The Ki-67 labeling index may predict clinical outcome in postsurgical management of acromegalic patients. We suggest routine Ki-67 evaluation in GH-secreting pituitary adenomas.

Infertile women with TAI treated with ICSI had no increased risk of a first trimester miscarriage compared with women without TAI.

Objective: Thyroid disorders and iron deficiency (ID) are associated with obstetrical and fetal complications. Iron is essential for the normal functioning of thyroid peroxidase (TPO-abs) and ID is frequent during pregnancy. The aim of this study was to compare the prevalence of thyroid autoimmunity (TAI) and dysfunction during the first trimester of pregnancy in women with and without ID. Design: Cross-sectional data analysis of 1900 pregnant women nested within an ongoing prospective collection of pregnant women's data. Method: The study was performed in a single, tertiary referral center. During the first antenatal visit, ferritin, TPO-abs, thyroid-stimulating hormone (TSH) and free T 4 (FT 4 ) were measured and age and BMI were recorded. ID was defined as ferritin <15 µg/L, TAI when TPO-abs was >60 kIU/L, and subclinical hypothyroidism (SCH) when TSH was >2.5 mIU/L. Results: ID was present in 35% of women. Age and BMI were comparable between both groups. In the ID group, the prevalence of TAI and SCH was significantly higher, compared with that in the non-ID group (10% vs 6% and 20% vs 16%; P = 0.011 and 0.049 respectively). Ferritin was inversely correlated with serum TSH (ρ = −0.076; P = 0.001) and positive with FT 4 levels (ρ = 0.112; P < 0.001). In the logistic regression model, ID remained associated with TAI after correction for confounding factors (P = 0.017). The association with SCH was absent after correction for the confounders in the logistic regression model (P = 0.082), but remained present in the linear regression model (P = 0.035). Conclusions: ID was frequent during the first trimester of pregnancy and was associated with a higher prevalence of TAI, higher serum TSH, and lower FT 4 levels.

Pregnant women with a sub-Saharan African background had a lower prevalence of TAI and TSH levels as compared with women from other backgrounds. The use of ethnicity-specific TSH cut-offs in early pregnancy was not more specific for the diagnosis of SCH as compared to the use of the institutional cut-off.

The GHR genotype could be useful in predicting dose and individual response to pegvisomant in acromegaly.

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Variability in thyroid function in pregnant women is the result of 2 main determinants, each accounting for approximately half of it. The first is the genetically determined part of which the knowledge increases fast, but most remains to be discovered. The second determinant is caused by an ensemble of variables of which thyroid autoimmunity is the best known, but also by others such as parity, smoking, age, and BMI. More recently, new candidate variables have been proposed, such as iron, endocrine disruptors, and the ethnicity of the pregnant women. In the future, the diagnosis and treatment of thyroid (dys)function may be optimized by the use of each individual’s pituitary-thyroid set point, corrected with a factor taking into account the impact of nongenetically determined variables.

No abstract