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Vaishnav S, Pandya D, Shrivastava R, Patel N, Phatak AG, Patel A. Early treatment will prevent feto-maternal complications in thyroid disorders during pregnancy: A prospective study. J Family Med Prim Care 2023; 12:3393-3398. [PMID: 38361867 PMCID: PMC10866218 DOI: 10.4103/jfmpc.jfmpc_1185_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/25/2023] [Accepted: 10/05/2023] [Indexed: 02/17/2024] Open
Abstract
Context Associations between adverse maternal complications and fetal outcomes are known entity in thyroid disorders during pregnancy. Thus, prompt identification of thyroid disorders and timely initiation of treatment is essential. Universal screening and early treatment of pregnant women for thyroid disorder should be considered especially in a resource-limited country like India with a high prevalence of undiagnosed thyroid disorders and adverse feto-maternal outcomes. Aims Early treatment will prevent feto-maternal complications in thyroid disorders in pregnant females visiting outpatient department in tertiary care hospital in rural settings. Settings and Design This study was conducted in a tertiary care rural-based medical college with participation from departments of Obstetrics and Gynaecology, Medicine, and ENT. Methods and Material Expectant mothers in first trimester who had urine pregnancy test positive in outpatient clinic were included after a written informed consent. Detailed history and examination was done. TSH was done if abnormal-FT3 and FT4 were done. All thyroid disorders were treated according to American Thyroid Association (ATA) 2017 guideline. All pregnancies were followed up for maternal complications and fetal outcomes. Statistical Analysis Used Data from the performa were entered in Office Excel and analysis was performed using STATA (14.2). Descriptive statistics (mean [standard deviation], Frequency [%], etc.) were used to depict profile of study participants, prevalence of thyroid dysfunction, and outcome measures. Chi-square test was employed to assess the association between thyroid dysfunction and various maternal and fetal outcomes. A P value less than. 05 was considered statistically significant. Results Of 350 pregnant females, 83 (23.5%) pregnant females had thyroid disorder. Of which, 33 (9.4%) had subclinical hypothyroidism, 37 (10.5%) had overt hypothyroidism, 11 (3.1%) had subclinical hyperthyroidism, and two (0.5%) had hyperthyroidism. The prevalence of hypothyroidism in pregnancy increases with increasing age (P value. 001) and not associated with parity, abortion, and consumption of iodized salt. Total patients with feto-maternal outcome follow-up were 241. Pre-eclampsia (P value. 004) was a significant complication in hypothyroid mothers. There was no significant difference in the rate of cesarean section and preterm delivery in hypothyroid and euthyroid mothers. Neonatal outcomes showed more trends of abortion, fetal demise, and IUFD in the hypothyroid group, although not statistically significant. (P value. 07). Conclusions Due to the high prevalence of thyroid disorders during pregnancy, universal screening of thyroid disorders should be done in early pregnancy instead of high-risk screening. Early detection and early treatment in the first 10 weeks of pregnancy help to prevent maternal and fetal complications of thyroid disorders in pregnancy. Pre-eclampsia is to be monitored in treated pregnant females with hypothyroidism.
