjusted OR from model 1-3: 1.86, 1.85, 1.78; 95% CI, 1.04-3.34, 1.03-3.32, 1.004-3.71; p = 0.038, 0.039, 0.049, respectively) had increased odds of having lower UIC levels <150 μg/L. CONCLUSION The iodine nutritional status in the first trimester is adequate in Taiwan; however, certain subgroups such as nulliparous and multivitamin nonusers are still at risk for iodine deficiency. Gestational thyroid function reference ranges are needed for correct diagnosis of thyroid dysfunction in pregnancy.
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Affiliation(s)
- Guan-Yu Su
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chang-Ching Yeh
- Department of Obstetrics & Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Nurse-Midwifery and Women Health, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Shun-Jie Yang
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chen-Chang Yang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Environmental & Occupational Health Sciences, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Occupational Medicine and Clinical Toxicology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chii-Min Hwu
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Fan-Fen Wang
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, Taipei City Hospital Yangming Branch, Taipei, Taiwan, ROC
| | - Chun-Jui Huang
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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2
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Jamaluddin J, Zainal Abidin S, Kathitasapathy G, Mohamad Isa MZ, Mohamed Kamel MA, Kaur P, Palaniyappan T. ABC approach for the management of adults with hyperthyroidism: A practical strategy in primary care. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2023; 18:57. [PMID: 37814670 PMCID: PMC10560458 DOI: 10.51866/rv.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Hyperthyroidism is commonly seen in primary care settings. However, the management of hyperthyroidism might be unclear to primary care doctors. Various guidelines have been published to assist clinicians in the management of thyroid disorders at various levels of care. The extensive coverage of these guidelines may not appeal to busy clinicians, and the guidelines do not focus on often resource-limited primary care settings. In this article, we aim to describe a practical guide for managing hyperthyroidism in primary care settings using an ABC approach.
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Affiliation(s)
- Jazlan Jamaluddin
- MD (Moscow), MMed (Family Medicine) (UiTM), Klinik Kesihatan Sauk, Jalan Besar, Lenggong, Sauk, Kuala Kangsar, Kuala Kangsar, Perak, Malaysia.
| | - Sofiah Zainal Abidin
- MD (UKM), MMed (Family Medicine) (UKM), Klinik Kesihatan Padang Rengas, Padang Rengas, Kuala Kangsar, Perak, Malaysia
| | - Gayathri Kathitasapathy
- MBBS (Manipal), MMed (Family Medicine) (USM), Klinik Kesihatan Karai, Enggor, Karai, Kuala Kangsar, Perak, Malaysia
| | - Mohamad Zikri Mohamad Isa
- MBBS (UiTM), MMed (Family Medicine) (UiTM), Klinik Kesihatan Lintang, Sg. Siput (U), Lintang Kuala Kangsar, Perak, Malaysia
| | - Mohd Azzahi Mohamed Kamel
- MD (Crimea), MMed (Family Medicine) (UiTM), Klinik Kesihatan Lenggong, Jalan Besar, Kampung Batu Berdinding, Lenggong, Hulu Perak, Perak, Malaysia
| | - Paream Kaur
- MBBS (Bangalore), MAFP (Malaysia), FRACGP (Australia), Klinik Kesihatan Manong, Jalan Rumah Awam II, Kuala Kangsar, Perak, Malaysia
| | - Thenmoli Palaniyappan
- MBBS (Otago), MAFP (Malaysia), FRACGP (Australia), Klinik Kesihatan Kuala Kangsar, Jalan Sultan Idris Shah 1, Kuala, Kangsar, Perak, Malaysia
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3
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D'Aurizio F, Kratzsch J, Gruson D, Petranović Ovčariček P, Giovanella L. Free thyroxine measurement in clinical practice: how to optimize indications, analytical procedures, and interpretation criteria while waiting for global standardization. Crit Rev Clin Lab Sci 2023; 60:101-140. [PMID: 36227760 DOI: 10.1080/10408363.2022.2121960] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Thyroid dysfunctions are among the most common endocrine disorders and accurate biochemical testing is needed to confirm or rule out a diagnosis. Notably, true hyperthyroidism and hypothyroidism in the setting of a normal thyroid-stimulating hormone level are highly unlikely, making the assessment of free thyroxine (FT4) inappropriate in most new cases. However, FT4 measurement is integral in both the diagnosis and management of relevant central dysfunctions (central hypothyroidism and central hyperthyroidism) as well as for monitoring therapy in hyperthyroid patients treated with anti-thyroid drugs or radioiodine. In such settings, accurate FT4 quantification is required. Global standardization will improve the comparability of the results across laboratories and allow the development of common clinical decision limits in evidence-based guidelines. The International Federation of Clinical Chemistry and Laboratory Medicine Committee for Standardization of Thyroid Function Tests has undertaken FT4 immunoassay method comparison and recalibration studies and developed a reference measurement procedure that is currently being validated. However, technical and implementation challenges, including the establishment of different clinical decision limits for distinct patient groups, still remain. Accordingly, different assays and reference values cannot be interchanged. Two-way communication between the laboratory and clinical specialists is pivotal to properly select a reliable FT4 assay, establish reference intervals, investigate discordant results, and monitor the analytical and clinical performance of the method over time.
