Outcome of clinical hypothyroidism in pregnancy: a case control study (original) (raw)
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Five-Year Follow-Up for Women With Subclinical Hypothyroidism in Pregnancy
The Journal of Clinical Endocrinology & Metabolism, 2013
Context: Increasing numbers of women are being treated with L-thyroxine in pregnancy for mild thyroid dysfunction because of its association with impaired neuropsychological development in their offspring and other adverse obstetric outcomes. However, there are limited data to indicate whether treatment should be continued outside of pregnancy. Objectives: We aimed to determine whether subclinical hypothyroidism and maternal hypothyroxinemia resolve postdelivery. Design, Setting, and Participants: A total of 523 pregnant healthy women with no known thyroid disorders were recruited during routine antenatal care and provided blood samples at 28 weeks of pregnancy and at a mean of 4.9 years postpregnancy. Main Outcome Measures: TSH, free T 4 , free T 3 , and thyroid peroxidase antibody levels were measured in serum taken in pregnancy and at follow-up. Results: Subclinical hypothyroidism in pregnancy (TSH Ͼ3 mIU/L) was present in 65 of 523 (12.4%) women. Of these, 49 (75.4%) women had normal thyroid function postpregnancy; 16 of 65 (24.6%) had persistent high TSH (TSH Ͼ4.5 mIU/L postpregnancy) with 3 women receiving L-thyroxine treatment. A total of 44 of 523 (8.4%) women had isolated maternal hypothyroxinemia in pregnancy (free T 4 Ͻ10th centile and TSH Յ3 mIU/L). Only 2 of 44 (4.5%) had TSH Ͼ4.5 mIU/L outside pregnancy. Of the women with subclinical hypothyroidism in pregnancy with antibody measurements available, those with thyroid peroxidase antibodies in pregnancy were more likely to have persistently elevated TSH or be receiving L-thyroxine replacement after pregnancy (6 of 7 [86%] vs 10 of 57 [18%], P Ͻ .001). Conclusions: The majority of cases of subclinical hypothyroidism in pregnancy are transient, so treatment with L-thyroxine in these patients should be reviewed because it may not be warranted after pregnancy.
HORMONES, 2002
women actually increases the prevalence of thyroid dysfunction during this period. Overall subclinical hypothyroidism (SCH) is reported to have a prevalence of 1-2% of all pregnancies, 3 with the prevalence of hypothyroidism being even higher in some studies. 4 Using recent Endosociety guidelines for definition of subclinical hypothyroidism, i.e. a serum TSH >2.5 mIU/L during the first and TSH >3 mIU/L during second and third trimesters, will also increase the prevalence of subclinical hypothyroidism. In a study, Shields et al reported the prevalence of subclinical hypothyroidism in pregnancy (TSH >3 mIU/L) to be 12.4% in pregnant women during routine antenatal care. 5 Meanwhile, two recent reports have cited the prevalence of subclinical or clinical hypothyroidism as being 12.3% in a Finnish study, 6 and 35.3% in a South American study. 7 In order to determine presence of thyroid diseases, the trimester-specific reference range must be applied, current data showing the upper reference range to be 2.5 mIU/L during the first and 3 mIU/L during the second and third trimesters. 8 Subclinical hypothyroidism (SCH) is defined as TSH levels above 2.5 but less than 10 mIU/L in the presence of normal FT4 levels. Overt hypothyroidism is defined as serum TSH level >2.5 mIU/L in conjunc-
Hypothyroidism in Pregnancy: A Hospital based cross sectional study
Innovative publication, 2016
Introduction: Uncontrolled hypothyroidism is associated with serious maternal, fetal, and neonatal morbidity, and mortality. Overt hypothyroidism is defined as a clinical syndrome of hypothyroidism associated with elevated TSH and decreased serum levels of T4 or T3. Subclinical hypothyroidism is defined as a condition without typical symptoms of hypothyroidism, elevated TSH (>5 µU/mL), and normal circulating thyroid hormone.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Pregnancy is a stress test of maternal thyroid function. The prevalence of thyroid dysfunction in pregnant women is high. This study is aimed to evaluate maternal and fetal outcomes in pregnant women with deranged thyroid profile. The relevance of this study is to document the association of hypothyroidism and its adverse effects on mother and fetus.Methods: All pregnant mother included in the study are subjected to written consent and detailed history taking and fasting blood sample collection. Blood sample collected in fasting state, because lipidemic content in blood interferes with serum thyroid stimulating hormone (TSH) level if blood sample collected in the fed state.Results: A total of 1000 cases were studied. Out of 1000 cases, 71(7.1%) cases found to be hypothyroid. Among them, 14 (19.4%) had overt hypothyroidism and 57 (80.5%) demonstrated subclinical hypothyroidism.Conclusions: Prevalence of subclinical hypothyroidism is 5.6% in 3rd trimester of pregnancy. Ane...
