scholarly journals The kidney, subclinical thyroid disease and cardiovascular outcomes in older patients

2020 ◽  
Vol 9 (1) ◽  
pp. 55-62
Author(s):  
L E Zijlstra ◽  
D M van Velzen ◽  
S Simsek ◽  
S P Mooijaart ◽  
M van Buren ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Thyroid Hormones ◽  
Kidney Function ◽  
Thyroid Function ◽  
Primary Endpoint ◽  
Subclinical Hypothyroidism ◽  
Thyroid Disease ◽  
Older Patients ◽  
Thyroid Dysfunction ◽  
Subclinical Hyperthyroidism

Objective Thyroid hormones have been implicated to play a role in cardiovascular disease, along with studies linking thyroid hormone to kidney function. The aim of this study is to investigate whether kidney function modifies the association of subclinical thyroid dysfunction and the risk of cardiovascular outcomes. Methods In total, 5804 patients were included in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). For the current analysis, 426 were excluded because of overt thyroid disease at baseline or 6 months, 266 because of inconsistent thyroid function at baseline and 6 months, 294 because of medication use that could influence thyroid function, and 16 because of missing kidney or thyroid values. Participants with normal fT4 were classified, based on TSH both at inclusion and 6 months, into three groups: subclinical hypothyroidism (TSH >4.5 mIU/L); euthyroidism (TSH = 0.45–4.5 mIU/L); and subclinical hyperthyroidism (TSH <0.45 mIU/L). Strata of kidney function were made based on estimated glomerular filtration rate into three clinically relevant groups: <45, 45–60, and >60 mL/min/1.73 m2. The primary endpoint consists of death from coronary heart disease, non-fatal myocardial infarction and (non)fatal stroke. Results Mean age was 75.3 years, and 49.0% patients were male. Mean follow-up was 3.2 years. Of all participants, 109 subjects (2.2%) had subclinical hypothyroidism, 4573 (94.0%) had euthyroidism, and 182 (3.7%) subclinical hyperthyroidism. For patients with subclinical hypothyroidism, euthyroidism, and subclinical hyperthyroidism, primary outcome occurred in 9 (8.3%), 712 (15.6%), and 23 (12.6%) patients, respectively. No statistically significant relationship was found between subclinical thyroid dysfunction and primary endpoint with adjusted hazard ratios of 0.51 (0.24–1.07) comparing subclinical hyperthyroidism and 0.90 (0.58–1.39) comparing subclinical hypothyroidism with euthyroidism. Neither was this relationship present in any of the strata of kidney function, nor did kidney function interact with subclinical thyroid dysfunction in the association with primary endpoint (P interaction = 0.602 for subclinical hyperthyroidism and 0.388 for subclinical hypothyroidism). Conclusions In this secondary analysis from PROSPER, we found no evidence that the potential association between thyroid hormones and cardiovascular disease is modified by kidney function in older patients with subclinical thyroid dysfunction.

scholarly journals Frequency of subclinical thyroid dysfunction and risk factors for cardiovascular disease among women at a workplace

2010 ◽  
Vol 128 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Rodrigo Diaz-Olmos ◽  
Antônio-Carlos Nogueira ◽  
Daniele Queirós Fucciolo Penalva ◽  
Paulo Andrade Lotufo ◽  
Isabela Martins Benseñor
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Thyroid Disease ◽  
Thyroid Dysfunction ◽  
Free T4 ◽  
Cross Sectional

