1
|
Li X, Zhang Z, Cai W, Zhou X, Zhang Y, Wu C, Xu X, Wu H. Association Between Serum Ferritin Levels in Early Pregnancy and Thyroid Function and Pregnancy Outcomes in Chinese Population. Int J Womens Health 2023; 15:1951-1957. [PMID: 38106565 PMCID: PMC10723073 DOI: 10.2147/ijwh.s436651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023] Open
Abstract
Background The relationship of iron deficiency and thyroid hormone has been researched a lot among pregnant or other healthy population. However, invisible iron deficiency, namely shortage of serum ferritin (sFer) level, has been barely investigated among Chinese pregnant women. This study aimed to explore the effects of sFer status on thyroid function and pregnancy outcomes in a population-based upper first-class hospital. Methods A total of 781 singleton pregnant women of gestation in Shanghai General Hospital took part in this retrospective cohort study. The participants were divided into four groups by quartiles of serum ferritin levels (Q1-4). Binary logistic regressions were used to examine the strength of association between the different traits and the serum ferritin (sFer) quartiles separately, where Q1 (lowest ferritin quartile) was taken as the base reference. One-way ANOVA was adopted to compare the averages of the different variables across sFer quartiles. Categorical measures were compared by Fisher exact test or chi-square test. Results As the sFer concentration rises, incidence of premature birth (15.8%vs 12.3% vs 9.20% vs 6.20% p = 0.016) as well as threatened miscarriage (14.8% vs 7.2% vs 8.70% vs 6.70% p = 0.021) presented a downward trend. Compared with the other sFer group, subjects of the low sFer group were older, more often to be found to have lower serum γT3 and FT4 levels in early pregnancy but not in middle pregnancy. Conclusion sFer concentration in the first trimester can affect thyroid function. The correction of invisible iron deficiency with inadequate sFer status prior to pregnancy or during early pregnancy is imperative, not only to prevent anemia, but also for maintaining optimum thyroid function and normal fetal development. For clinicians, sFer status of pregnant women should be attached great importance apart from attention to iron level.
Collapse
Affiliation(s)
- Xing Li
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Zhuyuan Zhang
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Wen Cai
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Xuexin Zhou
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Yan Zhang
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Cailiang Wu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Xianming Xu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Hao Wu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| |
Collapse
|
2
|
Garofalo V, Condorelli RA, Cannarella R, Aversa A, Calogero AE, La Vignera S. Relationship between Iron Deficiency and Thyroid Function: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:4790. [PMID: 38004184 PMCID: PMC10675576 DOI: 10.3390/nu15224790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/05/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
Objective: Iron deficiency (ID) is the most prevalent nutritional deficiency worldwide. Low levels of serum ferritin (SF) could affect the thyroid gland and its functioning. The purpose of this systematic review and meta-analysis is to summarize the main currently available evidence and analyze data on the relationship between ID and thyroid function. Methods: This study included all articles evaluating the relationship between ID and thyroid function. Quality assessment was performed using Cambridge Quality Checklists. The search strategy included the following combination of Medical Subjects Headings terms and keywords: "iron deficiency", "thyroid function", "thyroid disease", "thyroid dysfunction", and "hypothyroidism". A meta-analysis was performed to evaluate whether thyroid stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) levels differed between patients with ID and healthy controls without ID. For statistical comparison between cases and controls, the mean difference (MD) was calculated, and a subgroup analysis of pregnant and non-pregnant women was performed. Cochran's Q testing and heterogeneity indices (I2) were used to assess statistical heterogeneity. Sensitivity analysis and publication bias analyses were also performed, both qualitatively and quantitatively. Finally, a meta-regression analysis was performed to evaluate the correlation between serum TSH or FT4 levels and SF in the study population. Results: Ten cross-sectional studies were identified and reviewed. Patients with ID showed TSH (MD: -0.24 mIU/L; 95% CI -0.41, -0.07; I2 = 100%, p = 0.005), FT4 (MD: -1.18 pmol/L; 95% CI -1.43, -0.94; I2 = 99%, p < 0.000001), and FT3 (MD: -0.22 pmol/L; 95% CI -0.32, -0.12; I2 = 99%, p < 0.00001) levels that were significantly lower. Subgroup analysis confirmed significantly lower TSH, FT4, and FT3 levels in pregnant women. Non-pregnant women showed significantly lower serum FT4 and FT3 levels but no difference in TSH values. Meta-regression analysis showed that serum TSH and FT4 levels were positively correlated with SF levels. Our systematic review of the literature found that ID significantly increases the prevalence of thyroid autoantibody (anti-thyroglobulin antibodies and anti-thyroid peroxidase antibodies) positivity both individually and collectively. Conclusion: Studies currently published in the literature indicate a possible relationship between ID, thyroid function, and autoimmunity, especially in some patient groups. Data analysis shows that thyroid hormone levels are lower in patients with ID and, in particular, in pregnant women. Further studies are needed to understand the role played by iron in thyroid metabolism.
Collapse
Affiliation(s)
- Vincenzo Garofalo
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (V.G.); (R.C.); (A.E.C.); (S.L.V.)
| | - Rosita A. Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (V.G.); (R.C.); (A.E.C.); (S.L.V.)
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (V.G.); (R.C.); (A.E.C.); (S.L.V.)
- Cleveland Clinic Foundation, Glickman Urological & Kidney Institute, Cleveland, OH 44195, USA
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy;
| | - Aldo E. Calogero
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (V.G.); (R.C.); (A.E.C.); (S.L.V.)
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (V.G.); (R.C.); (A.E.C.); (S.L.V.)
| |
Collapse
|
3
|
Peng CCH, Lee SY, Pearce EN. Isolated Maternal Hypothyroxinemia: Adverse Maternofetal Outcomes but Uncertainty About Treatment Remains. Thyroid 2023; 33:535-537. [PMID: 36987374 PMCID: PMC10325797 DOI: 10.1089/thy.2023.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Affiliation(s)
- Carol Chiung-Hui Peng
- Section of Endocrinology, Diabetes, Nutrition & Weight Management, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Sun Y. Lee
- Section of Endocrinology, Diabetes, Nutrition & Weight Management, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Elizabeth N. Pearce
- Section of Endocrinology, Diabetes, Nutrition & Weight Management, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Selenium, Iodine and Iron-Essential Trace Elements for Thyroid Hormone Synthesis and Metabolism. Int J Mol Sci 2023; 24:ijms24043393. [PMID: 36834802 PMCID: PMC9967593 DOI: 10.3390/ijms24043393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/16/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
The adequate availability and metabolism of three essential trace elements, iodine, selenium and iron, provide the basic requirements for the function and action of the thyroid hormone system in humans, vertebrate animals and their evolutionary precursors. Selenocysteine-containing proteins convey both cellular protection along with H2O2-dependent biosynthesis and the deiodinase-mediated (in-)activation of thyroid hormones, which is critical for their receptor-mediated mechanism of cellular action. Disbalances between the thyroidal content of these elements challenge the negative feedback regulation of the hypothalamus-pituitary-thyroid periphery axis, causing or facilitating common diseases related to disturbed thyroid hormone status such as autoimmune thyroid disease and metabolic disorders. Iodide is accumulated by the sodium-iodide-symporter NIS, and oxidized and incorporated into thyroglobulin by the hemoprotein thyroperoxidase, which requires local H2O2 as cofactor. The latter is generated by the dual oxidase system organized as 'thyroxisome' at the surface of the apical membrane facing the colloidal lumen of the thyroid follicles. Various selenoproteins expressed in thyrocytes defend the follicular structure and function against life-long exposure to H2O2 and reactive oxygen species derived therefrom. The pituitary hormone thyrotropin (TSH) stimulates all processes required for thyroid hormone synthesis and secretion and regulates thyrocyte growth, differentiation and function. Worldwide deficiencies of nutritional iodine, selenium and iron supply and the resulting endemic diseases are preventable with educational, societal and political measures.
Collapse
|
5
|
Wang F, Zhang Y, Yuan Z, Li Y, Liu S, Zeng X, Qiu X, Ye L, Huang D. The association between iron status and thyroid hormone levels during pregnancy. J Trace Elem Med Biol 2022; 74:127047. [PMID: 35930951 DOI: 10.1016/j.jtemb.2022.127047] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/07/2022] [Accepted: 07/19/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Iron deficiency may be a risk factor for thyroid disorder; however, the relationship between iron deficiency and thyroid disorder as well as mechanism involved remain unclear. METHODS A hospital-based cross-sectional study was conducted to analyze the correlation between iron status and thyroid hormone levels in pregnant women. A total of 2218 pregnant women were recruited, and iron status and thyroid hormones were measured. Canonical correlation, Lasso regression, and Receiver operator characteristic (ROC) curve analysis were used to determine the association and related factors. RESULTS There were 219 cases with iron deficiency anemia (IDA), 168 cases with iron deficiency (ID), and 1831 subjects with normal iron status. Compared with normal group, free triiodothyronine (FT3) and free thyroxine (FT4) in ID group and IDA group had a significant decreasing trend (P < 0.05), with the lowest levels in IDA group. Thyroid stimulating hormone (TSH) was significantly increased in ID group and IDA group (P < 0.05). Moreover, the proportion of hypothyroidism in both ID group and IDA group was higher than the normal group, meanwhile the proportion of hyperthyroidism was lower in both groups (P < 0.05). Serum ferritin (SF) and hemoglobin (Hb) were positively correlated with FT3 and FT4 but negatively correlated with TSH. Correlation analysis indicated that iron status was associated with thyroid hormone levels (P < 0.05). Lasso regression analysis showed that SF, Hb and other variables could be included in the prediction model of FT4. The variables selected by Lasso model were used for ROC curve analysis, and the prediction accuracy was acceptable (AUC=0.778, P < 0.05). CONCLUSION Our study indicated that there is an association between iron status and thyroid hormone levels in pregnant women, and the level of FT4 may change with iron status. Our findings provide new ideas for regulating the thyroid hormone levels to prevent thyroid dysfunction during pregnancy.
Collapse
Affiliation(s)
- Fengyi Wang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China; Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
| | - Yuanxiao Zhang
- Pingguo Maternal and Child Health Hospital, Baise, Guangxi, China.
| | - Zongxiang Yuan
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China; Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
| | - Yanning Li
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
| | - Shun Liu
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
| | - Xiaoyun Zeng
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
| | - Xiaoqiang Qiu
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
| | - Li Ye
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China; Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China; Guangxi-ASEAN Collaborative Innovation Center for Major Disease Prevention and Treatment, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China.
| | - Dongping Huang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
| |
Collapse
|
6
|
Benson AE, Shatzel JJ, Ryan KS, Hedges MA, Martens K, Aslan JE, Lo JO. The incidence, complications, and treatment of iron deficiency in pregnancy. Eur J Haematol 2022; 109:633-642. [PMID: 36153674 PMCID: PMC9669178 DOI: 10.1111/ejh.13870] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/30/2022]
Abstract
Iron deficiency and/or iron deficiency anemia (IDA) complicate nearly 50% of pregnancies globally, negatively impacting both maternal and fetal outcomes. Iron deficiency can cause a range of symptoms that range from aggravating to debilitating including fatigue, poor quality of life, pagophagia, and restless leg syndrome. Iron deficiency and IDA are also associated with maternal complications including preterm labor, increased rates of cesarean delivery, postpartum hemorrhage, and maternal death. Fetal complications include increased rates of low birth weight and small for gestational age newborns. Prenatal maternal anemia has also been associated with autism spectrum disorders in the neonate, although causation is not established. Deficiency in the newborn is associated with compromised memory, processing, and bonding, with some of these deficits persisting into adulthood. Despite the prevalence and consequences associated with iron deficiency in pregnancy, data show that it is routinely undertreated. Due to the physiologic changes of pregnancy, all pregnant individuals should receive oral iron supplementation. However, the bioavailability of oral iron is poor and it is often ineffective at preventing and treating iron deficiency. Likewise, it frequently causes gastrointestinal symptoms that can worsen the quality of life in pregnancy. Intravenous iron formulations administered in a single or multiple dose series are now available. There is increasing data suggesting that newer intravenous formulations are safe and effective in the second and third trimesters and should be strongly considered in pregnant individuals without optimal response to oral iron repletion.
Collapse
Affiliation(s)
- Ashley E Benson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| | - Joseph J Shatzel
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon, USA
| | - Kim S Ryan
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| | - Madeline A Hedges
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| | - Kylee Martens
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Joseph E Aslan
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Jamie O Lo
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| |
Collapse
|
7
|
Rezgale R, Pudule I, Cauce V, Klaramunta Antila K, Bule V, Lazdane G, Rezeberga D, Meija L. Iron Status in Pregnant Women in Latvia: An Epidemiological, Cross-Sectional, Multicenter Study According to WHO and UK Criteria. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58070955. [PMID: 35888674 PMCID: PMC9321800 DOI: 10.3390/medicina58070955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 12/04/2022]
Abstract
Background and Objectives: During pregnancy, iron deficiency anaemia is a common problem associated with health risks for both the mother and her foetus/infant. This study aimed to investigate the prevalence of iron deficiency, iron deficiency anaemia, and related dietary patterns in pregnant women in Latvia. Materials and Methods: This cross-sectional, multicentre study included pregnancy data from 974 women. The sample selection was based on the stratification principle (population of women of childbearing age in regions of Latvia). Maternal demographic details, anthropometric measurements, iron status, dietary patterns, and supplementation information were obtained from maternal files and during interviews held in eight outpatient departments of medical institutions and maternity departments. The prevalence was assessed. Chi-square tests and logistic regression were used to identify associations between iron deficiency and sociodemographic characteristics, dietary patterns, and iron supplement intake during pregnancy. The criterion used for the diagnosis of iron deficiency anaemia is a Hb level <110 g/L in the 1st and 3rd trimesters and <105 g/L during the 2nd trimester as recommended by the WHO. However, the UK guideline was used for borderline iron deficiency, which is an SF level <30 μg/L in all trimesters. Results: The observed prevalence of anaemia was 2.8% in the first trimester, 7.9% in the second trimester, and 27.0% in the third trimester. The prevalence of iron deficiency was 46.7% in the first trimester, 78.1% in the second trimester, and 91.7% in the third trimester. No associations with dietary patterns were found. Single women had 1.85 times the odds (95% CI 1.07 to 3.18) of being anaemic than married women. Conclusions: Iron deficiency affects a large proportion of pregnant women in Latvia in all trimesters, with iron deficiency anaemia affecting pregnant women in the third trimester. Monitoring and intervention should be performed in a timely and more targeted manner.
