Thyroid Disease II: Hypothyroidism in Pregnancy

2020 ◽  
Author(s):  
Robert B. Martin ◽  
Brian Casey
Keyword(s):  
Thyroid Disease ◽  
Elevated Serum ◽  
Disease Diagnosis ◽  
Small Subset ◽  
Overt Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Postpartum Thyroiditis ◽  
Increased Risk ◽  
Serum Tsh ◽  
In Pregnancy

Hypothyroidism affects between 2 and 12 per 1000 pregnancies.  Symptoms in pregnancy are similar those encountered in the nonpregnant population, but may be attributed to the pregnancy itself. Thyroxine-binding globulin increases in pregnancy, leading to increased thyroxine levels in order to meet the metabolic needs of normal pregnancy.  Routine screening is not recommended, and testing should be done using a targeted approach in women with symptoms or history of thyroid disease. Diagnosis is based upon the finding of an elevated serum TSH using population and trimester-specific ranges. Overt hypothyroidism, identified by high serum TSH and low free thyroxine, is associated with increased risk of pregnancy-related complications, and is treated with maternal thyroxine supplementation.  Adequate iodine is necessary for fetal neurodevelopment, and women with iodine deficiency may present with a goiter, though it is important to distinguish it from other causes of thyroid enlargement, including malignancy.  Postpartum thyroiditis is diagnosed infrequently, as only a small subset of women will demonstrate the classic biphasic presentation,  Additionally, symptoms are often vague, nonspecific, and self-limited.  Importantly, many women are at risk of eventually developing permanent hypothyroidism. This review contains 6 tables, and 48 references.  Key words: euthyroid, goiter, overt hypothyroidism, postpartum thyroiditis, thyroixine binding globulin, thyroid peroxidase, thryroid nodules

scholarly journals An international survey of screening and management of hypothyroidism during pregnancy in Latin America

2014 ◽  
Vol 58 (9) ◽  
pp. 906-911 ◽  
Author(s):  
Mateus Fernandes da Silva Medeiros ◽  
Taise Lima de Oliveira Cerqueira ◽  
Joaquim Custódio Silva Junior ◽  
Magali Teresopolis Reis Amaral ◽  
Bijay Vaidya ◽  
...  
Keyword(s):  
Latin America ◽  
Latin American ◽  
Thyroid Disease ◽  
Thyroid Autoimmunity ◽  
First Trimester ◽  
Overt Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Starting Dose ◽  
Clinical Case Scenarios ◽  
In Pregnancy

Objective To determine how endocrinologists in Latin America deal with clinical case scenarios related to hypothyroidism and pregnancy. Materials and methods In January 2013, we sent an electronic questionnaire on current practice relating to management of hypothyroidism in pregnancy to 856 members of the Latin American Thyroid Society (LATS) who manage pregnant patients with thyroid disease. Subsequently, we have analyzed responses from physician members. Results Two hundred and ninety-three responders represent clinicians from 13 countries. All were directly involved in the management of maternal hypothyroidism and 90.7% were endocrinologists. The recommendation of a starting dose of L-thyoxine for a woman diagnosed with overt hypothyroidism in pregnancy, preconception management of euthyroid women with known thyroid autoimmunity and approach related to ovarian hyperstimulation in women with thyroid peroxidase antibodies were widely variable. For women with known hypothyroidism, 34.6% of responders would increase L-thyroxine dose by 30-50% as soon as pregnancy is confirmed. With regard to screening, 42.7% of responders perform universal evaluation and 70% recommend TSH < 2.5 mUI/L in the first trimester and TSH < 3 mUI/L in the second and third trimester as target results in known hypothyroid pregnant women. Conclusion Deficiencies in diagnosis and management of hypothyroidism during pregnancy were observed in our survey, highlighting the need for improvement of specialist education and quality of care offered to patients with thyroid disease during pregnancy in Latin America. Arq Bras Endocrinol Metab. 2014;58(9):906-11

Subclinical hypothyroidism: an audit of management

2003 ◽  
Vol 40 (6) ◽  
pp. 694-696
Author(s):  
PK Prakash ◽  
H Bolusani ◽  
A Hameed ◽  
LDKE Premawardhana
Keyword(s):  
Subclinical Hypothyroidism ◽  
Thyroid Disease ◽  
Treatment Guidelines ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Amiodarone Therapy ◽  
Retrospective Case ◽  
General Physicians ◽  
Serum Tsh