CONTEXT AND OBJECTIVE: Subclinical thyroid dysfunction is very common in clinical practice and there is some evidence that it may be associated with cardiovascular disease. The aim here was to evaluate the frequencies of subclinical thyroid disease and risk factors for cardiovascular disease among women at a workplace, and to evaluate the association between subclinical thyroid disease and cardiovascular risk factors among them. DESIGN AND SETTING: Cross-sectional study on 314 women aged 40 years or over who were working at Universidade de São Paulo (USP). METHODS: All the women answered a questionnaire on sociodemographic characteristics and risk factors for cardiovascular disease and the Rose angina questionnaire. Anthropometric variables were measured and blood samples were analyzed for blood glucose, total cholesterol and fractions, high-sensitivity C-reactive protein, thyroid-stimulating hormone (TSH), free thyroxine (free-T4) and anti-thyroperoxidase antibodies (anti-TPO). RESULTS: The frequencies of subclinical hypothyroidism and hyperthyroidism were, respectively, 7.3% and 5.1%. Women with subclinical thyroid disease presented higher levels of anti-TPO than did women with normal thyroid function (P = 0.01). There were no differences in sociodemographic factors and cardiovascular risk factors according to thyroid function status, except for greater sedentarism among the women with subclinical hypothyroidism. Restricting the comparison to women with subclinical hypothyroidism (TSH > 10 mIU/l) did not change the results. CONCLUSION: In this sample of women, there was no association between poor profile of cardiovascular risk factors and presence of subclinical thyroid disease that would justify screening at the workplace.

scholarly journals Thyroid Function in Children with Down Syndrome in the Polish Population: A Case–Control Study

2020 ◽  
Vol 23 (6) ◽  
pp. 386-390
Author(s):  
Beata Zelazowska-Rutkowska ◽  
Anna Jakubiuk-Tomaszuk ◽  
Bogdan Cylwik
Keyword(s):  
Down Syndrome ◽  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Thyroid Disease ◽  
Thyroid Dysfunction ◽  
Clinical Symptoms ◽  
Control Group ◽  
Healthy Population ◽  
Polish Population ◽  
Children With Down Syndrome

Background: Patients with subclinical thyroid disease have few or no clinical symptoms of thyroid dysfunction and thus, laboratory diagnosis is needed. In this context, the objective of the current study was to analyze the prevalence rate and pattern of thyroid function in children with Down syndrome in the Polish population. Methods: A total of 30 children, aged 6–12 years, with cytogenetically confirmed Down syndrome were studied. The control group included 27 children. Results: Of the 30 patients with Down syndrome, 14 (46.7%) had abnormal thyroid profiles. Mean thyroid-stimulating hormone (TSH) and fT4 concentrations in children with Down syndrome were found to be significantly increased compared with the controls (4.30 ± 1.9 µIU/mL, 95% CI: 3.55–5.04 µIU/mL vs. 3.10 ± 1.47 µIU/mL, 95% CI: 2.52–3.68 µIU/mL, P = 0.013, 95% CI: 0.26–2.14, and 1.33 ± 0.23 ng/dL, 95% CI: 1.25–1.42 vs. 1.19 ± 0.14 ng/dL, 95% CI: 1.13–1.25, P = 0.008, 95% CI: 0.04–0.24, respectively). In Down syndrome, subclinical hypothyroidism was recognized in 10 children (33.3%) (high TSH and normal fT4 and fT3 levels). Two children (6.67%) had evident hypothyroidism (high TSH and low fT4). In the control group, subclinical hypothyroidism was diagnosed in four (14.8%) children. Conclusion: Children with Down syndrome may have increased secretion of TSH, even when thyroid hormone and autoantibodies are normal, suggesting that an isolated increase in TSH does not predispose the patient to the development of thyroid disease. We also recommend that all patients with Down syndrome should be screened for thyroid dysgenesis, since they have thyroid dysfunction more frequently as compared to the general healthy population.

Thyroid hormones and thermogenesis: A microcalorimetric study of overall cell metabolism in lymphocytes from patients with different degrees of thyroid dysfunction

1990 ◽  
Vol 123 (2) ◽  
pp. 155-160 ◽  
Author(s):  
Stig Valdemarsson ◽  
Julie Ikomi-Kumm ◽  
Mario Monti
Keyword(s):  
Thyroid Hormones ◽  
Production Rate ◽  
Heat Production ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Control Group ◽  
Subclinical Hyperthyroidism ◽  
Significant Difference ◽  
Heat Production Rate ◽  
Serum Tsh

