A study of thyroid disorders in pregnancy
Adela Voican1, Oana Pavel1, Ionut Vasile1, Areta Cerga2 & Marian Bistriceanu1
Background and aims: Thyroid disorders (TDs) are frequent in women of reproductive age, with a major influence on both female reproductive function and fetal development. During pregnancy, TDs associate a high risk of miscarriages, premature birth or neonatal morbidity. Our study aimed to assess both TDs prevalence in pregnant women and the need to adjust the necessary treatment during pregnancies complicated with TDs.
Patients and method: This is a retrospective study of 146 pregnant women (with clinical signs or symptoms suggesting thyroid dysfunctions) addressing the Endocrinology ambulatory care unit of the County Emergency Hospital of Craiova from January 2008 till December 2009. Thyroid function assessment included the following serum parameters: thyroid-stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), free thyroxine (FT4), free triiodothyronine (FT3), anti-thyroid peroxidase antibodies (anti-TPO Ab) and antithyroglobulin antibodies (ATG Ab). After exclusion of the pregnant women with normal thyroid function, the patients were divided into two groups according to the presence or absence of thyroid antibodies: group A (positive thyroid antibodies) and group B (negative thyroid antibodies). Assessment of changes in instituted treatment was also performed in pregnancies associated with TDs.
Results: Thyroid dysfunctions were found in 91 patients (61.48%), 46 patients being included in group A and 45 in group B. According to thyroid hormones values, 31 patients (67.4%) from group A had hypothyroidism, 4 of them (8.7%) thyrotoxicosis and the remaining 11 (23.9%) being eufunctional. In group B, 42 patients (93.3%) were diagnosed with hypothyroidism and 3 patients (6.7%) with hyperthyroidism. Changes in the therapeutic attitude of the 73 hypothyroid patients showed an increased need of thyroid hormone substitution in 41 patients and a decreased need in 1 patient. Concerning the 7 hyperthyroid patients, antithyroid therapy was needed in 3 cases.
Conclusions: The high prevalence of thyroid abnormalities in pregnant women suggests the need for thyroid screening in early pregnancy, while the treatment changes of these patients show the importance of a close endocrine follow-up in order to obtain good pregnancy outcome.