Background: Subclinical hypothyroidism (SH) is a marker for overt hypothyroidism and vascular disease. Treatment guidelines are not universally followed. Thyroxine is recommended if serum thyroid-stimulating hormone (TSH) concentration is 10 mU/L or more, or if serum TSH is 5-9.9 mU/L (mild SH) with other risk factors, such as thyroid peroxidase antibodies (TPOAb). Methods: We examined the management of mild SH in a retrospective case note audit of 150 consecutive subjects. Twenty-seven subjects with a serum TSH concentration above 10 mU/L were excluded from analysis. Of the group with mild SH, 27 were also excluded because of previous thyroid disease or amiodarone therapy. Results: The prevalence of previous thyroid disease was similar in subjects with TSH 10 mU/L or more, compared to those with mild SH. Overall, both TPOAb and goitre status were determined in only 39% of subjects with mild SH, but in more by endocrinologists compared with general physicians (63% versus 22% for TPOAb; 47% versus 17% for goitre) ( P = 0.001). Endocrinologists treated a greater number of subjects with mild SH who were eligible for thyroxine therapy compared to nonendocrine colleagues (96% versus 67%) ( P = 0.024). Both groups treated subjects in whom TPOAb status was not determined (endocrinologists 21% versus general physicians 40%) ( P = 0.21). Conclusion: In subjects with mild SH, evaluation is incomplete, a large percentage who were TPOAb positive were on appropriate therapy, thyroxine was prescribed when TPOAb status was unknown and, on the whole, endocrinologists performed better than general physicians.

SERUM THYROTROPHIN AND THE RESPONSE TO THYROTROPHIN RELEASING HORMONE IN SYMPTOMLESS AUTOIMMUNE THYROIDITIS AND IN BORDERLINE AND OVERT HYPOTHYROIDISM

1974 ◽  
Vol 75 (2) ◽  
pp. 274-285 ◽  
Author(s):  
A. Gordin ◽  
P. Saarinen ◽  
R. Pelkonen ◽  
B.-A. Lamberg
Keyword(s):  
Autoimmune Thyroiditis ◽  
Elevated Serum ◽  
Mean Value ◽  
Primary Hypothyroidism ◽  
Overt Hypothyroidism ◽  
Thyrotrophin Releasing Hormone ◽  
Releasing Hormone ◽  
The Mean ◽  
The Individual ◽  
Serum Tsh

ABSTRACT Serum thyrotrophin (TSH) was determined by the double-antibody radioimmunoassay in 58 patients with primary hypothyroidism and was found to be elevated in all but 2 patients, one of whom had overt and one clinically borderline hypothyroidism. Six (29%) out of 21 subjects with symptomless autoimmune thyroiditis (SAT) had an elevated serum TSH level. There was little correlation between the severity of the disease and the serum TSH values in individual cases. However, the mean serum TSH value in overt hypothyroidism (93.4 μU/ml) was significantly higher than the mean value both in clinically borderline hypothyroidism (34.4 μU/ml) and in SAT (8.8 μU/ml). The response to the thyrotrophin-releasing hormone (TRH) was increased in all 39 patients with overt or borderline hypothyroidism and in 9 (43 %) of the 21 subjects with SAT. The individual TRH response in these two groups showed a marked overlap, but the mean response was significantly higher in overt (149.5 μU/ml) or clinically borderline hypothyroidism (99.9 μU/ml) than in SAT (35.3 μU/ml). Thus a normal basal TSH level in connection with a normal response to TRH excludes primary hypothyroidism, but nevertheless not all patients with elevated TSH values or increased responses to TRH are clinically hypothyroid.