Abstract. We used microcalorimetry to measure lymphocyte heat production rate in patients with clinical and laboratoy hyperthyroidism (serum TSH ↓, serum FT4 ↑, serum FT3 ↑ ), subclinical hyperthyroidism (serum TSH ↓, serum FT4 ↑, serum FT3=), and subclinical hypothyroidism (serum TSH ↑, serum FT4 ↓, serum FT3=) compared with healthy controls (N= 13). The lymphocyte heat production rate was significantly correlated to the free thyroxine level (r=0.53, p<0.01) and to the free triiodothyronine level (r=0.51, p<0.01) when calculated from pooled data for the three patients groups. The hyperthyroid patients (N = 8) had a significantly increased lymphocyte heat production rate, 3.43±0.25 pW/cell, as compared with 2.31±0.12 pW/cell in the control group (p<0.001). The groups with subclinical hyperthyroidism (N = 7) and subclinical hypothyroidism (N=9) had lymphocyte heat production rates of 2.14±0.11 and 2.56±0.15 pW/cell, respectively, not significantly different from that in the controls. Consistently, there was no significant difference between patients with subclinical hyperthyroidism (N=5) and controls (N=5) with regard to lymphocyte energy production as calculated from separately measured oxygen comsumption rates in vitro, 1.36±0.20 and 1.56±0.12 pW/cell, respectively. Thus microcalorimetry seems to be suitable for studying the influence of thyroid hormones on cellular metabolism. Subclinical thyroid dysfunction does not seem to alter the overall rate of lymphocyte metabolism.

scholarly journals Subclinical thyroid dysfunctions are independent risk factors for mortality in a 7.5-year follow-up: the Japanese–Brazilian thyroid study

2010 ◽  
Vol 162 (3) ◽  
pp. 569-577 ◽  
Author(s):  
José A Sgarbi ◽  
Luiza K Matsumura ◽  
Teresa S Kasamatsu ◽  
Sandra R Ferreira ◽  
Rui M B Maciel
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Mortality ◽  
Subclinical Hypothyroidism ◽  
Thyroid Disease ◽  
Subclinical Hyperthyroidism ◽  
Cross Sectional ◽  
All Cause Mortality ◽  
Thyroid Medication ◽  
Cardiometabolic Profile

ObjectiveThe currently available data concerning the influence of subclinical thyroid disease (STD) on morbidity and mortality are conflicting. Our objective was to investigate the relationships between STD and cardiometabolic profile and cardiovascular disease at baseline, as well as with all-cause and cardiovascular mortality in a 7.5-year follow-up.DesignProspective, observational study.MethodsAn overall of 1110 Japanese–Brazilians aged above 30 years, free of thyroid disease, and not taking thyroid medication at baseline were studied. In a cross-sectional analysis, we investigated the prevalence of STD and its relationship with cardiometabolic profile and cardiovascular disease. All-cause and cardiovascular mortality rates were assessed for participants followed for up to 7.5 years. Association between STD and mortality was drawn using multivariate analysis, adjusting for potential confounders.ResultsA total of 913 (82.3%) participants had euthyroidism, 99 (8.7%) had subclinical hypothyroidism, and 69 (6.2%) had subclinical hyperthyroidism. At baseline, no association was found between STD and cardiometabolic profile or cardiovascular disease. Multivariate-adjusted hazard ratios (HRs (95% confidence interval)) for all-cause mortality were significantly higher for individuals with both subclinical hyperthyroidism (HR, 3.0 (1.5–5.9); n=14) and subclinical hypothyroidism (HR, 2.3 (1.2–4.4); n=13) than for euthyroid subjects. Cardiovascular mortality was significantly associated with subclinical hyperthyroidism (HR, 3.3 (1.4–7.5); n=8), but not with subclinical hypothyroidism (HR, 1.6 (0.6–4.2); n=5).ConclusionIn the Japanese–Brazilian population, subclinical hyperthyroidism is an independent risk factor for all-cause and cardiovascular mortality, while subclinical hypothyroidism is associated with all-cause mortality.

scholarly journals Thyroid Function in 3000 Cases of Patients With Atrial Fibrillation Treated With Catheter Ablation

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A979-A980
Author(s):  
Sayaka Yamada ◽  
Yasuyo Nakajima ◽  
Ayaka Nishikido ◽  
Masako Akuzawa ◽  
Koji Sakamaki ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Thyroid Hormones ◽  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Treated Group ◽  
Control Group ◽  
Subclinical Hyperthyroidism ◽  
Treated Male ◽  
Overt Hyperthyroidism

