Thyroid disorders in subfertility and early pregnancy

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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THYROID FUNCTION IN PREGNANCY: MATERNAL AND FETAL OUTCOMES WITH HYPOTHYROIDISM AND SUBCLINICAL THYROID DYSFUNCTION

Fetal and Maternal Medicine Review ◽

10.1017/s096553951100009x ◽

2011 ◽

Vol 22 (3) ◽

pp. 169-187

Author(s):

NEIL K VANES ◽

JOHN H LAZARUS ◽

SHIAO-Y CHAN

Keyword(s):

Thyroid Hormones ◽

Pregnant Women ◽

Thyroid Function ◽

Thyroid Dysfunction ◽

Thyroid Disorders ◽

Thyroid Function Tests ◽

Fetal Outcomes ◽

Function Tests ◽

Maternal Wellbeing ◽

In Pregnancy

Thyroid hormones are important in the development of the fetus and the placenta as well as in maintaining maternal wellbeing. Thyroid disorders are common in the population as a whole, particularly in women, and therefore are common during pregnancy and the puerperium. Biochemical derangement of thyroid function tests are present in approximately 2.5–5% of pregnant women.

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Gestational thyroid function abnormalities in conditions of mild iodine deficiency: early screening versus continuous monitoring of maternal thyroid status

Acta Endocrinologica ◽

10.1530/eje-08-0709 ◽

2009 ◽

Vol 160 (4) ◽

pp. 611-617 ◽

Cited By ~ 44

Author(s):

Mariacarla Moleti ◽

Vincenzo Pio Lo Presti ◽

Filiberto Mattina ◽

Alfredo Mancuso ◽

Antonio De Vivo ◽

...

Keyword(s):

Pregnant Women ◽

Thyroid Function ◽

Iodine Deficiency ◽

Thyroid Autoimmunity ◽

Thyroid Autoantibodies ◽

Thyroid Function Tests ◽

Increased Risk ◽

Thyroid Function Testing ◽

Maternal Thyroid ◽

Function Testing

ObjectiveTo longitudinally evaluate the timing of maternal thyroid underfunction occurrence in mildly iodine-deficient (ID) pregnant women, and ultimately assess the benefit of thyroid function testing at early gestation only in identifying maternal thyroid underfunction.Participants/methodsSerum free-thyroxine and TSH were measured in 220 consecutive women once in early pregnancy (by week 12) and twice per trimester subsequently. Anti-thyroperoxidase and anti-thyroglobulin were also determined at initial and final observation.ResultsThyroid autoantibodies were detectable in 8.2% women. Overall, the prevalence of hypothyroidism over the course of gestation was 11.8% (26/220), with a relative risk of hypothyroidism in antibody-positive women of 5.0 (χ2 20.02, P<0.0005). Nonetheless, almost 70% hypothyroid women tested negative for thyroid autoantibodies. Fifteen/26 (57.7%) hypothyroid women were identified at presentation, and the remaining 11 at either early (6/11) or late (5/11) phases of the 2nd trimester. Isolated hypothyroxinemia was observed in 56/220 (25.4%) women, mostly from the 2nd trimester onwards.ConclusionsIn mildly ID areas thyroid function testing early in gestation seems to be only partly effective in identifying thyroid underfunction in pregnant women. Indeed, in our series more than 40% hypothyroid women would not have been diagnosed had we limited our observation to early thyroid function tests alone. Although thyroid autoimmunity carried a 5-fold increased risk of hypothyroidism, iodine deficiency seems to be a major determinant in the occurrence of thyroid underfunction. Adequate iodine supplementation should be strongly recommended to meet the increased hormone demand over gestation.

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Assessment of Thyroid Function in Early Pregnancy

Bangladesh Journal of Nuclear Medicine ◽

10.3329/bjnm.v19i2.35864 ◽

2018 ◽

Vol 19 (2) ◽

pp. 98

Author(s):

Mohammad Saifur Rahman ◽

Sadia Sultana ◽

Ayesha Nazneen

Keyword(s):

