İLK TRİMESTER GEBELİKLERİNDE SUBKLİNİK VE AŞİKAR HİPOTİROİDİ İNSİDANSI

Amaç Bu çalışma Aksaray ilindeki ilk trimester gebeliklerinde subklinik ve aşikar hipotiroidi sıklığının belirlenmesi amacıyla planlanmıştır. Gereç ve Yöntem Bu bir retrospektif çalışma olup kadın hastalıkları ve doğum polikliniğine gebeliğin 7-12inci haftasında başvuran ve geçmişinde hipotirodi tanısı ve/veya tiroit hormon replasman tedavisi öyküsü bulunmayan tekil 502 gebenin yaş, serum tiroit-stimülan hormon, serbest tri-iyodotronin ve serbest tiroksin düzeyleri hastane kayıt sisteminden elde edildi. Serum TSH için üst sınır 4 mIU/L olarak kabul edildi. Karşılaştırmalarda Mann Whitney U ile ki-kare testleri kullanıldı ve p <0.05 istatistiksel olarak alındı. Bulgular Olguların yaş ortalaması 26.3 ± 5.9 yıl idi. Subklinik ve aşikar hipotiroidi sıklığı sırasıyla %4 ve %0 olarak bulundu. Tiroit fonksiyon test sonuçları normal olan ve subklinik hipotiroidisi olan gebelerin yaşları benzer olarak saptandı (p=0.201). Sonuç Gebelik öncesinde hipotiroidi tanısı olmayan asemptomatik gebelerin ilk trimesterde hipotiroidi açısından taranması, anne yaşından bağımsız olarak aşikar hastalık tanısında kısıtlı role sahip gözükmektedir. Toplum tabanlı trimestere özgül TSH normal referans değerlerinin belirlenmesi, gerçek subklinik hipotiroidi insidansının saptanması bakımından önem taşıyabilir.

Anahtar Kelimeler:

Aşikar hipotiroidi, Gebelik, Subklinik hipotiroidi, Tiroit stimülan hormon

THE INCIDENCE OF SUBCLINICAL AND OVERT HYPOTHYROIDISM IN FIRST TRIMESTER PREGNANCIES

Objective This study aims to define the first-trimester prevalence of overt and subclinical hypothyroidism in Aksaray province. Material and Methods This is a retrospective study carried out in a single obstetrics and gynecology outpatient unit, including hospital-based data on maternal age, serum thyroidstimulating hormone, thyroxine, and tri-iodothyronine levels from 502 singleton pregnancies at 7-12 weeks of gestational age. Cut-off for serum TSH was considered as 4 mIU/L. Mann-Whitney U and chisquare tests were used for comparisons, with p <0.05 considered statistically significant. Results The mean maternal age was 26.3 ± 5.9 years. Subclinical and overt hypothyroidism was present in 4% and 0% of included women, respectively. Mean maternal age in euthyroid and subclinical hypothyroid pregnancies were similar (p=0.201). Conclusions First trimester screening of asymptomatic women without a prepregnancy diagnosis of hypothyroidism seems to be limited for diagnosing overt hypothyroidism during pregnancy, regardless of maternal age. Definition of population-based trimester specific reference ranges for serum TSH may be important to detect the genuine prevalence of subclinical hypothyroidism

Keywords:

Overt hypothyroidism, Pregnancy, Subclinical hypothyroidism, Thyroid-stimulating hormone,