Collapse
Affiliation(s)
- Roberta Rezgale
- Faculty of Medicine, Rīga Stradiņš University, 16 Dzirciema Street, LV-1007 Rīga, Latvia; (R.R.); (V.C.); (K.K.A.); (V.B.); (G.L.); (D.R.)
| | - Iveta Pudule
- Centre for Disease Prevention and Control of Latvia, 22 Duntes Street, LV-1005 Rīga, Latvia;
| | - Vinita Cauce
- Faculty of Medicine, Rīga Stradiņš University, 16 Dzirciema Street, LV-1007 Rīga, Latvia; (R.R.); (V.C.); (K.K.A.); (V.B.); (G.L.); (D.R.)
| | - Kristine Klaramunta Antila
- Faculty of Medicine, Rīga Stradiņš University, 16 Dzirciema Street, LV-1007 Rīga, Latvia; (R.R.); (V.C.); (K.K.A.); (V.B.); (G.L.); (D.R.)
| | - Violeta Bule
- Faculty of Medicine, Rīga Stradiņš University, 16 Dzirciema Street, LV-1007 Rīga, Latvia; (R.R.); (V.C.); (K.K.A.); (V.B.); (G.L.); (D.R.)
- Riga East Clinical University Hospital, 2 Hipokrāta Street, LV-1038 Rīga, Latvia
| | - Gunta Lazdane
- Faculty of Medicine, Rīga Stradiņš University, 16 Dzirciema Street, LV-1007 Rīga, Latvia; (R.R.); (V.C.); (K.K.A.); (V.B.); (G.L.); (D.R.)
| | - Dace Rezeberga
- Faculty of Medicine, Rīga Stradiņš University, 16 Dzirciema Street, LV-1007 Rīga, Latvia; (R.R.); (V.C.); (K.K.A.); (V.B.); (G.L.); (D.R.)
- Riga Maternity Hospital, 45 Miera Street, LV-1013 Rīga, Latvia
| | - Laila Meija
- Faculty of Medicine, Rīga Stradiņš University, 16 Dzirciema Street, LV-1007 Rīga, Latvia; (R.R.); (V.C.); (K.K.A.); (V.B.); (G.L.); (D.R.)
- Pauls Stradins Clinical University Hospital, 13 Pilsoņu Street, LV-1002 Rīga, Latvia
- Correspondence: ; Tel.: +371-294-081-99
| |
Collapse
|
8
|
Cochrane KM, Hutcheon JA, Karakochuk CD. Iron-Deficiency Prevalence and Supplementation Practices Among Pregnant Women: A Secondary Data Analysis From a Clinical Trial in Vancouver, Canada. J Nutr 2022; 152:2238-2244. [PMID: 35687377 PMCID: PMC9535446 DOI: 10.1093/jn/nxac135] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND North American public health guidelines recommend supplementation with an iron-containing prenatal multivitamin throughout pregnancy to meet the RDA of 27 mg of elemental iron daily. However, whether supplementation with standard prenatal multivitamins is sufficient to prevent maternal iron deficiency is unclear, as needs increase substantially with advancing gestation. OBJECTIVES This study aimed to assess iron status in early and late pregnancy among 60 pregnant women receiving 27 mg/day of elemental iron as part of a randomized trial in Vancouver, Canada. METHODS Study visits were conducted at 8-21 (baseline) and 24-38 (endline) weeks of gestation. Venous blood specimens were collected for a complete blood count and measurement of iron and inflammatory biomarkers. Supplementation with any additional iron (beyond 27 mg/day) was reported by participants (treatment with additional iron is recommended if ferritin is <30 μg/L). Quantile regression was used to explore predictors of endline ferritin concentrations, including ethnicity, education, income, and baseline ferritin measurement. RESULTS Overall, 60 and 54 women participated in baseline and endline visits, respectively. Rates of probable iron deficiency (ferritin <30 μg/L) at baseline and endline were 17 (28%) and 44 (81%), respectively. Less than half (n = 18; 41%) of participants with probable iron deficiency at endline reported supplementation with additional iron. Ethnicity was the only significant modifier of endline ferritin, with higher concentrations in those of South, East, and Southeast Asian ethnicity compared to those of European ethnicity (β: 10.4 μg/L; 95% CI: 0.3-20.5). CONCLUSIONS Pregnant individuals may require additional supplemental iron beyond 27 mg to meet requirements in later pregnancy, given the high rates of iron deficiency observed in this clinical trial, despite consumption meeting 100% of the RDA. This trial was registered at clinicaltrials.gov as NCT04022135.
Collapse
Affiliation(s)
- Kelsey M Cochrane
- Food Nutrition and Health Faculty of Land and Food Systems University of British Columbia, Vancouver, Canada,BC Children's Hospital Research Institute University of British Columbia, Vancouver, Canada
| | - Jennifer A Hutcheon
- BC Children's Hospital Research Institute University of British Columbia, Vancouver, Canada,Obstetrics and Gynaecology Faculty of Medicine University of British Columbia, Vancouver, Canada
| | | |
Collapse
|
9
|
Liu Y, Li G, Guo N, Liu X, Huang S, Du Q. Association Between Maternal Characteristics and the Risk of Isolated Maternal Hypothyroxinemia. Front Endocrinol (Lausanne) 2022; 13:843324. [PMID: 35498400 PMCID: PMC9039333 DOI: 10.3389/fendo.2022.843324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 03/08/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We aimed to determine the association between maternal characteristics and isolated maternal hypothyroxinemia (IMH). METHODS Pregnancies registered at Shanghai First Maternity and Infant Hospital between January 2014 and September 2020 were included in this cross-sectional study. IMH was defined as free thyroxine (FT4) levels below the 10th percentile with TSH within the normal reference range. Multivariate logistic regression models were used to identify potential risk factors for IMH, including demographic information, anthropometric measurements and nutritional status. RESULTS A total of 54586 singleton pregnancies were included, involving 6084 women with IMH and 48502 euthyroid women. Multivariate logistic regression analyses showed that the variables for women with ages ≥35 (adjusted OR = 1.30, 95% CI:1.20-1.40), non-local residence (adjusted OR = 1.16, 95% CI:1.09-1.23), multiparas (adjusted OR = 1.11, 95% CI:1.03-1.21), pre-pregnancy overweight (adjusted OR = 1.37, 95% CI:1.27-1.49) or obesity (adjusted OR = 1.35, 95% CI:1.18-1.54), and iron deficiency (adjusted OR = 1.27, 95% CI:1.20-1.35) were independent risk factors for IMH in the overall study population, which were identical to those in the first trimester subgroup. CONCLUSIONS Maternal characteristics were associated with the onset of IMH. Maternal age, residence of origin, parity, pre-pregnancy body mass index (BMI) and iron status should be comprehensively considered to evaluate the risk of IMH, according to which obstetricians could determine an optimal assessment time for thyroid function.
Collapse
Affiliation(s)
- Yang Liu
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Guohua Li
- Department of Reproductive Immunology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Nafei Guo
- Department of Nursing, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaosong Liu
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shijia Huang
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qiaoling Du
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Qiaoling Du,
| |
Collapse
|
10
|
Aleksić J. The influence of vitamin D and iron on thyroid function and thyroid autoimmunity. MEDICINSKI GLASNIK SPECIJALNE BOLNICE ZA BOLESTI ŠTITASTE ŽLEZDE I BOLESTI METABOLIZMA 2022. [DOI: 10.5937/mgiszm2287064a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
11
|
Moreno-Reyes R, Corvilain B, Daelemans C, Wolff F, Fuentes Peña C, Vandevijvere S. Iron Deficiency Is a Risk Factor for Thyroid Dysfunction During Pregnancy: A Population-Based Study in Belgium. Thyroid 2021; 31:1868-1877. [PMID: 34538131 DOI: 10.1089/thy.2021.0286] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Iron deficiency affects thyroid hormone synthesis by impairing the activity of the heme-dependent thyroid peroxidase. The prevalence of iron deficiency is elevated particularly in pregnant women. This study aimed to investigate the effects of iron status on thyroid function in a nationally representative sample of mildly iodine-deficient pregnant women. Methods: The study population comprised a sample of pregnant women in Belgium during the first and third trimesters of pregnancy (n = 1241). Women were selected according to a multistage proportional-to-size stratified and clustered sampling design. Urine and blood samples were collected, and a questionnaire was completed face to face with the study nurse. Concentrations of free thyroxine (fT4), total thyroxine (T4), free triiodothyronine, thyrotropin (TSH), thyroglobulin (Tg), thyroid peroxidase antibodies, Tg antibodies, hemoglobin, serum ferritin (SF), soluble transferrin receptor, urinary iodine concentrations (UICs) were measured and body iron stores (BIS) were calculated. Results: Median UICs were 117 and 132 μg/L in the first and third trimesters of pregnancy, respectively (p < 0.05). The frequency of SF <15 μg/L was 6.2% in the first trimester and 39.6% in the third trimester of pregnancy (p < 0.05). UIC was a significant predictor of serum Tg concentrations (p < 0.01) but not of thyroid hormone or TSH concentrations. The frequency of fT4<percentile 10th in the third trimester of pregnancy was 24% and 14% in pregnant women with negative BIS and positive BIS, respectively (p < 0.05). SF and BIS were significant predictors of fT4 and T4 in the first trimester of pregnancy (p < 0.05). Hemoglobin was a significant predictor of fT4 in both trimesters (p < 0.01) and for T4 in the third trimester (p = 0.015). Conclusion: Iron deficiency, but not mild iodine deficiency, is a determinant of serum fT4 and T4 in pregnant women. Correcting iron deficiency may help to maintain optimal thyroid function, in addition to preventing anemia during pregnancy.
Collapse
Affiliation(s)
- Rodrigo Moreno-Reyes
- Department of Nuclear Medicine, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB); Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Bernard Corvilain
- Department of Endocrinology and Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB); Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Caroline Daelemans
- Department of Gynecology and Obstetrics, Hôpital Erasme; Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB); Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Fleur Wolff
- Department of Department of Clinical Chemistry, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB); Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Camilo Fuentes Peña
- Department of Nuclear Medicine, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB); Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | |
Collapse
|
12
|
Jin Y, Coad J, Zhou SJ, Skeaff S, Ramilan T, Brough L. Prevalence of thyroid dysfunction in postpartum women with suboptimal iodine and selenium and adequate iron status. Clin Endocrinol (Oxf) 2021; 95:873-881. [PMID: 34008190 DOI: 10.1111/cen.14502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Postpartum women experience thyroid dysfunction at twice the prevalence of the general population. Adequate biosynthesis of thyroid hormones depends on three trace elements: iodine, selenium and iron. This study aimed to investigate thyroid dysfunction within a cohort of women at six months postpartum in relation to iodine, selenium and iron status. DESIGN This cross-sectional study was part of an observational longitudinal cohort Mother and Infant Nutrition Investigation; data obtained at six months postpartum are reported. SUBJECTS Mother-infant pairs (n = 87) were recruited at three months postpartum and followed up at six months postpartum (n = 78). MEASUREMENTS Thyroid hormones (free triiodothyronine, free thyroxine, thyroid-stimulating hormone) and thyroid peroxidase antibodies were measured. Urinary iodine concentration, breast milk iodine concentration, serum thyroglobulin, plasma selenium, serum ferritin and serum soluble transferrin receptors were determined. Nonparametric data were expressed as median (25th, 75th percentile). RESULTS Thyroid dysfunction was found in 18% of women, and 4% of women had iron deficiency. Median urinary iodine concentration was 85 (43, 134) µg/L, median breast milk iodine concentration was 59 (39, 109) µg/L, and median serum thyroglobulin at 11.4 (8.6, 18.6) µg/L, indicating iodine deficiency. Median plasma selenium concentration was 105.8 (95.6, 115.3) µg/L. Women with marginally lower plasma selenium concentration were 1.12% times more likely to have abnormal TSH concentrations (p = .001). CONCLUSIONS There was a high prevalence of thyroid dysfunction. Plasma selenium concentration was the only significant predictor of the likelihood that women had thyroid dysfunction within this cohort, who were iodine deficient and mostly had adequate iron status. Strategies are required to improve both iodine and selenium status to better support maternal thyroid function.
Collapse
Affiliation(s)
- Ying Jin
- School of Health Sciences, College of Health, Massey University, Palmerston North, New Zealand
| | - Jane Coad
- Nutrition Science, School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North, New Zealand
| | - Shao J Zhou
- School of Agriculture, Food and Wine, Faculty of Sciences & Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Sheila Skeaff
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Thiagarajah Ramilan
- School of Agriculture and Environment, College of Sciences, Massey University, Palmerston North, New Zealand
- School of Agriculture and Food, The University of Melbourne, Victoria, Australia
| | - Louise Brough
- Nutrition Science, School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North, New Zealand
| |
Collapse
|
13
|
Harnessing the Wild Relatives and Landraces for Fe and Zn Biofortification in Wheat through Genetic Interventions—A Review. SUSTAINABILITY 2021. [DOI: 10.3390/su132312975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Micronutrient deficiencies, particularly iron (Fe) and zinc (Zn), in human diets are affecting over three billion people globally, especially in developing nations where diet is cereal-based. Wheat is one of several important cereal crops that provide food calories to nearly one-third of the population of the world. However, the bioavailability of Zn and Fe in wheat is inherently low, especially under Zn deficient soils. Although various fortification approaches are available, biofortification, i.e., development of mineral-enriched cultivars, is an efficient and sustainable approach to alleviate malnutrition. There is enormous variability in Fe and Zn in wheat germplasm, especially in wild relatives, but this is not utilized to the full extent. Grain Fe and Zn are quantitatively inherited, but high-heritability and genetic correlation at multiple locations indicate the high stability of Fe and Zn in wheat. In the last decade, pre-breeding activities have explored the potential of wild relatives to develop Fe and Zn rich wheat varieties. Furthermore, recent advances in molecular biology have improved the understanding of the uptake, storage, and bioavailability of Fe and Zn. Various transportation proteins encoding genes like YSL 2, IRT 1, OsNAS 3, VIT 1, and VIT 2 have been identified for Fe and Zn uptake, transfer, and accumulation at different developing stages. Hence, the availability of major genomic regions for Fe and Zn content and genome editing technologies are likely to result in high-yielding Fe and Zn biofortified wheat varieties. This review covers the importance of wheat wild relatives for Fe and Zn biofortification, progress in genomics-assisted breeding, and transgenic breeding for improving Fe and Zn content in wheat.
