scholarly journals Reference values and the effect of clinical parameters on thyroid hormone levels during early pregnancy

2020 ◽  
Author(s):  
Huijia Lin ◽  
Mudan Ye ◽  
Zhenwen Zhou ◽  
Lianxiong Yuan ◽  
Gendie Lash ◽  
...  
Keyword(s):  
Risk Factors ◽  
Thyroid Hormone ◽  
Reference Values ◽  
Early Pregnancy ◽  
Maternal Age ◽  
Thyroid Dysfunction ◽  
First Trimester ◽  
Reference Ranges ◽  
Study Objective ◽  
Maternal Parity

Objective: Thyroid dysfunction is a common endocrine problem during pregnancy, correct diagnosis and appropriate treatments are essential to avoid adverse pregnancy outcomes. Besides, it is vital to identify and quantify the major risk factors for gestational thyroid dysfunction, including thyroid autoimmunity, human chorionic gonadotropin (HCG) concentration, body mass index (BMI) and parity. The study objective was to establish reference ranges during early pregnancy and to explore the relationship between risk factors and thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyroxine (FT3). Design, patients, measurements: To establish the reference ranges of thyroid hormone during early pregnancy in China and to identify the risk factors for thyroid dysfunction, woman in the first trimester of pregnancy (4 to 12 weeks gestation) were recruited. After excluding thyroid peroxidase antibody (TPO-Ab) positive and/or thyroglobulin antibody (TG-Ab) positive women, previous thyroid disease, a lack of iodine intake, reference values were calculated by 2.5th to 97.5th percentiles. Results: After exclusion of TPO-Ab and/or TG-Ab positive women, reference values were as follows: TSH, 0.11-3.67 mIU/L; FT3, 3.19-5.91 pmol/L; FT4 10.95-16.79 pmol/L. Higher BMI was associated with lower FT4 concentrations (P=0.005). In multiple regression analysis, TSH was significantly and positively associated with TG (P=0.03). Maternal parity and maternal age may be risk factors for the abnormal thyroidal response to hCG concentrations. Conclusions: Our study defined first trimester-specific reference ranges for serum TSH, FT4, FT3 in a Chinese population, and demonstrated that BMI ≥23, maternal parity ≥3 and maternal age ≥30 years may increase the risk of thyroid dysfunction.

scholarly journals Reference Values of D-Dimers and Fibrinogen in the Course of Physiological Pregnancy: the Potential Impact of Selected Risk Factors—A Pilot Study

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
Aldona Siennicka ◽  
Magdalena Kłysz ◽  
Kornel Chełstowski ◽  
Aleksandra Tabaczniuk ◽  
Zuzanna Marcinowska ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gestational Diabetes ◽  
Reference Values ◽  
Venous Blood ◽  
Fibrinogen Concentration ◽  
Reference Ranges ◽  
Second Trimester ◽  
Increase Risk ◽  
Potential Impact ◽  
D Dimer

Pregnancy predisposes to thrombotic hemostasis, reflected in the laboratory as, e.g., increased levels of D-Dimers and fibrinogen, but in physiological pregnancy, the risk of venous thrombosis does not increase. Risk may increase if gestational diabetes mellitus (GDM) or nicotinism coexists. Study aims were to determine reference values ​​for D-Dimers and fibrinogen concentrations in each trimester of pregnancy, corrected for GDM and nicotinism. Subjects and Methods. The study involved 71 pregnant women aged 25-44 y. Venous blood was collected three times: in the first (11-14 weeks), second (20-22 weeks), and third (30-31 weeks) trimesters. D-Dimer concentrations were determined by an enzyme-linked fluorescence assay, fibrinogen concentrations by a coagulation method according to Clauss. Results. Significant increases in D-Dimers and fibrinogen concentrations were observed, increasing with successive trimesters (p ANOVA<0.0001). Furthermore, a positive correlation between D-Dimers and fibrinogen was detected in the second trimester of pregnancy (r=0.475; p<0.0001). In addition, a significantly higher fibrinogen concentration was found in women with GDM compared to without GDM (p=0.0449). Reference ranges for D-Dimers were established, in trimester order, as follows: 167-721 ng/mL, 298-1653 ng/mL, and 483-2256 ng/mL. After adjusting for risk factors, significantly higher D-Dimer values ​​(mainly second and third trimesters) were obtained: 165-638 ng/mL, 282-3474 ng/mL, and 483-4486 ng/mL, respectively. Reference ranges for fibrinogen were, in trimester order, 2.60-6.56 g/L, 3.40-8.53 g/L, and 3.63-9.14 g/L and, after adjustment for risk factors, 3.34-6.73 g/L, 3.40-8.84 g/L, and 3.12-9.91 g/L. Conclusions. We conclude that the increase in D-Dimers and fibrinogen levels in women with physiological pregnancy was compounded by gestational diabetes (GDM) and nicotinism. Therefore, D-Dimers and fibrinogen pregnancy reference values require correction for these risk factors.

