scholarly journals Management of thyroid disease in pregnancy – Room for improvement in the first trimester

2016 ◽  
Vol 9 (3) ◽  
pp. 126-129 ◽  
Author(s):  
Helen Robinson ◽  
Philip Robinson ◽  
Michael D’Emden ◽  
Kassam Mahomed
Keyword(s):  
General Practitioner ◽  
Thyroid Function ◽  
Thyroid Disease ◽  
Thyroid Dysfunction ◽  
First Trimester ◽  
Antenatal Clinic ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
In Pregnancy ◽  
Stimulating Hormone

Background First-trimester care of maternal thyroid dysfunction has previously been shown to be poor. This study evaluates early management of thyroid dysfunction in pregnancy in Australia. Methods Patients reviewed by the Obstetric Medicine team for thyroid dysfunction from 1 January 2012 to 30 June 2013 were included. Data were collected on gestation at referral from the patient’s general practitioner to the antenatal clinic, information provided in the referral letter, thyroid function tests and thyroid medications. Results Eighty-five women were included in the study. At the time of general practitioner referral to antenatal services, 19% of women with preexisting thyroid disease had no thyroid function tested. Forty-three percent had an abnormal thyroid-stimulating hormone defined as being outside the laboratory-specific pregnancy reference range if available, or outside the level of 0.1–2.5 mIu/L in the first trimester, 0.2–3.0 mIu/L in the second trimester and 0.3–3.0 mIu/L in the third trimester. Only 21% of women increased their thyroxine dose prior to their first antenatal clinic review. Conclusion This study highlights that a significant proportion of women with known thyroid disease either have untested thyroid function in the first trimester or a thyroid-stimulating hormone outside of levels recommended by guidelines.

THYROID DYSFUNCTION, RECOVERY, AND PROGNOSIS IN MELANOMA PATIENTS TREATED WITH IMMUNE CHECKPOINT INHIBITORS: A RETROSPECTIVE REVIEW

2020 ◽  
Vol 26 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Mazen Al Mushref ◽  
Paul A. Guido ◽  
Frances A. Collichio ◽  
Dominic T. Moore ◽  
David R. Clemmons
Keyword(s):  
Thyroid Function ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Thyroid Dysfunction ◽  
Checkpoint Inhibitors ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
Melanoma Patients ◽  
Recovery Group ◽  
Stimulating Hormone

Objective: To describe thyroid dysfunction, factors associated with thyroid recovery, and survival in melanoma patients treated with immune checkpoint inhibitors that developed thyroid immune-related adverse events (irAEs). Methods: This was a retrospective study in a tertiary center from 2010–2017. We reviewed the charts of patients with melanoma that developed thyroid dysfunction after checkpoint inhibitor therapy. Cases with thyroid irAEs were grouped by recovery of thyroid function at 1 year. We collected a timeline of thyroid function tests, medication exposure, and survival and compared variables between the groups. We studied survival in comparison to a matched group without thyroid dysfunction. Results: A total of 186 melanoma patients received checkpoint inhibitors, and 17 (9%) had thyroid irAEs. Median time to abnormal thyroid-stimulating hormone was 38 days and followed a pattern of thyroiditis. Seven of 17 had thyroid recovery. In the no-recovery group, free thyroxine (T4) was often above 2 ng/dL (5/10 in no recovery, 0/7 in recovery; P = .04). In the recovery group, irAE grade was significantly lower, with 7/7 grade 1 ( P = .004). Exposure to glucocorticoids was associated with recovery (3/10 in no recovery, 6/7 in recovery; P = .049). There was no difference in overall survival between the thyroid dysfunction group and controls, or between those that received glucocorticoids or not. Conclusion: Certain aspects of thyroid irAEs may correlate with thyroid recovery, including grade 1 thyroid irAEs, exposure to glucocorticoids, and peak free T4 levels less than 2 ng/dL. Thyroid irAEs did not appear to be associated with change in survival nor did exposure to glucocorticoids. Abbreviations: ASCO = American Society of Clinical Oncology; CTLA-4 = cytotoxic T-lymphocyte–associated protein 4; irAE = immune-related adverse event; PD-1 = programmed cell death protein 1; T4 = thyroxine; TSH = thyroid-stimulating hormone

scholarly journals Management Thyroid Disease in Pregnancy: Preconception, and the postpartum complications

