Halenur BOZDAĞ, Fulya GÖKDAĞLI, Hacer KAVAK, Sedef KABACA, Fatma Bilge Selvi ÖĞÜTCÜOĞLU, Necati Cihan TANYOLAÇ

İlk Trimester Gebeliklerde Subklinik Tiroid Fonksiyon Bozuklukları ve Obstetrik Sonuçlar Üzerine Etkisi

Amaç: Gebeliğin birinci trimesterinde saptanan subklinik tiroid fonksiyon bozukları ve Hashimoto tiroiditininin olumsuz gebelik sonuçları ile ilişkisinin araştırılması.Gereç ve Yöntemler: Çalışmaya, İstanbul Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniği Gebe Polikliniği’ne başvuran 288 gebe dahil edildi.Olgular tiroid fonksiyon testlerine göre, subklinik hipotiroid, subklinik hipertiroid ve ötiroid gruplarına ayrıldı.Tiroid otoantikor testi pozitif olan olgular Hashimoto tiroiditi olarak değerlendirildi ve tiroid fonksiyon testlerine göre ötiroid , sublinik hipotiroidi alt grupları oluşturuldu. Birinci trimester gebelik kaybı, preterm doğum, preeklampsi, gestasyonel hipertansiyon, gestasyonel diyabet, erken membran rüptürü, gebelik yaşına göre düşük doğum ağırlığı ve yenidoğan yoğun bakım ihtiyacı mevcut gebelikte kötü obstetrik sonuçlar olarak belirlendi. Yukarıda belirlenen gruplar ile bu obstetrik sonuçlar arasındaki ilişki araştırıldı.Bulgular: Olguların %75,3’ü ötiroidik, %19,4’ü subklinik hipotiroidik ve %5,2 ‘si subklinik hipertiroidik idi.Subklinik hipotiroidi olgularının %32,1’inde 18/56 ; ötiroidi olguların %24,9’unda 54/217 kötü obstetrik sonuç gelişti p>0,05 . Yenidoğan yoğun bakım ihtiyacı subklinik hipotiroidi ve ötiroidi grubunda %43,8 20/56 ve %29,5 61/217 oranında bulundu p>0,05 . Yenidoğan yoğun bakım ihtiyacı Hashimoto tiroiditli subklinik hipotiroidi grubunda %63.6 ve Hashimoto tiroiditli ötiroidi grubunda %43.2 oranında bulundu p=0,009 . Farklılığı yaratan grubu belirlemek amacıyla ikili karşılaştırmalar yapıldı. Yenidoğan yoğun bakım ihtiyacı subklinik hipotiroidik Hashimoto tiroidi olgularda ötiroid gebelerden yüksek bulundu p=0,041 .Sonuç: Gebeliğin birinci trimesterindeki subklinik tiroid fonksiyon bozuklukları kötü obstetrik sonuçları ile ilişki bulunmadı. Hashimoto tiroidit varlığında subklinik hipotiroidi yenidoğan yoğun bakım ünitesi ihtiyacında artışla ilişkilidir.

Anahtar Kelimeler:

Subklinik hipotiroidi, subklinik hipertiroidi, hashimoto tiroiditi, olumsuz gebelik sonuçları

Subclinical Thyroid Dysfunction In The First Trimester And Effects On Obstetric Outcomes

Aim: To investigate the relationship between subclinical thyroid disfunctions and Hashimoto thyroiditis and adverse pregnancy outcomes in early pregnancy.Material and Methods: In this study 288 pregnant women who were examined at Medeniyet University Goztepe Education and Research Hospital Obstetrics and Gynecology Department were included. All cases were classified as subclinical hypothyroidism, subclinical hypertiroidism and euthyroidism according to their thyroid function tests. Cases with positive thyroid auto antibody tests were considered as Hashimoto thyroiditis and classified to subclinical hypothyroidism and euthyroidism subgroups. Adverse pregnancy outcomes were defined as first trimester pregnancy loss, preterm delivery, preeclampsia, gestational hypertension, gestasional diabetes, premature rupture of membranes , small for gestasyonel age and neonatal intensive care needs.Results: In this study euthyroidism ,subclinical hyperthyroidism and subclinical hyperthyroidism were 75.3%, 19.4%, 5.2% , respectively. Adverse pregnancy outcomes were occured in 32.1% of subclinical hypothroid 18/56 and 24.9% of euthyroid 54/217 patients. Neonatal intensive care need was found 43.8% 20/56 and 29.5% 61/217 at subclinical hypothroidism and euthyroid groups, respectively p>0,05 . Neonatal intensive care need was found 63.6% and 43.2% at subclinical hypothyroidism and euthyroidism subgroups of Hashimoto’s thyroiditis, respectively p=0,009 . Comparisons were performed to determine the group make all the difference. Neonatal intensive care need in subclinical hypothyroidism subgroup of Hashimoto’s thyroiditis was higher than euthyroid group p = 0.041 .Conclusion: Subclinical thyroid dysfunction in the first trimester of pregnancy was not associated with adverse pregnancy outcomes. Subclinical hypothyroidism with Hashimoto thyroiditis was associated with increased neonatal intensive care unit need.

Keywords:

Subclinical hypothyroidism, subclinical hyperthyroidism, hashimoto thyroiditis, adverse pregnancy outcomes,

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