scholarly journals Risk Factors for Postpartum Thyroid Dysfunction in Euthyroid Women Prior to Pregnancy

Folia Medica ◽  
2017 ◽  
Vol 59 (2) ◽  
pp. 190-196
Author(s):  
Boyan I. Nonchev ◽  
Antoaneta V. Argatska ◽  
Blagovest K. Pehlivanov ◽  
Maria M. Orbetzova
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Early Pregnancy ◽  
Thyroid Disease ◽  
Thyroid Dysfunction ◽  
Multivariate Logistic Regression Analysis ◽  
Postpartum Women ◽  
Increased Risk ◽  
History Of ◽  
Postpartum Thyroid Dysfunction

AbstractBackground:Thyroid dysfunction is common during the postpartum and the predisposing factors for its development are considered specific for the population studied. The aim of this study was to evaluate the risk factors for the occurrence of postpartum thyroid dysfunction (PPTD) in euthyroid women prior to pregnancy.Materials and methods:Forty-five women with PPTD and 55 age-matched euthyroid postpartum women from Plovdiv, Bulgaria were included in the study. TSH, FT4, FT3, TPOAb, TgAb, TRAb were measured and ultrasound evaluation of the thyroid was performed in the first trimester of pregnancy and during the postpartum.Results:The study found higher risk of developing PPTD in women with family history of thyroid disease (OR 4.42; 95% CI 1.87,10.43), smokers (OR 4.01; 95% CI 1.72,9.35), personal history of autoimmune thyroid disease (OR 5.37; 95% CI 1.15,28.53), positive TPOAb (OR 18.12; 95% CI 4.93,66.65) and thyroid US hypoechogenicity during early pregnancy (OR 6.39; 95% CI 2.53,16.12) and those who needed levothyroxine during pregnancy (OR 3.69; 95% CI 1.28,10.61). BMI before pregnancy was significantly lower in women with PPTD than in euthyroid postpartum women (22.80±0.55 vs 26.25±0.97, p=0.013). The multivariate logistic regression analysis identified as most important independent risk factors for PPTD occurrence the TPOAb positivity during early pregnancy, family history of thyroid disease, smoking and lower BMI before pregnancy.Conclusion:Our data suggest that in the population studied several factors are associated with an increased risk of PPTD and screening for thyroid disorders among those women can be beneficial.

scholarly journals Thyroid Hormone Changes in Early Pregnancy Along With the COVID-19 Pandemic

2020 ◽  
Vol 11 ◽  
Author(s):  
Ting-Ting Lin ◽  
Chen Zhang ◽  
Han-Qiu Zhang ◽  
Yu Wang ◽  
Lei Chen ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Pregnant Women ◽  
Early Pregnancy ◽  
Pregnancy Outcomes ◽  
First Trimester ◽  
Thyroid Peroxidase ◽  
Free Triiodothyronine ◽  
Increased Risk ◽  
Group 2 ◽  
Group 1