Collapse
|
14
|
Margetaki K, Vafeiadi M, Kampouri M, Roumeliotaki T, Karakosta P, Daraki V, Kogevinas M, Hu H, Kippler M, Chatzi L. Associations of exposure to cadmium, antimony, lead and their mixture with gestational thyroid homeostasis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 289:117905. [PMID: 34371266 DOI: 10.1016/j.envpol.2021.117905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/29/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
Maintaining thyroid homeostasis during pregnancy is vital for fetal development. The few studies that have investigated associations between metal exposure and gestational thyroid function have yielded mixed findings. To evaluate the association of exposure to a mixture of toxic metals with thyroid parameters in 824 pregnant women from the Rhea birth cohort in Crete, Greece. Concentrations of three toxic metals [cadmium (Cd), antimony (Sb), lead (Pb)] and iodine were measured in urine using inductively coupled plasma mass spectrometry and thyroid hormones [Thyroid Stimulating Hormone (TSH), free thyroxine (fT4), and free triiodothyronine (fT3)] were measured in serum in early pregnancy. Associations of individual metals with thyroid parameters were assessed using adjusted regression models, while associations of the metal mixture with thyroid parameters were assessed using Bayesian Kernel Machine Regression (BKMR).Women with high (3rd tertile) concentrations of urinary Cd, Sb and Pb, respectively, had 13.3 % (95%CI: 2.0 %, 23.2 %), 12.5 % (95%CI: 1.8 %, 22.0 %) and 16.0 % (95%CI: 5.7 %, 25.2 %) lower TSH compared to women with low concentrations (2nd and 1st tertile). In addition, women with high urinary Cd had 2.2 % (95%CI: 0.0 %, 4.4 %) higher fT4 and 4.0 % (95%CI: -0.1 %, 8.1 %) higher fT3 levels, and women with high urinary Pb had 4 % (95%CI: 0.2 %, 8.0 %) higher fT3 levels compared to women with low exposure. The negative association of Cd with TSH persisted only when iodine sufficiency was unfavorable. BKMR attested that simultaneous exposure to toxic metals was associated with decreased TSH and increased fT3 and revealed a potential synergistic interaction of Cd and Pb in association with TSH. The present results suggest that exposure to toxic metals even at low levels can alter gestational thyroid homeostasis.
Collapse
Affiliation(s)
- Katerina Margetaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
| | - Mariza Kampouri
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Theano Roumeliotaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Polyxeni Karakosta
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Vasiliki Daraki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Manolis Kogevinas
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Howard Hu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Maria Kippler
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Leda Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| |
Collapse
|
15
|
Verma NR, Naik G, Patel S, Padhi P, Naik T, Nanda R. A detailed observational study of maternal and neonatal variables affecting the thyroid-stimulating hormone levels in neonates. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2021. [DOI: 10.1186/s43054-021-00080-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Thyroid hormones are essential for fetal growth and the central nervous system development. Thyroid-stimulating hormone (TSH) is the key regulatory hormone. Their levels are quite dynamic in the perinatal period and are influenced by multiple factors. These factors should be taken into consideration during newborn screening. This study aimed to observe the impact of maternal and neonatal factors on neonatal TSH status.
Results
Neonatal TSH (nTSH) depicted a positive correlation with parity (p = 0.066) while negative correlation recorded with maternal blood haemoglobin (p = 0.007) among maternal factors.
New-born length (p = 0.027) and birth weight (p < 0.001) exhibited a negative correlation with nTSH among neonatal factors.
Conclusions
This study concludes that among all the maternal and neonatal factors, birth weight shows the most influence on nTSH. However, the effect may be compounded by other factors. As these risk elements rarely occur singly, it is often difficult to find the exposure which confer the risk on children. These factors should be considered while interpreting the result of the screening program.
Collapse
|
16
|
Löser A, Ramke K, Grohmann M, Krause L, Roser P, Greinert F, Finger A, Sommer M, Culmann E, Lorenz T, Becker S, Henze M, Schodrok D, von Grundherr J, Tribius S, Krüll A, Petersen C. The impact of nutritional counseling on thyroid disorders in head and neck cancer patients after (chemo)radiotherapy: results from a prospective interventional trial. Strahlenther Onkol 2021; 198:135-148. [PMID: 34724084 PMCID: PMC8789704 DOI: 10.1007/s00066-021-01865-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/03/2021] [Indexed: 11/27/2022]
Abstract
Objective To analyze the impact of nutritional counseling on the development of hypothyroidism after (chemo)radiotherapy in head and neck cancer patients to propose a new normal tissue complication probability (NTCP) model. Materials and methods At baseline, at the end of (chemo)radiotherapy, and during follow-up, thyroid-stimulating hormone (TSH) with free thyroxin (fT3 and fT4), nutritional status, and nutrient intake were prospectively analyzed in 46 out of 220 screened patients. Patients received (chemo)radiotherapy within an intervention (individual nutritional counseling every 2 weeks during therapy) and a control group (no nutritional counseling). Results Overall median follow-up was 16.5 [IQR: 12; 22] months. Fourteen patients (30.4%) presented with hypothyroidism after 13.5 [8.8; 17] months. During (chemo)radiotherapy, nutritional status worsened in the entire cohort: body mass index (p < 0.001) and fat-free mass index (p < 0.001) decreased, calorie deficit (p = 0.02) increased, and the baseline protein intake dropped (p = 0.028). The baseline selenium intake (p = 0.002) increased until the end of therapy. Application of the NTCP models by Rønjom, Cella, and Boomsma et al. resulted in good performance of all three models, with an AUC ranging from 0.76 to 0.78. Our newly developed NTCP model was based on baseline TSH and baseline ferritin. Model performance was good, receiving an AUC of 0.76 (95% CI: 0.61–0.87), with a sensitivity of 57.1% and specificity of 96.9% calculated for a Youden index of 0.73 (p = 0.004; area = 0.5). Conclusion Baseline TSH and ferritin act as independent predictors for radiotherapy-associated hypothyroidism. The exclusion of such laboratory chemistry parameters in future NTCP models may result in poor model performance.
Collapse
Affiliation(s)
- Anastassia Löser
- Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Kerstin Ramke
- Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Maximilian Grohmann
- Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Linda Krause
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Pia Roser
- Center for Internal Medicine, Department of Nephrology, Rheumatology and Endocrinology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Franziska Greinert
- Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Anna Finger
- Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Margaret Sommer
- Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Eva Culmann
- Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Tessa Lorenz
- Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Saskia Becker
- Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Marvin Henze
- Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Daniel Schodrok
- Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Julia von Grundherr
- University Medical Center Hamburg-Eppendorf, University Cancer Center Hamburg (UCCH), Martinistraße 52, 20246, Hamburg, Germany
| | - Silke Tribius
- Hermann Holthusen Institute for Radiation Oncology, Asklepios Hospital St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Andreas Krüll
- Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Cordula Petersen
- Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| |
Collapse
|
17
|
Guo C, Qian Y, Yan L, Li Z, Liu H, Li X, Wang Z, Zhu X, Wang Z, Wang J, Wei Y. The changes of essential trace elements in residents from an e-waste site and the relationships between elements and hormones of the hypothalamic-pituitary-thyroid (HPT) axis. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 222:112513. [PMID: 34274839 DOI: 10.1016/j.ecoenv.2021.112513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 06/13/2023]
Abstract
The heavy metals pollution and related health issues were widely reported in e-waste sites, while the impacts of e-waste exposure on the essential trace elements have been neglected. The aim of this study was focused on the internal Cu, Fe, Mn and Zn levels in the residents from an e-waste site and the potential endocrine disrupting effects of these essential trace elements on the hypothalamic-pituitary-thyroid (HPT) axis. This was a cross-sectional study that 87 subjects were recruited from the e-waste site and 81 from the reference site. The results indicated that the e-waste exposed group had significantly lower Fe, Mn level when compared with the reference group (p < 0.05). Cu and Zn were also lower in the exposed group but the differences were not statistically significant. The exposed group had significantly higher TSH level and Fe was significantly associated with TSH in the females (β (95% CI): - 1.892 (-3.309, -0.475), p = 0.009), rather than in males or all subjects. The exposed group also showed oxidative stress which was indicated by the increased concentrations of MDA and 8-iso-PG. It was further indicated the elevated MDA was mediated by the increase of TSH in the females but not directly related to Fe. In conclusion, the e-waste exposed group showed a decrease of essential trace elements, an increase of TSH and oxidative stress. The decreased Fe was related to the elevated TSH in the females, which further indirectly mediated the increase of oxidative stress. The results suggested that the internal exposure levels and the potential health effects of the essential trace elements in populations from e-waste sites should be of more concern. And the women might be more vulnerable and they need more protection to against the adverse health effects from e-waste.
Collapse
Affiliation(s)
- Chen Guo
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100012, China
| | - Yan Qian
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100012, China
| | - Lailai Yan
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing 100191, China
| | - Zhigang Li
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100012, China
| | - Huijie Liu
- Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100005, China
| | - Xiaoqian Li
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100012, China
| | - Zhanshan Wang
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100012, China
| | - Xiaojing Zhu
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100012, China
| | - Ziye Wang
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100012, China
| | - Jingyu Wang
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing 100191, China
| | - Yongjie Wei
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100012, China.
| |
Collapse
|
18
|
Lakhal-Littleton S. Advances in understanding the crosstalk between mother and fetus on iron utilization. Semin Hematol 2021; 58:153-160. [PMID: 34389107 DOI: 10.1053/j.seminhematol.2021.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/16/2021] [Accepted: 06/25/2021] [Indexed: 12/24/2022]
Abstract
A full-term pregnancy comes with significant demand for iron. Not meeting this demand has adverse effects on maternal health and on the intrauterine and postnatal development of the infant. In the infant, some of these adverse effects cannot be reversed by postnatal iron supplementation, highlighting the need to tackle iron deficiency in utero. Achieving this requires sound understanding of the pathways that govern iron transfer at the fetomaternal interface. Two pathways are emerging as key players in this context; the hepcidin/ferroportin axis pathway and the iron regulatory protein (IRPs) pathway. In late gestation, suppression of maternal hepcidin, by as yet unknown factors, is required for increasing iron availability to the growing fetus. In the placenta, the rate of iron uptake by transferrin receptor TfR1 at the apical/maternal side and of iron release by ferroportin FPN at the basal/fetal side is controlled by IRP1. In fetal hepatocytes, build up of fetal iron stores requires post-translational inhibition of FPN by the cell-autonomous action of hepcidin. In the fetal liver, FPN is also subject to additional control at the transcriptional level, possibly by the action of hypoxia-inducible factor HIF2α. The rates of apical iron uptake and basal iron release in the placenta are modulated according to iron availability in the maternal blood and the placenta's own needs. This placental modulation ensures that the amount of iron delivered to the fetal circulation is maintained within a normal range, even in the face of mild maternal iron deficiency or overload. However, when maternal iron deficiency or overload are extreme, placental modulation is not sufficient to maintain normal iron supply to the fetus, resulting in fetal iron deficiency and overload respectively. Thus, the rate of iron transfer at the fetomaternal interface is subject to several regulatory signals operating simultaneously in the maternal liver, the placenta and the fetal liver. These regulatory signals act in concert to maintain normal iron supply to the fetus within a wide range of maternal iron states, but fail to do so when maternal iron deficiency or overload are extreme. The limitations of existing experimental models must be overcome if we are to gain better understanding of the role of these regulatory signals in normal and complicated pregnancy. Ultimately, that understanding could help identify better markers of fetal iron demand and underpin novel iron replacement strategies to treat maternal and fetal iron deficiency.
Collapse
|
19
|
Iodine nutrition: Disorders, monitoring and policies. ADVANCES IN FOOD AND NUTRITION RESEARCH 2021; 96:365-415. [PMID: 34112358 DOI: 10.1016/bs.afnr.2021.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Iodine is an essential mineral nutrient and an integral component of thyroid hormones. Iodine deficiency is typically associated with goiter, but can have more serious health implications. Adequate iodine status is important for normal brain development. Iodine deficiency in utero or in early life can cause severe neurological and cognitive impairment. Over the last three decades, global efforts have reduced the prevalence of iodine deficiency disorders (IDD) in many areas of the world with implementation of nutrition policies and programs such as "salt" iodization. However, in a number of areas iodine deficiency is still widespread. Iodine deficiency in remote regions with high poverty will be more difficult to eradicate. Efforts to eliminate IDD in affected areas and sustaining successful iodine programs will be a priority given the substantial public health and economic benefits. A key component will be periodic monitoring of population iodine status to ensure sufficient intakes and the absence of excessive intakes. Median urinary iodine concentration (UIC), a validated biomarker for assessing population iodine status, will facilitate monitoring. Research validating "usual" UIC for use in combination with the Estimated Average Requirement cut-point method will expand its utility and allow accurate determination of the prevalence of inadequate intakes in populations. Further research on the development of biomarkers for assessment of individual iodine status for routine patient care will be important.