Evolution of Hashimoto thyroiditis in children with type 1 diabetes mellitus (TIDM)

2020 ◽  
Vol 33 (12) ◽  
pp. 1525-1531
Author(s):  
Feneli Karachaliou ◽  
Nikitas Skarakis ◽  
Evangelia Bountouvi ◽  
Theodora Spyropoulou ◽  
Eleni Tsintzou ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Randomized Trials ◽  
Elevated Serum ◽  
Hashimoto Thyroiditis ◽  
Diabetes Mellitus Type 1 ◽  
Overt Hypothyroidism ◽  
Normal Ranges ◽  
Serum Tsh

AbstractObjectivesTreatment of children with Hashimoto thyroiditis (HT) and particularly of those with coexistent diabetes mellitus type 1 (TIDM) and normal/mildly elevated serum TSH is controversial. The aim of the study was to evaluate the natural course of HT in children with TIDM compared with children with no other coexistent autoimmunity and investigate for possible predictive factors of thyroid function deterioration.MethodsData from 96 children with HT, 32 with T1DM (23 girls, nine boys) mean (sd) age: 10.6 (2.3) years, and 64 age and sex-matched without T1DΜ (46 girls, 18 boys), mean (sd) age: 10.2 (2.9) years were evaluated retrospectively. They all had fT4 and TSH values within normal ranges and available data for at least three years’ follow-up.ResultsDuring the follow-up period, 11 children (34.4%) with TIDM exhibited subclinical hypothyroidism and two children (6.2%) progressed to overt hypothyroidism compared to 12 (18.8%) and two (3.1%) among children without TIDM, respectively. Among children with HT, a higher percentage (40.6%) of children with T1DM progressed to subclinical or overt hypothyroidism, compared with children (21.9%) with similar characteristics but without TIDM or other coexistent autoimmunity.ConclusionsThe annual conversion rate from euthyroidism to hypothyroidism in children with T1DM was significantly higher compared to sex and age-matched children without TIDM. Prospective randomized trials are needed to support the view of an earlier intervention therapy even in milder degrees of thyroid failure in these children.

Autoimmune thyroid disease in diabetic children and adolescents: a single center study from south Punjab

2021 ◽  
Vol 71 (7) ◽  
pp. 1804-1807
Author(s):  
Waqas Imran Khan ◽  
Erum Afzal ◽  
Sajjad Hussain
Keyword(s):  
Children And Adolescents ◽  
Thyroid Disease ◽  
Autoimmune Thyroid Disease ◽  
Glycosylated Hemoglobin ◽  
Overt Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Pediatric Endocrinology ◽  
Autoimmune Thyroid ◽  
Thyroid Peroxidase Antibody ◽  
Diabetic Children

Objective: To evaluate the prevalence of autoimmune thyroid disease (AITD) in diabetic children in south Punjab. Methods: This was an observational cross sectional study from Jan 2019 to Dec 2019 in the outpatient diabetic clinic of the department of pediatric endocrinology at Children Hospital and The Institute of Child Health Multan. A total of 161 consecutive patients of both genders with TIDM were enrolled in this study after taking informed consent. Blood samples for Thyroid functions testes including thyroid stimulating hormone (TSH), free thyroxin (fT4), Thyroid peroxidase antibody (TPO-Ab), thyroglobulin antibody (TG-Ab) and glycosylated hemoglobin (HbA1C) level were sent. Results: Among diabetic children males were 83 (51.6%). Age range was 2-15 years. Mean age and standard deviation was 9.7± 4.3. TPO-Ab was positive in 34 patients (21.1%) and TG-Ab in 27 patients (16.7%), whereas both antibodies were positive in 17 patients (10.5%). Six patients (3.7%) had evidence of subclinical hypothyroidism, 8 patients (4.9%) had overt hypothyroidism and 1 patient (0.62%) had hyperthyroidism Conclusion: The prevalence of AITD among children and adolescents with type 1 diabetes mellitus was 21.1% in our study. Hypothyroidism was more prevalent in these children compared to hyperthyroidism. All diabetic children should be screened for AITD. Thyroid functions should be checked where TPO antibody is positive. Keywords: Autoimmune thyroid disease, anti thyroid peroxidase antibody, anti thyroglobulin Continuous...

Falsely elevated serum TSH assay values in two cases of thyroid disease

1994 ◽  
Vol 27 (3) ◽  
pp. 225
Author(s):  
M.L. Givner ◽  
E.C. Abbott ◽  
G.J. Mosher ◽  
L.C. Dymond ◽  
K. Dooley
Keyword(s):  
Thyroid Disease ◽  
Elevated Serum ◽  
Serum Tsh

scholarly journals Pregnancy outcomes are not altered by variation in thyroid function within the normal range in women free of thyroid disease

