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Cabalar I, Le TH, Silber A, O'Hara M, Abdallah B, Parikh M, Busch R. The Role of Blood Testing in Prevention, Diagnosis, and Management of Chronic Diseases: A Review. Am J Med Sci 2024:S0002-9629(24)01169-8. [PMID: 38636653 DOI: 10.1016/j.amjms.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/06/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
Blood tests are vital to prevention, diagnosis, and management of chronic diseases. Despite this, it can be challenging to construct a comprehensive view of the clinical importance of blood testing because relevant literature is typically fragmented across different disease areas and patient populations. This lack of collated evidence can also make it difficult for primary care providers to adhere to best practices for blood testing across different diseases and guidelines. Thus, this review article synthesizes the recommendations for, and importance of, blood testing across several common chronic conditions encountered in primary care and internal medicine, including cardiovascular diseases, diabetes mellitus, chronic kidney disease, vitamin D deficiency, iron deficiency, and rheumatoid arthritis. Future research is needed to continue improving chronic disease management through clearer dissemination and awareness of clinical guidelines among providers, and better access to blood testing for patients (e.g., via pre-visit laboratory testing).
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Affiliation(s)
- Imelda Cabalar
- Division of Rheumatology, Department of Medicine, Adventist HealthCare Fort Washington Medical Center, Fort Washington, MD, USA.
| | - Thu H Le
- Division of Nephrology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | | | | | | | | | - Robert Busch
- Division of Community Endocrinology, Department of Medicine, Albany Medical Center, Albany, NY, USA.
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2
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Urgatz B, Poppe KG. Update on therapeutic use of levothyroxine for the management of hypothyroidism during pregnancy. Endocr Connect 2024; 13:e230420. [PMID: 38190256 PMCID: PMC10895322 DOI: 10.1530/ec-23-0420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/08/2024] [Indexed: 01/10/2024]
Abstract
Hypothyroidism is a relatively common finding during pregnancy. This may be due either to the presence of existing thyroid disease and/or to the increased demands that pregnancy places the thyroid gland to provide thyroid hormones for the mother and the developing fetus. There is no doubt that overt hypothyroidism is associated strongly with adverse pregnancy outcomes, including miscarriage. Meta-analyses show that thyroid hormone replacement with levothyroxine (LT4) reduces the risk of adverse pregnancy outcomes in the setting of overt hypothyroidism. Accordingly, management guidelines in this area are unanimous in recommending intervention with to control the level of thyrotropin (TSH) to below 2.5 μIU/mL. The evidence for an adverse impact of subclinical hypothyroidism (SCH) on pregnancy outcomes is less clear, although meta-analyses suggest that SCH reduces the chance of a successful pregnancy outcome. Guidelines also support intervention for some patients with SCH, particularly where TSH is high (>10 μIU/mL), or where TSH is above its trimester-specific reference range in a woman with thyroid autoimmunity (giving LT4 to euthyroid women with thyroid autoimmunity is not supported). Real-world evidence suggests that hypothyroidism in pregnancy is often overlooked or that LT4 is not given appropriately to gain tight control of TSH. More research is needed to identify the barriers to optimal thyroid care with LT4 at this crucial time.
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Affiliation(s)
| | - Kris G Poppe
- University Hospital CHU Saint Pierre, Free University of Brussels, Brussels, Belgium
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3
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Joshi JS, Shanoo A, Patel N, Gupta A. From Conception to Delivery: A Comprehensive Review of Thyroid Disorders and Their Far-Reaching Impact on Feto-Maternal Health. Cureus 2024; 16:e53362. [PMID: 38435202 PMCID: PMC10907906 DOI: 10.7759/cureus.53362] [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: 01/15/2024] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
This comprehensive review delves into the multifaceted landscape of thyroid disorders during pregnancy, exploring their impact from conception to postpartum considerations. Key findings highlight the intricate interplay between maternal thyroid health and fetal development, emphasizing the critical importance of timely screening and targeted interventions. The evolving landscape of research and technology suggests a paradigm shift toward personalized approaches in clinical practice, emphasizing integrated care models and the integration of telehealth platforms. Postpartum considerations, including postpartum thyroiditis, underscore the necessity for ongoing monitoring and intervention for maternal well-being. Implications for clinical practice encompass healthcare provider education, public awareness campaigns, and policy advocacy for standardized screening guidelines. The call to action resonates for increased research funding to advance understanding and improve outcomes. By fostering awareness, education, and collaborative efforts, this review aims to navigate the complexities of thyroid disorders during pregnancy, ensuring a healthier start for both mothers and their infants.