Collapse
|
20
|
Ramezani Tehrani F, Nazarpour S, Behboudi-Gandevani S. Isolated maternal hypothyroxinemia and adverse pregnancy outcomes: A systematic review. J Gynecol Obstet Hum Reprod 2021; 50:102057. [PMID: 33401029 DOI: 10.1016/j.jogoh.2020.102057] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 02/08/2023]
Abstract
Maternal thyroid hormones are vital for a normal pregnancy and the development of fetus and childhood; inadequate availability of thyroid hormones during pregnancy is associated with adverse pregnancy outcomes. Isolated maternal hypothyroxinemia (IMH) is defined as a low maternal T4 in the absence of TSH elevation. This systematic review aimed to investigate the association between IMH and adverse pregnancy outcomes. PubMed, Scopus and Web of science were searched for retrieving observational studies published up to September 2020, investigating the association of IMH with adverse pregnancy outcomes. From a total of 308 articles, 17 met our eligibility criteria and were used for the purpose of the present study. Definition of IMH varied in different studies. While some studies reported no adverse pregnancy outcomes for IMH, other studies found a positive association between first trimester IMH and feto-maternal outcomes including gestational hypertension, gestational diabetes, preterm delivery, fetal distress, small for gestational age, musculoskeletal malformations, spontaneous abortion, placental abruption and macrosomia. IMH, identified in the second trimester was associated with an increase in the risk of gestational diabetes, and hypertensive disorders of pregnancy in one study. There is no consensus on the adverse effects of IMH on pregnancy outcomes. Further comprehensive cohort studies using one standard definition for IMH, with large sample size and control of important confounders such as iodine status and maternal Thyroid peroxidase antibody (TPOAb) are needed for precise assessment of this association.
Collapse
Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Sima Nazarpour
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Midwifery, Varamin - Pishva Branch, Islamic Azad University, Tehran, Iran.
| | | |
Collapse
|
21
|
Luo J, Wang X, Yuan L, Guo L. Iron Deficiency, a Risk Factor of Thyroid Disorders in Reproductive-Age and Pregnant Women: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:629831. [PMID: 33716980 PMCID: PMC7947868 DOI: 10.3389/fendo.2021.629831] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/21/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Iron deficiency (ID) is concerned as the most common nutritional deficiency worldwide. The effects of ID on thyroid function and autoimmunity in pregnant women and reproductive-age women are controversial. The aim of the current study was to summarize the evidences and evaluate the relationship between ID and thyroid disorders. METHODS In this systematic review and meta-analysis, studies published on the Cochrane, Embase, Medline, and PubMed databases by October 2020 were searched. A total of 636 studies which discussed the correlation between ID and thyroid disorders were eligible in the initial search. Pooled mean differences (MD) and 95% confidence intervals (CI) were calculated for the assessment of thyrotropin (TSH) and free thyroxine (FT4) levels. Combined odd ratios (OR) and 95% CI were calculated for the assessment of the prevalence of overt and subclinical hypothyroidism, positive thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb). RESULTS For women of reproductive age, ID could significantly increase the risk of positive TPOAb (OR: 1.89; 95% CI: 1.17, 3.06: P = 0.01) and both positive TPOAb and TgAb (OR: 1.48; 95% CI: 1.03, 2.11: P = 0.03). The meta-analysis of pregnant women showed that pregnant women with ID had increased serum TSH levels (MD: 0.12; 95% CI: 0.07, 0.17; P < 0.00001) and decreased FT4 levels (MD: -0.73; 95% CI: -1.04, -0.41; P < 0.00001). Meanwhile, the prevalence of overt (OR: 1.60; 95% CI: 1.17, 2.19; P = 0.004) and subclinical (OR: 1.37; 95% CI: 1.13, 1.66; P = 0.001) hypothyroidism in pregnant women with ID was significantly increased. CONCLUSIONS ID may adversely affect thyroid function and autoimmunity of pregnant and reproductive-age women and it is very necessary for monitoring iron nutritional status and early treatment of ID for them.
Collapse
Affiliation(s)
- Jingyi Luo
- Department of Endocrinology, Beijing Hospital, The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoxia Wang
- Department of Endocrinology, Beijing Hospital, The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Li Yuan
- The Savaid School of Medicine, University of Chinese Academy of Sciences, Beijing, China
- *Correspondence: Lixin Guo, ; Li Yuan,
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Lixin Guo, ; Li Yuan,
| |
Collapse
|
22
|
Nie GY, Wang R, Liu P, Li M, Sun DJ. Mild Anemia May Affect Thyroid Function in Pregnant Chinese Women During the First Trimester. Front Endocrinol (Lausanne) 2021; 12:772917. [PMID: 34956084 PMCID: PMC8695550 DOI: 10.3389/fendo.2021.772917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pregnant women are often susceptible to anemia, which can damage the thyroid gland. However, compared with moderate and severe anemia, less attention has been paid to mild anemia. The purpose of this study was to evaluate the effect of mild anemia on the thyroid function in pregnant women during the first trimester. METHODS A total of 1,761 women in the first trimester of their pregnancy were enrolled from Shenyang, China, and divided into mild anemia and normal control groups based on their hemoglobin levels. Thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) levels were compared between the two groups. RESULTS The TSH levels of pregnant women with mild anemia were higher than those of pregnant women without mild anemia (p < 0.05). Normal control women were selected to set new reference intervals for TSH, FT3, and FT4 levels during the first trimester, which were 0.11-4.13 mIU/l, 3.45-5.47 pmol/l, and 7.96-16.54 pmol/l, respectively. The upper limit of TSH 4.13 mU/l is close to the upper limit 4.0 mU/l recommended in the 2017 American Thyroid Association (ATA) guidelines, indicating that exclusion of mild anemia may reduce the difference in reference values from different regions. Mild anemia was related to 4.40 times odds of abnormally TSH levels (95% CI: 2.84, 6.76) and 5.87 increased odds of abnormal FT3 (95% CI: 3.89, 8.85). The proportion of hypothyroidism and subclinical hypothyroidism in patients with mild anemia was higher than that in those without anemia (0.6% vs. 0, p = 0.009; 12.1% vs. 1.9%, p < 0.001). Mild anemia was related to 7.61 times increased odds of subclinical hypothyroidism (95% CI: 4.53, 12.90). CONCLUSIONS Mild anemia may affect thyroid function during the first trimester, which highlights the importance of excluding mild anemia confounding when establishing a locally derived specific reference interval for early pregnancy.
Collapse
Affiliation(s)
- Guan-ying Nie
- Key Lab of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504), Key Laboratory of Trace Elements and Human Health, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Rui Wang
- Examination Department, Central Hospital Affiliated to Shenyang Medical College, Shenyang, China
| | - Peng Liu
- Key Lab of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504), Key Laboratory of Trace Elements and Human Health, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Ming Li
- Key Lab of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504), Key Laboratory of Trace Elements and Human Health, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
- *Correspondence: Ming Li, ; Dian-jun Sun,
| | - Dian-jun Sun
- Key Lab of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504), Key Laboratory of Trace Elements and Human Health, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
- *Correspondence: Ming Li, ; Dian-jun Sun,
| |
Collapse
|
23
|
Mahadik K, Choudhary P, Roy PK. Study of thyroid function in pregnancy, its feto-maternal outcome; a prospective observational study. BMC Pregnancy Childbirth 2020; 20:769. [PMID: 33302910 PMCID: PMC7726876 DOI: 10.1186/s12884-020-03448-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 11/22/2020] [Indexed: 12/13/2022] Open
Abstract
Background Pregnancy is a stress test of maternal thyroid function. The prevalence of thyroid dysfunction in pregnant women is high. Subclinical hypothyroidism occurs in 10% of all pregnancies. Effects of hypothyroidism in pregnancy are anemia, low birth weight and mental retardation in neonate. 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 This prospective observational study was carried out at R.D. Gardi Medical College, Ujjain, India. Subjects of this study were 198 antenatal women in third trimester with singleton pregnancy admitted in the obstetric ward, and informed consent was obtained. Women were chosen irrespective of age, parity, residence and socioeconomic status. Women with multiple pregnancy, a known case of thyroid disorder, or any pre-existing medical disorder were excluded. Routine hematological parameters and estimation of T3, T4 and TSH was conducted. Patients with deranged thyroid profile were subsequently assessed for maternal and fetal complications. History of infertility, family history of thyroid disease, menstrual pattern, recurrent abortion, hemoglobin level and fetal outcome were the main study variables. Data was analysed in SPSS software for statistical co-relation. Results Prevalence of thyroid disorder is 11%; with subclinical hypothyroidism, overt hypothyroidism and subclinical hyperthyroidism occurring in 5.6, 3.5 and 1.5% of subjects respectively. In women with subclinical and overt hypothyroidism, anemia was present in 26.3% being significantly associated with hypothyroidism (p = 0.008). With respect to fetal outcome, LBW 31.6% (p = 0.001), NICU admission 42.1%, (p = 0.000) and low APGAR Score (21.1%, p = 0.042) were statistically associated with hypothyroidism. Risk of anemia, Low Birth weight, NICU admissions, and low APGAR score was 4.8, 6.3, 0.14 and 3.64 times higher respectively in women with hypothyroidism than in women who are euthyroid. Conclusion Prevalence of subclinical hypothyroidism is 5.6% in 3rd trimester of pregnancy. Anemia, pre-eclampsia, high caesarean rates and neonatal morbidities is significantly associated with hypothyroidism.
Collapse
Affiliation(s)
- Kalpana Mahadik
- Department of Obstetrics & Gynecology, R.D. Gardi Medical College, Ujjain, Pin-456006, India.
| | - Payal Choudhary
- Department of Obstetrics & Gynecology, R.D. Gardi Medical College, Ujjain, Pin-456006, India
| | - P K Roy
- Department of Obstetrics & Gynecology, R.D. Gardi Medical College, Ujjain, Pin-456006, India
| |
Collapse
|
24
|
Khan SZA, Lungba RM, Ajibawo-Aganbi U, Veliginti S, Perez Bastidas MV, Saleem S, Cancarevic I. Minerals: An Untapped Remedy for Autoimmune Hypothyroidism? Cureus 2020; 12:e11008. [PMID: 33094039 PMCID: PMC7574993 DOI: 10.7759/cureus.11008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
For decades, the focus of managing autoimmune hypothyroidism has been on thyroxine replacement. Correcting lab parameters such as thyroid stimulating hormone (TSH) has been a primary goal. The increasing prevalence of Hashimoto’s thyroiditis (HT) continues to impact the quality of life in patients. We believe a holistic approach to this disease entity, considering its underlying complex etiopathogenesis, would benefit patients. Nutraceuticals are combinations of essential nutrients and are becoming a part of novel medical treatments despite the lack of regulation. This review aims to present a concise summary of recent developments regarding minerals such as zinc, selenium, magnesium, iron, and their potential clinical benefit as nutraceuticals in patients with HT. We have explored the potential benefits and associations of these minerals in HT and thyroid function. We reviewed relevant articles, metanalyses, and clinical trials in literature platforms such as PubMed, PubMed Central, and Google Scholar. Significant data found in the literature suggesting a potential health benefit of these minerals in HT though there were many studies to the contrary. Many trials demonstrated the restoration of residual symptoms, reversal of HT-associated thyroid morphological changes, and improvement in thyroid functions. Many of these trials lack statistical power due to the small sample sizes, and their external validity may be questionable due to unaccounted confounding factors. In our opinion, to support an evidence-based holistic clinical approach, further scientific evidence is needed. The association of these elements in thyroid function necessitates more large scale pragmatic trials to elucidate the benefits of nutraceuticals in HT.
Collapse
Affiliation(s)
- Seyad Zulficar Ali Khan
- Research and Development, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Primary Care & Emergency, Ministry of Health Oman, Salalah, OMN
| | - Rayan M Lungba
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Uvie Ajibawo-Aganbi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Swathi Veliginti
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Maria V Perez Bastidas
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sania Saleem
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ivan Cancarevic
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| |
Collapse
|
25
|
Association between iron deficiency and prevalence of thyroid autoimmunity in pregnant and non-pregnant women of childbearing age: a cross-sectional study. Chin Med J (Engl) 2020; 132:2143-2149. [PMID: 31478926 PMCID: PMC6797140 DOI: 10.1097/cm9.0000000000000409] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Thyroid autoimmunity (TAI) is prevalent among women of reproductive age and associated with adverse pregnancy outcomes. This study aimed to investigate the association between iron nutritional status and the prevalence of TAI in women during the first trimester of pregnancy and in non-pregnant women of childbearing age. Methods: Cross-sectional analysis of 7463 pregnant women during the first trimester of pregnancy and 2185 non-pregnant women of childbearing age nested within the sub-clinical hypothyroid in early pregnancy study, a prospective collection of pregnant and non-pregnant women's data, was conducted in Liaoning province of China between 2012 and 2015. Serum thyrotropin, free thyroxine, thyroid peroxidase antibodies (TPOAbs), thyroglobulin antibodies (TgAbs), serum ferritin, and urinary iodine were measured. Iron deficiency (ID) was defined as serum ferritin <15 μg/L and iron overload (IO) was defined as ferritin >150 μg/L. TPOAb-positive was defined as >34 U/mL and TgAb-positive was defined as >115 U/mL. Multilevel logistic regression was conducted to examine the association between TAI and different iron nutritional status after adjusting for potential confounders. Results: The prevalence of isolated TPOAb-positive was markedly higher in women with ID than those without ID, in both pregnant and non-pregnant women (6.28% vs. 3.23%, χ2 = 10.264, P = 0.002; 6.25% vs. 3.70%, χ2 = 3,791, P = 0.044; respectively). After adjusting for confounders and the cluster effect of hospitals, ID remained associated with TPOAb-positive in pregnant and non-pregnant women (odds ratio [OR]: 2.111, 95% confidence interval [CI]: 1.241–3.591, P = 0.006; and OR: 1.822, 95% CI: 1.011–3.282, P = 0.046, respectively). Conclusion: ID was associated with a higher prevalence of isolated TPOAbs-positive, but not with isolated TgAb-positive, in both pregnant women during the first trimester of pregnancy and non-pregnant women of childbearing age, while IO was not associated with either isolated TPOAb-positive or isolated TgAb-positive. Clinical trial registration: ChiCTR-TRC-13003805, http://www.chictr.org.cn/index.aspx.
