Araştırma Makalesi
Yıl 2024,
Cilt: 6 Sayı: 2, 70 - 73
Öz
Objective: The normal free T4 level together with a high TSH level is called subclinical hypothyroidism. In this study, we investigated cases of subclinical hypothyroidism diagnosed in the first trimester for possible adverse effects. The study aims to show the pregnancy outcomes and neonatal effects.
Material and Methods: The study we planned was conducted retrospectively as a record study based on diagnoses. Three hospitals; one city and two state hospitals, were included in our study. Pregnant women treated at these centers between 2019 and 2021 were included the screening of newborns was similarly performed by our pediatric colleagues, based on the diagnosis in the form of scanning the files.
Results: It became statistically significant when prematurity (p: 0.005), fetal weight, and week of birth were evaluated. The T4 values of the pregnant women who taken part in the study were normal, and their TSH values were ≥ 2.5-4 mIU/L. The evaluation showed that preterm birth was statistically higher and fetal weight and week of birth were significantly lower.
Conclusions: In the study of pregnant women diagnosed with subclinical hypothyroidism, it was found that the preterm delivery rate was higher than in the control group, and the delivery week was also lower than in the control group.
Anahtar Kelimeler
Kaynakça
- Yamamoto JM, Benham JL, Nerenberg KA, Donovan LE. Impact of levothyroxine therapy on obstetric, neonatal and childhood outcomes in women with subclinical hypothyroidism diagnosed in pregnancy: a systematic review and meta-analysis of randomised controlled trials. BMJ open. 2018;8(9):e022837.
- Gietka-Czernel M, Glinicki P. Subclinical hypothyroidism in pregnancy: controversies on diagnosis and treatment. Pol Arch Intern Med. 2021;131(3):266-75.
- Wu MQ, Liu J, Wang YQ, Yang Y, Yan CH, Hua J. The impact of subclinical hypothyroidism on adverse perinatal outcomes and the role of thyroid screening in pregnancy. Frontiers in endocrinology. 2019;10:522.
- Maraka S, Singh Ospina NM, Mastorakos G, O’Keeffe DT. Subclinical hypothyroidism in women planning conception and during pregnancy: who should be treated and how? Journal of the Endocrine Society. 2018;2(6):533-46.
- Korkut S, Çaylan N, Özgü Erdinç AS, Akın MŞ, Ceyhan M, Kara F, et al. Effect of Maternal Subclinical Hypothyroidism on Congenital Hypothyroidism Screening Results: A Retrospective Cohort Study. Am J Perinatol. 2022;6. doi: 10.1055/a-1819-1669.
- Dhillon-Smith RK, Boelaert K, Jeve YB, Maheshwari A, Coomarasamy A; Royal College of Obstetricians and Gynaecologists. Subclinical hypothyroidism and antithyroid autoantibodies in women with subfertility or recurrent pregnancy loss: Scientific Impact Paper No. 70 June 2022. BJOG. 2022;129(12):e75-e88. doi: 10.1111/1471-0528.17187.
- Bein M, Yu OHY, Grandi SM, Frati FY, Kandil I, Filion KB. Levothyroxine and the risk of adverse pregnancy outcomes in women with subclinical hypothyroidism: a systematic review and meta-analysis. BMC endocrine disorders. 2021;21(1):1-17.
- Nazarpour S, Ramezani Tehrani F, Amiri M, Bidhendi Yarandi R, Azizi F. Levothyroxine treatment and pregnancy outcomes in women with subclinical hypothyroidism: a systematic review and meta-analysis. Archives of gynecology and obstetrics. 2019;300(4):805-19.
- López-Tinoco C, Rodríguez-Mengual A, Lara-Barea A, Barcala J, Larrán L, Saez-Benito A, et al. Impact of positive thyroid autoimmunity on pregnant women with subclinical hypothyroidism. Endocrinología, Diabetes y Nutrición (English ed). 2018;65(3):150-5.
- Beneventi F, De Maggio I, Bellingeri C, Cavagnoli C, Spada C, Boschetti A, et al. Thyroid autoimmunity and adverse pregnancy outcomes: a prospective cohort study. Endocrine. 2022;76(1):198-207.
- Rotondi M, Chiovato L, Pacini F, Bartalena L, Vitti P. Management of subclinical hypothyroidism in pregnancy: a comment from the Italian Society of Endocrinology and the Italian Thyroid Association to the 2017 American Thyroid Association guidelines—“The Italian Way”. Mary Ann Liebert, Inc. 140 Huguenot Street, 3rd Floor New Rochelle, NY 10801 USA; 2018. p. 551-5.