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Affiliation(s)
- Jalormy S Joshi
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amardeep Shanoo
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nainita Patel
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aishwarya Gupta
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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4
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Sitoris G, Veltri F, Jelloul E, Kleynen P, Rozenberg S, Poppe KG. Impact of thyroid hormone treatment on maternal pregnancy outcomes in women with subclinical hypothyroidism without TPOAb: a retrospective cross-sectional study. Thyroid Res 2023; 16:29. [PMID: 37691132 PMCID: PMC10494333 DOI: 10.1186/s13044-023-00171-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/03/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Evidence on the impact of thyroid hormone treatment (LT4) on maternal pregnancy outcomes in women with subclinical hypothyroidism (SCH) without thyroid peroxidase antibodies (TPOAb) positivity is scarce. METHODS Single centre, cross-sectional study in 1460 women screened for TSH, free T4 and TPOAb at median 13 (11-17) weeks of gestation during the period 2013-2014. Exclusion criteria were twin- and assisted reproduction pregnancies, TPO positivity, overt thyroid dysfunction, and treatment with LT4 before screening. The impact of LT4 on maternal pregnancy outcomes was investigated in a group of 53 women with SCH (TSH > 3.74 mIU/L) in which LT4 was initiated at median 13 (10-22) weeks (treated group). The control group included 18 women with SCH (TSH > 3.74 mIU/L). The prevalence of pregnancy complications in these two groups was compared with that in a euthyroid reference (REF) group of 1389 women (TSH ≤ 3.74 mIU/L). RESULTS The prevalence of pre-eclampsia and gestational diabetes (GDM) was higher in the control group vs the REF group (16.7% vs 5.0% and 27.8% vs 18.9%; p = 0.017 and p = 0.016, respectively), but comparable in the treated group vs the REF group (7.6% vs 5.0% and 22.6% vs 18.9%; p = 0.918 and 0.676, respectively). The prevalence of iron-deficiency anaemia was lower in the treated vs the REF group (17.0% vs 32.5%; p = 0.017). CONCLUSION Pregnant women with untreated SCH and without TPOAb positivity had a higher prevalence of pre-eclampsia and GDM compared with euthyroid women, while this was not the case in women with treated SCH, even when it was initiated after the first trimester.
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Affiliation(s)
- Georgiana Sitoris
- Endocrine Unit Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Rue Haute 322, Brussels, 1000, Belgium
| | - Flora Veltri
- Endocrine Unit Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Rue Haute 322, Brussels, 1000, Belgium
| | - Emna Jelloul
- Endocrine Unit Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Rue Haute 322, Brussels, 1000, Belgium
| | - Pierre Kleynen
- Endocrine Unit Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Rue Haute 322, Brussels, 1000, Belgium
| | - Serge Rozenberg
- Departement of Gynecology and Obstetrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Rue Haute 322, Brussels, 1000, Belgium
| | - Kris G Poppe
- Endocrine Unit Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Rue Haute 322, Brussels, 1000, Belgium.
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5
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Pinto S, Croce L, Carlier L, Cosson E, Rotondi M. Thyroid dysfunction during gestation and gestational diabetes mellitus: a complex relationship. J Endocrinol Invest 2023:10.1007/s40618-023-02079-3. [PMID: 37024642 PMCID: PMC10372128 DOI: 10.1007/s40618-023-02079-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/24/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE Gestational diabetes mellitus (GDM) and thyroid dysfunction during gestation (GTD) are the two most prevalent endocrinopathies during pregnancy. The aim of the present review is to provide an overview of the peculiar aspects of GDM and GTD, to highlight the potential interactions and clinical consequences of these two frequent clinical conditions. METHODS A literature review regarding GDM and GTD was carried out with particular interest on meta-analyses and human studies dealing with the (i) shared risk factors between GDM and GTD, (ii) the epidemiological link between GTD and GDM, (iii) physiopathologic link between GTD and GDM, (iv) clinical consequences of GDM and GTD, and (v) post-partum implications of GDM and GTD. RESULTS The association between GDM and GTD is common and may be explained by the insulin-resistance state due to maternal GTD, to alterations in the placentation process or to the many shared risk factors. Discrepant results of epidemiologic studies can be explained, at least in part, by the changes in diagnostic criteria and screening strategies throughout the years for both conditions. GDM and GTD impact pregnancy outcome and have post-partum long-term consequences, but more studies are needed to prove an additional adverse effect. CONCLUSIONS Based on the epidemiological and physio-pathological link between GDM and GTD, it could be suggested that a diagnosis of GTD could lead to screen GDM and the other way round.