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Affiliation(s)
- Federica D'Aurizio
- Department of Laboratory Medicine, University Hospital of Udine, Udine, Italy
| | - Jürgen Kratzsch
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, University of Leipzig, Leipzig, Germany
| | - Damien Gruson
- Department of Clinical Biochemistry, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Clinic for Nuclear Medicine and Thyroid Center, University and University Hospital of Zurich, Zurich, Switzerland
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4
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Athar S, Beer SF, Martis Z, Alloub MI. The Prevalence of Thyroid Autoimmunity in Pregnancy and Adverse Neonatal Outcomes at a Secondary Care Hospital in the Middle East. Cureus 2022; 14:e24814. [PMID: 35686265 PMCID: PMC9170529 DOI: 10.7759/cureus.24814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 11/05/2022] Open
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5
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Turroni F, Rizzo SM, Ventura M, Bernasconi S. Cross-talk between the infant/maternal gut microbiota and the endocrine system: a promising topic of research. MICROBIOME RESEARCH REPORTS 2022; 1:14. [PMID: 38045647 PMCID: PMC10688790 DOI: 10.20517/mrr.2021.14] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 12/05/2023]
Abstract
The infant gut microbiota is the set of microorganisms colonizing the baby's intestine. This complex ecosystem appears to be related to various physiological conditions of the host and it has also been shown to act as one of the most crucial determinants of infant's health. Furthermore, the mother's endocrine system, through its hormones, can have an effect on the composition of the newborn's gut microbiota. In this perspective, we summarize the recent state of the art on the intricate relationships involving the intestinal microbiota and the endocrine system of mother/baby to underline the need to study the molecular mechanisms that appear to be involved.
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Affiliation(s)
- Francesca Turroni
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences, and Environmental Sustainability, University of Parma, Parma 43124, Italy
- Microbiome Research Hub, University of Parma, Parma 43124, Italy
| | - Sonia Mirjam Rizzo
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences, and Environmental Sustainability, University of Parma, Parma 43124, Italy
| | - Marco Ventura
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences, and Environmental Sustainability, University of Parma, Parma 43124, Italy
- Microbiome Research Hub, University of Parma, Parma 43124, Italy
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6
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Nanda R, Nayak PK, Patel S, Mohapatra E, Agrawal S. First-Trimester Reference Intervals for Thyroid Function Testing among Women Screened at a Tertiary Care Hospital in India. J Lab Physicians 2021; 14:183-189. [PMID: 35982874 PMCID: PMC9381317 DOI: 10.1055/s-0041-1736520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives
Due to differences in the method of assay and population-specific factors, each laboratory needs to establish its own gestation-specific reference intervals (GRIs) for thyroid hormones.
Materials and Methods
Three-hundred forty-one women with less than 14 weeks gestation were screened at a tertiary care hospital in Chhattisgarh, India. Serum levels of thyroid-stimulating hormone (TSH), free thyroxine (fT4), and thyroid peroxidase antibody (anti-TPO) were measured using an ADVIA Centaur XP immunoassay.