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Affiliation(s)
- Smruti Vaishnav
- Obstetrics and Gynaecology Department, Pramukhswami Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Dharak Pandya
- Consultant Physician, Yogeshwar Hospital, Chhotaudepur, Gujarat, India
| | - Rama Shrivastava
- Obstetrics and Gynaecology Department, Pramukhswami Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Nimeshkumar Patel
- ENT Department, Pramukhswami Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Ajay G. Phatak
- Central Research Services, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Alpaben Patel
- Medicine Department, Pramukhswami Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Anand, Gujarat, India
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Dhabhai N, Chowdhury R, Virmani A, Chaudhary R, Taneja S, Mittal P, Dewan R, Dang A, Kaur J, Bhandari N. Burden, risk factors and outcomes associated with adequately treated hypothyroidism in a population-based cohort of pregnant women from North India. PLoS One 2023; 18:e0282381. [PMID: 37703246 PMCID: PMC10499229 DOI: 10.1371/journal.pone.0282381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/15/2023] [Indexed: 09/15/2023] Open
Abstract
Hypothyroidism is the commonest endocrine disorder of pregnancy, with known adverse feto-maternal outcomes. There is limited data on population-based prevalence, risk factors and outcomes associated with treatment of hypothyroidism in early pregnancy. We conducted analysis on data from an urban and peri-urban low to mid socioeconomic population-based cohort of pregnant women in North Delhi, India to ascertain the burden, risk factors and impact of treatment, on adverse pregnancy outcomes- low birth weight, prematurity, small for gestational age and stillbirth. This is an observational study embedded within the intervention group of the Women and Infants Integrated Interventions for Growth Study, an individually randomized factorial design trial. Thyroid stimulating hormone was tested in 2317 women in early (9-13 weeks) pregnancy, and thyroxin replacement started hypothyroid (TSH ≥2.5mIU/mL). Univariable and multivariable generalized linear model with binomial family and log link were performed to ascertain risk factors associated with hypothyroidism and association between hypothyroidism and adverse pregnancy outcomes. Of 2317 women, 29.2% (95% CI: 27.4 to 31.1) had hypothyroidism and were started on thyroxin replacement with close monitoring. Overweight or obesity was associated with increased risk (adjusted RR 1.29, 95% CI 1.10 to 1.51), while higher hemoglobin concentration was associated with decreased risk (adjusted RR 0.93, 95% CI 0.88 to 0.98 for each g/dL) for hypothyroidism. Hypothyroid women received appropriate treatment with no increase in adverse pregnancy outcomes. Almost a third of women from low to mid socio-economic population had hypothyroidism in early pregnancy, more so if anemic and overweight or obese. With early screening and adequate replacement, adverse pregnancy outcomes may be avoided. These findings highlight the need in early pregnancy for universal TSH screening and adequate treatment of hypothyroidism; as well as for attempts to reduce pre and peri-conception overweight, obesity and anemia. Clinical trial registration: Clinical trial registration of Women and Infants Integrated Interventions for Growth Study Clinical Trial Registry-India, #CTRI/2017/06/008908; Registered on: 23/06/2017, (http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=19339&EncHid=&userName=society%20for%20applied%20studies).
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Affiliation(s)
- Neeta Dhabhai
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Anju Virmani
- Department of Pediatrics, Max Smart Superspeciality Hospital, Saket, Rainbow Hospital, New Delhi, India
| | - Ritu Chaudhary
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Pratima Mittal
- Department of Obstetrics and Gynaecology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rupali Dewan
- Department of Obstetrics and Gynaecology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | | | - Jasmine Kaur
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
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Kumar R, Bansal R, Shergill HK, Garg P. Prevalence of thyroid dysfunction in pregnancy and its association with feto-maternal outcomes: A prospective observational study from a tertiary care institute in Northern India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023. [DOI: 10.1016/j.cegh.2022.101201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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UÇKAN K, ÇELEĞEN İ, BAŞKIRAN Y. Evaluation of thyroid dysfunctions frequency in the first trimester. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1015213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Mumtaz A, Sadiq F, Zaki S, Batool H, Ibrahim M, Khurram M, Awan UA, Saeed K, Afzal MS. Trimester-specific reference ranges for thyroid hormones of pregnant females at tertiary care hospitals in Lahore, Pakistan. BMC Pregnancy Childbirth 2021; 21:717. [PMID: 34702203 PMCID: PMC8547102 DOI: 10.1186/s12884-021-04200-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 09/28/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The significance of investigation for diagnosing and managing thyroid dysfunction in pregnant females has been extensively documented in the medical literature. This study aimed to determine trimester-specific reference ranges for thyroid-stimulating hormones (TSH), free T3 (FT3), and free T4 (FT4) in apparently healthy pregnant women attending tertiary care hospitals in Lahore. METHODS This cross-sectional study was conducted at two tertiary care Hospitals in Lahore, Pakistan. In this multi-centric study, 500 pregnant females were initially enrolled from September 2019 to December 2019 who fulfilled the inclusion criteria. For measurement of serum FT3, FT4, thyroid stimulating hormone (TSH), anti-thyroid peroxidase (anti-TPO), and thyroglobulin antibodies, 5 ml of the blood sample was drawn, under aseptic conditions, from each subject using Maglumi 800 chemiluminescence immunoassay (CLIA) system. RESULTS Out of 500 subjects, 23 subjects with positive anti-TPO, 19 subjects with anti-TG antibodies, and 12 subjects due to less volume of serum yielded from whole blood (serum less than 3 ml) were excluded from the analysis. Ten samples were hemolyzed and not included in the analysis. A total of 436 samples were examined for analysis. Of the remaining 436 subjects, 133 (30.5%) were from 1st trimester, 153 (35.1%) from 2nd trimester, and 150 (34.4%) from 3rd trimester. As the data were non-normal, the 2.5th, 50th, and 97.5th percentiles were calculated to express each group's results. Trimester specific range of TSH 0.168-4.294, 0.258-4.584 and 0.341-4.625 mIU/mL, FT31.857-4.408, 1.958-4.621 and 2.025-4.821 pmol/L and FT4 8.815-18.006, 8.306-17.341 and 7.402-17.292 pmol/L. CONCLUSION In this study, we established a trimester-specific reference range for our local population's thyroid function test. The results of this study have complemented the results of previous studies.
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Affiliation(s)
- Asim Mumtaz
- Department of Pathology Akhtar Saeed Medical College, Lahore, Pakistan
| | - Fauzia Sadiq
- Lahore Medical & Dental College, Lahore, Pakistan
| | - Saima Zaki
- Department of Gynae & OBS Jinnah Hospital Lahore, Lahore, Pakistan
| | | | - Muhammad Ibrahim
- Department of Biostatistics, School of Alibied Health Sciences, Children Hospital Lahore, Lahore, Pakistan
| | - Muhammad Khurram
- Department of Life Sciences, School of Science, University of Management and Technology (UMT), Lahore, Postal Code # 54700, Pakistan
| | - Usman Ayub Awan
- Department of Medical Laboratory Technology, The University of Haripur, Haripur, Khyber Pakhtunkhwa, Pakistan
| | | | - Muhammad Sohail Afzal
- Department of Life Sciences, School of Science, University of Management and Technology (UMT), Lahore, Postal Code # 54700, Pakistan.
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Study on thyroid function test in pregnancy in a tertiary care hospital. EUREKA: HEALTH SCIENCES 2021. [DOI: 10.21303/2504-5679.2021.001918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Thyroid disorder is a very common endocrine problem encountered by pregnant women. Maternal thyroid dysfunction is associated with adverse outcome both in mother and fetus.
The aim of the study: to find out the prevalence of various thyroid disorders in pregnant women attending antenatal clinic.
Materials and methods. This prospective cross-sectional study was carried out in the Department of Obstetrics and Gynecology, F.M. Medical College & Hospital, Balasore, Odisha from June 2020 to May 2021. 220 women with uncomplicated singleton pregnancy were included. Serum Thyroid-stimulating hormone (TSH), free T4 (FT4) and free T3 (FT3) were estimated by using electro-chemiluminescence immunoassay technique.
Results. Out of 220 pregnant women screened for thyroid dysfunction, 68 were found to have thyroid disorders. 27.3 % of pregnant women had subclinical hypothyroidism, 1.4 % had overt hypothyroidism, 1.8 % had subclinical hyperthyroidism and 0.5 % had overt hyperthyroidism. Prevalence of subclinical hypothyroidism was 6.36 % when the upper reference limit of TSH level taken as 4 mIU/L. Prevalence of thyroid disorder among pregnant women in the age groups 18–25 years, 26–30 years and 31–40 years were 28.9 %, 32.1 % and 38.9 % respectively. There were 35.5 %, 28 % and 26 % pregnant women with thyroid disorders in the first, second and third trimester respectively. Prevalence of both subclinical and overt hypothyroidism were more in multigravida compared to primigravida.
Conclusion. Our study revealed high prevalence of thyroid disorders in pregnant women and maternal subclinical hypothyroidism was the most common pattern.