Pregnant Women ◽

Thyroid Function ◽

Early Pregnancy ◽

Correct Diagnosis ◽

First Trimester ◽

Military Hospital ◽

Thyroid Disorders ◽

Thyroid Disorder ◽

Cross Sectional ◽

In Pregnancy

Objectives: Thyroid disorders are commonly observed in pregnancy. Thyroid hormones play an important role in embryogenesis and fetal development. The fetus is completely dependent on the mother for thyroid hormone in first trimester. About 10% of all pregnant women can be affected by thyroid disorders during pregnancy. Thyroid function abnormalities in pregnancy are a challenge for the concerned physicians. The objective of this study was to assess the maternal thyroid function in first trimester of pregnancy.Patients and Methods: A descriptive cross sectional study was carried out at the Combined Military Hospital (CMH), Dhaka over a period of one year from January 2013 to December 2013 to see the serum FT3, FT4, TSH, thyroid antibodies level and common thyroid disorders in pregnancy. A total of 138 pregnant women in their first trimester (up to 12 weeks) of pregnancy with an age range of 18-35 years were enrolled in this study. Pregnant women with known thyroid disorder and on treatment and pregnancy more than three months were excluded. Measurement of serum FT3, FT4, TSH, Anti TPO-Ab and Anti TG-Ab were done in each patient at the time of enrolment. Ultrasonography of each patient was done for confirmation of pregnancy and correlation of gestational age.Results: Among 138 pregnant women, subclinical hypothyroidism was detected in 10 (7.2%) patients and subclinical hyperthyroidism was detected in 3 (2.2%) patients. Mean difference of the investigation findings were not statistically significant among primi and multi gravida. TPO-Ab and TG-Ab difference were statistically significant between two age groups.Conclusion: Subclinical thyroid disorders are fairly high among pregnant women. Correct diagnosis in early pregnancy and prompt treatment will bring an excellent prognosis for both mother and offspring.Bangladesh J. Nuclear Med. 19(2): 98-102, July 2016

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

Frontiers in Endocrinology ◽

10.3389/fendo.2020.523319 ◽

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 (<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.

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The Evaluation of Thyroid Diseases in Patients with Pemphigus Vulgaris

The Scientific World JOURNAL ◽

10.1100/2012/146897 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 15

Author(s):

Mukaddes Kavala ◽

Esra Kural ◽

Emek Kocaturk ◽

Ilkin Zindanci ◽

Zafer Turkoglu ◽

...

Keyword(s):

Thyroid Function ◽

Systemic Corticosteroid ◽

Thyroid Autoimmunity ◽

Pemphigus Vulgaris ◽

Hashimoto Thyroiditis ◽

Thyroid Diseases ◽

Control Group ◽

Thyroid Disorders ◽

Thyroid Function Tests ◽

Antithyroid Antibodies

Background. Thyroid disorders may affect all of the organ systems of the body and they are also highly associated with a wide variety of skin disorders. The aim of this study was to investigate the prevalence of thyroid function abnormalities and thyroid autoimmunity in patients with pemphigus vulgaris (PV) and to determine the association between thyroid disorders and clinical involvement and systemic corticosteroid treatment in patients with PV.Methods. The study consisted of eighty patients with PV and eighty healthy individuals. Thyroid functions (fT3, fT4, and TSH) and thyroid autoimmunity (anti-thyroid peroxidase (anti-TPO), and anti-thyroglobulin (anti-Tg) antibodies) were investigated in both groups. Primary thyroid disease (PTD) was diagnosed with one or more of the following diagnostic criteria: (i) positive antithyroid antibodies, (ii) primary thyroid function abnormalities.Results. Significant changes in the serum thyroid profile were found in 16% (13/80) of the PV group and 5% (4/80) of the control group. Positive titers of antithyroid antibodies (anti-TPO and anti-Tg) were observed in 7 patients (9%) with PV and one in the control group (1,2%). Hashimoto thyroiditis was diagnosed in 9% of PV patients and it was found to be more prevalent in the mucosal form of PV. PTD was found in 13 of (%16) PV patients which was significantly high compared to controls. PTD was not found to be associated with systemic corticosteroid use. Free T3 levels were significantly lower in PV group compared to the control group and free T4 levels were significantly higher in PV group compared to the controls.Conclusions. PV may exist together with autoimmune thyroid diseases especially Hashimoto thyroiditis and primer thyroid diseases. Laboratory work-up for thyroid function tests and thyroid autoantibodies should be performed to determine underlying thyroid diseases in patients with PV.

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Screening for Thyroid Dysfunction in Pregnancy: Is It Worthwhile?