GRIs (2.5th and 97.5th percentiles) were determined for TSH and fT4. TSH and fT4 concentrations were converted to multiples of the median (MoM) values. Effect of maternal age, gestational age, and maternal weight was analyzed. Statistical Analysis
Quantitative variables were expressed as means and standard deviations (SD), and qualitative variables were expressed as frequencies and percentages. Normality of the data was checked using the Kolmogorov–Smirnov test. Values that were normally distributed were expressed only as means and SD. Those that were not normally distributed were expressed as medians and interquartile range. For all statistical analysis,
p
< 0.05 was considered as statistically significant.
Results
First-trimester GRI was 0.245 to 4.971 mIU/L for TSH, 10.2 to 18.9 pmol/L for fT4, and 27.0 to 56.89 kIU/L for anti-TPO. There was no significant difference in the mean serum TSH (
p
= 0.920), fT4 (
p
= 0.714), or anti-TPO (
p
= 0.754) values among women in 4 to 7th week and 7 to 14th week of gestation. The 1st and 99th centile MoMs were 0.03 and 4.09 for TSH and 0.66 and 1.39 for fT4. There was a significant positive correlation between the maternal weight and TSH MoM values (
p
= 0.027,
r
= 0.120).
Conclusion
These laboratory- and first-trimester-specific GRI for TSH and fT4 shall help in proper diagnosis and treatment of subclinical thyroid dysfunctions. TSH and fT4 MoM values can be used to indicate high or low values in a quantitative manner independent of the reference ranges and may be used by other laboratories.
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Affiliation(s)
- Rachita Nanda
- Department of Biochemistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Prasanta Kumar Nayak
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Suprava Patel
- Department of Biochemistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Eli Mohapatra
- Department of Biochemistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Sarita Agrawal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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7
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Percy Z, Vuong AM, Xu Y, Xie C, Ospina M, Calafat AM, Hoofnagle A, Lanphear BP, Braun JM, Cecil KM, Dietrich KN, Yolton K, Chen A. Maternal Urinary Organophosphate Esters and Alterations in Maternal and Neonatal Thyroid Hormones. Am J Epidemiol 2021; 190:1793-1802. [PMID: 33778842 DOI: 10.1093/aje/kwab086] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 12/23/2022] Open
Abstract
Production of organophosphate esters (OPEs), which represent a major flame-retardant class present in consumer goods, has increased over the past 2 decades. Experimental studies suggest that OPEs may be associated with thyroid hormone disruption, but few human studies have examined this association. We quantified OPE metabolites in the urine of 298 pregnant women from Cincinnati, Ohio, in the Health Outcomes and Measures of the Environment Study (enrolled 2003-2006) at 3 time points (16 and 26 weeks' gestation, and at delivery), and thyroid hormones in 16-week maternal and newborn cord sera. Urinary bis(1,3-dichloro-2-propyl)-phosphate concentrations were generally associated with decreased triiodothyronine and thyroxine levels and increased thyroid-stimulating hormone levels in maternal and newborn thyroid hormones in quartile dose-response analyses and multiple informant models. There was weaker evidence for thyroid hormone alterations in association with diphenyl-phosphate and di-n-butyl-phosphate. Bis-2-chloroethyl-phosphate was not associated with alterations in thyroid hormones in any analyses. We did not observe any evidence of effect modification by infant sex. These results suggest that gestational exposure to some OPEs may influence maternal and neonatal thyroid function, although replication in other cohorts is needed.
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8
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Okosieme OE, Agrawal M, Usman D, Evans C. Method-dependent variation in TSH and FT4 reference intervals in pregnancy: A systematic review. Ann Clin Biochem 2021; 58:537-546. [PMID: 34120478 DOI: 10.1177/00045632211026955] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Gestational TSH and FT4 reference intervals may differ according to assay method, but the extent of variation is unclear and has not been systematically evaluated. We conducted a systematic review of published studies on TSH and FT4 reference intervals in pregnancy. Our aim was to quantify method-related differences in gestation reference intervals, across four commonly used assay methods, Abbott, Beckman, Roche and Siemens. METHODS We searched the literature for relevant studies, published between January 2000 and December 2020, in healthy pregnant women without thyroid antibodies or disease. For each study, we extracted trimester-specific reference intervals (2.5-97.5 percentiles) for TSH and FT4 as well as the manufacturer-provided reference interval for the corresponding non-pregnant population. RESULTS TSH reference intervals showed a wide range of study-to-study differences with upper limits ranging from 2.33 to 8.30 mU/L. FT4 lower limits ranged from 4.40 to 13.93 pmol/L, with consistently lower reference intervals observed with the Beckman method. Differences between non-pregnant and first trimester reference intervals were highly variable, and for most studies, the TSH upper limit in the first trimester could not be predicted or extrapolated from non-pregnant values. CONCLUSIONS Our study confirms significant intra- and intermethod disparities in gestational thyroid hormone reference intervals. The relationship between pregnant and non-pregnant values is inconsistent and does not support the existing practice in many laboratories of extrapolating gestation references from non-pregnant values. Laboratories should invest in deriving method-specific gestation reference intervals for their population.