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Venugopalan L, Rajan A, Prasad HK, Sankaran A, Murugesan G, Ramanathan S. Impact of maternal thyroid disease on neonatal thyroid status. J Pediatr Endocrinol Metab 2021; 34:237-241. [PMID: 33048836 DOI: 10.1515/jpem-2020-0349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/23/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Prevalence of Maternal and congenital hypothyroidism is on the rise. To present the thyroid stimulating hormone screening results in babies born to hypothyroid mothers and assess the burden, aetiology of hypothyroidism in these babies. METHODS All antenatal mothers attending our hospital during the study period were enrolled into the study. Group I includes 249 term babies born to hypothyroid mothers and group II comprises 2154 newborns born to mothers who are euthyroid. Heel prick thyroid stimulating hormone was done for all newborns on day 3 for both groups. Confirmatory venous testing was done for all for babies in group I and screen positives belonging to group II. Evaluation and therapy done as per standard guidelines. RESULTS Thyroid stimulating hormone values in the two groups are presented. There was significant correlation between peak maternal thyroid stimulating hormone and neonatal day 3 heel prick in group I (r=0.7, P<0.05). The prevalence of positive screening test in groups I and II was 3.8 and 1.03% (p<0.05) whereas corresponding values for confirmed disease was 4.3 and 0.6%, respectively (p<0.05). Aetiological evaluation revealed both transient hypothyroidism (33.3%) and permanent hypothyroidism (66.6%). CONCLUSION 4.3% of babies born to hypothyroid mothers develop congenital hypothyroidism; aetiology being both transient and permanent. A venous test by 3 weeks is helpful in these babies to improve case identification.
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Affiliation(s)
- Lakshmi Venugopalan
- Department of Neonatology, Mehta Multispeciality Hospitals India pvt Ltd., Chetpet, Chennai, India
| | - Aishwarya Rajan
- Department of Paediatrics, Mehta Multispeciality Hospitals India pvt Ltd., Chetpet, Chennai, India
| | - Hemchand K Prasad
- Department of Paediatric Endocrinology and Diabetes, Mehta Multispeciality Hospitals India pvt Ltd., Chetpet, Chennai, India
| | - Anupama Sankaran
- Department of Paediatrics, Mehta Multispeciality Hospitals India pvt Ltd., Chetpet, Chennai, India
| | - Gnanabalan Murugesan
- Department of Neonatology, Mehta Multispeciality Hospitals India pvt Ltd., Chetpet, Chennai, India
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Prevalence of Hypothyroidism in Pregnant Women in India: A Meta-Analysis of Observational Studies. J Thyroid Res 2021; 2021:5515831. [PMID: 33680424 PMCID: PMC7910053 DOI: 10.1155/2021/5515831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction This meta-analysis was conducted to estimate the prevalence of hypothyroidism among pregnant women in India. Methods We searched PubMed, Web of Science, Scopus, Google Scholar, and Shodhganga (Indian thesis repository) for observational studies, providing prevalence of hypothyroidism among pregnant women in India. Systematic study selection and data extraction procedures were followed. Quality assessment of each study was done using JBI critical appraisal checklist. The random effects model was used for pooling the effect sizes. Publication bias was assessed using the funnel plot and rank correlation test. I 2 statistics was used to measure heterogeneity across the studies. Heterogeneity in the pooled estimates was further explored with subgroup analyses and meta-regression analysis. Results Sixty-one studies were found eligible and included in this review. The pooled estimate of the prevalence of hypothyroidism in pregnant women was 11.07% (95% CI: 8.79-13.84, I 2 = 99%). Pooled prevalence estimates of subclinical and overt hypothyroidism are 9.51% (95% CI: 7.48-12.04, I 2 = 98%) and 2.74% (95% CI: 2.08-3.58, I 2 = 94%). Conclusion We documented 11.07% pooled prevalence of hypothyroidism in pregnant women in India.