Abstract Objective: Thyroid hormones have various effects on cardiac and circulatory systems, leading to arrhythmias and heart failure. In Europe and the United States, it has been reported that elevated thyroid hormones within the normal range have been reported to be associated with a risk of atrial fibrillation, however, there was no report on Japanese cases, a country that differs in iodine intake and ethnicity from the West. Therefore, we evaluated the abnormality of thyroid function in a large number of cases of atrial fibrillation (AF) who received catheter ablation (RFCA) in Japan. Methods: We evaluated 2,937 cases of atrial fibrillation (2,084 males, mean age 64.1±10.7 years and 853 females, 69.0±8.5 years) who underwent RFCA at the Gunma Prefectural Cardiovascular Center between 2012 and 2018. As a control we used a total of 15,660 participants for health check-up (9,176 males, mean age 49.7±9.8 years and 6,484 females, 48.9±10.3 years) from 2006 to 2013, and we evaluated thyroid function after adjusting for gender-specific age. Results: The prevalence of overt hyperthyroidism was significantly higher in the RFCA-treated male group (0.43%) than in the control group (0.07%), even after adjusting for age (p&lt;0.01). Similarly, the prevalence of subclinical hyperthyroidism was also significantly higher in the RFCA-treated male group (3.12%) than in the control group (0.94%) after adjusting for age (p&lt;0.01). On the other hand, subclinical hypothyroidism was significantly lower in the RFCA-treated group after adjusting for age (2.97% in the RFCA-treated group and 3.93% in the control group, p&lt;0.01). Females showed the same results as males. Conclusions: In an iodine rich country Japan, not only overt hyperthyroidism but also subclinical hyperthyroidism is an obvious risk factor for severe atrial fibrillation in Japan. Intriguingly, subclinical hypothyroidism might contribute to the prevention of atrial fibrillation, suggesting that slightly higher serum TSH levels might be better for elderlies.

Thyroid Dysfunction States and Incident Cardiovascular Events: The Tehran Thyroid Study

2017 ◽  
Vol 50 (01) ◽  
pp. 37-43 ◽  
Author(s):  
Maryam Tohidi ◽  
Arash Derakhshan ◽  
Samaneh Akbarpour ◽  
Atieh Amouzegar ◽  
Ladan Mehran ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Middle Eastern ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Subclinical Hyperthyroidism ◽  
Significant Difference ◽  
Middle Eastern Population

AbstractThe objective of the study was to investigate the relation of different thyroid function states with the incidence of cardiovascular disease (CVD)/coronary heart disease (CHD) among a Middle-Eastern population with a high incidence of CVD/CHD. A total of 3975 participants entered the study (43.6% men). According to their thyroid stimulating hormone (TSH) and free thyroxin (FT4) levels, the participants were categorized into 5 groups: euthyroid, subclinical hypothyroidism, overt hypothyroidism, subclinical hyperthyroidism, and overt hyperthyroidism. Multivariable Cox proportional hazard models were used to assess the relation of different thyroid function states with incident CVD/CHD, with euthyroid state as reference. The mean age (SD) of the participants was 46.5 (12.0) years. At baseline, no significant difference was observed in the frequency of prevalent CVD cases (n=201) between all groups. No significant interaction was found between prevalent CVD and different thyroid function states with outcomes, hence, we did not exclude participants with prevalent CVD from data analysis. A total of 400 CVD events (358 CHD cases) during a median follow-up of 11.2 years (inter-quartile range: 1.96) occurred. During the follow-up, even in the age and sex adjusted model, no association was observed between different states of thyroid dysfunction and incidence of CVD/CHD. The multivariable hazard ratios (95% CI) of subclinical hypothyroidism, hypothyroidism, subclinical hyperthyroidism, and hyperthyroidism for CVD events were 1.21 (0.77–1.88), 0.76 (0.33–1.69), 0.81 (0.46–1.41) and 1.48 (0.70–3.16), respectively. Both at baseline and during follow-up, no relation was observed between different states of thyroid function with prevalence and incidence of CVD/CHD.

scholarly journals Association between Sleep Duration and Subclinical Thyroid Dysfunction Based on Nationally Representative Data