2018 ◽  
Vol 178 (2) ◽  
pp. 189-197 ◽  
Author(s):  
Flora Veltri ◽  
Pierre Kleynen ◽  
Lidia Grabczan ◽  
Alexandra Salajan ◽  
Serge Rozenberg ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Thyroid Function ◽  
Pregnancy Outcomes ◽  
Thyroid Disease ◽  
Thyroid Autoimmunity ◽  
Thyroid Peroxidase ◽  
Normal Range ◽  
Baseline Characteristics ◽  
Serum Tsh ◽  
Tsh Levels

ObjectiveIn the recently revised guidelines on the management of thyroid dysfunction during pregnancy, treatment with thyroid hormone (LT4) is not recommended in women without thyroid autoimmunity (TAI) and TSH levels in the range 2.5–4.0 mIU/L, and in a recent study in that particular group of pregnant women, more complications were observed when a treatment with LT4 was given. The objective of the study was therefore to investigate whether variation in thyroid function within the normal (non-pregnant) range in women free of thyroid disease was associated with altered pregnancy outcomes?DesignCross-sectional data analysis of 1321 pregnant women nested within an ongoing prospective collection of pregnant women’s data in a single centre in Brussels, Belgium.MethodsThyroid peroxidase antibodies (TPO-abs), thyroid-stimulating hormone (TSH), free T4 (FT4) and ferritin levels were measured and baseline characteristics were recorded. Women taking LT4, with TAI and thyroid function outside the normal non-pregnant range were excluded. Pregnancy outcomes and baseline characteristics were correlated with all TSH and FT4 levels within the normal range and compared between two groups (TSH cut-off < and ≥2.5 mIU/L).ResultsTobacco use was associated with higher serum TSH levels (OR: 1.38; CI 95%: 1.08–1.74);P = 0.009. FT4 levels were inversely correlated with age and BMI (rho = −0.096 and −0.089;P < 0.001 and 0.001 respectively) and positively correlated with ferritin levels (rho = 0.097;P < 0.001). Postpartum haemorrhage (>500 mL) was inversely associated with serum FT4 levels (OR: 0.35; CI 95%: 0.13–0.96);P = 0.040. Also 10% of women free of thyroid disease had serum TSH levels ≥2.5 mIU/L.ConclusionsVariation in thyroid function during the first trimester within the normal (non-pregnant) range in women free of thyroid disease was not associated with altered pregnancy outcomes. These results add evidence to the recommendation against LT4 treatment in pregnant women with high normal TSH levels and without TPO antibodies.

scholarly journals Prevalence of Non-autoimmune Hypothyroidism in Steroid Resistant Nephrotic Syndrome in Paediatric Age Group

2020 ◽  
Author(s):  
Seema Rani Sinha ◽  
Rekha Kumari ◽  
Rakesh Kumar ◽  
Ravi Shekhar ◽  
Pritam Prakash ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Rational Approach ◽  
Control Group ◽  
Overt Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Normal Range ◽  
Steroid Resistant ◽  
Autoimmune Hypothyroidism ◽  
Thyroid Profile ◽  
Serum Tsh

Introduction: It was observed that approximately 10% of children with Nephrotic Syndrome (NS) are found as Steroid Resistant NS (SRNS). The data on the prevalence of non-autoimmune hypothyroidism among the SRNS in India is limited. Aim: To assess the prevalence of non-autoimmune hypothyroidism in the case of SRNS. Materials and Methods: A case control cross-sectional study was conducted in which 52 cases of SRNS and 52 healthy controls were enrolled. Thyroid profile like serum Thyroid Stimulating Hormone (TSH), Free Triiodothyronine (T3), Free Thyroxine (T4) done in the all cases and controls but anti-Thyroid Peroxidase (TPO), and anti-thyroglobulin antibody test was done in the case and control group with deranged thyroid function test. Low Free T4 (normal: 0.7-2 ng/mL) and elevated serum TSH above the upper limit of the reference range (>4.5 mIU/L) was defined as overt hypothyroidism, whereas elevation in serum TSH with a normal serum FT4 concentration was defined as sub clinical hypothyroidism. MedCalc statistical software Version 19.2.6 was used to do statistical analysis. Results: Prevalence of Non-autoimmune hypothyroidism was 38.46% (20 out of 52), 16 (30.76%) had subclinical and 4 (7.69%) had overt hypothyroidism in case of SRNS in comparison to 1.96% (1 out of 52) in control group. Out of 16 subclinical hypothyroid patients, two cases with grade 1, 12 cases with grade 2, and two cases with grade 3 found. Patients with SRNS had a mean (SD) TSH value of 4.5±4.7 mlU/L which was significantly higher than control (1.8±1.1 mlU/L). Serum levels of FT4 were within normal range. Anti-TPO and anti-thyroglobulin titre were in normal range in children with hypothyroidism. Conclusion: The prevalence of non-autoimmune hypothyroidism was high in cases of idiopathic SRNS. So, on the basis of this study estimation of thyroid profile in children with SRNS seems to be the rational approach which will lead to early diagnosis and timely management of hypothyroidism in SRNS.

