Prevalence of gestational thyrotoxicosis in Asian women evaluated in the 8th to 14th weeks of pregnancy: correlations with total and free beta human chorionic gonadotrophin

Yeo, Chin Pin; Khoo, D. H. C.; Eng, P. H. K.; Tan, Hak Koon; Yo, Sui Lan; Jacob, Edward

doi:10.1046/j.1365-2265.2001.01353.x

Cited by 61 publications

(35 citation statements)

References 36 publications

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“…A significant negative correlation between TSH and β-hCG levels was found (p-value 0.025). These findings are similar to those of Yeo et al (13) who investigated the prevalence of gestational thyrotoxicosis in Asian women in Singapore and found-out that the total and free β-hCG correlated negatively with TSH (P < 0.0001 and P < 0.0001, respectively), positively with FT4 (P < 0.001 and P < 0.001) and FT3 (P < 0.001 and P < 0.01).…”

Section: Discussionsupporting

confidence: 91%

Gestational Thyrotoxicosis Associated With Emesis In Early Pregnancy

Ndungu

Amayo²,

Qureshi³

et al. 2009

E Af Med Jrnl

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Objectives:To determine the thyroid profile and the prevalence of gestational thyrotoxicosis among women with emesis during early pregnancy. Design: A descriptive cross -sectional study. Setting: Kenyatta National Hospital acute gynaecology ward and the ante-natal clinic. Subjects: Seventy two women presenting with emesis up to 16 weeks gestation. Main outcome measures:The levels of FT3, FT4, TSH and β-hCG during the first 16 weeks of gestation. Correlation between the thyroid hormones and β-hCG as well as the severity of vomiting was also done. Results: The point prevalence of gestational thyrotoxicosis was 8.3%. There was a significant positive correlation between β-hCG levels and FT3 and FT4 (P-values < 0.05), and a significant negative correlation between β-hCG and TSH (P < 0.05). Correlation between the severity of vomiting and the thyroid hormones as well as β-hCG was not statistically significant. Patients' age ranged from 14-38 years (median 26). Majority of the women studied were at a gestation of 8 to 11 weeks (38.9%). Most patients (84.7%) had one to five episodes of vomiting per day. Peak β-hCG was at 12 -15 weeks gestation. Conclusions: Thyrotoxicosis does occur among women with emesis in pregnancy in this set-up. Screening for it may be beneficial to such women and also those with high serum β-hCG levels above the median for the gestational age.

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Section: Discussionsupporting

confidence: 91%

Gestational Thyrotoxicosis Associated With Emesis In Early Pregnancy

Ndungu

Amayo²,

Qureshi³

et al. 2009

E Af Med Jrnl

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“…(16 ). However, the prevalence of gestational thyrotoxicosis in Asian women was found to be significantly higher during weeks 8 to 11 of gestation than at 12 to 14 weeks (14 ). Further studies of thyroid reference intervals should be conducted during the 1st trimester of pregnancy and include Asian women.…”

Section: Discussionmentioning

confidence: 93%

Second-Trimester Reference Intervals for Thyroid Tests: The Role of Ethnicity

La’ulu

Roberts

2007

Clinical Chemistry

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Background: Thyroid function changes during pregnancy, complicating the diagnosis of thyroid disorders. Maternal thyroid dysfunction has been associated with a variety of adverse outcomes. We evaluated thyroid function test results by ethnicity and week of gestation during the 2nd trimester of pregnancy. Methods: We collected 3064 blood specimens in serum tubes from Asians (13%), blacks (22%), Hispanics (23%), and whites (42%). We measured thyroid-stimulating hormone (TSH), total and free thyroxine (TT4 and FT4), total and free triiodothyronine (TT3 and FT3), thyroglobulin autoantibodies (TgAb), and thyroid peroxidase autoantibodies (TPOAb) by use of an ARCHITECT i2000 SR (Abbott Diagnostics). The TSH reference interval was calculated for samples negative for both TgAb and TPOAb and reference intervals for TT4, FT4, TT3, and FT3 in antibody-negative samples with normal TSH. Results: Serum samples were positive for TgAb in 10.6%, 1.8%, 6.2%, 6.5%, and 5.9% of Asian, black, Hispanic, white, and combined groups, respectively. Samples were positive for TPOAb in 12.4%, 4.1%, 11.8%, 12.3%, and 10.4% of the same groups, respectively. The nonparametric reference intervals for all participants were 0.15-3.11 mIU/L (TSH) ,

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“…16 In Asian women in Singapore at 8 -14 weeks of pregnancy, 33% had suppressed TSH and 11% had suppressed TSH and elevated free T4 levels. 17 …”

Section: Thyrotropic Action In Normal Pregnancymentioning

confidence: 99%

Physiological and pathological aspects of the effect of human chorionic gonadotropin on the thyroid

Hershman¹

2004

Best Practice & Research Clinical Endocrinology & Metab

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Human chorionic gonadotropin (hCG) is a glycoprotein hormone that has structural similarity to TSH. At the time of the peak hCG levels in normal pregnancy, serum TSH levels fall and bear a mirror image to the hCG peak. This reduction in TSH suggests that hCG causes an increased secretion of T4 and T3.Women with hyperemisis gravidarum often have high hCG levels that cause transient hyperthyroidsm. In the vast majority of such patients, there will be spontaneous remission of the increased thyroid function when the vomiting stops in several weeks. When there are clinical features of hyperthyroidism, it is be reasonable to treat with antithyroid drugs or a betaadrenergic blocker, but treatment is rarely required beyond 22 weeks of gestation.Hyperthyroidism or increased thyroid function has been reported in many patients with trophoblastic tumors, either hydatiditform mole or choriocarcinoma. The diagnosis of hydatidiform mole is made by ultrasonography that shows a 'snowstorm' appearance without a fetus. Hydatidiform moles secrete large amounts of hCG proportional to the mass of the tumor. The development of hyperthyroidism requires hCG levels of . 200 U/ml that are sustained for several weeks. Removal of the mole cures the hyperthyroidism. There have been many case reports of hyperthyroidism in women with choriocarcinoma and high hCG levels. The principal therapy is chemotherapy, usually given at a specialized center. With effective chemotherapy, longterm survival exceeds 95%.A unique family with recurrent gestational hyperthyroidism associated with hyperemesis gravidarum was found to have a mutation in the extracellular domain of the TSH receptor that made it responsive to normal levels of hCG.Key words: human chorionic gonadotropin; thyrotropin; pregnancy; hyperemesis gravidarum; hydatidiform mole; choriocarcinoma; mutant thyroid-stimulating hormone receptor.

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Prevalence of gestational thyrotoxicosis in Asian women evaluated in the 8th to 14th weeks of pregnancy: correlations with total and free beta human chorionic gonadotrophin

Cited by 61 publications

References 36 publications

Gestational Thyrotoxicosis Associated With Emesis In Early Pregnancy

Gestational Thyrotoxicosis Associated With Emesis In Early Pregnancy

Second-Trimester Reference Intervals for Thyroid Tests: The Role of Ethnicity

Physiological and pathological aspects of the effect of human chorionic gonadotropin on the thyroid

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