2019 ◽  
Vol 8 (11) ◽  
pp. 2010 ◽  
Author(s):  
Woojun Kim ◽  
Jeongmin Lee ◽  
Jeonghoon Ha ◽  
Kwanghoon Jo ◽  
Dong-Jun Lim ◽  
...  
Keyword(s):  
Sleep Duration ◽  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Multiple Logistic Regression Analysis ◽  
Subclinical Hyperthyroidism ◽  
Free T4 ◽  
Representative Data ◽  
Increased Risk ◽  
The Impact

Background: Sleep duration is an identified risk factor for adverse health outcomes. As the endocrine system is closely intertwined with sleep duration and quality, the association between endocrine dysfunction and sleep has been evaluated. Thyroid function, particularly that related to thyrotropin (TSH), is also known to be influenced by the sleep/awake status and circadian rhythm. Additionally, a link between sleep duration and autoimmunity, which is a common cause of thyroid dysfunction, has been suggested; however, depending on the sleep deprivation method used in studies, the effects of sleep on thyroid function vary. The relationship between subclinical thyroid dysfunction and sleep duration is poorly documented. Thus, to elucidate the impact of sleep on thyroid function, we investigated the association of subclinical thyroid dysfunction with sleep duration using representative data from the sixth Korea National Health and Nutrition Examination Survey, conducted from 2013 to 2015. Methods: In all, 4945 participants (2543 male and 2402 female) were included after excluding subjects using the following criteria: <19 years of age, free T4 level outside the normal range, history of thyroid disease, or incomplete data. The population was classified into three groups: short sleeper (<7 h/day), normal sleeper (7–8 h/day), and long sleeper (>8 h/day). The odds ratio (OR) for subclinical hypothyroidism or hyperthyroidism according to sleep duration was evaluated. Results: The short, normal, and long sleeper groups consisted of 2097, 2514, and 334 subjects, respectively. On multiple logistic regression analysis, compared to normal sleepers, short sleepers showed a significantly increased risk of subclinical hyperthyroidism (OR 1.37, 95% confidential interval (CI) 1.02–1.84, p = 0.036), while the risk of subclinical hypothyroidism in short sleepers was not elevated. Comparing long sleepers to normal sleepers, the OR for subclinical hyperthyroidism and hypothyroidism was 1.79 (95% CI 1.12–2.86, p = 0.015) and 1.91 (95% CI 1.03–3.53, p = 0.039), respectively. Conclusions: Both shorter and longer sleep durations were associated with an increase in the risk of subclinical thyroid dysfunction compared to the optimal sleep duration. This analysis of representative population data shows that sleep duration could intertwine with thyroid function resulting in increased risk of subclinical thyroid dysfunction.

scholarly journals Retrospective analysis of the effects induced by maternal thyroid dysfunction on obstetrical complications and outcomes

2020 ◽  
Author(s):  
Manna Sun ◽  
Xinghe Wang ◽  
Yunyong Fang ◽  
Jiwu Lou ◽  
Chenning Liu ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Pregnancy Outcomes ◽  
Pregnancy Complications ◽  
Thyroid Dysfunction ◽  
Subclinical Hyperthyroidism ◽  
Obstetrical Complications ◽  
Significant Difference ◽  
Maternal Thyroid

Abstract Background: Abnormal concentrations of maternal thyroid hormones are risk factors for some obstetrical complications. However, the influence induced by different types of maternal thyroid dysfunction on obstetrical complications and outcomes is still controversial.Methods: A total of 17219 pregnant women were drawn for a thyroid function test, including TSH and fT4. All participants were divided into 7 groups, on the basis of their blood tested results, and their pregnancy outcomes were followed up. The isolated hypothyroxinemia group was further divided into 2 cohorts, according to whether they receive levothyroxine. Pregnant complications and outcomes in two cohorts were observed and analyzed.Results: A total of 2621 (15.22%)were identified to have abnormal thyroid function, including 1150 with subclinical hypothyroidism, 526 with gestational transient thyrotoxicosis (GTT), 419 with subclinical hyperthyroidism, 336 with isolated hypothyroxinemia, 78 with hyperthyroidism and 76 with hypothyroidism. Compare to control group, subclinical hypothyroidism, subclinical hyperthyroidism, isolated hypothyroxinemia and hypothyroidism groups presented higher incidence in one or more complications of pregnancy, while, GTT and drug-controlled hyperthyroidism had little significant effect on pregnancy complications. In isolated hypothyroxinemia group, there were no significant difference outcomes between cohorts using levothyroxine and not treatment.Conclusions: Our results showed a high incidence rate of thyroid dysfunction in pregnant women, and subclinical hypothyroidism is most common, followed by GTT. In general, pregnant women with thyroid dysfunction presented high risk of pregnancy complications. Isolated hypothyroxinemia in pregnant women is a matter of concern and treatment with levothyroxine couldn’t improve pregnancy outcomes and obstetrical complications.