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Affiliation(s)
- Onyebuchi E Okosieme
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK.,Diabetes Department, Prince Charles Hospital, Cwm Taf University Health Board, Merthyr Tydfil, UK
| | - Medha Agrawal
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK.,Diabetes Department, Prince Charles Hospital, Cwm Taf University Health Board, Merthyr Tydfil, UK
| | - Danyal Usman
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK.,Diabetes Department, Prince Charles Hospital, Cwm Taf University Health Board, Merthyr Tydfil, UK
| | - Carol Evans
- Department of Medical Biochemistry & Immunology, University Hospital of Wales, Cardiff, UK
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9
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Dong Y, Peng S, Tang H, Yang P, Yang L, Yang X, Qiu B, Bao G. The application of the three-dimensional high-definition laparoscope in thyroid microcarcinoma. Transl Cancer Res 2021; 10:977-982. [PMID: 35116425 PMCID: PMC8797585 DOI: 10.21037/tcr-20-1525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study aimed to evaluate the feasibility and safety of the three-dimensional (3D) high-definition (HD) laparoscope via a chest-breast approach in thyroid microcarcinoma. METHODS In this retrospective study, ten patients with thyroid microcarcinoma who underwent laparoscopic thyroidectomy in the Department of General Surgery of Tangdu Hospital from May 2016 to October 2016 were included. Preoperative thyroid and neck ultrasound in these patients showed a thyroid nodule ≤1 cm, and no significantly enlarged cervical lymph nodes were observed. The patients' thyroid function showed no subclinical hyperthyroidism. Three trocars were used via the chest and breast during the surgery. The main outcome measures included the operation time, intraoperative blood loss, postoperative hospital stay time, postoperative drainage volume, and the incidence of complications. RESULTS The ten patients were successfully treated using a 3D HD laparoscope. The mean operation time was 70-160 minutes, the average intraoperative blood loss was 10-30 mL, the mean postoperative hospital stay was 4.5 days, and the mean postoperative drainage volume was 10-20 mL. None of the patients needed to receive a traditional open thyroidectomy during the operation. No patient experienced hoarseness, numbness of limbs, or choking or coughing while drinking water. CONCLUSIONS The 3D endoscopic thyroidectomy operation via the chest-breast approach is a feasible and safe therapeutic method for the treatment of thyroid microcarcinoma.
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Affiliation(s)
- Yanming Dong
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Shujia Peng
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Haili Tang
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Ping Yang
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Lin Yang
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Xiaojun Yang
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Bo Qiu
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Guoqiang Bao
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
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10
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Anandappa S, Joshi M, Polanski L, Carroll PV. Thyroid disorders in subfertility and early pregnancy. Ther Adv Endocrinol Metab 2020; 11:2042018820945855. [PMID: 33133491 PMCID: PMC7576916 DOI: 10.1177/2042018820945855] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/08/2020] [Indexed: 01/04/2023] Open
Abstract
Disorders of thyroid function are common in pregnancy and have implications for foetal and maternal health. Thyroid autoimmunity, as evidenced by the presence of elevated levels of anti-thyroid antibodies (anti-TPO and anti-Tg antibodies) is associated with an increased risk of miscarriage, though the mechanism remains poorly understood. There has been considerable focus on the implications and optimal management of pregnant women with thyroid disease, especially those undergoing assisted reproduction. Pregnancy results in significant changes in thyroid physiology and these need to be understood by clinicians involved in the care of pregnant women. Guidelines for the use of thyroxine and target thyroid function tests have been produced by international bodies but it is recognised that these predominantly reflect expert opinion rather than established evidence-based practice. Importantly a number of key clinical trials have been performed to aid understanding, particularly of the consequences of hypothyroidism for mother and baby, and the effectiveness of thyroid hormone use in autoimmune and subclinical hypothyroidism. This review summarises the current knowledge base and guidance for practice relating to thyroid disorders in pregnancy and subfertility.
