Epidemiology and management of thyroid disorders in pregnancy


Authors: A. Skřivánek 1;  M. Lubušký 2,3;  M. Studničková 2;  I. Holusková 4;  M. Procházka 2
Authors‘ workplace: G-Centrum Olomouc, vedoucí MUDr. A. Skřivánek 1;  Porodnicko-gynekologická klinika, FN a LF UP, Olomouc, přednosta prof. MUDr. R. Pilka, Ph. D. 2;  Ústav lekařské genetiky a fetální medicíny, FN a LF UP, Olomouc, přednosta prof. MUDr. J. Šantavý, CSc. 3;  Transfuzní oddělení, FN a LF UP, Olomouc, primářka MUDr. D. Galuszková, MBA, Ph. D. 4
Published in: Čes. Gynek.2013, 78, č. 1 s. 62-67

Overview

Objective:
Determine the incidence of asymptomatic decrease of thyroid function at pregnant women in the first trimester of pregnancy in the Olomouc region.

Material and methods:
The authors examined461 women in the first trimester of pregnancy. There was measured serum concentrations of thyrotropin (TSH), free thyroxine (FT4) and thyroidperoxidaseantibody (TPOAb).

Results:
TSH concentration > 2.5 mIU/l was in 21% women (96/461). Reduction of FT4 < 9.8 pmol/l was found in 15 of the 96 women screened with a TSH greater than 2.5 mU/l. For women with TSH ≤ 2.5 mU/l, however, was found reduction of the FT4 < 9.8 pmol/l in 11 cases.

TSH concentration > 3 mIU/l was found in 14% women (64/461). Reduction of FT4 < 9.8 pmol/l was found in 13 of the 64 women screened with a TSH greaterthan 3 mU/l.

TSH concentration> 3.5 mIU/l in 10% of women (45/461). Reduction of FT4 <9.8 pmol/l was found in 11 of 45 examined women with TSH greater than 3.5 mU/l.

TSH concentration > 4 mIU/l in 8% of women (35/461). Reduction of FT4 < 9.8 pmol/l was found in 10 of35 examined women with TSH greater than 4 mU/l.

TPOAb was raised over 20 kU/l in 17% of women (78/461).

Conclusions:

Asymptomatic decrease of thyroid function was during direct examination in the first trimester of pregnancy diagnosed at more than 8% of pregnant women. Untreated decreased of thyroid function at mothers may have a negative impact on the course of pregnancy, as well as on fetal development, especially in the psychomotoric area. The presence of TPOAb indicate an increased risk of developing thyroid fictional disorders in pregnancy or postpartum thyroiditis. TSH in pregnancy may be affected by elevated levels of hCG and may slightly decrease because hCG and TSH have a common alpha subunit. Discussed the specific standards for TSH in pregnant and implementation of systematic screening for women in early pregnancy or before planned conception. Perspective, however, we see in tests of thyroid function already in preconception period.

Keywords:
hypothyroidism – pregnancy – thyrotropin – free thyroxine – thyroidperoxidase


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Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

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