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Affiliation(s)
- S Pinto
- AP-HP, Department of Endocrinology-Diabetology-Nutrition, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France
- AP-HP, Ambulatory Unit of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bondy, France
| | - L Croce
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, PV, Italy
- Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Department of Internal Medicine and Therapeutics, University of Pavia, Via S. Maugeri 4, 27100, Pavia, PV, Italy
- NBFC, National Biodiversity Future Center, 90133, Palermo, PA, Italy
| | - L Carlier
- AP-HP, Ambulatory Unit of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bondy, France
| | - E Cosson
- AP-HP, Department of Endocrinology-Diabetology-Nutrition, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France
- UMR U1153 INSERM/U11125 INRA/CNAM/Université Paris 13, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France
| | - M Rotondi
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, PV, Italy.
- Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Department of Internal Medicine and Therapeutics, University of Pavia, Via S. Maugeri 4, 27100, Pavia, PV, Italy.
- NBFC, National Biodiversity Future Center, 90133, Palermo, PA, Italy.
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6
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Hatting LC, Kristensen MØ, Lundgaard MH, Sørensen A, Andersen SL. Screening for thyroid disease in pregnancy: a study of Danish clinical practice. Thyroid Res 2023; 16:9. [PMID: 37004092 PMCID: PMC10063953 DOI: 10.1186/s13044-023-00151-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/04/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Thyroid disease in pregnant women is a matter of clinical awareness, and current clinical guidelines recommend a risk-based screening strategy. This study aimed to evaluate current clinical practice regarding screening for thyroid disease in pregnancy in Denmark. METHODS A cross-sectional study was performed in the North Denmark Region with consecutive inclusion of 150 pregnant women from Aalborg University Hospital each year in 2020 and 2021. Medical records were reviewed according to the recommended risk-based screening criteria for thyroid disease in pregnancy. Any measurement of thyroid-stimulating hormone (TSH) was assessed 3 months prior to and in pregnancy. RESULTS Altogether 292 pregnant women who received no current treatment for thyroid disease were included. A total of 81 (27.7%) had a measurement of TSH before or during the pregnancy, and 30 women (10.3%) in the early pregnancy specifically. One or more of the screening criteria for thyroid disease recommended in the Danish clinical practice guideline were fulfilled in 37 of the 81 women (45.7%) with thyroid function tested and among 41 of the 211 (19.4%) women who did not have thyroid function tested before or during pregnancy. CONCLUSION In a Danish regional investigation, 1 in 4 women had their thyroid function tested in relation to a pregnancy. However, recommended risk-based screening criteria for thyroid disease in pregnancy were heterogeneously distributed. Results encourage considerations on the current practice for the screening of thyroid function in Danish pregnant women and inform the general debate.