Collapse
|
26
|
Mohammed H, Marquis GS, Aboud F, Bougma K, Samuel A. Pre-pregnancy iodized salt improved children's cognitive development in randomized trial in Ethiopia. MATERNAL AND CHILD NUTRITION 2020; 16:e12943. [PMID: 31912649 PMCID: PMC7296810 DOI: 10.1111/mcn.12943] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 12/04/2019] [Accepted: 12/15/2019] [Indexed: 12/04/2022]
Abstract
The overarching Ethiopia project examined the effects of early market introduction of iodized salt on the growth and mental development of young children. Sixty districts were randomly assigned to intervention (early market access to iodized salt) or control (later access through market forces), and one community per district was randomly chosen as the sampling unit. For this project, 22 of the districts were included. The participants were 1,220 pregnant women who conceived after the intervention began. When their children were 2 to 13 months old, field staff collected information on household sociodemographic status and iodized salt intake, child stimulation, maternal depression symptoms, children's diet, anthropometry, urinary iodine concentration (UIC), hemoglobin, and mental development scores (Bayley III scales). Fewer mothers prepartum (28% vs. 41%, p < .05) and their children (13% vs. 20%, p < .05) were iodine deficient (UIC <50 μg/L) in the intervention compared with the control group. The intervention children had higher cognitive scores (33.3 ± 0.3 vs. 32.6 ± 0.3; Δ = 0.6; 95% CI [0.0, 1.3]; d = 0.17; p = .01; 4 IQ points) than their controls. The other Bayley subscale scores did not differ from control children. The intervention group had a higher child stimulation (22.7 ± 0.2 vs. 22.1 ± 0.2; Δ = 0.5; 95% CI [0.02, 0.89]; d = 0.17; p = .01) but not growth indicators (weight‐for‐age z score, length‐for‐age z score, and weight‐for‐length z score: −1.1 ± 0.1 vs. −1.1 ± 0.1, −1.7 ± 0.1 vs. −1.7 ± 0.1; −0.2 ± 0.1 vs. −0.1 ± 0.1, respectively, all p > .05) compared with their controls. Iodized salt intake improved iodine status of both pregnant women and their children and also child cognitive development.
Collapse
Affiliation(s)
- Husein Mohammed
- Nutrition and Food Science Department, University of Ghana, Accra, Ghana
| | - Grace S Marquis
- School of Dietetics and Human Nutrition, McGill University, Quebec, Canada
| | - Frances Aboud
- Department of Psychology, McGill University, Quebec, Canada
| | - Karim Bougma
- School of Dietetics and Human Nutrition, McGill University, Quebec, Canada
| | - Aregash Samuel
- Food Sciences and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| |
Collapse
|
27
|
Okuroglu N, Ozturk A, Özdemir A. IS IRON DEFICIENCY A RISK FACTOR FOR THE DEVELOPMENT OF THYROID AUTOANTIBODIES IN EUTHYROID WOMEN WITH REPRODUCTIVE AGES? ACTA ENDOCRINOLOGICA-BUCHAREST 2020; 16:49-52. [PMID: 32685038 DOI: 10.4183/aeb.2020.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Contex The first trimester of pregnancy is the most sensitive period in terms of thyroid hypofunction. Iron deficiency has been associated with both thyroid function and thyroid autoimmunity. Objective We aimed to investigate whether iron deficiency is a risk factor for thyroid autoimmunity in non-pregnant women at childbearing age. Design This cross- sectional study was conducted in non-pregnant women who presented to the Internal Medicine Policlinic between January 2018 and December 2018 in the University of Health Sciences "Fatih Sultan Mehmet" Training and Research Hospital. Methods Three hundred fifty-eight non-pregnant women of reproductive ages (203 iron deficient-ID, 155 control) participated in this study. Women with known thyroid disease, currently undergoing treatment for thyroid disease or whose thyroid function tests were outside the reference range were excluded from the study. Blood sample was taken after at least 8-10 hours of fasting for measurement of serum iron (Fe), total iron binding capacity (TIBC), serum ferritin (SF), whole blood count, thyroid function tests (fT4, TSH), anti-thyroid peroxidase antibodies (TPOAb) and anti-thyroglobulin antibody (TgAb). The patients with SF levels ≤ 15 ng/dL were accepted as iron deficiency. Results The group with ID had higher TSH and lower T4 values that did not reach statistical significance compared to the control group (p=0.101 and p=0.098, respectively). Antibody positivity was more frequent in the ID group than in the control group (35.96% vs. 20.65%, p = 0.002). Conclusions Iron deficiency is associated with thyroid autoimmunity and it should be considered as a risk factor for screening thyroid antibody, particularly in pregnancy planning women.
Collapse
Affiliation(s)
- N Okuroglu
- University of Health Sciences, "Fatih Sultan Mehmet" Training and Research Hospital, Istanbul, Turkey
| | - A Ozturk
- University of Health Sciences, "Fatih Sultan Mehmet" Training and Research Hospital, Istanbul, Turkey
| | - A Özdemir
- University of Health Sciences, "Fatih Sultan Mehmet" Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
28
|
Pop VJ, Ormindean V, Mocan A, Meems M, Broeren M, Denollet JK, Wiersinga WM, Bunevicius A. Maternal cognitive function during pregnancy in relation to hypo- and hyperthyroxinemia. Clin Endocrinol (Oxf) 2019; 91:824-833. [PMID: 31614008 PMCID: PMC6900117 DOI: 10.1111/cen.14107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/01/2019] [Accepted: 10/07/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To assess a possible relationship between maternal cognitive dysfunction during pregnancy and hypothyroxinemia, adjusted for major confounders. BACKGROUND Thyroid dysfunction in general is associated with cognitive dysfunction. Cognitive dysfunction is common during pregnancy. DESIGN Prospective follow-up study from 12 to 32 weeks of pregnancy. PARTICIPANTS 2082 healthy pregnant women. MEASUREMENTS Cognitive function, depression and sleeping problems were assessed by self-report questionnaires at 12, 22 and 32 weeks of gestation, higher scores reflecting more symptoms. FT4, TSH and TPO-Ab were assessed at 12 weeks of gestation. DEFINITIONS healthy (euthyroxinemia) control group: FT4 within 10-90th percentiles, without elevated TPO-Ab titres and TSH within first trimester-specific reference range (0.23-4.0 mU/L). Hypothyroxinemia: FT4 <2.5th percentile with TSH within first trimester-specific reference range. Poor cognitive function: a score >1 SD > mean on the cognitive function scale. RESULTS A total of 54 women showed hypothyroxinemia and 1476 women had euthyroxinemia. At 12 weeks, multiple logistic regression showed that poor cognitive function was independently related to hypothyroxinemia: OR: 2.9 (95% CI: 1.6-5.4), adjusted for depression (OR: 3.1; 95% CI: 2.7-4.6) and sleeping problems (OR: 2.8, 95% CI: 1.9-3.9). TPO-Ab + women with hypothyroxinemia had the highest levels of cognitive dysfunction. Other cut-offs of hypothyroxinemia (<5th or <10th percentile with normal TSH) showed similar results. GLM-ANOVA showed that throughout pregnancy women with hypothyroxinemia at 12 weeks had significantly higher cognitive dysfunction scores compared with the healthy controls: F = 12.1, P = .001. CONCLUSIONS Women with hypothyroxinemia during early gestation are at risk for poor cognitive function throughout gestation, adjusted for depression and sleeping problems.
Collapse
Affiliation(s)
- Victor J. Pop
- Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands
| | - Vlad Ormindean
- Iuliu HațieganuUniversity of Medicine and PharmacyCluj‐NapocaRomania
| | - Andreia Mocan
- Center for Diabetes, Nutrition and Metabolic DiseasesEmergency Clinical County HospitalCluj‐NapocaRomania
| | - Margreet Meems
- Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands
| | | | - Johan K. Denollet
- Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands
| | - Wilmar M. Wiersinga
- Department of Endocrinology and MetabolismAcademic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - Adomas Bunevicius
- Computational Neuroscience Outcomes CenterBrigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
- Lithuanian University of Health SciencesKaunasLithuania
| |
Collapse
|
29
|
O'Kane SM, Mulhern MS, Pourshahidi LK, Strain JJ, Yeates AJ. Micronutrients, iodine status and concentrations of thyroid hormones: a systematic review. Nutr Rev 2019; 76:418-431. [PMID: 29596650 DOI: 10.1093/nutrit/nuy008] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Context The metabolism of thyroid hormones, which are essential for normal development, involves many proteins and enzymes. It requires iodine as a key component but is also influenced by several other micronutrients, including selenium, zinc, iron, and vitamin A. Objective This systematic review was designed to investigate the effect of micronutrient status and supplementation on iodine status and thyroid hormone concentrations. Data Sources Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, electronic databases were searched from their inception to April 2016. Study Selection Human studies published in English and reporting data on micronutrient status and iodine status and/or thyroid hormone concentrations were included. Studies that examined the effect of micronutrient supplementation on iodine status and/or thyroid hormone concentrations were also included. Data Extraction A predesigned and piloted data extraction form was used to compile data from individual studies. Results A total of 57 studies were included: 20 intervention studies and 37 observational studies. Although observational evidence suggests that concentrations of selenium, zinc, and iron are positively associated with iodine status, data from randomized controlled trials fail to confirm this relationship. Conclusions Further studies are needed to provide greater understanding of the role of micronutrient status in iodine nutrition and thyroid function to ascertain the public health implications for populations worldwide.
Collapse
Affiliation(s)
- S Maria O'Kane
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, County Londonderry, United Kingdom
| | - Maria S Mulhern
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, County Londonderry, United Kingdom
| | - L Kirsty Pourshahidi
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, County Londonderry, United Kingdom
| | - J J Strain
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, County Londonderry, United Kingdom
| | - Alison J Yeates
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, County Londonderry, United Kingdom
| |
Collapse
|
30
|
Mogahed MM, El Sayed Amer E, El-Awady MA. Maternal thyroid status and its relation to ferritin and vitamin B12 in Saudi pregnant women. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2019. [DOI: 10.4103/ejim.ejim_107_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
31
|
Sitoris G, Veltri F, Kleynen P, Belhomme J, Rozenberg S, Poppe K. Screening for Thyroid Dysfunction in Pregnancy With Targeted High-Risk Case Finding: Can It Be Improved? J Clin Endocrinol Metab 2019; 104:2346-2354. [PMID: 30608533 DOI: 10.1210/jc.2018-02303] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/26/2018] [Indexed: 01/28/2023]
Abstract
CONTEXT AND OBJECTIVE Targeted screening is proposed for the detection of thyroid dysfunction in pregnant women rather than universal screening (US). We aimed to determine the detection rate of subclinical hypothyroidism (SCH) and overt hypothyroidism (OH) based on American Thyroid Association guidelines (ATA-GL) and whether it could be improved. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of 1832 pregnant women in a single center. Thyroid function (TSH and free T4) and iron status were determined. The high-risk group (HRG) included women with one or more ATA-GL risk factors and the low-risk group (LRG) included women without. Participants with other risk factors [body mass index (BMI) 30 to 39.9 kg/m2, Caucasian background] were classified as HRG+ and those with iron deficiency as HRG++. RESULTS The HRG included 64% of women and the LRG included 36% (P < 0.001). Of all participants, 4.5% had SCH and 0.5% OH. The detection rate of SCH and OH was comparable between the LRG and HRG (46% vs 54% and 25% vs 75%; P = 0.560 and 0.157, respectively). In the HRG, the detection rate of SCH was lower than that of US (54% vs 100%; P < 0.001), but that of OH was comparable (75%; P = 0.596). The detection rate of SCH in the HRG+ and HRG++ was comparable to that in the US group (81% and 88% vs 100%; P = 0.220 and 0.439, respectively). CONCLUSIONS Targeted high-risk case finding screening was not effective for the detection of SCH but performed better for OH. When obesity in the range BMI 30 to 39.9 kg/m2 and a Caucasian background were included as risk factors, the detection rate of SCH became comparable with that of US.
Collapse
Affiliation(s)
- Georgiana Sitoris
- Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Flora Veltri
- Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Kleynen
- Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Belhomme
- Department of Gynecology and Obstetrics, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge Rozenberg
- Department of Gynecology and Obstetrics, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Kris Poppe
- Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
32
|
Juul SE, Derman RJ, Auerbach M. Perinatal Iron Deficiency: Implications for Mothers and Infants. Neonatology 2019; 115:269-274. [PMID: 30759449 DOI: 10.1159/000495978] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 12/04/2018] [Indexed: 11/19/2022]
Abstract
Iron deficiency, with or without anemia, is common in pregnant women. In fact, nearly 30% of reproductive-age women are anemic worldwide, and anemia in pregnancy has an estimated global prevalence of 38%. Severe anemia can substantially increase the risk of maternal mortality, and can adversely affect fetal development. In this review, we examine the available data regarding epidemiology and consequences of iron deficiency in mothers and infants, current treatment strategies, and make recommendations for screening and treatment of iron deficiency anemia in gravidas and neonates.
Collapse
Affiliation(s)
- Sandra E Juul
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Richard J Derman
- Global Affairs, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael Auerbach
- Georgetown University School of Medicine, Washington, District of Columbia, USA,
| |
Collapse
|
33
|
Multiple nutritional factors and thyroid disease, with particular reference to autoimmune thyroid disease. Proc Nutr Soc 2018; 78:34-44. [DOI: 10.1017/s0029665118001192] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Hashimoto's thyroiditis (HT) and Graves’ disease (GD) are examples of autoimmune thyroid disease (AITD), the commonest autoimmune condition. Antibodies to thyroid peroxidase (TPO), the enzyme that catalyses thyroid-hormone production and antibodies to the receptor for the thyroid-stimulating hormone, are characteristic of HT and GD, respectively. It is presently accepted that genetic susceptibility, environmental factors, including nutritional factors and immune disorders contribute to the development of AITD. Aiming to investigate the effect of iodine, iron and selenium in the risk, pathogenesis and treatment of thyroid disease, PubMed and the Cochrane Library were searched for relevant publications to provide a narrative review.Iodine: chronic exposure to excess iodine intake induces autoimmune thyroiditis, partly because highly-iodinated thyroglobulin (Tg) is more immunogenic. The recent introduction of universal salt iodisation can have a similar, although transient, effect.Iron: iron deficiency impairs thyroid metabolism. TPO is a haem enzyme that becomes active only after binding haem. AITD patients are frequently iron-deficient since autoimmune gastritis, which reduces iron absorption and coeliac disease which causes iron loss, are frequent co-morbidities. In two-thirds of women with persistent symptoms of hypothyroidism despite appropriate levothyroxine therapy, restoration of serum ferritin above 100 µg/l ameliorated symptoms.Selenium: selenoproteins are essential to thyroid action. In particular, the glutathione peroxidases remove excessive hydrogen peroxide produced there for the iodination of Tg to form thyroid hormones. There is evidence from observational studies and randomised controlled trials that selenium, probably as selenoproteins, can reduce TPO-antibody concentration, hypothyroidism and postpartum thyroiditis. Appropriate status of iodine, iron and selenium is crucial to thyroid health.