- Fadeyev VV. Review of American Thyroid Association guidelines for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Clinical and experimental thyroidology. 2018;14(3):128-39.
- Castillo C, Lustig N, Margozzini P, Gomez A, Rojas MP, Muzzo S, et al. Thyroid-stimulating hormone reference ranges in the first trimester of pregnancy in an iodine-sufficient country. Endocrinology and Metabolism. 2018;33(4):466-72.
- Macaulay S, Buchmann EJ, Dunger DB, Norris SA. Reliability and validity of last menstrual period for gestational age estimation in a low‐to‐middle‐income setting. Journal of Obstetrics and Gynaecology Research. 2019;45(1):217-25.
- Futela D, Maheswari K, Khanna T. Fasting versus postprandial state: Impact on thyroid function testing. Thyroid Research and Practice. 2021;18(2):61.
- Toloza FJ, Abedzadeh-Anaraki S, Maraka S. Subclinical hypothyroidism in pregnancy. Current Opinion in Endocrinology, Diabetes and Obesity. 2019;26(5):225-31.
- Toloza FJ, Singh Ospina NM, Rodriguez-Gutierrez R, O’Keeffe DT, Brito JP, Montori VM, et al. Practice variation in the care of subclinical hypothyroidism during pregnancy: a national survey of physicians in the United States. Journal of the Endocrine Society. 2019;3(10):1892-906.
- Taylor PN, Zouras S, Min T, Nagarahaj K, Lazarus JH, Okosieme O. Thyroid screening in early pregnancy: pros and cons. Frontiers in endocrinology. 2018;9:626.
- Sullivan SA. Hypothyroidism in pregnancy. Clinical Obstetrics and Gynecology. 2019;62(2):308-19.
- Eastman CJ, Blumenthal NJ. Gestational Subclinical Hypothyroidism. Thyroid Diseases in Pregnancy. 2022:93-108.
- Agrawal P, Mehta S, Gupta M, Khare P. Prevalence of hypothyroidism in the first trimester pregnancy in primigravida in North India. Indian Journal of Obstetrics and Gynecology Research. 2019;6(1):68-70.
- Allon R, Schiller T, Ziv Y, Lahav Y, Cohen O, Zornitzki T. Posthemithyroidectomy Pregnancy Thyroid Function Surveillance: Frequency, Adherence, and Guideline Impact. Endocr Pract. 2022;28(9):847-852. doi: 10.1016/j.eprac.2022.06.004.
- Chen J, Zhu J, Huang X, Zhao S, Xiang H, Zhou P, et al. Subclinical hypothyroidism with negative for thyroid peroxidase antibodies in pregnancy: intellectual development of offspring. Thyroid. 2022;32(4):449-58.
- Negro R. Outcomes in Pregnant Patients with Subclinical Hypothyroidism and Thyroid Autoimmunity: A Critical Appraisal of Recent Randomized Controlled Trials. Endocrine, Metabolic & Immune Disorders-Drug Targets (Formerly Current Drug Targets-Immune, Endocrine & Metabolic Disorders). 2021;21(8):1387-91.
- Lucaccioni L, Ficara M, Cenciarelli V, Berardi A, Predieri B, Iughetti L. Long term outcomes of infants born by mothers with thyroid dysfunction during pregnancy. Acta Biomed. 2020;15:92(1):e2021010. doi: 10.23750/abm.v92i1.9696. PMID: 33682817; PMCID: PMC7975942.
- Kiran Z, Sheikh A, Humayun KN, Islam N. Neonatal outcomes and congenital anomalies in pregnancies affected by hypothyroidism. Annals of medicine. 2021;53(1):1560-8.
- Mayhew CE, Simonson KR, Ellsworth Bowers ER. Antepartum Care for Pregnant People with Overt Hypothyroidism, Subclinical Hypothyroidism, and Positive Thyroid Autoantibodies. J Midwifery Womens Health. 2022;67(3):295-304. doi: 10.1111/jmwh.13306.
- Rao M, Zeng Z, Zhou F, Wang H, Liu J, Wang R, et al. Effect of levothyroxine supplementation on pregnancy loss and preterm birth in women with subclinical hypothyroidism and thyroid autoimmunity: a systematic review and meta-analysis. Human reproduction update. 2019;25(3):344-61.
Yıl 2024,
Cilt: 6 Sayı: 2, 70 - 73
Öz
Amaç: Yüksek TSH düzeyi ile birlikte normal serbest T4 düzeyine subklinik hipotiroidizm denir. Bu çalışmada olası yan etkiler açısından ilk trimesterde teşhis edilen subklinik hipotiroidi vakalarını araştırdık. Çalışma, gebelik sonuçlarını ve yenidoğan etkilerini göstermeyi amaçlamaktadır.