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Affiliation(s)
- Line Cleman Hatting
- Department of Clinical Biochemistry, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | | | - Maja Hjelm Lundgaard
- Department of Clinical Biochemistry, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Anne Sørensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Gynecology and Obstetrics, Aalborg University Hospital, Aalborg, Denmark
| | - Stine Linding Andersen
- Department of Clinical Biochemistry, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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7
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Costa RV, Marafona AS, Martins AO. [Advanced Maternal Age: A Perspective of the Portuguese Reality]. ACTA MEDICA PORT 2023; 36:69-70. [PMID: 36592484 DOI: 10.20344/amp.19115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/28/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Rafaela Vieira Costa
- Unidade de Saúde Familiar Amadeo de Souza-Cardoso. Agrupamento de Centros de Saúde Baixo-Tâmega I. Amarante. Portugal
| | - Ana Sofia Marafona
- Unidade de Saúde Familiar Douro Vita. Agrupamento de Centros de Saúde Douro II - Douro Sul. Lamego. Grupo de Estudos de Saúde da Mulher. Associação Portuguesa de Medicina Geral e Familiar. Lisboa. Portugal
| | - Andreia Oliveira Martins
- Unidade de Saúde Familiar Terra e Mar. Agrupamento de Centros de Saúde Grande Porto IV. Póvoa de Varzim. Portugal
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Selim S, Pathan M, Rahman M, Saifuddin M, Qureshi N, Mir A, Afsana F, Haq T, Kamrul-Hasan AM, Ashrafuzzaman S. Bangladesh endocrine society guidelines for the diagnosis and management of thyroid disease during pregnancy and the postpartum. BANGLADESH JOURNAL OF ENDOCRINOLOGY AND METABOLISM 2023. [DOI: 10.4103/bjem.bjem_2_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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9
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Panagiotou G, Taylor PN, Rees DA, Okosieme OE. Late offspring effects of antenatal thyroid screening. Br Med Bull 2022; 143:16-29. [PMID: 35868487 DOI: 10.1093/bmb/ldac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Thyroid dysfunction in pregnancy is associated with adverse offspring outcomes and recent birth-cohort studies suggest that even mild degrees of thyroid dysfunction may be linked with a range of late cognitive and behavioural effects in childhood and adolescence. SOURCES OF DATA This review summarizes recent literature of observational studies and critically appraises randomized controlled trials (RCTs) of antenatal thyroid screening and Levothyroxine intervention. AREAS OF AGREEMENT Overt hypothyroidism and hyperthyroidism carry significant risks for unfavourable offspring outcomes and should be appropriately corrected in pregnancy. AREAS OF CONTROVERSY The significance of subclinical hypothyroidism and hypothyroxinaemia is still unclear. Meta-analyses of birth-cohort studies show associations of maternal subclinical hypothyroidism and hypothyroxinaemia with intellectual deficits, attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders, while hyperthyroidism and high-normal FT4 were linked with ADHD. RCTs have shown no benefits of screening on neurodevelopmental outcomes although Levothyroxine could have been initiated too late in pregnancy in these trials. GROWING POINTS A small number of studies have shown inconsistent associations of maternal thyroid dysfunction with offspring cardiometabolic indices including blood pressure and body weight. Correction of maternal thyroid dysfunction was, however, associated with favourable long-term metabolic profiles in mothers, including lipid profiles, fat mass and body mass index. Antenatal thyroid screening may therefore present opportunities for optimizing a wider range of outcomes than envisaged. AREAS FOR DEVELOPING RESEARCH Future trials with early antenatal thyroid screening and intervention are necessary to clarify the impact of screening on late offspring and maternal effects.
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Affiliation(s)
| | - Peter N Taylor
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK
| | - D Aled Rees
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK
| | - Onyebuchi E Okosieme
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK.,Diabetes Department, Prince Charles Hospital, Cwm Taf University Health Board, Gurnos Estate, Merthyr Tydfil, UK
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10
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Pearce EN. Management of Hypothyroidism and Hypothyroxinemia in Pregnancy. Endocr Pract 2022; 28:711-718. [PMID: 35569735 DOI: 10.1016/j.eprac.2022.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To review the diagnosis and management of hypothyroidism in pregnancy, preconception, and the postpartum period. METHODS Literature review of English-language papers published between 1982 and 2022, focusing on the most recent literature. RESULTS During pregnancy, thyroid function laboratory tests need to be interpreted with regard to gestational age. Overt hypothyroidism, regardless of the TSH level, should always be promptly treated when it is diagnosed preconception or during pregnancy or lactation. Most women with preexisting treated hypothyroidism will require an increase in levothyroxine dosing to maintain euthyroidism during gestation. levothyroxine-treated pregnant patients need close monitoring with serum thyroid stimulating hormone (TSH) to avoid or- or under treatment. There is no consensus about whether to initiate levothyroxine in women with mild forms of gestational thyroid hypofunction. However, in light of current evidence it is reasonable to treat subclinically hypothyroid women with levothyroxine, particularly if the TSH is >10 mIU/L or the thyroperoxidase antibody is positive. Women who are not treated need to be followed to ensure that treatment is initiated promptly if thyroid failure progresses. Additional studies are needed to better understand the effects of the initiation of levothyroxine in early gestation in subclinically hypothyroid and hypothyroxinemic women and to determine optimal strategies for thyroid function screening in preconception and pregnancy. CONCLUSION The diagnosis and management of hypothyroidism in the peripregnancy period present specific challenges. In making management decisions, it is essential to weigh the risks and benefits of treatments not just for the mother but also for the fetus.