Collapse
|
34
|
Pop V, Broeren M, Wijnen H, Endendijk J, van Baar A, Wiersinga W, Williams GR. Longitudinal Trajectories of Gestational Thyroid Function: A New Approach to Better Understand Changes in Thyroid Function. J Clin Endocrinol Metab 2018; 103:2889-2900. [PMID: 29846629 DOI: 10.1210/jc.2017-02556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/15/2018] [Indexed: 12/26/2022]
Abstract
CONTEXT Most studies of thyroid function changes during pregnancy use a cross-sectional design comparing means between groups rather than similarities within groups. OBJECTIVE Latent class growth analysis (LCGA) is a novel approach to investigate longitudinal changes that provide dynamic understanding of the relationship between thyroid status and advancing pregnancy. DESIGN Prospective observational study with repeated assessments. SETTING General community. PATIENTS Eleven hundred healthy women were included at 12 weeks' gestation. MAIN OUTCOME MEASURES The existence of both free T4 (fT4) and TSH trajectories throughout pregnancy determined by LCGA. RESULTS LCGA revealed three trajectory classes. Class 1 (n = 1019; 92.4%), a low increasing TSH reference group, had a gradual increase in TSH throughout gestation (from 1.1 to 1.3 IU/L). Class 2 (n = 30; 2.8%), a high increasing TSH group, displayed the largest increase in TSH (from 1.9 to 3.3 IU/L). Class 3 (n = 51; 4.6%), a decreasing TSH group, had the largest fall in TSH (from 3.2 to 2.4 IU/L). Subclinical hypothyroidism at 12 weeks occurred in up to 60% of class 3 women and was accompanied by elevated thyroid peroxidase antibodies (TPO-Ab) titers (50%) and a parental history of thyroid dysfunction (23%). In class 2, 70% of women were nulliparous compared with 46% in class 1 and 49% in class 3. CONCLUSIONS LCGA revealed distinct trajectories of longitudinal changes in fT4 and TSH levels during pregnancy in 7.4% of women. These trajectories were correlated with parity and TPO-Ab status and followed patterns that might reflect differences in pregnancy-specific immune tolerance between nulliparous and multiparous women.
Collapse
Affiliation(s)
- Victor Pop
- Department of Clinical Health Psychology, Tilburg University, LE Tilburg, Netherlands
| | - Maarten Broeren
- Department of Clinical Chemistry, Máxima Medical Hospital Veldhoven, MB Veldhoven, Netherlands
| | - Hennie Wijnen
- Department of Clinical Health Psychology, Tilburg University, LE Tilburg, Netherlands
| | - Joyce Endendijk
- Child and Adolescent Studies, Utrecht University, TC Utrecht, Netherlands
| | - Anneloes van Baar
- Child and Adolescent Studies, Utrecht University, TC Utrecht, Netherlands
| | - Wilmar Wiersinga
- Department of Endocrinology & Metabolism, Academic Medical Center, University of Amsterdam, DD Amsterdam, Netherlands
| | - Graham R Williams
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom
| |
Collapse
|
35
|
Teng X, Shan Z, Li C, Yu X, Mao J, Wang W, Xie X, Du J, Zhang S, Gao Z, Zhang X, Li L, Fan C, Teng W. Iron Deficiency May Predict Greater Risk for Hypothyroxinemia: A Retrospective Cohort Study of Pregnant Women in China. Thyroid 2018; 28:968-975. [PMID: 29968513 DOI: 10.1089/thy.2017.0491] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Pregnant women are highly vulnerable to iron deficiency (ID) due to the increased iron needs during pregnancy. ID decreases circulating thyroid hormone concentrations likely through impairment of iron-dependent thyroid peroxidase. The present study aimed to explore the association between ID and hypothyroxinemia in a retrospective cohort of pregnant women in China. METHODS To investigate the relationship between ID and hypothyroxinemia, 723 pregnant women were retrospectively analyzed, including 675 and 309 women in the second and third trimesters, respectively. Trimester-specific hypothyroxinemia was defined as free thyroxine (fT4) levels below the 2.5th percentile of the reference range with normal serum thyrotropin (TSH) or TSH higher than the 97.5th percentile of the reference range in each trimester of pregnancy. Serum TSH, fT4, thyroid peroxidase antibodies, thyroglobulin antibodies, serum ferritin, soluble transferrin receptor, and urinary iodine concentrations were measured. Serum ferritin, soluble transferrin receptor, and total body iron were used to indicate the nutritional iron status. RESULTS Cross-sectional multiple linear regression analysis showed that iron status was positively associated with serum fT4 levels in the first and second trimesters of pregnancy, but not in the third trimester. Logistic regression analysis showed that ID was an independent risk factor for hypothyroxinemia (odds ratio = 14.86 [confidence interval 2.31-95.81], p = 0.005 in the first trimester and odds ratio = 3.36 [confidence interval 1.01-11.21], p = 0.048 in the second trimester). The prospective analysis showed that pregnant women with ID during the first trimester of pregnancy had lower serum fT4 levels and a higher rate of hypothyroxinemia in the second or third trimester than those without ID. CONCLUSIONS ID appears to be a risk factor to predict hypothyroxinemia in the first and second trimesters of pregnancy, but not in the third trimester. Pregnant women with ID in the first and second trimesters should be regarded as a high-risk group for maternal hypothyroxinemia.
Collapse
Affiliation(s)
- Xiaochun Teng
- 1 Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University , Shenyang, China
| | - Zhongyan Shan
- 1 Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University , Shenyang, China
| | - Chenyan Li
- 1 Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University , Shenyang, China
| | - Xiaohui Yu
- 1 Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University , Shenyang, China
| | - Jinyuan Mao
- 1 Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University , Shenyang, China
| | - Weiwei Wang
- 1 Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University , Shenyang, China
| | - Xiaochen Xie
- 1 Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University , Shenyang, China
| | - Jianling Du
- 2 Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University , Dalian, China
| | - Shaowei Zhang
- 3 Department of Endocrinology, No·202 Hospital of People's Liberation Army , Shenyang, China
| | - Zhengnan Gao
- 4 Department of Endocrinology, Dalian Municipal Central Hospital Affiliated of Dalian Medical University , Dalian, China
| | - Xiaomei Zhang
- 5 Department of Endocrinology, Peking University , International Hospital, Beijing, China
| | - Ling Li
- 6 Department of Endocrinology, Shengjing Hospital of China Medical University , Shenyang, China
| | - Chenling Fan
- 1 Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University , Shenyang, China
| | - Weiping Teng
- 1 Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University , Shenyang, China
| |
Collapse
|
36
|
Veltri F, Poppe K. Variables Contributing to Thyroid (Dys)Function in Pregnant Women: More than Thyroid Antibodies? Eur Thyroid J 2018; 7:120-128. [PMID: 30023343 PMCID: PMC6047490 DOI: 10.1159/000488279] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/06/2018] [Indexed: 01/03/2023] Open
Abstract
Variability in thyroid function in pregnant women is the result of 2 main determinants, each accounting for approximately half of it. The first is the genetically determined part of which the knowledge increases fast, but most remains to be discovered. The second determinant is caused by an ensemble of variables of which thyroid autoimmunity is the best known, but also by others such as parity, smoking, age, and BMI. More recently, new candidate variables have been proposed, such as iron, endocrine disruptors, and the ethnicity of the pregnant women. In the future, the diagnosis and treatment of thyroid (dys)function may be optimized by the use of each individual's pituitary-thyroid set point, corrected with a factor taking into account the impact of nongenetically determined variables.
Collapse
Affiliation(s)
| | - Kris Poppe
- *K. Poppe, MD, PhD, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Rue Haute 322, BE-1000 Brussels (Belgium), E-Mail
| |
Collapse
|
37
|
Rosario PW, Oliveira LFF, Calsolari MR. Maternal hypothyroxinemia in the first trimester of gestation and association with obstetric and neonatal outcomes and iron deficiency: a prospective Brazilian study. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:332-336. [PMID: 29791654 PMCID: PMC10118786 DOI: 10.20945/2359-3997000000043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/19/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the association of isolated hypothyroxinemia in the first trimester with obstetric and neonatal outcomes and iron deficiency. SUBJECTS AND METHODS The study was prospective. Women who had become pregnant spontaneously were initially selected. Next, anti-thyroid peroxidase antibodies (TPOAb), free T4 (FT4), total T4 (TT4), TSH, and ferritin were measured. TPOAb-positive women were excluded. The final sample consisted of 596 women with serum TSH between 0.1 and 2.5 mIU/l. Hypothyroxinemia was defined as FT4 < 0.86 ng/dL and < 0.92 ng/dL, corresponding to the 5th and 10th percentiles, respectively, and TT4 < 7.8 ng/dL. None of the pregnant women was treated with levothyroxine until the end of pregnancy. RESULTS The women ranged in age from 18 to 36 years, with a median gestation of 9 weeks. T4 levels were not correlated with BMI or maternal TSH. Isolated hypothyroxinemia was observed in 4.3% (FT4 < 0.86 ng/dL), 9% (FT4 < 0.92 ng/dL), and 7% (TT4 < 7.8 ng/dL) of the pregnant women. The frequencies of obstetric and neonatal outcomes were similar in women with versus without hypothyroxinemia. In women without iron deficiency, 8.4%, 3.9%, and 6.5% had FT4 < 0.92 ng/dl, FT4 < 0.86 ng/dL and TT4 < 7.8 ng/dL, respectively. These frequencies of hypothyroxinemia were significantly higher among women with iron deficiency (20.7%, 14.8% and 17.2%, respectively). CONCLUSIONS This prospective Brazilian study found no association between isolated hypothyroxinemia in the first trimester of gestation and obstetric or neonatal outcomes, but an association was demonstrated with iron deficiency.
Collapse
Affiliation(s)
- Pedro Weslley Rosario
- Programa de Pós-Graduação e Serviço de Endocrinologia, Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brasil
| | | | - Maria Regina Calsolari
- Programa de Pós-Graduação e Serviço de Endocrinologia, Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brasil
| |
Collapse
|
38
|
Maldonado-Araque C, Valdés S, Lago-Sampedro A, Lillo-Muñoz JA, Garcia-Fuentes E, Perez-Valero V, Gutierrez-Repiso C, Goday A, Urrutia I, Peláez L, Calle-Pascual A, Castaño L, Castell C, Delgado E, Menendez E, Franch-Nadal J, Gaztambide S, Girbés J, Ortega E, Vendrell J, Chacón MR, Chaves FJ, Soriguer F, Rojo-Martínez G. Iron deficiency is associated with Hypothyroxinemia and Hypotriiodothyroninemia in the Spanish general adult population: Di@bet.es study. Sci Rep 2018; 8:6571. [PMID: 29700318 PMCID: PMC5919900 DOI: 10.1038/s41598-018-24352-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/23/2018] [Indexed: 01/08/2023] Open
Abstract
Previous studies have suggested that iron deficiency (ID) may impair thyroid hormone metabolism, however replication in wide samples of the general adult population has not been performed. We studied 3846 individuals free of thyroid disease, participants in a national, cross sectional, population based study representative of the Spanish adult population. Thyroid stimulating hormone (TSH), free thyroxin (FT4) and free triiodothyronine (FT3) were analyzed by electrochemiluminescence (E170, Roche Diagnostics). Serum ferritin was analyzed by immunochemiluminescence (Architect I2000, Abbott Laboratories). As ferritin levels decreased (>100, 30–100, 15–30, <15 µg/L) the adjusted mean concentrations of FT4 (p < 0.001) and FT3 (p < 0.001) descended, whereas TSH levels remained unchanged (p = 0.451). In multivariate logistic regression models adjusted for age, sex, UI, BMI and smoking status, subjects with ferritin levels <30 µg/L were more likely to present hypothyroxinemia (FT4 < 12.0 pmol/L p5): OR 1.5 [1.1–2.2] p = 0.024, and hypotriiodothyroninemia (FT3 < 3.9 pmol/L p5): OR 1.8 [1.3–2.6] p = 0.001 than the reference category with ferritin ≥30 µg/L. There was no significant heterogeneity of the results between men, pre-menopausal and post-menopausal women or according to the iodine nutrition status. Our results confirm an association between ID and hypothyroxinemia and hypotriiodothyroninemia in the general adult population without changes in TSH.