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Affiliation(s)
- Samantha Anandappa
- Department of Endocrinology, Guy’s & St. Thomas’ NHS Foundation Trust, London, UK
| | - Mamta Joshi
- Department of Endocrinology, Guy’s & St. Thomas’ NHS Foundation Trust, London, UK
| | - Lukasz Polanski
- Assisted Conception, Guy’s & St. Thomas’ NHS Foundation Trust, London, UK
| | - Paul V. Carroll
- Department of Endocrinology, Guy’s & St. Thomas’ NHS Foundation Trust, DEDC 3rd Floor Lambeth Wing, St. Thomas’ Hospital, London, SE1 7EH, UK
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11
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Sepasi F, Rashidian T, Shokri M, Badfar G, Kazemi F, Azami M. Thyroid dysfunction in Iranian pregnant women: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2020; 20:405. [PMID: 32664874 PMCID: PMC7386166 DOI: 10.1186/s12884-020-03040-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/29/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Thyroid dysfunction during pregnancy is associated with adverse outcomes for both mother and fetus. The present meta-analysis was conducted to evaluate thyroid dysfunction in Iranian pregnant women. METHODS We registered this review at PROSPERO (registration number: CRD42020166655). The research steps in this systematic review and meta-analysis were performed according to the MOOSE protocol, and finally, reports were provided based on the PRISMA guidelines. The literature search was performed in October 2019 using the international online databases, including Web of Science, Ovid, Science Direct, Scopus, EMBASE, PubMed/Medline, Cochrane Library, EBSCO, CINAHL, Google Scholar as well as national databases were reviewed. Data were extracted after applying the inclusion and exclusion criteria and qualitative evaluation of the studies. I2 index and Q test were used to assess differences in studies. All analyses were performed using Comprehensive Meta-Analysis Software. P-value less than 0.05 was considered statistically significant. We identified 1261 potential articles from the databases, and 426 articles remained after removing the duplicate and unrelated studies. After evaluating the full text, 52 articles were removed. RESULTS Finally, 19 eligible studies including 17,670 pregnant women included for meta-analysis. The prevalence of thyroid dysfunction in Iranian pregnant women was 18.10% (95%CI: 13.89-23.25). The prevalence of hypothyroidism, clinical hypothyroidism, and subclinical hypothyroidism in Iranian pregnant women was respectively estimated to be 13.01% (95%CI: 9.15-18.17), 1.35% (95%CI: 0.97-1.86) and 11.90% (95%CI: 7.40-18.57). The prevalence of hyperthyroidism, clinical hyperthyroidism, and subclinical hyperthyroidism in Iranian pregnant women was respectively estimated to be 3.31% (95%CI: 1.62-6.61), 1.06% (95%CI: 0.61-1.84) and 2.56% (95%CI: 0.90-7.05). The prevalence of anti-thyroperoxidase antibody was estimated to be 11.68% (95%CI: 7.92-16.89). CONCLUSION The results of this meta-analysis showed a high prevalence of thyroid disorders, especially hypothyroidism. The decision to recommend thyroid screening during pregnancy for all women is still under debate, because the positive effects of treatment on pregnancy outcomes must be ensured. On the other hand, evidence about the effect of thyroid screening and treatment of thyroid disorders on pregnancy outcomes is still insufficient. Nevertheless, a large percentage of general practitioners, obstetricians and gynecologists perform screening procedures in Iran.
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Affiliation(s)
- Farnaz Sepasi
- Department of Obstetrics and Gynecology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tayebeh Rashidian
- Department of Obstetrics and Gynecology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Mehdi Shokri
- Department of Pediatrics, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Gholamreza Badfar
- Department of Pediatric, Faculty of Medicine, Ahvaz Jundishapour University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Kazemi
- School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Milad Azami
- School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
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