Screening of disturbances of thyroid gland during pregnancy and postpartum


Authors: A. Kořenek
Authors‘ workplace: Gynekologicko-porodnické oddělení ;  Jesenická nemocnice, spol. s r.  o.
Published in: Prakt Gyn 2009; 13(3): 137-141

Overview

Aims:
The evaluation of thyroideal gland function during gravidity and after childbirth together with its dependence on iodine status in patients during early pregnancy, the level of thyroid-stimulating hormone (TSH), free thyroxin (fT4), thyroid antibodies against peroxidase (anti TPO) and thyreoglobulin (anti TG).

Type of study:
Prospective longitudinal study.


Title and address of workplace:


Obstetrics and Gynecology Department, Jeseník Hospital. Methods: In the period between June 2005 and December 2006, 174 patients with a confirmed vital pregnancy (up to 10th week of pregnancy) were random included into the study. Iodine status was established based on the amount of iodine in the urine during 24 hours, the TSH, fT4, anti TPO and anti TG levels were determined from the blood using chemoluminescence. Blood samplings were done after a confirmation of vital pregnancy (I), in 20th week of pregnancy (II), four days after delivery (III) and six months after delivery (IV).

Results:
165 of them completed study, seven patients used thyroxin before gravidity. The average ioduria value in patients was found to be 3.04 μmol/24 hours, none of the patients had a value lower than 0.6 μmol/24 hours. The 15 (9.1%) patients had levels of TSH (I) above 3 mIU/l (14 of them above 5 mIU/l), there are 8 (4.8%) patients in group IV, which levels of TSH were above 5 mIU/l. All patients had normal level of fT4: 10.3–25 pmol/l. Five pregnancies ended in miscarriage by week 22, the other pregnancies concluded by delivery between weeks 38–41.

Conclusions:
The results of our study did not demonstrate iodine insufficiency in any of patients, however 15 patients had elevated TSH levels (I), signaling subclinical or incipiently clinical hypothyroidism. There is alerting a elevation of level TSH (I) in 4 patients from 7 patients, which used euthyrox before pregnancy. Eight (4.8%) patients had levels of TSH (IV) higher than 5 mIU/l half year after delivery, what is confirming a subclinical postpartal hypothyroidism.

Key words:
iodine – thyroid-stimulating hormone (TSH) – pregnancy – hypothyroidism


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Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine
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