Collapse
Affiliation(s)
- Cristina Maldonado-Araque
- Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain
| | - Sergio Valdés
- Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain. .,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Ana Lago-Sampedro
- Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Eduardo Garcia-Fuentes
- UGC de Aparato Digestivo. Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain.,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Vidal Perez-Valero
- UGC de Laboratorio (Bioquímica). Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Carolina Gutierrez-Repiso
- Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain.,UGC de Endocrinología y Nutrición. Hospital Universitario Virgen de la Victoria. IBIMA, Málaga, Spain
| | - Albert Goday
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
| | - Ines Urrutia
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitario Cruces, BioCruces, UPV/EHU, Barakaldo, Spain
| | - Laura Peláez
- Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain
| | - Alfonso Calle-Pascual
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Endocrinology and Nutrition, Hospital Universitario S. Carlos de Madrid, Madrid, Spain
| | - Luis Castaño
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitario Cruces, BioCruces, UPV/EHU, Barakaldo, Spain
| | - Contxa Castell
- Public Health Agency of Catalonia, Department of Health, Barcelona, Spain
| | - Elias Delgado
- Endocrinology and Nutrition Service, Hospital Universitario Central de Asturias, Oviedo, Spain.,Department of Medicine, University of Oviedo, Hospital Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Edelmiro Menendez
- Endocrinology and Nutrition Service, Hospital Universitario Central de Asturias, Oviedo, Spain.,Department of Medicine, University of Oviedo, Hospital Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Josep Franch-Nadal
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.,EAP Raval Sud, Institut Català de la Salut, Red GEDAPS, Primary Care, Unitat de Suport a la Recerca (IDIAP - Fundació Jordi Gol), Barcelona, Spain
| | - Sonia Gaztambide
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Endocrinology and Nutrition, Hospital Universitario Cruces - UPV-EHU, Baracaldo, Barcelona, Spain
| | - Joan Girbés
- Diabetes Unit, Hospital Arnau de Vilanova, Valencia, Spain
| | - Emilio Ortega
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joan Vendrell
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Endocrinology and Nutrition, Hospital Universitario Joan XXIII, Institut d'Investigacions Sanitaries Pere Virgili, Tarragona, Spain
| | | | - Felipe J Chaves
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.,Genomic Studies and Genetic Diagnosis Unit, Fundación de Investigación del Hospital Clínico de Valencia-INCLIVA, Valencia, Spain
| | - Federico Soriguer
- Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Gemma Rojo-Martínez
- Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
39
|
Veltri F, Kleynen P, Grabczan L, Salajan A, Rozenberg S, Pepersack T, Poppe K. Pregnancy outcomes are not altered by variation in thyroid function within the normal range in women free of thyroid disease. Eur J Endocrinol 2018; 178:189-197. [PMID: 29187511 DOI: 10.1530/eje-17-0628] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/27/2017] [Accepted: 11/28/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In the recently revised guidelines on the management of thyroid dysfunction during pregnancy, treatment with thyroid hormone (LT4) is not recommended in women without thyroid autoimmunity (TAI) and TSH levels in the range 2.5-4.0 mIU/L, and in a recent study in that particular group of pregnant women, more complications were observed when a treatment with LT4 was given. The objective of the study was therefore to investigate whether variation in thyroid function within the normal (non-pregnant) range in women free of thyroid disease was associated with altered pregnancy outcomes? DESIGN Cross-sectional data analysis of 1321 pregnant women nested within an ongoing prospective collection of pregnant women's data in a single centre in Brussels, Belgium. METHODS Thyroid peroxidase antibodies (TPO-abs), thyroid-stimulating hormone (TSH), free T4 (FT4) and ferritin levels were measured and baseline characteristics were recorded. Women taking LT4, with TAI and thyroid function outside the normal non-pregnant range were excluded. Pregnancy outcomes and baseline characteristics were correlated with all TSH and FT4 levels within the normal range and compared between two groups (TSH cut-off < and ≥2.5 mIU/L). RESULTS Tobacco use was associated with higher serum TSH levels (OR: 1.38; CI 95%: 1.08-1.74); P = 0.009. FT4 levels were inversely correlated with age and BMI (rho = -0.096 and -0.089; P < 0.001 and 0.001 respectively) and positively correlated with ferritin levels (rho = 0.097; P < 0.001). Postpartum haemorrhage (>500 mL) was inversely associated with serum FT4 levels (OR: 0.35; CI 95%: 0.13-0.96); P = 0.040. Also 10% of women free of thyroid disease had serum TSH levels ≥2.5 mIU/L. CONCLUSIONS Variation in thyroid function during the first trimester within the normal (non-pregnant) range in women free of thyroid disease was not associated with altered pregnancy outcomes. These results add evidence to the recommendation against LT4 treatment in pregnant women with high normal TSH levels and without TPO antibodies.
Collapse
Affiliation(s)
- Flora Veltri
- Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pierre Kleynen
- Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lidia Grabczan
- Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Alexandra Salajan
- Departement of Gynecology and Obstetrics, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Serge Rozenberg
- Departement of Gynecology and Obstetrics, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Thierry Pepersack
- Geriatric Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Kris Poppe
- Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| |
Collapse
|
40
|
He L, Shen C, Zhang Y, Chen Z, Ding H, Liu J, Zha B. Evaluation of serum ferritin and thyroid function in the second trimester of pregnancy. Endocr J 2018; 65:75-82. [PMID: 29033409 DOI: 10.1507/endocrj.ej17-0253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Ferritin is a universal intracellular protein that acts as an iron carrier. Several studies have indicated that iron deficiency affects thyroid function in non-pregnant women. Our objective was to assess the relationship between serum ferritin levels and thyroid function in pregnant women during the second trimester. Pregnant women with sufficient iodine intake and normal antithyroid antibodies during the second trimester were recruited from the obstetric outpatient department of the Fifth People's Hospital of Fudan University. Serum ferritin (SF) levels, thyroid function, anti-thyroid antibodies and vitamin B12 were determined by electrochemiluminescence immunoassay kit. Maternal serum iron (Fe), unsaturated iron binding capacity (UIBC), hemoglobin (Hb), creatinine (Cr), fasting blood glucose (FBG), and alanine aminotransferase (ALT) were also evaluated. Stepwise regressions performed to evaluate the associations between SF and other maternal parameters. In the second trimester, 11.4% pregnant women had a SF concentration less than 12 μg/L, and 7.6% pregnant women were anemic. SF levels were negatively correlated with serum TSH levels (r = -0.219, p < 0.05), and positively correlated with FT4 levels (r = 0.203, p < 0.05). Linear regression analysis showed only SF, age, week of gestation were significant predictors of regression with TSH as the dependent variable (β: -0.007, -0.059, and 0.118 respectively; all p < 0.05). However consistent relation between the SF levels and FT4 was not observed in stepwise linear regression. Maternal iron status is a determinant of TSH concentrations during pregnancy in pregnant women during the second trimester.
Collapse
Affiliation(s)
- Leqi He
- Department of Clinical Laboratory Medicine, Fifth People's Hospital of Shanghai Fudan University, Shanghai, China
| | - Chunmei Shen
- Department of Clinical Laboratory Medicine, Fifth People's Hospital of Shanghai Fudan University, Shanghai, China
| | - Yanan Zhang
- Department of Endocrinology, Fifth People's Hospital of Shanghai Fudan University, Shanghai, China
| | - Zaoping Chen
- Department of Endocrinology, Fifth People's Hospital of Shanghai Fudan University, Shanghai, China
| | - Heyuan Ding
- Department of Endocrinology, Fifth People's Hospital of Shanghai Fudan University, Shanghai, China
| | - Jun Liu
- Department of Endocrinology, Fifth People's Hospital of Shanghai Fudan University, Shanghai, China
| | - Bingbing Zha
- Department of Endocrinology, Fifth People's Hospital of Shanghai Fudan University, Shanghai, China
| |
Collapse
|
41
|
Abstract
OBJECTIVE To consider the key implications of iron deficiency for biochemical and physiological functions beyond erythropoiesis. METHODS PubMed was searched for relevant journal articles published up to August 2017. RESULTS Anemia is the most well-recognized consequence of persisting iron deficiency, but various other unfavorable consequences can develop either before or concurrently with anemia. Mitochondrial function can be profoundly disturbed since iron is a cofactor for heme-containing enzymes and non-heme iron-containing enzymes in the mitochondrial electron transport chain. Biosynthesis of heme and iron-sulfur clusters in the mitochondria is inhibited, disrupting synthesis of compounds such as hemoglobin, myoglobin, cytochromes and nitric oxide synthase. The physiological consequences include fatigue, lethargy, and dyspnea; conversely, iron repletion in iron-deficient individuals has been shown to improve exercise capacity. The myocardium, with its high energy demands, is particularly at risk from the effects of iron deficiency. Randomized trials have found striking improvements in disease severity in anemic but also non-anemic chronic heart failure patients with iron deficiency after iron therapy. In vitro and pre-clinical studies have demonstrated that iron is required by numerous enzymes involved in DNA replication and repair, and for normal cell cycle regulation. Iron is also critical for immune cell growth, proliferation, and differentiation, and for specific cell-mediated effector pathways. Observational studies have shown that iron-deficient individuals have defective immune function, particularly T-cell immunity, but more evidence is required. Pre-clinical models have demonstrated abnormal myelogenesis, brain cell metabolism, neurotransmission, and hippocampal formation in iron-deficient neonates and young animals. In humans, iron deficiency anemia is associated with poorer cognitive and motor skills. However, the impact of iron deficiency without anemia is less clear. CONCLUSION The widespread cellular and physiological effects of iron deficiency highlight the need for early detection and treatment of iron deficiency, both to ameliorate these non-erythropoietic effects, and to avoid progression to iron deficiency anemia.
Collapse
Affiliation(s)
| | - Ali T Taher
- b American University of Beirut Medical Center , Beirut , Lebanon
| |
Collapse
|
42
|
Fu J, Yang A, Zhao J, Zhu Y, Gu Y, Xu Y, Chen D. The relationship between iron level and thyroid function during the first trimester of pregnancy: A cross-sectional study in Wuxi, China. J Trace Elem Med Biol 2017; 43:148-152. [PMID: 28126204 DOI: 10.1016/j.jtemb.2017.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 01/03/2017] [Accepted: 01/13/2017] [Indexed: 11/22/2022]
Abstract
Our objective was to evaluate the relationship between iron level and thyroid function during the first trimester of pregnancy in Eastern China. This was a hospital-based, cross-sectional observational study. A total of 1764 pregnant women were enrolled during their first trimester of gestation in Wuxi city. Serum ferritin (SF), hemoglobin (Hb), urinary iodine concentrations (UIC), thyroid-stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3) were measured and evaluated in pregnant women. The median of TSH,FT4 and FT3 were 1.53mIU/L,10.43pmol/L and 4.50pmol/L respectively. The median UIC was 200μg/L and the median Hb was 126g/L. Of all the women, 1.76% of the subjects had iron deficiency anaemia (IDA) (SF<20μg/L and Hb<105g/L), and 39.06% of the population had iron deficiency (ID) (SF<15μg/L). Compared with SF>100μg/L group, the FT4 level was significantly lower in SF<20μg/L group (P=0.031) and in SF 20-100μg/L group (P=0.048). The TSH value of SF>20μg/L group was significantly higher than that in SF 20-100μg/L group (P=0.038) and SF>100μg/L group(P=0.034). There was an inverse linear relationship between TSH and FT4 after log transformation (r=0.245,P=0.000). Moreover, spearman's correlation analysis showed that UIC were correlated with SF and FT3 (all P<0.001) and iodine status more than adequate was associated with reduced serum ferritin concentration and FT3 levels. Thus, it is recommended that iron deficiency and iron deficiency anaemia shoud be evaluated and treated to combat thyroid dysfunction during the first trimester of pregnancy, Meanwhile, an increased attention should be paid on iodine nutritional status among this pregnant women simultaneous iron deficiency and thyroid dysfunction.
Collapse
Affiliation(s)
- Jinyan Fu
- Department of Obstetrics, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China.
| | - Anqiang Yang
- Department of Pathology, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Jun Zhao
- Clinical laboratory, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Yunlong Zhu
- Department of Obstetrics, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Ying Gu
- Department of Obstetrics, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Yaohui Xu
- Clinical laboratory, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Daozhen Chen
- Clinical laboratory, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| |
Collapse
|
43
|
Li S, Gao X, Wei Y, Zhu G, Yang C. The Relationship between Iron Deficiency and Thyroid Function in Chinese Women during Early Pregnancy. J Nutr Sci Vitaminol (Tokyo) 2017; 62:397-401. [PMID: 28202844 DOI: 10.3177/jnsv.62.397] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Previous studies have identified an association between iron deficiency and thyroid function. We aimed to determine if there is a relationship between iron deficiency and thyroid function during the first trimester of pregnancy. Two thousand five hundred eighty-one pregnant women who presented for the first prenatal care were enrolled and divided into three groups, the mild iron deficiency (MID) group, iron deficiency anemia (IDA) group and normal control (NC) group, according to serum ferritin and hemoglobin levels. The former two groups can be merged into one iron deficiency (ID) group. Thyroid function parameters were compared among the three groups, including free thyroxine (FT4), thyroid stimulating hormone (TSH), total thyroxine (TT4) and thyroid peroxidase antibodies (TPOAb). Moreover, the rates of thyroid dysfunction were also compared. Our results show that pregnant women in the MID and IDA groups have higher TSH and lower FT4 status than those in the NC group (p<0.01), and the difference between the IDA group and MID group is significant (p<0.05). TPOAb in the IDA group is higher than in the MID group and NC group. Meanwhile, the rate of hypothyroidism or subclinical hypothyroidism in the IDA group was significantly higher than in the MID group and NC group (p<0.01). And the positive rate of TPOAb is also higher in the IDA group than MID group and NC group (p<0.05). Iron deficiency is related to thyroid function and could lead to hypothyroidism during early pregnancy, which could be explained by thyroid autoimmunity.
Collapse
Affiliation(s)
- Shuxiang Li
- Department of Nuclear Medicine, Suzhou Hospital Affiliated to Nanjing Medical University
| | | | | | | | | |
Collapse
|
44
|
Endendijk JJ, Wijnen HAA, Pop VJM, van Baar AL. Maternal thyroid hormone trajectories during pregnancy and child behavioral problems. Horm Behav 2017; 94:84-92. [PMID: 28668344 DOI: 10.1016/j.yhbeh.2017.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 06/15/2017] [Accepted: 06/25/2017] [Indexed: 12/11/2022]
Abstract
There is ample evidence demonstrating the importance of maternal thyroid hormones, assessed at single trimesters in pregnancy, for child cognition. Less is known, however, about the course of maternal thyroid hormone concentrations during pregnancy in relation to child behavioral development. Child sex might be an important moderator, because there are sex differences in externalizing and internalizing behavioral problems. The current study examined the associations between maternal thyroid hormone trajectories versus thyroid assessments at separate trimesters of pregnancy and child behavioral problems, as well as sex differences in these associations. In 442 pregnant mothers, serum levels of TSH and free T4 (fT4) were measured at 12, 24, and 36weeks gestation. Both mothers and fathers reported on their children's behavioral problems, between 23 and 60months of age. Latent growth mixture modeling was used to determine the number of different thyroid hormone trajectories. Three trajectory groups were discerned: 1) highest and non-increasing TSH with lowest fT4 that decreased least of the three trajectories; 2) increasing TSH and decreasing fT4 at intermediate levels; 3) lowest and increasing TSH with highest and decreasing fT4. Children of mothers with the most flattened thyroid hormone trajectories (trajectory 1) showed the most anxiety/depression symptoms. The following trimester-specific associations were found: 1) lower first-trimester fT4 was associated with more child anxiety/depression, 2) higher first-trimester TSH levels were related to more attention problems in boys only. A flattened course of maternal thyroid hormone concentrations during pregnancy was a better predictor of child anxiety/depression than first-trimester fT4 levels.