2017 ◽  
Vol 1 (3) ◽  
pp. 01-04
Author(s):  
R F Gross man
Keyword(s):  
Thyroid Function ◽  
Thyroid Disease ◽  
Postpartum Period ◽  
Past History ◽  
First Trimester ◽  
Thyroid Function Tests ◽  
Specialist Referral ◽  
Thyrotropin Receptor Antibodies ◽  
History Of ◽  
In Pregnancy

Pregnancy has a profound impact on the thyroid gland and thyroid function since the thyroid may encounter changes to hormones and size during pregnancy. The diagnosis and treatment of thyroid disease during pregnancy and the postpartum is complex but knowledge regarding the interaction between the thyroids and pregnancy/the postpartum period is advancing at a rapid pace. For women known to have hypothyroidism, an increase in thyroxine dose by 20–40% when pregnancy is confirmed usually ensures they remain euthyroid. Treatment of subclinical hypothyroidism is recommended if the woman has antithyroid antibodies. Treatment of hyperthyroidism, unless it is related to human chorionic gonadotrophin, involves propylthiouracil in the first trimester. Carbimazole may be used in the second trimester. Thyroid function tests are checked every month and every two weeks following a change in dose. Women with a current or a past history of Graves’ disease who have thyrotropin receptor antibodies require early specialist referral as there is a 1–5% risk of fetal hyperthyroidism. Women with thyroid disorders in pregnancy should be followed up by their GP in the postpartum period. Postpartum thyroiditis may present months after delivery.

scholarly journals Estimation of Thyroid Stimulating Hormone levels in pregnancy in a South Indian town- Kumbakonam Urban Rural Epidemiological Study – KURES 4

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 3080-3083
Author(s):  
Suchitra M. R. ◽  
Shanthi T. S. ◽  
Parthasarathy S.
Keyword(s):  
Thyroid Dysfunction ◽  
Eating Habits ◽  
First Trimester ◽  
Poverty Line ◽  
Thyroid Stimulating Hormone ◽  
South Indian ◽  
Targeted Testing ◽  
Urban Rural ◽  
In Pregnancy ◽  
Stimulating Hormone

Thyroid dysfunction in pregnancy, especially hidden, may lead on to increased morbidities both in mothers and the foetuses. With this in mind, we conducted a study of estimating Thyroid Stimulating Hormone (TSH) levels in the first trimester of asymptomatic antenatal mothers. In this 680-sample sized study, we measured TSH values after noting down, age, weight, religion, occupation and type of diet. The mean TSH value is 2.36 (0.02 to 31.67) mIU/ml. the incidence of subclinical hypothyroidism was 9.1 % whereas it was 2.9% in hyperthyroidism. All parturients with subclinical thyroid dysfunction were given appropriate treatment. The Hindus and Muslims constituted the majority. There was no difference between TSH values among both religions. Around 95 % were vegetarians, and the value of TSH was similar in parturients with either type of eating habits. A significantly higher level of thyroid dysfunction is noted in working women even though the sample is less. These values correspond to an affording community above the poverty line. We suggest more vigilant screening at the village antenatal care level to decrease thyroid-associated fetal and maternal morbidities. We also suggest that routine TSH screening rather than targeted testing of thyroid disorders should be made mandatory even in Government institutions. 

THYROID FUNCTION TESTS: A REVIEW

2021 ◽  
pp. 73-76
Author(s):  
Vasudev Sankhla ◽  
Aman Deep
Keyword(s):  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
Radioactive Iodine ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
Function Tests ◽  
Tsh Secretion ◽  
Line Test ◽  
Radioactive Iodine Uptake