scholarly journals Investigating the prevalence of primary thyroid dysfunction in obese and overweight individuals: Tehran thyroid study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mahdi Mahdavi ◽  
Atieh Amouzegar ◽  
Ladan Mehran ◽  
Elham Madreseh ◽  
Maryam Tohidi ◽  
...  
Keyword(s):  
Serum Levels ◽  
Thyroid Stimulating Hormone ◽  
Normal Weight ◽  
Control Group ◽  
Overt Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Cross Sectional ◽  
Increased Risk ◽  
Prevalence Of Obesity ◽  
Thyroid Dysfunctions

Abstract Background Due to the increasing worldwide prevalence of obesity, it is essential to determine the prevalence of obesity-related thyroid dysfunctions. The purpose of this study was to investigate the prevalence of thyroid dysfunctions, namely hypothyroidism and hyperthyroidism, and their association with BMI among adult Iranian overweight and obese individuals. Method This cross-sectional study was carried out within the framework of the Tehran Thyroid Study (TTS); 5353 participants (57.5% female) entered our study. Anthropometric measurements were performed. Serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid peroxidase antibody (TPOAb) were assayed. We categorized individuals into 3 BMI groups (normal-weight, overweight and obese), then calculated prevalence rate, odds ratio (OR), and 95% confidence interval (CI) for outcomes in overweight and obese groups. The normal-weight group was used as the control group. Results We found a higher prevalence of hypothyroidism (11.6% vs 8.2% Total, 4.0% vs 1.1% overt and 7.6% vs 7.1% subclinical, P < 0.001) and TPOAb positivity (17.3% vs 11.6%, P < 0.001) in obese participants compared with normal-weight participants. Hyperthyroidism’s overall prevalence was 4.2, 5.7, and 4.9% in obese, overweight, and normal-weight groups, respectively. Obesity was associated with higher odds of overt hypothyroidism (OR: 2.0, 95% CI: 1.15–3.49, P < 0.05) and TPOAb positivity (OR: 1.29, 95% CI: 1.04–1.60, P < 0.05) after adjusting for confounding variables. In contrast, no association was observed between the overweight group and the odds of hypothyroidism and TPOAb positivity in the adjusted results. Conclusions Obesity was associated with an increased risk of overt hypothyroidism and TPOAb positivity.

Subclinical hypothyroidism

2019 ◽  
Vol 12 (3) ◽  
pp. 131-135
Author(s):  
Adam Grice
Keyword(s):  
Cardiovascular Disease ◽  
Subclinical Hypothyroidism ◽  
Thyroid Stimulating Hormone ◽  
Normal Serum ◽  
Overt Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Autoimmune Thyroid ◽  
Thyroid Peroxidase Antibodies ◽  
Increased Risk ◽  
Stimulating Hormone

Subclinical hypothyroidism is a common condition associated with a raised thyroid-stimulating hormone and a normal serum free thyroxine that affects about 10% of females over 55 years in age. The most common cause is autoimmune thyroid disease, with 2.5% of patients with subclinical hypothyroidism progressing to clinically overt hypothyroidism each year. The rate of progression is higher in patients with anti-thyroid peroxidase antibodies and higher levels of thyroid-stimulating hormone. Only a small proportion of patients with subclinical hypothyroidism have symptoms, and although there is some debate in the literature about which patients should be treated, the National Institute for Health and Care Excellence clinical knowledge summaries give clear recommendations. There is an increased risk of cardiovascular disease in patients with subclinical hypothyroidism; it is uncertain whether treatment with levothyroxine reduces this risk. When deciding whether to treat subclinical hypothyroidism consider the patient’s age, symptoms, presence of anti-thyroid peroxidase antibodies, thyroid-stimulating hormone levels and risk factors such as cardiovascular disease.

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