Gereç ve Yöntem: Planladığımız çalışma tanılara dayalı olarak retrospektif olarak kayıt çalışması şeklinde yürütülmüştür. Üç hastane; bir şehir ve iki devlet hastanesi çalışmamıza dahil edildi. 2019-2021 yılları arasında bu merkezlerde tedavi gören gebeler dahil edilmiş, yenidoğan taramaları benzer şekilde pediatrik meslektaşlarımız tarafından dosyaların taranması şeklinde tanıya dayalı olarak yapılmıştır.
Bulgular: Prematürite (p: 0,005), fetal ağırlık ve doğum haftası değerlendirildiğinde istatistiksel olarak anlamlı hale geldi. Çalışmaya katılan gebelerin T4 değerleri normal, TSH değerleri ≥ 2.5-4 mIU/L idi. Değerlendirme, erken doğumun istatistiksel olarak daha yüksek olduğunu ve fetal ağırlığın ve doğum haftasının önemli ölçüde daha düşük olduğunu gösterdi.
Sonuç: Subklinik hipotiroidi tanısı alan gebelerde yapılan çalışmada erken doğum oranının kontrol grubuna göre daha yüksek olduğu ve doğum haftasının da kontrol grubuna göre daha düşük olduğu bulundu.
Anahtar Kelimeler
Kaynakça
- Yamamoto JM, Benham JL, Nerenberg KA, Donovan LE. Impact of levothyroxine therapy on obstetric, neonatal and childhood outcomes in women with subclinical hypothyroidism diagnosed in pregnancy: a systematic review and meta-analysis of randomised controlled trials. BMJ open. 2018;8(9):e022837.
- Gietka-Czernel M, Glinicki P. Subclinical hypothyroidism in pregnancy: controversies on diagnosis and treatment. Pol Arch Intern Med. 2021;131(3):266-75.
- Wu MQ, Liu J, Wang YQ, Yang Y, Yan CH, Hua J. The impact of subclinical hypothyroidism on adverse perinatal outcomes and the role of thyroid screening in pregnancy. Frontiers in endocrinology. 2019;10:522.
- Maraka S, Singh Ospina NM, Mastorakos G, O’Keeffe DT. Subclinical hypothyroidism in women planning conception and during pregnancy: who should be treated and how? Journal of the Endocrine Society. 2018;2(6):533-46.
- Korkut S, Çaylan N, Özgü Erdinç AS, Akın MŞ, Ceyhan M, Kara F, et al. Effect of Maternal Subclinical Hypothyroidism on Congenital Hypothyroidism Screening Results: A Retrospective Cohort Study. Am J Perinatol. 2022;6. doi: 10.1055/a-1819-1669.
- Dhillon-Smith RK, Boelaert K, Jeve YB, Maheshwari A, Coomarasamy A; Royal College of Obstetricians and Gynaecologists. Subclinical hypothyroidism and antithyroid autoantibodies in women with subfertility or recurrent pregnancy loss: Scientific Impact Paper No. 70 June 2022. BJOG. 2022;129(12):e75-e88. doi: 10.1111/1471-0528.17187.
- Bein M, Yu OHY, Grandi SM, Frati FY, Kandil I, Filion KB. Levothyroxine and the risk of adverse pregnancy outcomes in women with subclinical hypothyroidism: a systematic review and meta-analysis. BMC endocrine disorders. 2021;21(1):1-17.
- Nazarpour S, Ramezani Tehrani F, Amiri M, Bidhendi Yarandi R, Azizi F. Levothyroxine treatment and pregnancy outcomes in women with subclinical hypothyroidism: a systematic review and meta-analysis. Archives of gynecology and obstetrics. 2019;300(4):805-19.
- López-Tinoco C, Rodríguez-Mengual A, Lara-Barea A, Barcala J, Larrán L, Saez-Benito A, et al. Impact of positive thyroid autoimmunity on pregnant women with subclinical hypothyroidism. Endocrinología, Diabetes y Nutrición (English ed). 2018;65(3):150-5.
- Beneventi F, De Maggio I, Bellingeri C, Cavagnoli C, Spada C, Boschetti A, et al. Thyroid autoimmunity and adverse pregnancy outcomes: a prospective cohort study. Endocrine. 2022;76(1):198-207.
- Rotondi M, Chiovato L, Pacini F, Bartalena L, Vitti P. Management of subclinical hypothyroidism in pregnancy: a comment from the Italian Society of Endocrinology and the Italian Thyroid Association to the 2017 American Thyroid Association guidelines—“The Italian Way”. Mary Ann Liebert, Inc. 140 Huguenot Street, 3rd Floor New Rochelle, NY 10801 USA; 2018. p. 551-5.