Journal of Thyroid Research ◽

10.4061/2011/397012 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 19

Author(s):

John H. Lazarus

Keyword(s):

Thyroid Function ◽

Thyroid Dysfunction ◽

Post Partum ◽

Thyroid Autoimmunity ◽

Evidence Base ◽

Obstetric Outcomes ◽

Increased Risk ◽

Abruptio Placenta ◽

Anaemia In Pregnancy ◽

In Pregnancy

There is a high incidence of thyroid dysfunction during pregnancy resulting in adverse maternal (miscarriages, anaemia in pregnancy, preeclampsia, abruptio placenta and post-partum haemorrhage) and fetal effects (premature birth, low birth weight, increased neonatal respiratory distress) which may justify screening for thyroid function during early pregnancy with interventional levothyroxine therapy for thyroid hypofunction. There is a greater prevalence of subclinical hypothyroidism in women with delivery before 32 weeks and there is even an association between thyroid autoimmunity and adverse obstetric outcome, which is independent of thyroid function. Higher maternal TSH levels even within the normal reference range are associated with an increased risk of miscarriages, fetal and neonatal distress and preterm delivery. There are few prospective randomised trials to substantiate the benefit of screening and the recently reported CATS study did not show a benefit in child IQ at age 3 years. Nevertheless there seems to be a case for screening to prevent adverse obstetric outcomes. The clinical epidemiological evidence base does not justify universal screening at the present time. However, it is probable that more evidence will be produced which may alter this view in the future.

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Guest Editor: Raffaella Origa THYROID DISORDERS IN HOMOZYGOUS β-THALASSEMIA: CURRENT KNOWLEDGE, EMERGING ISSUES AND OPEN PROBLEMS

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2019.029 ◽

2019 ◽

Vol 11 (1) ◽

pp. e2019029

Author(s):

Vincenzo De Sanctis

Keyword(s):

Thyroid Function ◽

Current Knowledge ◽

Normal Serum ◽

Thyroid Disorders ◽

Thyroid Function Tests ◽

Hormone Regulation ◽

Open Problems ◽

Secondary Hypothyroidism ◽

Emerging Issues ◽

Serum Tsh

Abstract. Changes in thyroid function and thyroid function tests occur in patients with β-thalassemia major (TM). The frequency of hypothyroidism in TM patients ranges from 4% to 29 % in different reports. The wide variation has been attributed to several factors such as patients' genotype, age, ethnic variations, treatment protocols of transfusions and chelation, and varying compliance to treatment. Hypothyroidism is the result of primary gland failure or insufficient thyroid gland stimulation by the hypothalamus or pituitary gland. The main laboratory parameters of thyroid function are the assessments of serum thyroid-stimulating hormone (TSH) and serum free thyroxine (FT4). It is of primary importance to interpret these measurements within the context of the laboratory-specific normative range for each test. An elevated serum TSH level with a normal range of serum FT4 level is consistent with subclinical hypothyroidism. A low serum FT4 level with a low, or inappropriately normal, serum TSH level is consistent with secondary hypothyroidism. Doctors caring for TM patients most commonly encounter subjects with subclinical primary hypothyroidism in the second decade of life. Several aspects remain to be elucidated as the frequency of thyroid cancer and the possible existence of a relationship between thyroid dysfunction on one hand, cardiovascular diseases, components of metabolic syndrome (insulin resistance) and hypercoagulable state on the other hand. Further studies are needed to explain these emerging issues. Following a brief description of thyroid hormone regulation, production and actions, this article is conceptually divided into two parts; the first reports the spectrum of thyroid disease occurring in patients with TM, and the second part focuses on the emerging issues and the open problems in TM patients with thyroid disorders.

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Thyroid Disorders in Pregnancy: Role of Routine Antenatal Thyroid Screening

Ibrahim Cardiac Medical Journal ◽

10.3329/icmj.v10i1-2.54009 ◽

2021 ◽

Vol 10 (1-2) ◽

pp. 74-83

Author(s):