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Kiran Z, Sheikh A, Islam N. Association of thyroid antibodies status on the outcomes of pregnant women with hypothyroidism (maternal hypothyroidism on pregnancy outcomes, MHPO-4). BMC Pregnancy Childbirth 2021; 21:136. [PMID: 33588796 PMCID: PMC7885223 DOI: 10.1186/s12884-021-03594-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 01/27/2021] [Indexed: 01/19/2023] Open
Abstract
Background Autoimmunity increases with age and is often commonly evaluated in women of the reproductive age group. Prevalence of thyroid antibodies is common even in euthyroid pregnant women. We aim to compare the association of thyroid antibody status on the maternal and neonatal outcomes in pregnant women with hypothyroidism. Methods We conducted a cross-sectional retrospective study on 718 cases in the Aga Khan University Hospital. Information was collected on pregnant women who have been diagnosed with hypothyroidism before conception or during their antenatal period. Laboratory data were recorded for thyroid peroxidase antibodies, anti-thyroglobulin antibodies, and thyroid-stimulating hormone levels. Maternal and neonatal outcomes were also noted from medical file records. Data analysis was performed on Statistical Package for the Social Sciences version 20.0. Results Overall, 146 out 718 cases were included for final analysis. Thyroid peroxidase antibodies were positive in 66.4% and anti-thyroglobulin was positive in 52.1% cases, whereas 43.8% of cases had both antibodies positive. Pre-gestational diabetes was significantly associated with thyroid autoimmunity. There was a 73% less chance of gestational hypertension for thyroid autoimmune groups. Gestational diabetes and maternal (chronic) hypertension were found to have an independent effect on postpartum hemorrhage. Hypertensive disorders in pregnancy were found to have an independent risk for premature birth. Conclusion Our study reports a 74.7% prevalence of positive thyroid antibodies in hypothyroid pregnant women, with higher association with pre-gestational diabetes. Gestational hypertension was least likely to occur in thyroid autoimmune groups. None of the outcomes were independently associated with worse outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03594-y.
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Affiliation(s)
- Zareen Kiran
- Section of Endocrinology, Department of Medicine, The Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, Pakistan.
| | - Aisha Sheikh
- Section of Endocrinology, Department of Medicine, The Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, Pakistan
| | - Najmul Islam
- Section of Endocrinology, Department of Medicine, The Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, Pakistan
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Khakurel G, Karki C, Chalise S. Prevalence of Thyroid Disorder in Pregnant Women Visiting a Tertiary Care Teaching Hospital: A Descriptive Cross-sectional Study. ACTA ACUST UNITED AC 2021; 59:51-54. [PMID: 34508457 PMCID: PMC7893399 DOI: 10.31729/jnma.5529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Indexed: 11/22/2022]
Abstract
Introduction: The function of the thyroid gland is altered during pregnancy. Thyroid disorders during pregnancy are associated with serious maternal and fetal outcomes. Universal screening for thyroid disorders is recommended in the first trimester of pregnancy. This study aims to determine the prevalence of thyroid disorder during pregnancy in women attending a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynaecology of Kathmandu Medical College and Teaching Hospital from March 2020 to August 2020 after obtaining ethical approval from the Institutional Review committee with reference number 20032020. The pregnant women >18 years of age, irrespective of their gestational age and gravida status, were included in the study by convenience sampling method. The participants were screened by estimation of thyroid function test. Data were collected, and statistical analysis was done in Statistical Packages for Social Services version 20.0. Results: A total of 329 pregnant women were included in this study. The prevalence of thyroid disorders in the present study is 24.62%. The most common thyroid disorder observed was subclinical hypothyroidism comprising 65 (19.75%) cases followed by overt hypothyroidism 8 (2.43%) cases. Conclusions: There is a high prevalence of thyroid disorders during pregnancy in our settings. Timely screening of pregnant women helps in the early diagnosis and management of complications related to thyroid disorders.