Thyroid function tests are one of the most common endocrine panels in general practice because a good understanding of when to order them, indications for treatment are important for the optimal treatment of thyroid dysfunction. Thyroid-stimulating hormone (TSH) should be the rst test to be performed on any patient with suspected thyroid dysfunction and in follow-up of individuals on treatment. It is useful as a rst-line test because even small changes in thyroid function are sufcient to cause a signicant increase in TSH secretion. Thyroxine levels may be assessed in a patient with hyperthyroidism, to determine the severity of hyperthyroxinemia. Antithyroid peroxidase measurements should be considered while evaluating patients with subclinical hypothyroidism and can facilitate the identication of autoimmune thyroiditis during the evaluation of nodular thyroid disease. The measurement of TSH receptor antibody must be considered when conrmation of Graves’ disease is needed and radioactive iodine uptake cannot be done.

scholarly journals The Characteristics of Children with Abnormalities Detected in Thyroid Function Tests, and Distribution of Diagnoses

2020 ◽  
Author(s):  
Elif Çelik ◽  
Ayşe Anık
Keyword(s):  
Thyroid Function ◽  
Thyroid Disease ◽  
Correct Diagnosis ◽  
Thyroid Function Test ◽  
Hashimoto Thyroiditis ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
Test Results ◽  
Function Tests ◽  
Function Test

INTRODUCTION: Thyroid function tests are among the most frequently implemented laboratory tests in primary, and secondary healthcare institutions. The aim of the present study was to investigate the demographic and clinical characteristics and final diagnosis of children referred by primary and secondary healthcare institutions with the suspicion of an abnormality in thyroid function test and/or with the initial diagnosis of specific thyroid disease. METHODS: A total of two hundred eighty-nine pediatric patients, aged between 4 and 18 years admitted to the outpatient clinics of Behçet Uz Children’s Health and Diseases Hospital between January 2018 and January 2020, were included in the study. The patient data were obtained retrospectively from the hospital records. RESULTS: A total of 66% of the patients who were included in the study were female with a median age of 12 years (8.7-14.4), while 64% of them were pubertal; and 78% of the cases were referred by secondary healthcare institutions. The most common reason for referral was isolated elevation of thyroid stimulating hormone (TSH). A total of 56% of the patients were asymptomatic at the time of admission, and thyroid function test results of 75% of them were within normal limits. When evaluated according to their final diagnoses, the children were normal/healthy (64%), diagnosed with Hashimoto thyroiditis (30%), nodular thyroid disease (3%), Graves disease (2%) and isolated increase of TSH was related to obesity in 5 patients (1%). DISCUSSION AND CONCLUSION: It is essential to evaluate children with abnormal thyroid function test results with detailed history and physical examination. Besides, the thyroid function tests should be performed with reliable and sensitive methods in standardized laboratories to reach the correct diagnosis in these children.

scholarly journals Thyroid dysfunction in preeclampsia and related fetomaternal outcomes

2019 ◽  
Vol 8 (5) ◽  
pp. 1928
Author(s):  
Puja Banik ◽  
R. K. Praneshwari Devi ◽  
Aheibam Bidya ◽  
Akoijam Tamphasana ◽  
M. Agalya ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
Birth Asphyxia ◽  
Normal Pregnancy ◽  
Thyroid Stimulating Hormone ◽  
Severe Preeclampsia ◽  
Intrauterine Fetal Death ◽  
Overt Hypothyroidism ◽  
Thyroid Function Tests ◽  
Cross Sectional

Background: Changes in thyroid function in normal pregnancy are well-documented but in complicated pregnancy like preeclampsia, very little is known. Studies have shown evidences of hypothyroidism in preeclampsia necessitating thyroid function tests to be done in preeclampsia. The study was done to analyze the fetomaternal outcome of preeclampsia with coexisting thyroid dysfunction.Methods: A cross-sectional analytical study was done over 18 months on 95 preeclamptic patients admitted at the antenatal ward and fetomaternal outcomes were analyzed according to thyroid status.Results: Out of 95 patients with preeclampsia, 42 (44.2%) had thyroid dysfunction. Among these 42 patients, 37 (38.9%) patients had subclinical hypothyroidism, 4 (4.2%) had overt hypothyroidism and 1 (1%) had hyperthyroidism. Severe preeclampsia was seen in 64.3% of the patients with thyroid dysfunction compared with 39.6% in euthyroid patients. The mean thyroid stimulating hormone (TSH) level was significantly higher and means free thyroxine (fT4) level was significantly lower in severe preeclampsia compared with non-severe preeclampsia. Complications like abruption, intrauterine fetal death (IUD), intrauterine growth restriction (IUGR), oligohydramnios, preterm deliveries, postpartum hemorrhage (PPH), low birth weight babies, birth asphyxia in babies and subsequent neonatal intensive care unit (NICU) admissions were significantly higher (p <0.05) in the preeclampsia patients with thyroid dysfunction in comparison with euthyroid ones.Conclusions: Hypothyroidism may be a modifiable risk factor for preeclampsia. Thyroid screening early in pregnancy may be helpful in predicting the occurrence of preeclampsia and timely thyroid hormone administration can reduce the maternal and perinatal morbidity and mortality associated with preeclampsia.