PurposeCOVID-19 (Coronavirus Disease 2019) was first reported in December 2019 and quickly swept across China and around the world. Levels of anxiety and depression were increased among pregnant women during this infectious pandemic. Thyroid function is altered during stressful experiences, and any abnormality during early pregnancy may significantly affect fetal development and pregnancy outcomes. This study aimed to determine whether the COVID-19 pandemic induces thyroid hormone changes in early pregnant women.MethodsThis study comprised two groups of pregnant women in Shanghai in their first trimester – those pregnant women before the COVID-19 outbreak from January 20, 2019, to March 31, 2019 (Group 1) and those pregnant during the COVID-19 outbreak from January 20, 2020, to March 31, 2020 (Group 2). All women were included if they had early pregnancy thyrotropin (TSH), free triiodothyronine (FT3), free thyroxine (FT4), total triiodothyronine (TT3), and total thyroxine (TT4) concentrations, thyroid peroxidase (TPO) antibody or thyroglobulin antibody (TgAb) available and did not have a history of thyroid diseases or received thyroid treatment before or during pregnancy. We used propensity score matching to form a cohort in which patients had similar baseline characteristics.ResultsAmong 3338 eligible pregnant women, 727 women in Group 1 and 727 in Group 2 had similar propensity scores and were included in the analyses. Pregnant women in Group 2 had significantly higher FT3 (5.7 vs. 5.2 pmol/L, P&lt;0.001) and lower FT4 (12.8 vs. 13.2 pmol/L, P&lt;0.001) concentrations compared with those in Group 1. Pregnant women in Group 2 were more likely to develop isolated hypothyroxinemia (11.6% vs. 6.9%, OR, 1.75 [95% CI, 1.20–2.53], P=0.003) than those in Group 1 but had a significantly lower risk of TgAb positivity (12.0% vs. 19.0%, OR, 0.58 [95% CI, 0.43–0.78], P&lt;0.001).ConclusionPregnant women in their first trimester in Shanghai during the COVID-19 outbreak were at an increased risk of having higher FT3 concentrations, lower FT4 concentrations, and isolated hypothyroxinemia. The association between thyroid hormones, pregnancy outcomes, and the COVID-19 outbreak should be explored further.

Abstract P266: Prevalence and Risk Factors of Thyroid Dysfunction in Older Adults in the Community

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Nermin Diab ◽  
Natalie Daya ◽  
Stephen P Juraschek ◽  
Seth Martin ◽  
John W McEvoy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Cardiovascular Risk ◽  
Thyroid Hormone ◽  
Thyroid Dysfunction ◽  
Thyroid Peroxidase ◽  
Age Group ◽  
Cross Sectional ◽  
Hormone Levels ◽  
Thyroid Hormone Levels

Context: Prevalence estimates and evidence informing treatment targets for thyroid dysfunction largely come from studies of middle-aged adults. There are limited data on the prevalence of thyroid dysfunction in older populations. Objective: To determine the prevalence of thyroid dysfunction and risk factors for abnormal thyroid tests in older adults. Methods: We conducted a cross-sectional analysis of data from participants aged 65 or older in the Atherosclerosis Risk in Communities (ARIC) study who attended visit 5 in 2011-2013. We measured serum concentrations of triiodothyronine (T3), free thyroxine (FT4), thyroid peroxidase antibody (Anti-TPO), and thyroid stimulating hormone (TSH) in 5,392 participants. We used multivariable linear and logistic regression to assess associations of demographic and clinical risk factors with thyroid hormone levels. Results: In this population of older adults (mean age 76; 56% women and 22% black), the prevalence of thyroid dysfunction was up to 25% when accounting for treated and untreated thyroid dysfunction categories. 15.6% reported use of medication for thyroid dysfunction. Among those not being treated, the prevalence of overt chemical hypothyroidism was 6.0% and subclinical hypothyroidism was 0.82%. Overt chemical hyperthyroidism and subclinical hyperthyroidism affected 0.26% and 0.78% of the population, respectively. Multivariable adjusted cardiovascular risk factor associations for TSH, FT4 and T3 levels are presented in Table . Men were less likely to be anti-TPO positive compared to women (OR=0.59, CI: 0.47,0.75, P<0.001). Conclusions: There is a high prevalence of thyroid dysfunction in this older, community-based population. Prevalence of thyroid dysfunction and thyroid hormone levels vary with sex, race, age group and multiple cardiovascular risk factors. Accounting for these associations in the clinical setting might prove useful in improving thyroid function assessment in this age group.

scholarly journals Prevalence of hypothyroidism amongst pregnant women: a study done in rural set up

2018 ◽  
Vol 7 (4) ◽  
pp. 1586 ◽  
Author(s):  
Nancy S. Pillai ◽  
Jemela Bennet
Keyword(s):  
Thyroid Hormone ◽  
Pregnant Women ◽  
Intellectual Development ◽  
Thyroid Dysfunction ◽  
First Trimester ◽  
Reproductive Age ◽  
Overt Hypothyroidism ◽  
Endocrine Disorders ◽  
Thyroid Disorder ◽  
In Pregnancy