Collapse
Affiliation(s)
- Joyce J Endendijk
- Child and Adolescent Studies, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands.
| | - Hennie A A Wijnen
- Department Midwifery Sciences, AVM, University of Midwifery Education & Studies Maastricht, Universiteitssingel 60, 6229 ER Maastricht, The Netherlands
| | - Victor J M Pop
- Department of Medical Health Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
| | - Anneloes L van Baar
- Child and Adolescent Studies, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands
| |
Collapse
|
45
|
Moncayo R, Moncayo H. A post-publication analysis of the idealized upper reference value of 2.5 mIU/L for TSH: Time to support the thyroid axis with magnesium and iron especially in the setting of reproduction medicine. BBA CLINICAL 2017; 7:115-119. [PMID: 28409122 PMCID: PMC5385584 DOI: 10.1016/j.bbacli.2017.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/05/2017] [Accepted: 03/17/2017] [Indexed: 11/18/2022]
Abstract
Laboratory medicine approaches the evaluation of thyroid function mostly through the single determination of the blood level of thyroid stimulating hormone (TSH). Some authors have suggested an upper reference value for TSH of 2.5 mIU/L. This suggestion has not been confirmed by recent clinical studies. These studies have delivered a clinically valid reference range going from 0.3 to 3.5 mIU/L. These values are valid for both for the general population as well as in the setting of fertility and pregnancy. Current biochemical evidence about the elements required to maintain thyroid function shows that these not only include dietary iodine but also magnesium, iron, selenium and coenzyme Q10. Iron is important for the synthesis of thyroid peroxidase; magnesium-ATP contributes to the active process of iodine uptake; iodine has to be sufficiently present in the diet; selenium acts through selenoproteins to protect the thyroid cell during hormone synthesis and in deiodination of thyroxine; coenzyme Q10 influences thyroid vascularity. As a consequence, good clinical practice requires additional biochemical information on the blood levels of magnesium, selenium, coenzyme Q10 as well as iron status. Since these elements are also important for the maintenance of reproductive function, we postulate that they constitute the connecting link between both endocrine systems.
Collapse
Affiliation(s)
- Roy Moncayo
- WOMED, Karl-Kapferer-Strasse 5, 6020 Innsbruck, Austria
| | | |
Collapse
|
46
|
Applying a systems approach to thyroid physiology: Looking at the whole with a mitochondrial perspective instead of judging single TSH values or why we should know more about mitochondria to understand metabolism. BBA CLINICAL 2017; 7:127-140. [PMID: 28417080 PMCID: PMC5390562 DOI: 10.1016/j.bbacli.2017.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/20/2017] [Accepted: 03/28/2017] [Indexed: 12/17/2022]
Abstract
Classical thinking in endocrine physiology squeezes our diagnostic handling into a simple negative feedback mechanism with a controller and a controlled variable. In the case of the thyroid this is reduced to TSH and fT3 and fT4, respectively. The setting of this tight notion has no free space for any additions. In this paper we want to challenge this model of limited application by proposing a construct based on a systems approach departing from two basic considerations. In first place since the majority of cases of thyroid disease develop and appear during life it has to be considered as an acquired condition. In the second place, our experience with the reversibility of morphological changes makes the autoimmune theory inconsistent. While medical complexity can expand into the era of OMICS as well as into one where manipulations with the use of knock-outs and -ins are common in science, we have preferred to maintain a simple and practical approach. We will describe the interactions of iron, magnesium, zinc, selenium and coenzyme Q10 with the thyroid axis. The discourse will be then brought into the context of ovarian function, i.e. steroid hormone production. Finally the same elemental players will be presented in relation to the basic mitochondrial machinery that supports the endocrine. We propose that an intact mitochondrial function can guard the normal endocrine function of both the thyroid as well as of the ovarian axis. The basic elements required for this function appear to be magnesium and iron. In the case of the thyroid, magnesium-ATP acts in iodine uptake and the heme protein peroxidase in thyroid hormone synthesis. A similar biochemical process is found in steroid synthesis with cholesterol uptake being the initial energy-dependent step and later the heme protein ferredoxin 1 which is required for steroid synthesis. Magnesium plays a central role in determining the clinical picture associated with thyroid disease and is also involved in maintaining fertility. With the aid of 3D sonography patients needing selenium and/or coenzyme Q10 can be easily identified. By this we firmly believe that physicians should know more about basic biochemistry and the way it fits into mitochondrial function in order to understand metabolism. Contemplating only TSH is highly reductionistic. Outline Author's profiles and motivation for this analysis The philosophical alternatives in science and medicine Reductionism vs. systems approach in clinical thyroid disease guidelines The entry into complexity: the involvement of the musculoskeletal system Integrating East and West: teachings from Chinese Medicine and from evidence based medicine (EBM) Can a mathematical model represent complexity in the daily thyroid practice? How effective is thyroxine treatment? Resolving the situation of residual symptoms in treated patients with thyroid disease Importance of iron, zinc and magnesium in relation to thyroid function Putting together new concepts related to thyroid function for a systems approach Expanding our model into general aspects of medicine
Collapse
|
47
|
Dosiou C, Medici M. MANAGEMENT OF ENDOCRINE DISEASE: Isolated maternal hypothyroxinemia during pregnancy: knowns and unknowns. Eur J Endocrinol 2017; 176:R21-R38. [PMID: 27528503 DOI: 10.1530/eje-16-0354] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 02/10/2016] [Accepted: 02/15/2016] [Indexed: 12/16/2022]
Abstract
Isolated maternal hypothyroxinemia (IMH) during pregnancy is defined as a low maternal T4 in the absence of TSH elevation. As IMH is common, with a prevalence of 1-2% in iodine-sufficient populations, and early research has suggested adverse effects on fetal neurodevelopment, it has been the focus of many studies in the last decade. In the current review, we first discuss the significance of IMH based on data from animal models and recent discoveries regarding the role of thyroid hormone on neurodevelopment. We address issues surrounding the definition and prevalence of this entity and discuss new insights into the etiologies, clinical consequences and management of IMH. A number of large cohort studies have investigated the effects of IMH on the risk of various pregnancy complications and child neurodevelopment. We review these studies in detail and describe their limitations. We discuss the available research on management of IMH, including two recent randomized controlled trials (RCTs). Finally, we delineate the remaining uncertainties in this field and emphasize the need for a sufficiently powered, placebo-controlled RCT on the treatment of IMH early in the first trimester of pregnancy.
Collapse
Affiliation(s)
- Chrysoula Dosiou
- Division of EndocrinologyStanford University School of Medicine, Stanford, California, USA
| | - Marco Medici
- Department of Endocrinology and Rotterdam Thyroid CenterErasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
48
|
Veltri F, Decaillet S, Kleynen P, Grabczan L, Belhomme J, Rozenberg S, Pepersack T, Poppe K. Prevalence of thyroid autoimmunity and dysfunction in women with iron deficiency during early pregnancy: is it altered? Eur J Endocrinol 2016; 175:191-9. [PMID: 27450694 DOI: 10.1530/eje-16-0288] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/08/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Thyroid disorders and iron deficiency (ID) are associated with obstetrical and fetal complications. Iron is essential for the normal functioning of thyroid peroxidase (TPO-abs) and ID is frequent during pregnancy. The aim of this study was to compare the prevalence of thyroid autoimmunity (TAI) and dysfunction during the first trimester of pregnancy in women with and without ID. DESIGN Cross-sectional data analysis of 1900 pregnant women nested within an ongoing prospective collection of pregnant women's data. METHOD The study was performed in a single, tertiary referral center. During the first antenatal visit, ferritin, TPO-abs, thyroid-stimulating hormone (TSH) and free T4 (FT4) were measured and age and BMI were recorded. ID was defined as ferritin <15µg/L, TAI when TPO-abs was >60kIU/L, and subclinical hypothyroidism (SCH) when TSH was >2.5mIU/L. RESULTS ID was present in 35% of women. Age and BMI were comparable between both groups. In the ID group, the prevalence of TAI and SCH was significantly higher, compared with that in the non-ID group (10% vs 6% and 20% vs 16%; P=0.011 and 0.049 respectively). Ferritin was inversely correlated with serum TSH (ρ=-0.076; P=0.001) and positive with FT4 levels (ρ=0.112; P<0.001). In the logistic regression model, ID remained associated with TAI after correction for confounding factors (P=0.017). The association with SCH was absent after correction for the confounders in the logistic regression model (P=0.082), but remained present in the linear regression model (P=0.035). CONCLUSIONS ID was frequent during the first trimester of pregnancy and was associated with a higher prevalence of TAI, higher serum TSH, and lower FT4 levels.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Thierry Pepersack
- Geriatric UnitCentre Hosptilalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | |
Collapse
|
49
|
Pearce EN, Lazarus JH, Moreno-Reyes R, Zimmermann MB. Consequences of iodine deficiency and excess in pregnant women: an overview of current knowns and unknowns. Am J Clin Nutr 2016; 104 Suppl 3:918S-23S. [PMID: 27534632 PMCID: PMC5004501 DOI: 10.3945/ajcn.115.110429] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Severe iodine deficiency during development results in maternal and fetal hypothyroidism and associated serious adverse health effects, including cretinism and growth retardation. Universal salt iodization is the first-line strategy for the elimination of severe iodine deficiency. Iodine supplementation is recommended for vulnerable groups in severely iodine-deficient regions where salt iodization is infeasible or insufficient. A recent clinical trial has informed best practices for iodine supplementation of severely iodine-deficient lactating mothers. Because of successful programs of universal salt iodization in formerly severely iodine-deficient regions around the world, public health concern has shifted toward mild to moderate iodine deficiency, which remains prevalent in many regions, especially among pregnant women. Observational studies have shown associations between both mild maternal iodine deficiency and mild maternal thyroid hypofunction and decreased child cognition. Iodine supplementation has been shown to improve indexes of maternal thyroid function, even in marginally iodine-deficient areas. However, no data are yet available from randomized controlled trials in regions of mild to moderate iodine insufficiency on the relation between maternal iodine supplementation and neurobehavioral development in the offspring; thus, the long-term benefits and safety of such supplementation are uncertain. Although it is clear that excessive iodine intake can cause alterations in thyroid function in susceptible individuals, safe upper limits for iodine intake in pregnancy have not been well defined. Well-designed, prospective, randomized controlled trials that examine the effects of iodine supplementation on maternal thyroid function and infant neurobehavioral development in mildly to moderately iodine-deficient pregnant women are urgently needed. In addition, clinical data on the effects of iodine excess in pregnant and lactating women are needed to inform current recommendations for safe upper limits on chronic iodine ingestion in general and on iodine supplementation in particular.
Collapse
Affiliation(s)
- Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA;
| | - John H Lazarus
- Thyroid Research Group, Institute of Molecular and Experimental Medicine, Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - Rodrigo Moreno-Reyes
- Department of Nuclear Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; and
| | - Michael B Zimmermann
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland
| |
Collapse
|
50
|
Hu X, Wang R, Shan Z, Dong Y, Zheng H, Jesse FF, Rao E, Takahashi E, Li W, Teng W, Teng X. Perinatal Iron Deficiency-Induced Hypothyroxinemia Impairs Early Brain Development Regardless of Normal Iron Levels in the Neonatal Brain. Thyroid 2016; 26:891-900. [PMID: 27231981 DOI: 10.1089/thy.2015.0293] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Both perinatal hypothyroxinemia and perinatal iron deficiency (ID) are associated with poor neurodevelopment in offspring. Iron is an important component of thyroid peroxidase, a key enzyme in the synthesis of thyroid hormone. The authors' previous study demonstrated that perinatal ID can lead to maternal hypothyroxinemia during pregnancy. The goal of this study was to determine whether perinatal ID-associated hypothyroxinemia can cause brain defects prior to neonatal brain iron depletion. METHODS Two rat models were established to imitate the two common types of maternal ID (mild ID with anemia [ID + A] and ID without anemia [ID - A]), and iron limitation was initiated two weeks before pregnancy. Maternal and neonatal thyroid hormones in serum were analyzed at postnatal day (P) 0 and P10. Neonatal thyroid hormone, as well as mRNA expression of some thyroid hormone-responsive genes in the cerebral cortex and hippocampus, were measured at P10. Serum iron and brain iron concentrations were analyzed by inductively coupled plasma mass spectrometry. Liver iron concentration was determined using graphite furnace atomic absorption spectroscopy. Hemoglobin was analyzed with an automated blood coagulation analyzer. Surface righting reflex and vibrissae-evoked forelimb placing were measured to assess the sensorimotor behaviors. RESULTS It was found that pre-pregnant mild ID resulted in maternal hypothyroxinemia, which lasted from gestation day 13 to P10. Pre-pregnant mild ID decreased the neonatal brain total triiodothyronine level at P10. Consistent with a low total triiodothyronine level, the mRNA expression of some thyroid hormone-responsive genes (Mbp, RC3, and Srg1) were significantly reduced in the neonatal cerebral cortex and hippocampus in both ID rat models at P10. Furthermore, ID rat pups at P10 showed retarded sensorimotor skills. No significant difference was found between the control and the ID pups in terms of iron concentrations in the neonatal brain at P10. CONCLUSIONS This study demonstrates that perinatal ID-associated hypothyroxinemia is sufficient to impair early brain development, regardless of whether the neonatal brain iron level is normal, and monitoring thyroid hormone level is indicated in ID pregnant women.
Collapse
Affiliation(s)
- Xiaona Hu
- 1 Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University , Shenyang, China
- 2 Department of Endocrinology, The People's Hospital of Liaoning Province , Shenyang, China
| | - Ranran Wang
- 1 Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University , Shenyang, China
| | - Zhongyan Shan
- 1 Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University , Shenyang, China
| | - Yujie Dong
- 3 Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University , Shanghai, China
| | - Hongzhi Zheng
- 1 Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University , Shenyang, China
| | - Forrest Fabian Jesse
- 3 Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University , Shanghai, China
| | - Elizabeth Rao
- 3 Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University , Shanghai, China
| | - Eiki Takahashi
- 4 RIKEN Brain Science Institute , Research Resources Center, Support Unit for Animal Resources Development, Wako, Japan
| | - Weidong Li
- 3 Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University , Shanghai, China
| | - Weiping Teng
- 1 Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University , Shenyang, China
| | - Xiaochun Teng
- 1 Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University , Shenyang, China
| |
Collapse
|