Thyroid function in patients with Prader-Willi syndrome: an Italian multicenter study of 339 patients

2019 ◽  
Vol 32 (2) ◽  
pp. 159-165 ◽  
Author(s):  
Lorenzo Iughetti ◽  
Giulia Vivi ◽  
Antonio Balsamo ◽  
Andrea Corrias ◽  
Antonino Crinò ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
Genetic Disorder ◽  
Hypogonadotropic Hypogonadism ◽  
Thyroid Stimulating Hormone ◽  
Hormone Deficiency ◽  
Published Data ◽  
Prader Willi Syndrome ◽  
Thyroid Function Tests ◽  
Central Hypothyroidism

AbstractBackgroundPrader-Willi syndrome (PWS) is a genetic disorder due to loss of expression of paternally transcribed genes of the imprinted region of chromosome 15q11-13. PWS is characterized by peculiar signs and symptoms and many endocrine abnormalities have been described (growth hormone deficiency, hypogonadotropic hypogonadism). The abnormalities of thyroid function are discussed in literature and published data are discordant. The aim of our study was to report the thyroid function in patients with PWS to identify the prevalence of thyroid dysfunction.MethodsThyroid function tests were carried out in 339 patients with PWS, aged from 0.2 to 50 years. A database was created to collect personal data, anthropometric data, thyroid function data and possible replacement therapy with L-thyroxine. Subjects were classified according to thyroid function as: euthyroidism (EuT), congenital hypothyroidism (C-HT), hypothyroidism (HT – high thyroid-stimulating hormone [TSH] and low free thyroxine [fT4]), central hypothyroidism (CE-H – low/normal TSH and low fT4), subclinical hypothyroidism (SH – high TSH and normal fT4), and hyperthyroidism (HyperT – low TSH and high fT4).ResultsTwo hundred and forty-three out of 339 PWS patients were younger than 18 years (71.7%). The prevalence of thyroid dysfunction was 13.6%. Specifically, C-HT was found in four children (1.18%), HT in six patients (1.77%), CE-H in 23 patients (6.78%), SH in 13 patients (3.83%), and HyperT in none. All other subjects were in EuT (86.4%).ConclusionsHypothyroidism is a frequent feature in subjects with PWS. Thyroid function should be regularly investigated in all PWS patients both at the diagnosis and annually during follow-up.

scholarly journals Thyroid function in preterm infants and neurodevelopment at 2 years

2020 ◽  
Vol 105 (5) ◽  
pp. 504-509 ◽  
Author(s):  
Fiona L R Williams ◽  
Alice Lindgren ◽  
Jennifer Watson ◽  
Anita Boelen ◽  
Timothy Cheetham
Keyword(s):  
Preterm Infants ◽  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
Cohort Analysis ◽  
Dried Blood Spots ◽  
Thyroid Stimulating Hormone ◽  
Composite Score ◽  
Fine Motor ◽  
The Relationship ◽  
Stimulating Hormone

