Thyroid gland in the gravidity

Česká verzia

Authors: V. Vargová ¹; V. Mechírová ²; M. Pytliak ³
Authors place of work: III. interná klinika LF UPJŠ a FN LP, Košice, vedúci pracoviska doc. MUDr. P. Mitro, Ph. D. ¹; I. interná klinika LF UPJŠ, Košice ²; Ústav pre bakalárske a magisterské štúdiá, LF UPJŠ, Košice ³
Published in the journal: Ceska Gynekol 2009; 74(1): 12-17

Summary

Objectives:
Disorders of the thyroid gland are the most common endocrinopathies in the gravidity. The spectrum of thyroid diseases in the pregnancy is not different from the diseases that affect the thyroid outside this period of life. However, clinical manifestations of thyreopaties can be modified by gravidity. Some thyreopaties are associated with gravidity or post partum period, or become manifest in this periods for the first time. The aim of this study was to assess thyroidal status of healthy pregnant women without history or clinical signs of thyreopathy.

Type of the study:
One-time cross-sectional study. Setting: 3rd internal clinic FNLP, Košice.

Methods:
We examined 76 pregnant women (mean age 34.46 ± 5.34 years). The protocol included medical history, physical examination and assessment of TSH, fT4 and anti-TPO concentrations.

Results:
The mean concentration of TSH was 2.78 ± 1.25 mIU/ml. We found TSH concentration over 5.0 mIU/ml in 5 participants (6.58%), TSH levels in the borderline range between 4.0 – 5.0 mIU/ml had another 2 pregnants (2.63%). fT4 concentration was 15.02 ± 3.61 pmol/l. The mean anti-TPO concentration was 43.28 ± 15.75 IU/ml. 17 pregnant women (22%) had anti-TPO concentration over 25 IU/ml, which is the level that indicates autoimmune thyroiditis.

Conclusions:
Thyreopathies are the most common endocrinopathies in the population and there is the evidence that almost one third of European population is affected from diseases of thyroid gland, predominantly women in fertile age. In the clinical praxis it is essential to think of thyroid disorders and in the case of need screening of the thyroid function.

Key words:
thyroid gland, thyreopathies, gravidity, fertility, postpartum thyroiditis.

Zdroje

1. Amino, N., Tada, H., Hidaka, Y. Postpartum autoimmune thyroid syndrome: a model of aggravation of autoimmune disease. Thyroid, 1999, 9, p. 705-713.

2. Bandenhoop, K., Schwarz, G., Walfish, PG., et al. Susceptibility to thyroid autoimmume disease: molecular analysis of HLA-D region genes identifies new markers for goitrous Hashimotos’ thyroiditis. J Clin Endocrinol Metab, 1990, 71, p. 1131-1137.

3. Berghout, A., Wiersinga, W. Thyroid sial and thyroid function during pregnancy. An analysis. Eur J Endocrinol, 1998, 138, p. 536-541.

4. Branch, DW., Scott, JR. Autoimmunity and pregnancy loss. JAMA, 1990, 246, p. 1453-1454.

5. Bučková, K., Šeböková, E., Klimeš, I. et al. Sledovanie jodúrie a hladiny TSH u žien počas gravidity. Abstrakt. XXIV Endokrinologické dny. September 2001, Hradec Králové.

6. Burrow, GN., Fisher, DA., Larsen, PR. Maternal and fetal thyroid function. N Engl J Med, 1994, 331, p. 1072-1078.

7. Bussen, S., Steck, T. Increased prevalence of thyroid antibodies in euthyroid women with a history of reccurent in-vitro fertilization failure. Hum Reprod, 2000, 15, p. 545-548.

8. Bussen, S., Steck, T. Thyroid autoantibodies in euthyroid non-pregnant and pregnant women with recurrent abortions. Hum Reprod, 1995, 10, p. 2938-2940.