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Affiliation(s)
- Gita Khakurel
- Department of Physiology, Kathmandu Medical College Public Limited, Duwakot, Bhaktapur, Nepal
| | - Chandrima Karki
- Department of Obstetrics and Gynaecology, Kathmandu Medical College Public Limited, Sinamangal, Kathmandu, Nepal
| | - Sanat Chalise
- Department of Pathology, Kathmandu Medical College Public Limited, Sinamangal, Kathmandu, Nepal
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Dong AC, Stagnaro-Green A. Differences in Diagnostic Criteria Mask the True Prevalence of Thyroid Disease in Pregnancy: A Systematic Review and Meta-Analysis. Thyroid 2019; 29:278-289. [PMID: 30444186 DOI: 10.1089/thy.2018.0475] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The reported prevalence of thyroid disease in pregnancy varies widely through the published literature. These discrepancies are due to differences in criteria for euthyroidism, nationality, iodine status, and gestational age at screening. As a result, currently, an accepted rate of prevalence does not exist for the various thyroid diseases in pregnancy. Understanding the true prevalence rates of these disorders has important implications for clinical management and the ongoing discussion regarding universal screening. The aims of this study were to assess (i) the true prevalence of thyroid disorders in pregnancy and (ii) the impact of diagnostic methodology on these rates. METHODS A systematic review was conducted of the existing literature, including the Pubmed database and references from relevant review articles. Sixty-three studies reporting prevalence of overt hypothyroidism, subclinical hypothyroidism, isolated hypothyroxinemia, subclinical hyperthyroidism, and overt hyperthyroidism in pregnant women were included. Studies were further classified by thyrotropin (TSH) cutoff for diagnosis in hypothyroid disease and timing of screening for hyperthyroid disease. Meta-analysis yielded pooled prevalence rates, with subgroup analyses for TSH cutoff and timing of screening. Analysis of studies using the 97.5th percentile TSH cutoff was assessed to yield the most accurate prevalence rates for hypothyroidism. RESULTS Pooled prevalence rates for hypothyroidism calculated from studies using the 97.5th percentile as an upper limit for TSH were 0.50% for overt hypothyroidism, 3.47% for subclinical hypothyroidism, and 2.05% for isolated hypothyroxinemia. Pooled prevalence rates in the first and second trimesters for hyperthyroidism were 0.91% and 0.65%, respectively, for overt hyperthyroidism and 2.18% and 0.98%, respectively, for subclinical hyperthyroidism. CONCLUSION Population-based, trimester-specific TSH cutoffs for diagnosis of hypothyroid disease in pregnancy result in more accurate diagnosis and better estimates for prevalence of disease. Prevalence of hyperthyroidism in pregnancy varies depending on timing of screening. The prevalence rates reported in this study represent the best estimate to date of the true rates of thyroid disease in pregnancy.
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Affiliation(s)
- Allan Chen Dong
- 1 Department of Obstetrics and Gynecology, University of Illinois College of Medicine at Chicago, Chicago, Illinois
| | - Alex Stagnaro-Green
- 2 Department of Medicine, Obstetrics and Gynecology, and Medical Education, University of Illinois College of Medicine at Rockford, Rockford, Illinois
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Neelaveni K, Kumar KVSH, Sahay R, Ramesh J. Postpartum Follow-up in Women Diagnosed with Subclinical Hypothyroidism during Pregnancy. Indian J Endocrinol Metab 2017; 21:699-702. [PMID: 28989877 PMCID: PMC5628539 DOI: 10.4103/ijem.ijem_452_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Management guidelines about the thyroid disease in pregnancy are silent about the postpartum course of new onset subclinical hypothyroidism (SCH). Hence, we analyzed the 2 years outcome of SCH diagnosed during pregnancy. MATERIALS AND METHODS We conducted this retrospective study using the medical records of patients with new onset SCH during pregnancy between 2010 and 2013 (n = 718). Patients who stopped their levothyroxine after delivery with a 2-year follow-up record were included. We excluded patients with known thyroid disorders and continuous use of drugs that affect the thyroid results. The patients were divided into two groups (Group 1 - euthyroid and Group 2 - hypothyroid) based on the final outcome after 2 years. The data were analyzed using appropriate statistical methods and a P < 0.05 was considered statically significant. RESULTS A total of 559 (77.8%) women stopped levothyroxine after delivery, and the final follow-up data were available for 467 patients only. At the end of 2 years, 384 (82.2%) remained euthyroid, and the remaining 83 (17.8%) developed hypothyroidism. SCH and overt hypothyroidism were seen in 22 and 61 patients, respectively. Group 2 patients had higher mean age (25.5 vs. 23.6 years), goiter (51 vs. 2%), initial thyroid stimulating hormone (7.9 vs. 5.1 μIU/mL), and thyroid antibody positivity (76 vs. 13%) (P < 0.001). CONCLUSION The majority of patients with SCH during pregnancy remain euthyroid after delivery. Advanced age, goiter, positive family history, and thyroid autoimmunity increase the future risk of hypothyroidism in patients with SCH diagnosed during pregnancy.