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Affiliation(s)
- Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, 720 Harrison Ave, Suite 8100, Boston, MA, 02118.
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11
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Bucci I, Giuliani C, Di Dalmazi G, Formoso G, Napolitano G. Thyroid Autoimmunity in Female Infertility and Assisted Reproductive Technology Outcome. Front Endocrinol (Lausanne) 2022; 13:768363. [PMID: 35721757 PMCID: PMC9204244 DOI: 10.3389/fendo.2022.768363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/21/2022] [Indexed: 12/12/2022] Open
Abstract
The regulation of the female reproductive system is one of the most relevant actions of thyroid hormones. Adequate thyroid hormones production is essential for normal menstrual function and fertility as well as for the successful maintenance of pregnancy. The relationship between reproductive failure and thyroid disorders is particularly relevant and attracts attention worldwide. Thyroid autoimmunity (TAI), defined by the presence of circulating antithyroid antibodies targeting thyroid peroxidase (TPOAb) and thyroglobulin (TgAb), is prevalent among women of reproductive age and is the most frequent cause of thyroid dysfunction. Several studies addressed the association between TAI, thyroid function, and fertility as well as pregnancy outcome after spontaneous or assisted conception. Infertility, miscarriages, and fetal-maternal complications are described in overt autoimmune hypothyroidism. More debatable is the role of mild thyroid dysfunction, mainly subclinical hypothyroidism (SCH), and TAI in the absence of thyroid dysfunction in infertility and reproductive outcome. Assisted reproductive technology (ART) has become an integral element of care for infertility. Women with TAI undergoing ART are of particular interest since they carry a higher risk of developing hypothyroidism after the ovarian stimulation but whether TAI, in absence of thyroid dysfunction, adversely affects ART outcome is still controversial. Likewise, the role of levothyroxine (LT4) in improving fertility and the success of ART in euthyroid women with TAI is unclear. This review discusses the role of TAI, in the absence of thyroid dysfunction, in infertility and in ART outcome.
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Affiliation(s)
- Ines Bucci
- Center for Advanced Studies and Technology (CAST), University “G. d’Annunzio” of Chieti‐Pescara, Chieti, Italy
- Department of Medicine and Aging Science, University “G. d’Annunzio” of Chieti‐Pescara, Chieti, Italy
- *Correspondence: Ines Bucci,
| | - Cesidio Giuliani
- Center for Advanced Studies and Technology (CAST), University “G. d’Annunzio” of Chieti‐Pescara, Chieti, Italy
- Department of Medicine and Aging Science, University “G. d’Annunzio” of Chieti‐Pescara, Chieti, Italy
| | - Giulia Di Dalmazi
- Center for Advanced Studies and Technology (CAST), University “G. d’Annunzio” of Chieti‐Pescara, Chieti, Italy
- Department of Medicine and Aging Science, University “G. d’Annunzio” of Chieti‐Pescara, Chieti, Italy
| | - Gloria Formoso
- Center for Advanced Studies and Technology (CAST), University “G. d’Annunzio” of Chieti‐Pescara, Chieti, Italy
- Department of Medicine and Aging Science, University “G. d’Annunzio” of Chieti‐Pescara, Chieti, Italy
| | - Giorgio Napolitano
- Center for Advanced Studies and Technology (CAST), University “G. d’Annunzio” of Chieti‐Pescara, Chieti, Italy
- Department of Medicine and Aging Science, University “G. d’Annunzio” of Chieti‐Pescara, Chieti, Italy
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12