- Fadeyev VV. Review of American Thyroid Association guidelines for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Clinical and experimental thyroidology. 2018;14(3):128-39.
- Castillo C, Lustig N, Margozzini P, Gomez A, Rojas MP, Muzzo S, et al. Thyroid-stimulating hormone reference ranges in the first trimester of pregnancy in an iodine-sufficient country. Endocrinology and Metabolism. 2018;33(4):466-72.
- Macaulay S, Buchmann EJ, Dunger DB, Norris SA. Reliability and validity of last menstrual period for gestational age estimation in a low‐to‐middle‐income setting. Journal of Obstetrics and Gynaecology Research. 2019;45(1):217-25.
- Futela D, Maheswari K, Khanna T. Fasting versus postprandial state: Impact on thyroid function testing. Thyroid Research and Practice. 2021;18(2):61.
- Toloza FJ, Abedzadeh-Anaraki S, Maraka S. Subclinical hypothyroidism in pregnancy. Current Opinion in Endocrinology, Diabetes and Obesity. 2019;26(5):225-31.
- Toloza FJ, Singh Ospina NM, Rodriguez-Gutierrez R, O’Keeffe DT, Brito JP, Montori VM, et al. Practice variation in the care of subclinical hypothyroidism during pregnancy: a national survey of physicians in the United States. Journal of the Endocrine Society. 2019;3(10):1892-906.
- Taylor PN, Zouras S, Min T, Nagarahaj K, Lazarus JH, Okosieme O. Thyroid screening in early pregnancy: pros and cons. Frontiers in endocrinology. 2018;9:626.
- Sullivan SA. Hypothyroidism in pregnancy. Clinical Obstetrics and Gynecology. 2019;62(2):308-19.
- Eastman CJ, Blumenthal NJ. Gestational Subclinical Hypothyroidism. Thyroid Diseases in Pregnancy. 2022:93-108.
- Agrawal P, Mehta S, Gupta M, Khare P. Prevalence of hypothyroidism in the first trimester pregnancy in primigravida in North India. Indian Journal of Obstetrics and Gynecology Research. 2019;6(1):68-70.
- Allon R, Schiller T, Ziv Y, Lahav Y, Cohen O, Zornitzki T. Posthemithyroidectomy Pregnancy Thyroid Function Surveillance: Frequency, Adherence, and Guideline Impact. Endocr Pract. 2022;28(9):847-852. doi: 10.1016/j.eprac.2022.06.004.
- Chen J, Zhu J, Huang X, Zhao S, Xiang H, Zhou P, et al. Subclinical hypothyroidism with negative for thyroid peroxidase antibodies in pregnancy: intellectual development of offspring. Thyroid. 2022;32(4):449-58.
- Negro R. Outcomes in Pregnant Patients with Subclinical Hypothyroidism and Thyroid Autoimmunity: A Critical Appraisal of Recent Randomized Controlled Trials. Endocrine, Metabolic & Immune Disorders-Drug Targets (Formerly Current Drug Targets-Immune, Endocrine & Metabolic Disorders). 2021;21(8):1387-91.
- Lucaccioni L, Ficara M, Cenciarelli V, Berardi A, Predieri B, Iughetti L. Long term outcomes of infants born by mothers with thyroid dysfunction during pregnancy. Acta Biomed. 2020;15:92(1):e2021010. doi: 10.23750/abm.v92i1.9696. PMID: 33682817; PMCID: PMC7975942.
- Kiran Z, Sheikh A, Humayun KN, Islam N. Neonatal outcomes and congenital anomalies in pregnancies affected by hypothyroidism. Annals of medicine. 2021;53(1):1560-8.
- Mayhew CE, Simonson KR, Ellsworth Bowers ER. Antepartum Care for Pregnant People with Overt Hypothyroidism, Subclinical Hypothyroidism, and Positive Thyroid Autoantibodies. J Midwifery Womens Health. 2022;67(3):295-304. doi: 10.1111/jmwh.13306.
- Rao M, Zeng Z, Zhou F, Wang H, Liu J, Wang R, et al. Effect of levothyroxine supplementation on pregnancy loss and preterm birth in women with subclinical hypothyroidism and thyroid autoimmunity: a systematic review and meta-analysis. Human reproduction update. 2019;25(3):344-61.
Toplam 28 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Kadın Hastalıkları ve Doğum |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Erken Görünüm Tarihi | 13 Mayıs 2024 |
| Yayımlanma Tarihi | |
| Gönderilme Tarihi | 22 Kasım 2023 |
| Kabul Tarihi | 9 Şubat 2024 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 6 Sayı: 2 |
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