Background: Thyroid disorders are the commonest endocrine disorders affecting women of reproductive age group. The most frequent thyroid disorder in pregnancy is maternal hypothyroidism. During early pregnancy the foetus is totally dependent on maternal thyroid hormone supply. Thyroid hormone is critical for foetal brain and intellectual development and some preventable conditions like abruption, pre-eclampsia etc. which produce morbidity and pose special risk for pregnancy and the developing foetus.Methods: All subjects enrolled in the study as per the inclusion criteria will be subjected to a detailed history and clinical examination using a predesigned proforma. A serum TSH value will be sent in 1st trimester between 6-10 weeks period of gestation for all pregnant women.Results: The prevalence of thyroid dysfunction in pregnancy was 10.8% with hypothyroidism being 9.2%, out of which 8.5% were cases of subclinical hypothyroidism and 0.7% were cases of overt hypothyroidism. On assessing the risk factors for developing thyroid dysfunction in pregnancy, increases in incidence were seen with maternal age and increasing BMI, both of which were statistically significant.Conclusions: This study showed an increased prevalence of hypothyroidism in pregnancy recommending a need for universal screening for all pregnant women in the first trimester itself. This study aims at validating the efficacy of the above-mentioned screening.

scholarly journals Prediction of post partum thyroid dysfunction: can it be improved?

1998 ◽  
Vol 139 (1) ◽  
pp. 36-43 ◽  
Author(s):  
JL Kuijpens ◽  
VJ Pop ◽  
HL Vader ◽  
HA Drexhage ◽  
WM Wiersinga
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Thyroid Dysfunction ◽  
Post Partum ◽  
First Trimester ◽  
Thyroid Stimulating Hormone ◽  
Bottle Feeding ◽  
Smoking Habits ◽  
Thyroid Peroxidase ◽  
Independent Risk Factors

BACKGROUND: Screening pregnant women for thyroid peroxidase antibodies (TPOAb) to identify those at risk for post partum thyroid dysfunction (PPTD) is controversial, mainly because of the low positive predictive value (ppv) of TPOAb. OBJECTIVES: To evaluate if the ppv of TPOAb can be enhanced, either by taking into account the time of TPOAb testing, or by combining this parameter with other putative determinants of PPTD such as smoking, family history or other autoimmune diseases. METHODS: A prospective study was performed in the Kempenland region (southeastern Netherlands). Three hundred and ten unselected women were visited at 12 and 32 weeks gestation and 4, 12, 20, 28 and 36 weeks post partum. Serial thyroid stimulating hormone (TSH), free thyroxine (fT4) and TPOAb testing was performed. Thyroid dysfunction (TD) was defined as abnormal TSH either in combination with abnormal fT4 (overt TD) or without abnormal fT4 (subclinical TD). PPTD was defined as overt TD post partum. Multivariate regression analysis was performed for determining independent risk factors for PPTD. The sensitivity and specificity of TPOAb at different time points and at different concentrations were calculated and presented in receiver operating characteristic (ROC) curves. Women who had experienced PPTD were followed for 2.5-3 years. RESULTS: Data from 291 women were available for analysis. Serum fT4 declined during pregnancy and returned to baseline values post partum. TD in gestation was present in 23 women (7.9%): serum TSH was transiently decreased in 13 (6 had overt gestational thyrotoxicosis (2.1%)) and increased in 10 (2 had TPOAb). Both point prevalence and concentration of TPOAb decreased during gestation and returned to baseline levels within 12 weeks post partum. TD in post partum was present in 36 women (12.4%): 21 had subclinical and 15 overt TD. Out of the 15 women with overt TD (incidence of PPTD: 5.2%) 10 were positive for TPOAb (TPOAb+): 9 had thyrotoxicosis (4 TPOAb+), 5 hypothyroidism (5 TPOAb+) and 1 thyrotoxicosis followed by hypothyroidism (TPOAb+). Independent risk factors for PPTD were TPOAb (relative risk (RR) = 2 7.2), bottle feeding (RR = 11.1) and smoking habits (ever smoked: RR = 3.1; women with PPTD had smoked more cigarettes for a longer period of time). The sensitivity of TPOAb testing was highest at 12 weeks gestation (0.67). The ppv of TPOAb was 0.31-0.75 (depending on time of testing and concentration), increasing slightly to 0.38-0.80 when combined with bottle feeding or smoking habits. There appeared to be an autoimmune form of PPTD in 2/3 of cases and a non-autoimmune form; women with the autoimmune form were at risk for developing permanent hypothyroidism. CONCLUSIONS: A maximum of 2/3 of PPTD cases can be predicted from the presence of TPOAb because 1/3 remained negative for TPOAb. The most appropriate time for TPOAb testing is in the first trimester of pregnancy. The combination of TPOAb testing with anamnestic determinants of PPTD does not increase ppv substantially.