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Topaloğlu Ö, Yavuz A, Tiryaki Aylıkcı AB. Evaluation of adherence to levothyroxine and out-of-range thyroid-stimulating hormone levels in pregnant women with primary hypothyroidism. Int J Clin Pract 2021; 75:e14312. [PMID: 33999516 DOI: 10.1111/ijcp.14312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/28/2021] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Adherence to levothyroxine (LT4) and attaining thyroid-stimulating hormone (TSH) goal in pregnancy has not been well-defined yet. We aimed to investigate adherence to LT4, success to reach TSH goal, and association between them in pregnant women with primary hypothyroidism. MATERIALS AND METHODS Eight-item Morisky Medication Adherence Scale (MMAS-8) was applied in third trimester in pregnant women with primary hypothyroidism (Hashimoto's thyroiditis, surgical hypothyroidism or iodine deficiency) whom LT4 was given for at least 3 months. Those with chronic illness or thyroid cancer were excluded. We grouped the patients according to MMAS-8 score (<6, low adherence vs ≥6, medium/high adherence), and TSH measurement in third trimester (in-range vs out-of-range). RESULTS Of total (n = 85), 57.64% (n = 49) had medium/high adherence to LT4, and 41.17% (n = 35) out-of-range TSH, but no association was found among them (P = .937). LT4 initiation in pregestational period, surgical hypothyroidism, high LT4 dose in second/third trimester and alternate-day dosing were associated with medium/high adherence. Age, number of visits, and less time between ingestion of LT4 and breakfast were associated with medium/high adherence. LT4 dose in second trimester and dose increment at the beginning of pregnancy were positively associated with in-range TSH. CONCLUSION Non-adherence and treatment failure are frequent in LT4-treated pregnant women. Adherence seems not to be associated with treatment success. Regular follow-up may improve adherence. Our study is the first to analyse both treatment success and adherence to LT4 in pregnancy.
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Affiliation(s)
- Ömercan Topaloğlu
- Endocrinology Clinics, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Arzu Yavuz
- Gynecology and Obstetrics Clinics, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Ahsen Banu Tiryaki Aylıkcı
- Internal Medicine Clinics, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
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13
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Gholami S, Namiranian N, Shukohifar M, Kalantari F, Azizi R. Maternal thyroid function test level during the first trimester of pregnancy at a center Yazd, Iran: A cross-sectional study. Int J Reprod Biomed 2021; 19:255-260. [PMID: 33842822 PMCID: PMC8023001 DOI: 10.18502/ijrm.v19i3.8573] [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: 03/14/2020] [Revised: 08/15/2020] [Accepted: 09/28/2020] [Indexed: 12/04/2022] Open
Abstract
Background Thyroid dysfunction is associated with negative pregnancy outcomes. There is a lack of reliable information on thyroid hormones in Iranian pregnant women, especially in Yazd. Objective To determine the safe thyroid hormone levels in women of Yazd and also the first trimester-specific reference ranges for serum thyroid-stimulating hormone (TSH), thyroxine (T4), and triiodothyronine (T3). Materials and Methods In this cross-sectional study, the serum of 1,148 women in the first trimester of pregnancy was analyzed. Thyroid function tests (TSH, T4, T3) were measured through radioimmunoassay (RIA) [immunoradiometric (IRMA) for TSH]. The study was conducted in Yazd, from September 2018 to November 2019. Reference intervals were defined as the 5 th , 50 th , and 95 th percentiles. Results The mean age of the participants was 28.78 (± 5.86 yr) (range: 15-45 yr). The thyroid hormones reference intervals in the first trimester were TSH (0.2-3.8 mIU/l), T4 (7.45-12.75, μg/dl), and T3 (100-217 ng/dl). Conclusion The results of the present study determined a local thyroid function measurement in the first trimester of pregnancy at a center of Yazd, Iran. This could facilitate the decision-making of maternal TSH level during the first trimester of pregnancy.
