Prevalence of subclinical and overt hypothyroidism in antenatal women: A study from tertiary care center in North India

  • Arti Khatri Senior resident Department of pathology,VMMC and Safdarjung Hospital.New Delhi
  • Ankit Kaushik
  • Neha Tyagi
  • Akansha Deshwal
  • Wazid Ali Shah
  • Himani .
Keywords: Hypothyroidism, subclinical hypothyroidism, overt hypothyroidism, pregnancy

Abstract

Introduction: Thyroid hormones play a critical role in fetal neurodevelopment in pregnancy and postnatal life. Hypothyroidism ( HT ) is common in pregnancy and is associated with several adverse and fetal outcome. The benefits of treating overt HT during pregnancy include improved obstetric and neonatal outcomes. Methods: This  cross-sectional study  included 2492  pregnant women. The serum TSH were measured by ELISA and patient  with  0.1-4.5 mIU/L were considered as normal , while patient with serum TSH of greater than 4.5mIU/L to  10mIU/L with normal fT4 were considered to be subclinical HT, patient with serum TSH >10mIU/l were categorized as overt HT.Results: Out of total cases, 78.25%  cases were found to have normal TSH while 15.56% cases were found to have SHT and 3.41%  cases were affected with overt HT.Discussion: Pregnancy involves several physiological changes that affect maternal thyroid function and thyroid hormone levels. HT in pregnancy is associated with increased risk of adverse pregnancy and fetal outcomes that can be ameliorated by adequate levo-thyroxine therapy. This study showed prevalence of subclinical hypothyroidism (SCH) to be 15%, while 3.4% antenatal women were found to have overt HT. Conclusion: Timely management of HT and SCH is required to achieve a successful pregnancy outcome and serum TSH level is a simple and reliable indicator of thyroid status in pregnancy.

References

1. GlinoerD. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocr rev 1997;18: 404-33.
2. Burrow GN,Fisher DA, Larsen Pr. Maternal and fetal thyroid function. N Engl J med1994; 331: 1072-8.
3. Klein RZ, Haddow JE, Faixt JDet al. Prevalence of thyroid deficiency in pregnant women.
Clin Endocrinol1991;35:41-6.
4. Wiles KS, Jarvis S, Nelson-Piercy C.Are we overtreating subclinical hypothyroidism in pregnancy?BMJ.2015;351:h4726
5. McNeil AR, Stanford PE. Reporting Thyroid Function Tests in Pregnancy. Clin Biochem Rev 2015;36(4):109-26.
6. Baloch Z,Carayon P, Conte-Devolx B, et al. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease.Thyroid 2003;13:3-126
7. Surks MI, Ortiz E, Daniels GH, et al. Subclinical thyroid disease: Scientific review and guidelines for diagnosis and management. JAMA 2004;291:228-38.
8. Saki F, Dabbaghmanesh MH, Ghaemi SZ, Forouhari S, Omrani GR, Bakhshayeshkaram M. Thyroid function in pregnancy and ıts ınfluences on maternal and fetal outcomes. Int J Endocrinol Metab 2014;12:1-7.
9. Abalovich M, Gutierrez S, Alcaraz G, Maccallini G, Garcia A, Levalle O. Overt and subclinical HT complicating pregnancy. Thyroid 2002;12:63-8.
10. 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.
11. Leung AS, Millar LK, Koonings PP, Montoro M, Mestman JH. Perinatal outcome in hypothyroid pregnancies. Obstet Gynecol 1993;81:349–53
12. Negro R, Formoso G, Mangieri Tet al. Levothyroxine treatment in euthyroid pregnant
women with autoimmune thyroid disease: effects on obstetrical complications. J Clin
Endocrinol Metab2006;91:2587–91.
13. Haddow JE, Palomaki GE, Allan WC et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Eng J Med 1999;341:549-55.
14. De Groot L, Abalovich M, Alexander EK,etal. Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2012;97(8):2543-65
15. Klein RZ, Haddow JE, Faix JD, et al.Prevalence of thyroid deficiency in pregnant women .Clin Endocrinol (Oxf) 1991;35(1)41-6.
16..Nambiar V, Jagtap VS, Sarathi V,et al. Prevalence and impact of thyroid disorders on maternal outcome in Asian –Indian pregnant women. J Thyroid Res 2011;2011:429097
17..Sahu MT, Das V, Mittal S, Agarwal A, Sahu M.Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and fetal outcome. Arch Gynecol Obstet 2010; 281(2):215-20.
18.Stagnaro-green A, Abalovich M, Alexander E, et al. 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 21: 1081-1125.
Published
2016-03-29
Section
Original Articles

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