9. Davies, TF. The thyroid immunology of postpartum period. Thyroid, 1999, 9, p. 675-687.

10. Dayan, CM., Daniels, GH. Chronic autoimmune thyroiditis. N Engl J Med, 1996, 335, p. 99-107.

11. Fantz, CR., Dagogo, J., Ladenson, J., et al. Thyroid function during pregnancy. Clin Chem, 1999, 45, p. 2250-2258.

12. Galambos, C., Brink, DS., Chung, HD. Thyroid function during pregnancy. Clin Chem, 2000, 46, 7, p. 1115-1117.

13. Glinoer, D., Delange, F. The potential repercussions of maternal, fetal and neonatal hypothyroxinemia of the progeny. Thyroid, 2000, 10, 10, p. 871-87.

14. Greenspan, FS., Gardner, DG. Basic and clinical endocrinology. London: Mc Graw Hill, 2001.

15. Haddow, JE., Polomaki, GE., Allan, WC., et al. Mathernal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med, 1999, 341, p. 549-555.

16. Krassas, GE. Thyroid disease and female reproduction. Fertil Steril, 2000, 74, p. 1063-1070.

17. Kutteh, WH., Yetman, DL., Carr, AC., et al. Increased prevalence of antithyroid antibodies identified in women with recurrent pregnancy loss but not in women undergoing assisted reproduction. Fertil Steril, 1999, 71, p. 843-848.

18. Langer, P. Patofyziológia ochorení štítnej žľazy matky v gravidite. Ochorenia štítnej žľazy v gynekologickej praxi. Čes Gynek, 1998, s. 16-17.

19. Lazarus, JH., Premawardhana, LKDE., Parkes, AB. Postpartum thyroiditis. In Weetman, AP., et al. Immunology and medicine. Endocrine autoimmunity and associated conditions. London: Kluwer Academic Publishers, 1998, p. 83-97.

20. Lazarus, JH. Hyperthyroidism. Sem. Lancet, 1997, 349, p. 339-343.

21. Lazarus, JH. Thyroid disease and pregnancy. In Grossman, A., et al. Clinical endocrinology. 2nd Ed. Oxford: Blackwell Science, 1997, p. 376-382.

22. Masiukiewicz, US., Burrow, GN. Hyperthyroidism in pregnancy: diagnosis and treatment. Thyroid, 1999, 9, p. 647-652.

23. Mestman, JH. Thyroid diseases in pregnancy other than Graves’ disease and postpartum thyroid dysfunction. Endocrinologist, 2001, 9, p. 294-307.

24. Moravec, R. K diagnostike a liečbe chorôb štítnej žľazy. Medicínsky monitor, 2004, 1, s. 13-14.

25. Rushworth, FH., Backos, L. Prospective pregnancy outcome in untreated recurrent miscarries with thyroid antibodies. Hum Reprod, 2000, 7, p. 1637-1639.

26. Shahid, R. Pregnancy with hyperthyroidism. J Coll Physicians Surg Pak, 2003, 13, 5, p. 255-259.

27. Stagnaro-Green, A. Postpartum thyroiditis: prevalence, etiology and clinical implications. Thyroid Today, 1993, 16, p. 1-11.

28. Tajtáková, M., Hančinová, D. Tehotenstvo a štítna žľaza. Čes Gynek, 1994, 59, 2, s. 54-57.

29. Tajtáková, M., Langer, P., Fodor, G., et. al. Epidemický profil objemu štítnej žľazy a tyreopatií na Slovensku. Vnitř Lék, 2000, 46, s. 756-761.

30. Vanderpump, MPJ, Tunbridge, WMG, French, JM. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol, 1995, 43, p. 55-58.

31. Weetman, AP., McIntosh, RS., Watson, PF. Autoimmune hypothyroidism. In Weetman, AP., et al. Immunology and medicine. Endocrine autoimmunity and associated conditions. London: Kluwer Academic Publishers, 1998, p. 39-61.