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Affiliation(s)
- Somaye Gholami
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasim Namiranian
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Marzieh Shukohifar
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Foroozandeh Kalantari
- Deputy for Health Affairs, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Reyhaneh Azizi
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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14
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Ferreira JL, Gomes M, Príncipe RM. Controversial Screening for Thyroid Dysfunction in Preconception and Pregnancy: An Evidence-Based Review. J Family Reprod Health 2021; 14:234-241. [PMID: 34054992 PMCID: PMC8144488 DOI: 10.18502/jfrh.v14i4.5204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To evaluate the recommendations on the most adequate screening method (universal or selective) for thyroid dysfunction. Although thyroid dysfunction is a common disorder in fertile women and untreated cases may have negative maternal, fetal and neonatal outcomes, its screening in preconception and early pregnancy is controversial. Materials and methods: An evidence-based review was conducted to identify publications since 2017 of American Thyroid Association (ATA) guidelines, according to the following Population, Intervention, Comparison, Outcomes and Study (PICOS): women in preconception or pregnancy without thyroid disease who underwent universal or selective screening for thyroid dysfunction. Study selection obeyed the PRISMA criteria. Results: We included 15 of 325 publications. The 2017 ATA guidelines recommend selective screening in both preconception and pregnancy. The only two reviews on preconception recommended universal screening. For pregnancy, nine articles suggested universal screening, while a prospective study advocated selective screening. The main benefits advocated for universal screening were easy and low-cost tests; absence of missed diagnosis; safe and inexpensive treatment and its potential in preventing negative outcomes. Iodine deficiency is a decisive indication, but it was not evaluated in all clinical studies. Screening harms and knowledge gaps were the main arguments against universal screening. There are very few cost-effectiveness studies. Conclusion: We recommend universal screening for thyroid dysfunction in early pregnancy, which is a distinct point of view from 2017 ATA guidelines (weak recommendation, low-quality evidence). It is not possible to make a formal recommendation for preconception (insufficient evidence). We strongly suggest an individualized analysis by each country.
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Affiliation(s)
- Joana Lima Ferreira
- Department of Endocrinology, Pedro Hispano Hospital, Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Mafalda Gomes
- Department of Family Medicine, Family Health Unit of Mar, Greater Porto IV Health Centers Grouping,Póvoa de Varzim, Portugal
| | - Rosa Maria Príncipe
- Department of Endocrinology, Pedro Hispano Hospital, Matosinhos Local Health Unit, Matosinhos, Portugal
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15
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Gilbert ME, O'Shaughnessy KL, Axelstad M. Regulation of Thyroid-disrupting Chemicals to Protect the Developing Brain. Endocrinology 2020; 161:bqaa106. [PMID: 32615585 PMCID: PMC8650774 DOI: 10.1210/endocr/bqaa106] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/30/2020] [Indexed: 12/18/2022]
Abstract
Synthetic chemicals with endocrine disrupting properties are pervasive in the environment and are present in the bodies of humans and wildlife. As thyroid hormones (THs) control normal brain development, and maternal hypothyroxinemia is associated with neurological impairments in children, chemicals that interfere with TH signaling are of considerable concern for children's health. However, identifying thyroid-disrupting chemicals (TDCs) in vivo is largely based on measuring serum tetraiodothyronine in rats, which may be inadequate to assess TDCs with disparate mechanisms of action and insufficient to evaluate the potential neurotoxicity of TDCs. In this review 2 neurodevelopmental processes that are dependent on TH action are highlighted, neuronal migration and maturation of gamma amino butyric acid-ergic interneurons. We discuss how interruption of these processes by TDCs may contribute to abnormal brain circuitry following developmental TH insufficiency. Finally, we identify issues in evaluating the developmental neurotoxicity of TDCs and the strengths and limitations of current approaches designed to regulate them. It is clear that an enhanced understanding of how THs affect brain development will lead to refined toxicity testing, reducing uncertainty and improving our ability to protect children's health.
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Affiliation(s)
- Mary E Gilbert
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Research Triangle Park, North Carolina
| | - Katherine L O'Shaughnessy
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Research Triangle Park, North Carolina
| | - Marta Axelstad
- Division of Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
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16
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Taylor PN, Muller I, Nana M, Velasco I, Lazarus JH. Indications for treatment of subclinical hypothyroidism and isolated hypothyroxinaemia in pregnancy. Best Pract Res Clin Endocrinol Metab 2020; 34:101436. [PMID: 32828674 DOI: 10.1016/j.beem.2020.101436] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Thyroid hormones are essential for maintaining a pregnancy and optimal fetal neurological development. Pregnancy places additional demands on the thyroid axis and around 5% of women who have their thyroid function checked during gestation will have borderline low thyroid function (subclinical hypothyroidism or isolated hypothyroxinemia) identified. These borderline low thyroid states are associated with adverse obstetric and offspring outcomes. Whilst it is well established that overt hypothyroidism requires treatment with levothyroxine, it is less clear whether there is any benefit of treating borderline low thyroid states. This review summarizes the potential indications for treatment of subclinical hypothyroidism and isolated hypothyroxinemia.