ObjectivesPostnatal thyroid dysfunction is common in preterm infants but the relationship between mild dysfunction and neurodevelopment is unclear. Our aim is to describe the relationship between thyroid function and neurodevelopment.DesignCohort analysis.Patients1275 infants born under 31 weeks’ gestation; there were no exclusion criteria.SettingThe infants were part of a UK daily iodine supplementation trial.Main outcomesThyroid-stimulating hormone, thyroid-binding globulin and total thyroxine levels were measured in dried blood spots on postnatal days 7, 14, 28 and the equivalent of 34 weeks’ gestation. Neurodevelopment was measured using the Bayley-III Scales of infant development at 2 years of age.ResultsNo infant was identified as hypothyroid through routine screening. The 3% of infants consistently in the top decile of gestationally age-adjusted thyroid-stimulating hormone levels had a reduction in cognitive score of 7 Bayley units when compared with those not in the top decile (95% CI –13 to –1). A reduction in motor composite score of 6 units (95% CI −12 to <−0.1) and fine motor score of 1 unit (95% CI –2 to –0.1) was also identified. The 0.7% of infants consistently in the bottom decile of age-adjusted thyroxine levels had a reduction in motor composite score of 14 units (95% CI –25 to –2) and its two subset scores, fine and gross motor, of 2 units (95% CI respectively −4.5 to <−0.1 and –4.3 to –0.3).ConclusionsPreterm infants with consistent ‘mild’ thyroid dysfunction score less on neurodevelopmental tests at 2 years of age. Many of these infants will not be detected by current clinical protocols or screening programmes.

scholarly journals Moderate Iodine Deficiency Is Common in Pregnancy but Does Not Alter Maternal and Neonatal Thyroid Function Tests

2020 ◽  
Vol 11 ◽  
Author(s):  
Tal Schiller ◽  
Arnon Agmon ◽  
Viviana Ostrovsky ◽  
Gabi Shefer ◽  
Hilla Knobler ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Thyroid Function ◽  
Iodine Deficiency ◽  
Urinary Iodine ◽  
Iodine Content ◽  
First Trimester ◽  
Thyroid Function Tests ◽  
Neonatal Thyroid Function ◽  
Iodine Deficiency In Pregnancy ◽  
In Pregnancy

IntroductionAn Israeli national survey found that 85% of pregnant women had urinary iodine content (UIC) levels below the adequacy range (&lt;150 µg/L). Widespread desalinated water usage and no national fortification plan are possible causes. Studies assessing relationships between iodine status and maternal and neonatal thyroid function provided varying results. Our aims were to determine whether iodine deficiency was associated with altered maternal or neonatal thyroid function and the factors leading to iodine deficiency.MethodsA cross-sectional study including 100 healthy women without prior thyroid disease, in their first trimester of a singleton pregnancy were recruited from an HMO clinic in central Israel. The women were followed from their first trimester. All women completed a 24-h dietary recall and life habits questionnaires. We tested for UIC, maternal and neonatal thyroid function, maternal autoantibodies, and neonatal outcomes.ResultsMedian UIC in our cohort was 49 µg/L [25%–75% interquartile range (IQR) 16-91.5 µg/L], with 84% below adequacy range. No correlation was found between iodine deficiency and maternal or neonatal thyroid function which remained within normal ranges. Antibody status did not differ, but thyroglobulin levels were significantly higher in iodine insufficient subjects. UIC was higher in women consuming an iodine containing supplement. There was no association between UIC and dietary iodine content or water source.ConclusionsModerate iodine deficiency is common in our healthy pregnant women population. Our data imply that moderate iodine deficiency in pregnancy seem sufficient to maintain normal maternal and neonatal thyroid function.

scholarly journals Obesity and hypothyroidism

2013 ◽  
Vol 10 (2) ◽  
pp. 54-58 ◽  
Author(s):  
S M Zakharova ◽  
L V Savelieva ◽  
M I Fadeeva
Keyword(s):  
Weight Loss ◽  
Energy Expenditure ◽  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Obese Patients ◽  
Common Diseases ◽  
The Relationship ◽  
Stimulating Hormone

Obesity and hypothyroidism are common diseases, and consequently clinicians should be particularly alert to the possibility of thyroid dysfunction in obese patients. The relationship between thyroid function and obesity is likely to be bidirectional, with hypothyroidism affecting weight, but obesity also influencing thyroid function. Both serum thyroid-stimulating hormone and fT3 are typically increased in obese individuals, an effect likely mediated by leptin. Following L-T4 treatment for overt hypothyroidism, weight loss appears to be modest and mediated primarily by loss of water weight rather than fat. Selected thyroid analogs might be a means by which to improve weight loss by increasing energy expenditure in obese patients during continued caloric deprivation

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