Prevalent Practices of Thyroid Diseases During Pregnancy Among Endocrinologists, Internists and General Practitioners (original) (raw)
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IOSR Journals , 2019
Background;Thyroid disease is the second most common endocrine disorder affecting women of reproductive age after diabetes , hypothyroidism being the most common thyroid problem that might face physicians caring for pregnant women in Saudi Arabia . Objective;To determine the knowledge and practices of physicians dealing with pregnant women sufferingthyroid illness in Madina region. Methods; A crosssectional study that included 60 physicians from different disciplines in medina . General physicians working in primary health care facilities, endocrinologists and obstetricians were invited through a whats-up link to fill an electronic Multiple Choice Questionnaire ( MCQ ) .It consisted of 25 questions that were based on the latest American Thyroid Association for Clinical Endocrinologists ( AACE) guide lines in diagnosis and management of thyroid illnesses during pregnancy . knowledge assessmentwas based on the percentage of the rightly answered questions . Statistical analyses were conducted using SPSS version 16.0 . Participants’ characteristics were compared, using independent t test and Chi square test. Results: 13.3% of the participants hadagood knowledge and practice, while 56.7% hadan average and safe level of knowledge and practice . 30.0% of the included physicians were found to have poor knowledge and need to improve their practice ofmanaging the pregnant women with thyroid illness. The Highest scoreswere related to knowledge about thyroid screening during pregnancy and adjustment of levothyroxine dose once hypothyroid patient gotpregnant. The lowest scores wererelated to knowledge about thyroid hormone physiology during pregnancy ,Target TSH level , Iodine requirement and managing pregnant patient with Graves diseases or thyroid cancer. Conclusion: A welldesigned comprehensive education program should be delivered to all physicians caring for pregnant women focusing on the target thyroid function test during pregnancy , iodine replacement and timely referral tospecialized endocrinologist .
Thyroid Disorders in Pregnancy: Role of Routine Antenatal Thyroid Screening
Ibrahim cardiac medical journal, 2021
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 1 st , 2 nd , and 3 rd , 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.
Screening for Thyroid Disorder in First Trimester of Pregnancy: A Cross-Sectional Study
Journal of Clinical Gynecology and Obstetrics
Background: Alteration in thyroid function is very common among females, in particular during pregnancy. The majority of them are clinically veiled, and with considerable differences in outcome of mother and fetus, even more serious maternal and fetal outcome if present during the first trimester. So, we conducted this study to explore the magnitude of thyroid problems during first trimester of pregnancy at a tertiary health care facility in Nepal and highlight the benefits of its early diagnosis. Methods: This was a cross-sectional study conducted over a period of 1 year among 160 pregnant females in their first trimester, attending to the outpatient department of a tertiary care center. Blood samples were collected from all the patients for thyroid function test which included measurement of serum levels of thyroid-stimulating hormone (TSH), free thyroxine (fT4), and free tri-iodothyronine (fT3). Pregnant females with previously diagnosed thyroid disorders or currently under medications were excluded. Results: Among the 160 patients included in the study, 25.83 years was the mean age. The mean body mass index (BMI) was 24.62 kg/m 2 and most of the patients were overweight (40.625%). Of the patients 53.12% were primigravida and 46.87% were multigravida. Based on the thyroid function tests, 91.25% were found to be euthyroid, 3.125% were hyperthyroid and 5.625% were hypothyroid. The prevalence of subclinical hyperthyroidism and overt hyperthyroidism was found to be 60% and 40% respectively and that of subclinical hypothyroidism and overt hypothyroidism was 55.6% and 44.4% respectively. None of the patients had symptoms of thyroid disorder (neither hyperthyroidism nor hypothyroidism). The correlation between BMI and TSH among the pregnant females included in the study was statistically significant when tested by using Karl Pearson correlation coefficient (r = 0.164, P = 0.038). Conclusions: Based on this study, around one in every 12 pregnant women had thyroid disorder. Early identification of thyroid disorders and prompt initiation of treatment is very essential for the health of mother and fetus due to the significant maternal or fetal morbidity and mortality associated with thyroid disorders. Thus, routine screening for thyroid disorder should be considered during pregnancy.
Thyroid, 2011
INTRODUCTION P regnancy has a profound impact on the thyroid gland and thyroid function. The gland increases 10% in size during pregnancy in iodine-replete countries and by 20%-40% in areas of iodine deficiency. Production of thyroxine (T 4 ) and triiodothyronine (T 3 ) increases by 50%, along with a 50% increase in the daily iodine requirement. These physiological changes may result in hypothyroidism in the later stages of pregnancy in iodine-deficient women who were euthyroid in the first trimester. The range of thyrotropin (TSH), under the impact of placental human chorionic gonadotropin (hCG), is decreased throughout pregnancy with the lower normal TSH level in the first trimester being poorly defined and an upper limit of 2.5 mIU/L. Ten percent to 20% of all pregnant women in the first trimester of pregnancy are thyroid peroxidase (TPO) or thyroglobulin (Tg) antibody positive and euthyroid. Sixteen percent of the women who are euthyroid and positive for TPO or Tg antibody in the first trimester will develop a TSH that exceeds 4.0 mIU/L by the third trimester, and 33%-50% of women who are positive for TPO or Tg antibody in the first trimester will develop postpartum thyroiditis. In essence, pregnancy is a stress test for the thyroid, resulting in hypothyroidism in women with limited thyroidal reserve or iodine deficiency, and postpartum thyroiditis in women with underlying Hashimoto's disease who were euthyroid prior to conception.
