Gokcen ORGUL, Devrim Rüzgar DOĞAN, Oytun PORTAKAL, M.sinan BEKSAC

Gebeliğin ilk üç ayındaki kan TSH düzeyi ile Down sendromu tarama testleri arasındaki ilişki

Amaç: İlk üç ayda tüm gebelere Down Sendromu taraması amacıyla kombine test yapılması önerilmektedir. Tiroid stimulan hormonun (TSH) serbest beta subünit human koriyonik gonadotropin (fβ-hcg) ve gebelik ile ilişkili plazma protein A (PAPP-A) üretimini etkileyip etkilemediği net değildir. Bu çalışmada serum TSH düzeylerinin kombine test sonuçları üzerine etkisinin olup olmadığını araştırmayı amaçladık.Gereç ve Yöntem: İlk trimester TSH değeri ile birlikte ense saydamlığı (NT), fβ-hcg ve PAPP-A sonuçlarına ulaşılabilen 297 hasta çalışmaya dahil edilmiştir. Hastalar TSH değerlerine göre dört gruba ayrılmıştır; Grup 1 (<0.1 uIU/ml), Grup 2 (0.1-2,5 uIU/ml), Grup 3 (2.5-3.5 uIU/ml) ve Grup 4 (>3.5 uIU/ml). Gruplar NT, PAPP-A ve fβ-hcg düzeyleri açısından karşılaştırılmıştır.Bulgular: Ortalama PAPP-A (MoM) değeri grup 1’de 0.99, Grup 2’de 1.12, Grup 3’de 1,03 ve Grup 4’de 0,95 olarak tespit edilmiştir. Ortalama fβ-hcg (MoM) değeri ise grup 1’de 1.36, Grup 2’de 1.29, Grup 3’de 1.05 ve Grup 4’de 1.32 idi. Ortalama NT ölçümü grup 1’den grup 4’e doğru gittikçe sırasıyla 1.27 ± 0.25, 1.33 ± 0.38, 1.34 ± 0.33 ve 1.32 ± 0.37 mm olarak saptanmıştır. Gruplar arasında PAPP-A, fβ-hcg ve NT açısından istatistiksel olarak anlamlı bir fark olmadığı gösterilmiştir.Sonuç: İlk trimester TSH düzeylerinin kombine test parametrelerini etkilemediği gösterilmiştir. Hipotiroidisi veya hipertiroidisi olan kadınlarda NT, fβ-hCG and PAPP-A kullanılarak prenatal tarama testi yapılmasının güvenli olduğu düşünülmüştür.

Anahtar Kelimeler:

Gebelikle ilişkili plazma protein-A, Nukal saydamlık, Human koriyonik gonadotropin, Tiroid stimulan hormon

Relationship between first trimester maternal TSH levels and Down syndrome screening tests

Purpose: Down syndrome screening with first trimester combined test is recommended for all pregnancies. It is unclear, whether thyroid stimulating hormone (TSH) affects secretion of free beta subunit human chorionic gonadotropin (fβ-hcg) and pregnancy-related plasma protein (PAPP-A). We aimed to investigate the effect of serum thyroid stimulating hormone (TSH) levels on the combined test results.Materials and Methods: First trimester TSH levels together with nuchal translucency (NT(fβ-hcg and PAPP-A results of 297 patients were included in this study. Patients were divided into four groups according to their TSH levels; Group 1 (<0.1 μL / ml), Group 2 (0.1-2.5 μlU / ml), Group 3 (2.5-3.5 μlU / ml) and Group 4 (> 3.5 μlU / ml). Groups were compared in terms of NT, PAPP-A and fβ-hcg levels.Results: The mean PAPP-A (MoM) value was found to be 0.99 in group 1, 1.12 in group 2, 1.03 in group 3, and 0.95 in group 4. Mean fβ-hcg (MoM) value was 1.36 in group 1, 1.29 in group 2, 1.05 in group 3, and 1.32 in group 4. The mean NT measurement was 1.27 ± 0.25, 1.33 ± 0.38, 1.34 ± 0.33 and 1.32 ± 0.37 mm, from group 1 to group 4, respectively. There was no statistically significant difference between groups in terms of PAPP-A, fβ-hcg and NT.Conclusion: The present study have shown that first trimester TSH levels do not affect combined test parameters. Prenatal screening by using NT, fβ-hCG and PAPP-A seems to be safe for pregnant women with hypothyroidism or hyperthyroidism.

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