scholarly journals Prevalence of thyroid dysfunction in women in early pregnancy: does it increase with maternal age?

2015 ◽  
Vol 84 (1) ◽  
pp. 121-126 ◽  
Author(s):  
Marta Diéguez ◽  
Ana Herrero ◽  
Noelia Avello ◽  
Patricio Suárez ◽  
Elías Delgado ◽  
...  
Keyword(s):  
Early Pregnancy ◽  
Maternal Age ◽  
Thyroid Dysfunction

scholarly journals Reference ranges of AMH in early pregnancy: the Generation R Study, a population-based prospective cohort study

2021 ◽  
Author(s):  
Ramon Dykgraaf ◽  
Joop Laven ◽  
Sarah Timmermans ◽  
Maria Adank ◽  
Sjoerd van den Berg ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Early Pregnancy ◽  
Gestational Age ◽  
Prospective Cohort ◽  
Hospital Setting ◽  
First Trimester ◽  
Population Based ◽  
Reference Ranges ◽  
Placental Development

Objective: The objective of this study is to establish maternal reference values of AMH in a fertile multi-ethnic urban pregnant population and to evaluate the effect of gestational age. Design: The Generation R Study is an ongoing population-based prospective cohort study from early pregnancy onwards. Setting: Rotterdam, the Netherlands, out of hospital setting. Population: In 5806 women serum AMH levels were determined in early pregnancy (median 13.5 weeks; 95% range 10.5-17.2). Methods: The model-based AMH reference ranges for maternal age and gestational age were created using GAMLSS. Associations between AMH and several first trimester biomarkers were analyzed using multivariate linear regression analyses. Main outcome measures: AMH levels in early pregnancy and the association with placental biomarkers, hCG, sFLT, and PLGF. Results: A nomogram of AMH in early pregnancy was developed. Serum AMH levels showed a decline with advancing gestational age. Higher AMH levels were associated with a higher level of hCG and sFLT. This last association was predominantly mediated by hCG. AMH levels were negatively associated with PLGF levels. Conclusion: In this large study we show that AMH levels in the first trimester decrease with advancing gestational age. The association between AMH and the placental biomarkers hCG, sFLT and PLGF suggests a better placental development with a lower vascular resistance in mothers with higher AMH levels. AMH might be useful in predicting adverse pregnancy outcome due to impaired placental development. Keywords: Ovarian reserve, placental biomarker, nomogram, first trimester, human Choriogonadotrophin (hCG), soluble FMS-Like Tyrosine kinase-1 (sFLT), Placental Growth Factor (PLGF).

Hyperemesis Gravidarum and Thyrotoxicosis — A Diagnostic and Therapeutic Problem

1989 ◽  
Vol 34 (3) ◽  
pp. 472-473 ◽  
Author(s):  
J.A. Thomson ◽  
R. Wilson ◽  
C.G. Gray ◽  
A.C.A. Glen ◽  
D. Mack
Keyword(s):  
Early Pregnancy ◽  
Thyroid Dysfunction ◽  
Hyperemesis Gravidarum ◽  
First Trimester ◽  
Antithyroid Therapy ◽  
Spontaneous Improvement ◽  
Therapeutic Problem ◽  
Uneventful Pregnancy ◽  
In Pregnancy

We report a case of hyperemesis gravidarum complicated by thyrotoxicosis which was managed conservatively during pregnancy. Problems of diagnosing mild thyrotoxicosis in pregnancy are discussed. Although no specific antithyroid therapy was given, the patient had an uneventful pregnancy after the first trimester. Neither she nor her baby exhibited any subsequent features of thyroid dysfunction. This suggests that treatment of thyrotoxicosis in early pregnancy is not always required because of the spontaneous improvement which is likely to occur as pregnancy progresses.

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