CONTROVERSIES IN ENDOCRINOLOGY: On the need for universal thyroid screening in pregnant women
European Journal of Endocrinology, 2013
There is a well-known controversy among scientific societies regarding the recommendation to screen for thyroid dysfunction (TD) during pregnancy. Although several studies have shown an association between maternal subclinical hypothyroidism and/or hypothyroxinemia with obstetric problems and/or neurocognitive impairment in the offspring, there is only limited evidence on the possible positive effects of thyroxine (T4) treatment in such cases. Despite the scarcity of this evidence, there is a widespread agreement among clinicians on the need for treatment of clinical hypothyroidism during pregnancy and the risks that could arise due to therapeutic abstention. As maternal TD is a quite prevalent condition, easily diagnosed and for which an effective and safe treatment is available, some scientific societies have proposed to assess thyroid function during the first trimester of pregnancy and ideally before week 10 of gestational age. Given the physiologic changes of thyroid function d...
JNMA: Journal of the Nepal Medical Association, 2021
Introduction: The function of the thyroid gland is altered during pregnancy. Thyroid disorders during pregnancy are associated with serious maternal and fetal outcomes. Universal screening for thyroid disorders is recommended in the first trimester of pregnancy. This study aims to determine the prevalence of thyroid disorder during pregnancy in women attending a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynaecology of Kathmandu Medical College and Teaching Hospital from March 2020 to August 2020 after obtaining ethical approval from the Institutional Review committee with reference number 20032020. The pregnant women >18 years of age, irrespective of their gestational age and gravida status, were included in the study by convenience sampling method. The participants were screened by estimation of thyroid function test. Data were collected, and statistical analysis was done in Statistical Packages for Soc...
Bangladesh Endocrine Society Guidelines for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum, 2023
Background: In Bangladesh, patients with thyroid disorders are managed in accordance with the recognized guidelines and based on expert experience, as comprehensive national guidelines are currently lacking. The Bangladesh Endocrine Society (BES), as a professional body, has been working to develop guidelines for the last couple of years. Most recently, BES formulated practical recommendations for the management of thyroid disorders during pregnancy, which will be termed the "Guideline on Thyroid Disorders in Pregnancy in Bangladesh 2022," Methods: The BES formed a task force comprising experts in this field to formulate the practical recommendations for the management of thyroid disorders during pregnancy under several sections. The members of this task force comprehensively reviewed the available evidence for the specific conditions. Three well-known databases (Google Scholar, PubMed, and Scopus) were searched to determine the evidence. The task force members were well trained on reviewing the documents and methods of evidence synthesis. Each section of the recommendation was drafted by one member and subsequently reviewed. There was no barrier to the date or type of article published in the aforementioned databases except for articles published other than English. Due to the scarcity of intervention studies, ideas and findings of observational studies, case studies and expert recommendations were considered during the formulation of the guidelines. All members and affiliated persons declared no competing interest, and it was managed and communicated by the President of the BES. Results: The current guidelines for the management of thyroid disease in pregnancy include recommendations about the screening of thyroid function in pregnancy, planning pregnancy in women with thyroid disorders, interpretation of thyroid function tests, management of hypothyroidism and hyperthyroidism in pregnancy, management of thyroid nodules and thyroid emergencies throughout pregnancy, postpartum care, and directions of future research. Conclusions: Our utmost efforts were centered on developing evidence-based recommendations to inform all the levels of clinicians of Bangladesh for the easy understanding and decision-making processes in the management of thyroid disorders in pregnancy and afterward. While we care most to prepare the guideline, all recommendations are the opinion of society and admit the scope of making individualized decisions for the optimal care of patients.
The Study of Prevalence and Pattern of Thyroid Disorder in Pregnant Women: A Prospective Study
Cureus, 2021
Background The most frequent thyroid disorder in pregnancy is maternal hypothyroidism. The geographical variation in the prevalence of hypothyroidism during pregnancy is very wide and ranges from 2.5% to 11%. The prevalence of hypothyroidism is more in Asian countries as compared to western countries. Thus, this study was conducted to find out the prevalence of thyroid disorder in pregnancy at our center. Methods The present study was conducted in the Department of Physiology in collaboration with the Department of Obstetrics & Gynecology, Index Medical College, Hospital and Research Center, Indore, MP, India over a period of one and a half years from October 2018 to March 2020. It was a cross-sectional study including 865 pregnant women. The patients' demographic profile was noted in all cases. A detailed history and thorough examination were done in all cases. Serum thyroid-stimulating hormone (TSH), Free T3, and Free T4 (FT3 and FT4) were done along with routine blood investi...