Pregnancy outcome in overt hypothyroidism
International Journal of Research in Medical Sciences, 2016
thyroid stimulating hormone (TSH) during pregnancy. 4 This increased TBG concentration leads to an expansion of the extra-thyroidal pool and result in elevated total T 3 and T 4 levels due to an increase in maternal thyroid hormone synthesis. Maternal thyroid synthesis is also increased due to an accelerated renal clearance of iodide resulting from the increased maternal glomerular filtration rate. 5 Women with hypothyroidism have increased risk of abortion, gestational hypertension, anemia, abruptio placentae and postpartum hemorrhage. 6 The risk of these complications is greater in women with overt, rather than subclinical hypothyroidism. 5 Severe maternal hypothyroidism can result in irreversible ABSTRACT Background: To study the pregnancy outcomes in terms of miscarriage, gestational hypertension, preeclampsia, placenta previa, placental abruption, preterm labour, preterm PROM, rate of caesarean section, postpartum hemorrhage, premature birth, low-birth weight, fetal distress in labour, fetal death and congenital anomalies. Methods: The studied subjects included all pregnant women reported to the hospital for a period of one year (November 2012 to October 2013). They were subjected to detailed history, general physical, systemic, local examinations, routine investigations, thyroid function tests (serum TSH, T3, T4) and divided into two groups, Group-I: Overt hypothyroidism (TSH >10Mu/L; T3 and T4 <normal) and Group-II: Euthyroid pregnant women (control group).Outcomes of study group were compared with control group. The data was analyzed using computer software Microsoft Excel and SPSS version 19.0 for Windows. Chi square test was performed to evaluate statistical significance. A p-value of <0.05 was considered as statistically significant. Results: 17045 women reported to hospital during one year period and after applying exclusion criteria 14810 women qualified. Out of these, 14770 pregnant women were found euthyroid and 40 (0.23%) women were overt hypothyroid. Pregnancy outcome like miscarriage (p<0.001), placental abruption (p<0.03), preterm premature rupture of membrane (p=0.003), low birth weight (p<0.001) and premature birth (p=0.003) was found to be statistically significant. Conclusions: Due to adverse pregnancy outcome, women in early pregnancy should be screened for thyroid disorder and those found hypothyroid should be treated.
Fetomaternal Outcome of Pregnancy with Hypothyroidism
IOSR Journals , 2019
Thyroid diseases are common disorders affecting women of reproductive age group and hence constitute the commonest endocrine disorder in pregnancy also. According to ACOG, the prevalence of hypothyroidism in pregnancy is 2-5%. Women with hypothyroidism are at an increased risk for early pregnancy loss , low birth weight, placental abruption, low IQ babies etc. So early detection and treatment prevents such adverse outcomes. Aim And Objective: To study the fetomaternal outcome among pregnant women with hypothyroidism. Study Design: This is a retrospective study that includes pregnant women from the year june 2017 to may 2018, which consists of 103 patients with hypothyroid in the Results: The study consists of 103 patients with hypothyroidism out of 5034 deliveries (2.01%), in which 20 (19.4%) had overt hypothyroidism and 83(80.5%) had subclinical hypothyroidism out of total hypothyroid patients. Conclusion: The present study shows significant association between hypothyroidism and adverse fetomaternal outcomes. So routine maternal thyroid function testing, especially serum TSH should be done as soon as pregnancy is confirmed.