THYROID DYSFUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE: THE STATE OF THE PROBLEM AND THE WAYS OF SOLVING

2018 ◽  
Vol 22 (4) ◽  
pp. 40-49 ◽  
Author(s):  
A. R. Volkova ◽  
O. D. Dygun ◽  
B. G. Lukichev ◽  
S. V. Dora ◽  
O. V. Galkina
Keyword(s):  
Chronic Kidney Disease ◽  
Thyroid Gland ◽  
Kidney Disease ◽  
Thyroid Hormones ◽  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
The Body ◽  
Type I ◽  
Low T3 ◽  
Iodine Excretion

Disturbance of the thyroid function is often detected in patients with different profiles. A special feature of patients with chronic kidney  disease is the higher incidence of various thyroid function  disturbances, especially hypothyroidism. It is known that in patients  with chronic kidney disease (CKD) iodine excretion from the body is  violated, since normally 90% of iodine is excreted in urine.  Accumulation of high concentrations of inorganic iodine leads to the  formation of the Wolf-Chaikoff effect: suppression of iodine  organization in the thyroid gland and disruption of the thyroid  hormones synthesis. Peripheral metabolism of thyroid hormones is  also disturbed, namely, deiodinase type I activity is suppressed and  peripheral conversion of T4 into T3 is inhibited (so-called low T3  syndrome). Therefore, patients with CKD are often diagnosed with  hypothyroidism, and the origin of hypothyroidism is not always  associated with the outcome of autoimmune thyroiditis. The article  presents an overview of a large number of population studies of  thyroid gland dysfunction in patients with CKD, as well as  experimental data specifying the pathogenetic mechanisms of  thyroid dysfunction in patients with CKD. Therapeutic tactics are still  not regulated. However, in a number of studies, replacement therapy with thyroid hormones in patients with CKD had some advantages.

scholarly journals Management of thyroid disease in pregnancy – Room for improvement in the first trimester

2016 ◽  
Vol 9 (3) ◽  
pp. 126-129 ◽  
Author(s):  
Helen Robinson ◽  
Philip Robinson ◽  
Michael D’Emden ◽  
Kassam Mahomed
Keyword(s):  
General Practitioner ◽  
Thyroid Function ◽  
Thyroid Disease ◽  
Thyroid Dysfunction ◽  
First Trimester ◽  
Antenatal Clinic ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
In Pregnancy ◽  
Stimulating Hormone

Background First-trimester care of maternal thyroid dysfunction has previously been shown to be poor. This study evaluates early management of thyroid dysfunction in pregnancy in Australia. Methods Patients reviewed by the Obstetric Medicine team for thyroid dysfunction from 1 January 2012 to 30 June 2013 were included. Data were collected on gestation at referral from the patient’s general practitioner to the antenatal clinic, information provided in the referral letter, thyroid function tests and thyroid medications. Results Eighty-five women were included in the study. At the time of general practitioner referral to antenatal services, 19% of women with preexisting thyroid disease had no thyroid function tested. Forty-three percent had an abnormal thyroid-stimulating hormone defined as being outside the laboratory-specific pregnancy reference range if available, or outside the level of 0.1–2.5 mIu/L in the first trimester, 0.2–3.0 mIu/L in the second trimester and 0.3–3.0 mIu/L in the third trimester. Only 21% of women increased their thyroxine dose prior to their first antenatal clinic review. Conclusion This study highlights that a significant proportion of women with known thyroid disease either have untested thyroid function in the first trimester or a thyroid-stimulating hormone outside of levels recommended by guidelines.

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