Individualized Follow-up of Pregnant Women with Asymptomatic Autoimmune Thyroid Disease

Abstract

Maternal hormones are essential for the normal fetal development during pregnancy. Autoimmune thyroid disease is a frequent pathology in our iodine replete region. The aim of this study is to evaluate the occurrence of subclinical hypothyroidism (SCH) in cases with known autoimmune thyroid disease, which were in a euthyroid state prior to pregnancy, and to assess the association between supplemental treatments administered and the outcome of the pregnancy. The study is a prospective interventional controlled study. The two cohorts comprise the interventional group, consisting of 109 pregnant women with known autoimmune asymptomatic thyroid disease, without any levothyroxine (LT4) treatment and an aged-matched control group, with an unknown thyroid disease. After the pregnancy, a monthly evaluation of TSH, FT3, and FT4 was performed. Offspring evaluation was made at birth time. 88.8% of the women developed SCH in the first four weeks of pregnancy. Average LT4 doses increased as the pregnancy progressed. The monthly adjustment was 12.5 or 25 μg. All SCH cases developed in the first trimester of pregnancy. There was no significant difference regarding the gestational week, weight, or length at birth between the interventional group and controls, when TSH values were in the optimal range, during the whole pregnancy. Premature birth was described in one case in the interventional group.

Effects of maternal hypothyroidism in the gastrointestinal system of male young offspring from Wistar rats

“…46 The consequences of untreated maternal hypothyroidism during pregnancy range from preeclampsia to complications such as perinatal death, premature birth, among others. 12,13,47 In our study, pups from hypothyroid mothers (E1 and E2) had lower weight at 30 days old compared to controls, as it reinforces the importance of maternal thyroid hormones for the proper development of offspring. In this context, from human studies, fetal sex also appears to interfere with intrauterine development, so that male fetuses are most exposed to macrosomia, whereas female fetuses more predisposed to intrauterine growth restriction.…”

“…10,11 Consequences of the untreated hypothyroidism during pregnancy may be a miscarriage, preterm birth, preeclampsia, complications at birth, neonatal hypothyroidism, changes in fetal brain development, and growth, besides congenital hypothyroidism. 12,13 In this context, thyroid hormones have an important participation in early developmental processes, controlling cell growth, maturation, and the metabolism of virtually all tissues. 14 Patients with hypothyroidism have alterations associated with gastrointestinal (GI) function, presenting symptoms such as constipation and flatulence.…”

Is there a Need for Own Median Calculation in the Second Trimester Biochemical Markers Screening?

“…Identification of early markers predictive of pregnancy complications is a goal of materno-fetal medicine [7,[13][14][15][16][17]. The algorithm of aneuploidy risk calculation needs a correct evaluation of gestational age.…”

The efficacy of acupuncture for the treatment and the fertility improvement in child-bearing period female with Hashimoto Disease

“…[ 46 ] According to one study, women that are considered euthyroid, before pregnancy, are reclassified as having subclinical hypothyroidism, in cases of TSH between 2.5 and 4 mIU/L. [ 47 ] Most endocrinologists use a TSH value of 2.5 mIU/L as the threshold for diagnosing hypothyroidism and starting levothyroxine in pregnant women because of an evident association between mild thyroid impairment and adverse outcomes in pregnancy. [ 48 ] LT4 supplementation can slow the progression of HT, control the early stage of hypothyroidism, and support follicular development.…”