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Affiliation(s)
- K. Neelaveni
- Department of Endocrinology, Osmania Medical College, Hyderabad, Telangana, India
| | | | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, Telangana, India
| | - Jayanthy Ramesh
- Department of Endocrinology, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
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Rajput R, Singh B, Goel V, Verma A, Seth S, Nanda S. Trimester-specific reference interval for thyroid hormones during pregnancy at a Tertiary Care Hospital in Haryana, India. Indian J Endocrinol Metab 2016; 20:810-815. [PMID: 27867885 PMCID: PMC5105566 DOI: 10.4103/2230-8210.192903] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Reference intervals for thyroid hormone during pregnancy need to be gestational age, method, and population specific and there is need to establish trimester-specific thyroid levels for the different population across the world. The aim of this study was to establish trimester-specific reference range for thyroid hormone during pregnancy in a tertiary care center in Haryana. MATERIALS AND METHODS A total of 1430 pregnant women were recruited for the study. Participants having any history of chronic illness, goiter on physical examination, thyroid illness in the past or present, consuming thyroid medications, family history of thyroid illness, presence of anti-thyroid peroxidase antibody, poor obstetrics history were excluded from the study and reference population was identified to calculate serum free triiodothyronine (FT3), free thyroxine (FT4) and thyrotropin (TSH) for each trimester of pregnancy. RESULTS The 2.5-97.5th percentiles for FT3, FT4, and TSH obtained in this study were 2.53-4.54 pg/ml, 0.88-1.78 ng/ml and 0.37-3.69 μIU/ml in the first trimester, 2.0-4.73 pg/ml, 0.91-1.78 ng/ml and 0.54-4.47 μIU/ml in the second trimester, 2.01-4.01 pg/ml, 0.83-1.73 ng/ml, and 0.70-4.64 μIU/ml in the third trimester of pregnancy. Mean TSH increased and mean FT3 decreased significantly with the progression of gestational period. FT4 decreased from trimester 1-3rd, but the decrease was nonsignificant from 2nd to 3rd trimester. CONCLUSIONS Existing results for trimester-specific reference intervals for thyroid hormones are inconsistent and cannot be extrapolated due to differences in ethnicity, maternal iodine status, laboratory assay method, and rigor for selection of reference population. Thus, establishment of reference intervals in each region is of great importance.
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Affiliation(s)
- Rajesh Rajput
- Department of Endocrinology and Medicine Unit VI, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Bhagat Singh
- Department of Endocrinology and Medicine Unit VI, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Vasudha Goel
- Department of Endocrinology and Medicine Unit VI, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Amit Verma
- Department of Endocrinology and Medicine Unit VI, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Shashi Seth
- Department of Biochemistry, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Smiti Nanda
- Department of Obstertrics and Gynaecology, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
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14
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Almomin AMS, Mansour AA, Sharief M. Trimester-Specific Reference Intervals of Thyroid Function Testing in Pregnant Women from Basrah, Iraq Using Electrochemiluminescent Immunoassay. Diseases 2016; 4:diseases4020020. [PMID: 28933400 PMCID: PMC5456279 DOI: 10.3390/diseases4020020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/18/2016] [Accepted: 04/18/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Abbas Ali Mansour
- Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine, Basrah 61013, Iraq.
| | - Maysoon Sharief
- Department of Gynecology and Obstetrics, Basrah College of Medicine, Basrah 61013, Iraq.
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