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1.Bjoro T, Holmen J, Kruger O, et al. [Prevalence of hypothyroidism and hyperthyroidism in Nord-Trondelag]. Tidsskr Nor Laegeforen 2002;122:1022–1028.
2. Krassas GE. Thyroid function and human reproductive health. Endocr Rev 2010;31:702–755.
3. Stagnaro-Green A, Glinoer D. Thyroid autoimmunity and the risk of miscarriage. Best Pract Res Clin Endocrinol Metab 2004;18:167–181.
4. Casey BM, Dashe JS, Wells CE, et al. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol 2005; 105:239–245.
5.Haddow JE, Palomaki GE, Allan WC, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 1999;341:549–555.
6. Allan WC, Haddow JE, Palomaki GE, et al. Maternal thyroid deficiency and pregnancy complications: implications for population screening. J Med Screen 2000; 7: 127–30.
7.Cleary-Goldman J, Malone FD, Lambert-Messerlian G, et al. Maternal thyroid hypofunction and pregnancy outcome. Obstet Gynecol 2008; 112: 85–92.
8. Blatt AJ, Nakamoto JM, Kaufman HW. National status of testing for hypothyroidism during pregnancy and postpartum.J Clin Endocrinol Metab 2012; 97: 777–84.
9. Glinoer D. Pregnancy and iodine. Thyroid 2001; 11: 471–81.
10. Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, Nixon A, Pearce EN, Soldin OP, Sullivan S, Wiersinga W, American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum 2011 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 2011;1081–1125.
11.Yamamoto T, Amino N, Tanizawa O, et al. Longitudinal study of serum thyroid hormones, chorionic gonadotrophin and thyrotrophin during and after normal pregnancy. Clin Endocrinol (Oxf) 1979;10:459-468.
12.Surks MI,Hollowell JG.Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population:İmplications for the prevalance of subclinical hypothyroidism.J Clin Endocrineol Metab 2007;92:4575-4582.
13.Chakroborti S, Chakroborti T,Mandal M,Das S,Batabyal SK.Hypothalamic-pituitary-thyroid axis status of humans during development of ageing process.Clin Chim Acta 1999:288:137-145.
14.Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. European Thyroid Association Guidelines for the magement of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J 2014;3:76e94.
15. de Escobar GM, Obregon MJ, del Rey FE. Maternal thyroid hormones early in pregnancy and fetal brain development. Best Pract Res Clin Endocrinol Metabol 2004;18:225e48.
16. Nazarpour S, Ramezani Tehrani F, Simbar M, Tohidi M, alavi Majd H, Azizi F. Effects of levothyroxine treatment on pregnancy outcomes in pregnant women with autoinmmune thyroid disease. Eur J Endocrinol 2017;176:253e65.
17. Reid SM, Middleton P, Cossich MC, Crowther CA, Bain E. Interventions for clinical and subclinical hypothyroidism pre-pregnancy and during pregnancy. Cochrane Database Syst Rev 2013:CD007752.
18. Li C, Shan Z, Mao J, Wang W, Xie X, Zhou W, et al. Assessment of thyroid function during first-trimester pregnancy: what is the rational upper limit of serum TSH during the first trimester in Chinese pregnant women? J Clin Endocrinol Metab 2014;99:73-9.
19.Granfors M, Akerud H, Skogo J, Stridsberg M, Wikstrom AK, Sundstrom-Poromaa I. Targeted thyroid testing during pregnancy in clinical practice. Obstet Gynecol 2014;124: 10–15.
20. Männistö T, Vääräsmäki M, Pouta A, et al. Thyroid dysfunction and autoantibodies during pregnancy as predictive factors of pregnancy complications and maternal morbidity in later life. J Clin Endocrinol Metab 2010;95:1084–1094.
21.Subclinical Thyroid Dysfunction In The First Trimester And Effects On Obstetric Outcomes .Sedef Kabaca, Halenur Bozdağ, Fatma Bilge Selvi Öğütcüoglu, Fulya Gökdağlı, Hacer Kavak, Necati Cihan Tanyolaç. Jinekoloji - Obstetrik ve Neonatoloji Tıp Dergisi 2016; 13: 143-147.
22. Haddow JE, Knight GJ, Palomaki GE, McClain MR, Pulk- kinen AJ. The reference range and within person variability of thyroid stimulating hormone during the first and second trimesters of pregnancy. J Med Screen 2004:170–174.
23. Panesar NS, Li CY, Rogers MS. Reference intervals for thyroid hormones in pregnant Chinese women. Ann Clin Biochem 2001:329–332.
24.De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, Eastman CJ, Lazarus JH, Luton D, Mandel SJ, Mestman J, Rovet J, Sullivan S. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012;2543–2565.
25.Yan YQ, Dong ZL, Dong L, Wang FR, Yang XM, Jin XY, Lin LX, Sun YN, Chen ZP 2011 Trimester- and method- specific reference intervals for thyroid tests in pregnant Chinese women: methodology, euthyroid definition and iodine status can influence the setting of reference intervals. Clin Endocrinol (Oxf ) 20011:262–269.
26.Moon HW, Chung HJ, Park CM, Hur M, Yun YM. Establishment of trimester-specific reference intervals for thyroid hormones in Korean pregnant women. Ann Lab Med 2015:198–204.
27.Medici M, Korevaar TI, Visser WE, Visser TJ, Peeters RP. Thyroid function in pregnancy: what is normal? Clin Chem (2015) 61:704-13.
28.Erik K. Alexander, Elizabeth N. Pearce, Gregory A. Brent, Rosalind S. Brown, Herbert Chen, Chrysoula Dosiou, William A. Grobman, Peter Laurberg, John H. Lazarus, Susan J. Mandel, Robin P. Peeters, and Scott Sullivan. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum Thyroid 2017; 27:315-388.
29. American College of Obstetrician and Gynecologists practice bulletin thyroid disease in pregnancy. Obstet Gynecol 2015; 125:996-1005.