Observational Study of Subclinical Hypothyroidism in Pregnancy
Introduction: Maternal thyroid dysfunction is the second common endocrine disorder during pregnancy. Prevalence of subclinical hypothyroidism during pregnancy is increasing. It is associated with adverse maternal and foetal outcomes like pre-eclampsia, GDM, preterm, IUGR and miscarriage, anaemia, IUD. Objective: To study the prevalence of Subclinical hypothyroidism during pregnancy and its relation with adverse maternal and foetal outcomes. Methods and materials: It was an observational study undertaken at RRMCH from May-2013 to Feb 2014. Pregnant women were screened for thyroid dysfunction irrespective of gestational age. Women with raised Thyroid stimulating Hormone (TSH) were included in the study. Pregnancy outcome of women with raised TSH was compared with euthyroid pregnant women. Results: Study group included 1663 pregnant women. Among them 168 women had hypothyroidism, women with subclinical and overt hypothyroidism were 156 and 12 respectively. Prevalence of hypothyroidism in this study was 10.1%, Subclinical Hypothyroidism and Overt hypothyroidism was 9.3% and 0.72% respectively. Overall prevalence of autoimmunity was 19.04% (n=32) in women with hypothyroidism. Prevalence of autoimmunity in SCH and OH was 17.9% (n=28) and 33.3% (n=4) respectively. In women with SCH 81.4% developed complications like Pre-eclampsia (21.8%), GDM (6.4%), Preterm labor (7.1%) and IUGR (7.7%) anemia (5.8%) compared to euthyroid women (p value <0.001). Conclusions: Increasing prevalence of Subclinical Hypothyroidism during pregnancy and its association with adverse maternal and foetal outcome makes it a high risk factor. Subclinical hypothyroidism is like the bottom of the iceberg, hence prompt screening for thyroid dysfunction and early initiation of treatment can prevent adverse maternal and fetal morbidity.
BMC Pregnancy and Childbirth
Background Hypothyroidism in pregnancy is an arena of ongoing research, with international conflicts regarding screening, management, and outcomes. Various studies have described the outcomes depending on geographical and international diagnostic criteria. No study has been conducted in this regard from the region of Pakistan. Therefore, we aim to report the clinical features and maternal outcomes of hypothyroid pregnancies and compare the maternal outcomes between uncontrolled and controlled TSH levels in the preconception as well as the gestational period. Methods We conducted a cross-sectional retrospective study on 718 cases in the Aga Khan University Hospital after ethical approval. We collected information on pregnant females who have diagnosed hypothyroidism before conception or during their antenatal period. We noted the maternal characteristics and maternal comorbidities. Laboratory data were recorded for thyroid stimulating hormone levels before conception and during gesta...
Pregnancy outcomes in women with severe hypothyroidism
European Journal of Endocrinology, 2013
ObjectiveHypothyroidism during pregnancy has been associated with adverse obstetrical outcomes. Most studies have focused on subjects with a mild or subclinical disorder. The aims of the present study were to determine the relative rate of severe thyroid dysfunction among pregnant women with hypothyroidism, identify related factors and analyse the impact on pregnancy outcomes.DesignA retrospective case series design was employed.MethodsThe study group included 101 pregnant women (103 pregnancies) with an antenatal serum TSH level >20.0 mIU/l identified from the 2009–2010 computerised database of a health maintenance organisation. Data were collected from the medical records. Pregnancy outcomes were compared with those of a control group of 205 euthyroid pregnant women during the same period.ResultsThe study group accounted for 1.04% of all insured pregnant women with recorded hypothyroidism during the study period. Most cases had an autoimmune aetiology. All women were treated wi...
Subclinical hypothyroidism (SCH) in first trimester of pregnancy
The professional medical journal, 2020
Material & Methods: We obtained informed consent from all patients. 457 pregnant ladies having last missed period till 12 th week with age group between 18-45 years were included in this study. Samples were collected for T4 (Thyroxine), TSH (Thyroid Stimulating Hormone) and T3 (Triiodothyronine). Patients were followed for their entire pregnancy period. Adverse events and complications were noted. Results: Out of 457 patients who were included in our study, 169 subjects had TSH levels well above 4.6-10 mIU/L. 288 subjects were having TSH levels below 4 mIU/L. The overall prevalence of subclinical hypothyroidism (SCH) was found to be 37% in pregnant women during their first trimester of pregnancy. Pregnant women having subclinical hypothyroidism (SCH) were having higher risks of loss of pregnancy, placental abruption and neonatal death rates as compared to euthyroid pregnant women. Conclusion: Our study concludes that overall prevalence of subclinical hypothyroidism (SCH) in Pakistani pregnant women during their first trimester of pregnancy was found to be 37%.