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Affiliation(s)
- Peter N Taylor
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, CF14 4XN, UK.
| | - Ilaria Muller
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, CF14 4XN, UK; Department of Endocrinology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Melanie Nana
- Department of Diabetes and Endocrinology, Wrexham Maelor Hospital, Wrexham, LL13 7TD, UK
| | - Ines Velasco
- Pediatrics, Gynecology & Obstetrics Unit, Riotinto Hospital, Huelva, Spain
| | - John H Lazarus
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, CF14 4XN, UK
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17
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Berbara TMBL, Morais NSD, Saraiva DA, Corcino CM, Schtscherbyna A, Moreira KL, Teixeira PDFDS, Vaisman M. Selective case finding versus universal screening for detecting hypothyroidism in the first trimester of pregnancy: a comparative evaluation of a group of pregnant women from Rio de Janeiro. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:159-164. [PMID: 32236307 PMCID: PMC10118952 DOI: 10.20945/2359-3997000000209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 09/13/2019] [Indexed: 11/23/2022]
Abstract
Objective Maternal hypothyroidism during pregnancy may lead to adverse outcomes. Recently published guidelines by the American Thyroid Association (ATA) do not advocate for universal screening but recommend a case-finding approach in high-risk pregnant women. The present study aims to evaluate the accuracy of this approach in identifying women with thyroid dysfunction during early pregnancy. Subjects and methods This is a multiple-center, cross-sectional study. Three hundred and one pregnant women were enrolled. Anamnesis and a physical examination were performed to detect which women fulfilled the criteria to undergo laboratory screening of thyroid dysfunction, according to the ATA's 2017 guidelines. The Zulewski's validated clinical score was applied to assess signs and symptoms of hypothyroidism. Serum levels of thyrotropin (TSH), free thyroxine (FT4), anti-thyroperoxidase (TPO-Ab), and anti-thyroglobulin (Tg-Ab) antibodies were determined. Results Two hundred and thirty one women (78%) were classified as high risk, and 65 (22%) were classified as low risk for thyroid dysfunction. Regarding the clinical score, 75 patients (31.2%) presented mild symptoms that were compatible with SCH, of which 22 (7.4%) had symptoms as the only risk factor for thyroid disease. 17 patients (5.7%) had SCH, of which 10 (58.8%) belonged to the high-risk group, and 7 (41.2%) belonged to the low-risk group. OH was found in 4 patients (1.4%): 3 (75%) in the high-risk group and 1 (25%) in the low-risk group. Conclusions The ATA's proposed screening criteria were not accurate in the diagnosis of thyroid dysfunction in pregnancy. Testing only the high-risk pregnant women would miss approximately 40% of all hypothyroid patients.
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Affiliation(s)
| | - Nathalie Silva de Morais
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Débora Ayres Saraiva
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Carolina Martins Corcino
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Annie Schtscherbyna
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Karina Lúcia Moreira
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Mario Vaisman
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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18
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Abstract
Thyroid hormone is essential for pregnancy and ensuring fetal development. Pregnancy also places substantial demands on the thyroid axis. Overt hypothyroidism is associated with substantial adverse obstetric and offspring outcomes and requires treatment. Borderline thyroid dysfunction is common in women and associated with adverse obstetric and offspring outcomes, although benefits of screening for and treating borderline thyroid function are unclear. Many women are established on thyroid hormone replacement before pregnancy and doses need increasing during pregnancy. Care is taken to prevent overreplacement. Universal thyroid screening in pregnancy is being undertaken in several countries, although it remains a matter of debate.
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Affiliation(s)
- Peter N Taylor
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, UHW, C2 Link Corridor, Heath Park, Cardiff CF14 4XN, UK.
| | - John H Lazarus
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, UHW, C2 Link Corridor, Heath Park, Cardiff CF14 4XN, UK
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