Fatema Binta Islam ◽

Lipika Ghosh ◽

Nurun Nahar Khanam ◽

AM Ashraful Anam

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Pregnant Women ◽

Thyroid Function ◽

Thyroid Dysfunction ◽

Thyroid Disorders ◽

Thyroid Screening ◽

History Of ◽

Serum Tsh ◽

In Pregnancy

Background & objective:Thyroid disorders are among the common endocrine problems during pregnancy with well-known adverse effects on both mother and fetus. Many of these adverse effects could be prevented or ameliorated by early detection and appropriate treatment of conditions, provided routine antenatal thyroid screening is done. Considering this view, the present study was aimed to find the prevalence of thyroid disorders and their spectrum in pregnancy in order to justify the necessity of routine antenatal thyroid screening. Methods: This cross-sectional study was conducted in the Department of Obstetrics & Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka over a period 1 year from July 2012 to June 2013 on pregnant women to screen for the thyroid disorders in pregnancy. Based on predefined eligibility criteria, a total of 246 pregnant women up to 36 weeks of gestation were consecutively included in the study. A short history with brief physical examination was done followed by collection of blood samples. Thyroid function was assessed by measuring serum levels of thyroid stimulating hormone (TSH). Serum free thyroxin (FT4) level was estimated in 71 cases, where TSH value was deranged. Trimester specific reference range of serum TSH was used to define hypothyroid, euthyroid and hyperthyroid cases. The suspected risk factors were then compared between abnormal and euthyroid groups to find their association with thyroid disorders. Result: The results of the study showed that the overall prevalence of abnormal thyroid function status was 30.9% (hypothyroidism 29.7% and hyperthyroidism 1.2%) based on normal range of serum TSH in different trimesters of pregnancy. Pregnant women with thyroid disorders were generally older than their euthyroid counterparts (p = 0.039). Hypothyroid state was fairly common with advancing gestation (21.3%, 30.3% and 34% in the 1st, 2nd, and 3rd, trimesters respectively). Pregnant women with personal or family history of thyroid disease in the past exhibited a higher prevalence of abnormal thyroid function than those who did not have such history (p = 0.041 and p = 0.044 respectively). Past menstrual irregularity, past history of subfertility or abortion were significantly associated with thyroid disorders (p = 0.042, p = 0.004 and p < 0.001 respectively). Presence of goitre (21.1%) in current pregnancy also showed significant association with thyroid dysfunction (p = 0.001). The risk of developing abnormal thyroid function was observed to be 3.6(95% CI = 1.9 – 6.4) times higher in those who had at least one risk factor than those who did not have any risk factors (p < 0.001). However, a sizable portion (27.6%) of pregnant women without any risk factors developed abnormal thyroid function. Conclusion: The study concluded that one in every three women may have thyroid disorder during pregnancy, primarily hypothyroidism. Adopting risk factor-based screening for thyroid disorders in pregnancy, there is every chance that a substantial number of cases with thyroid dysfunction may be missed. Therefore, routine antenatal thyroid screening is recommended. Ibrahim Card Med J 2020; 10 (1&2): 74-83

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Investigation of the Free and Total Thyroxine-binding Capacity of Plasma Proteins in Thyroid Disorders

Nuklearmedizin ◽

10.1055/s-0038-1624755 ◽

1971 ◽

Vol 10 (04) ◽

pp. 299-304

Author(s):

József Takó ◽

János Fischer ◽

Jusztina Juhász ◽

Ilona Sztraka ◽

István Kapus ◽

...

Keyword(s):

Blood Cell ◽

Thyroid Function ◽

Oral Contraceptives ◽

Red Blood Cell ◽

Plasma Proteins ◽

Binding Capacity ◽

Thyroid Disorders ◽

Thyroid Function Tests ◽

Total Thyroxine

SummaryThe results of thyroid function tests have been compared with data on the thyroxine-binding capacity of plasma proteins in hyper-, hypo- and euthyroid cases, the latter including women taking oral contraceptives (Infecundin). It was found that there exists a significant correlation of exponential nature between the in vitro red blood cell 125I-triiodothyronine uptake (RCU) and the free thyroxine-binding capacity of the thyroxine-inding globulin (TBG).

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Prenatal electrocardiogram testing and postpartum depression: A population-based cohort study

Obstetric Medicine ◽

10.1177/1753495x211012502 ◽

2021 ◽

pp. 1753495X2110125

Author(s):

Jonathan S Zipursky ◽

Deva Thiruchelvam ◽

Donald A Redelmeier

Keyword(s):

Cohort Study ◽

Postpartum Depression ◽

Pregnant Women ◽

Odds Ratio ◽

Population Based ◽

Relative Increase ◽

Organic Disease ◽

Increased Risk ◽

Clinical Clue ◽

In Pregnancy

Background Cardiovascular symptoms in pregnancy may be a clue to psychological distress. We examined whether electrocardiogram testing in pregnant women is associated with an increased risk of subsequent postpartum depression. Methods We conducted a population-based cohort study of pregnant women who delivered in Ontario, Canada comparing women who received a prenatal ECG to women who did not. Results In total, 3,238,218 women gave birth during the 25-year study period of whom 157,352 (5%) received an electrocardiogram during prenatal care. Receiving an electrocardiogram test was associated with a one-third relative increase in the odds of postpartum depression (odds ratio 1.34; 95% confidence interval 1.29–1.39, p < 0.001). Conclusion The association between prenatal electrocardiogram testing and postpartum depression suggests a possible link of organic disease with mental illness, and emphasizes that cardiovascular symptoms may be a clinical clue to the presence of an underlying mood disorder.

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