An observational study of fetomaternal outcome in euthyroid women with anti-thyroid peroxidase antibodies at tertiary care hospital

Background: Several changes are observed in maternal thyroid function during pregnancy and failure to adapt to these physiological changes results in thyroid dysfunction, especially if complicated by the presence of thyroid antibodies. The presence of TPO-Ab is associated with increased rate of pregnancy complications such as miscarriage, preterm delivery, placental abruption, pregnancy-induced hypertension, intrauterine death and low birth weight. Objective of this study was to study the effect of anti-TPO Ab positivity on pregnancy outcome and estimate the prevalence of anti-TPO Ab in euthyroid obstetric women.Methods: This observational study enrolled 500 euthyroid pregnant women, age 20-35 years, up to 20 weeks gestation. Venous blood samples collected and analyzed for the anti TPO Ab levels. On the basis of anti TPO Ab positivity they were divided into two groups, anti-TPO Ab positive and Ab negative group. These two groups were followed up till delivery or abortion and compared for maternal and fetal outcomes.Results: Prevalence of anti-TPO antibody positivity was 5.2% in euthyroid obstetric women. Most of anti-TPO Ab positive women were overweight. There were higher numbers of miscarriage (11.54%) in anti-TPO Ab positive euthyroid pregnancies than (2.53%) in antibody negative women. Incidence of low birth weight babies was 4-fold higher in anti-TPO Ab positive women. More than two-fold increase in incidence of placental abruption in anti-TPO Ab positive women. Parity, anaemia, gestational hypertension, preeclampsia, GDM, PROM, PPH, low Apgar scores, NICU admission, IUD and neonatal death were not significantly associated with anti-TPO Ab positivity.Conclusions: Anti TPO Ab positivity significantly associated with pre-pregnancy BMI, miscarriage rates and low birth weight of newborns.

Vitamin D Status Association with Thyroid Antibodies in Hypothyroidism Patients

Background: Deficiency in Vitamin D is a global health issue, in the recent decade, there has been substantial proof that low levels of Vitamin D can lead to thyroid disorders. The present study aims to analyze the relationship between hypothyroidism and the level of Vitamin D, as well as to analyze the relationship between Vitamin D level with thyroid antibodies (TPO-Abs and TG-Abs). Methods: Forty patients diagnosed as hypothyroidism which compared with twenty healthy control groups with matching in sex and age between studied groups. The blood sample was collected from both groups to estimate the level of vitamin D, T3, T4, TSH hormones and the existence of thyroid autoantibodies. Results: Patients with hypothyroidism showed a significantly lower mean of Vitamin D level compared with the healthy control group (p=0.0001). Half (20/40) of the hypothyroid group tested positive for TPO-Ab, (15/40) were positive for TG-Ab, and (14/40) of hypothyroidism patients have positive results for Anti-Thyroid Peroxidase and AntiThyroglobulin antibodies with highly statistical significant between hypothyroid group according to the presences of autoantibodies. As for the interaction of vitamin D levels with autoantibodies in patients with hypothyroidism, we observed that levels of Vitamin D were correlated with neither TPO antibodies (p=0.292) nor TG antibodies (p=0.108). Conclusion: The levels of vitamin D were significantly lower in patients with hypothyroidism relative to healthy control. Vitamin D does not have a strong association with the titers of thyroid antibodies.

Association between Serum 25 (OH) Vitamin D level and Thyroiditis in Western Saudi Arabian Population

The association of low vitamin D status with Autoimmune Thyroid Disease (AITD), which includes Hashimoto’s Thyroiditis (HT), is controversial. (HT) is a chronic autoimmune thyroid disease caused by an interaction between genetic factors and environmental conditions, both of which are yet to be fully understood. The management of HT depends on its clinical manifestations, commonly including diffuse or nodular goiter with euthyroidism, subclinical hypothyroidism and permanent hypothyroidism. The aim of this study was to investigate mainly the correlation between vitamin D deficiency and HT. Methods: This study was carried out in tertiary hospitals, included patients who visited the hospital for thyroid evaluation or follow-up. Results: A total of 310 subjects were included, of whom 84 participants were healthy, and 226 patients with hypothyroid disease, 119 subjects were diagnosed as having HT (AITD), 107 Non-AITD. Conclusion: The prevalence of vitamin D deficiency was significantly higher in HT group than in non AITD (48.9 % vs. 37.4 %, p=0.013). Among HT cases, patients with overt hypothyroidism had a significantly higher prevalence of vitamin D insufficiency than HT with euthyroidism, subclinical hypothyroidism (60.4% vs. 44.1%, 29.7%, respectively, p 0.009, 0.017, 0.026). Conclusion: Considering current evidence, presented in this study, screening for vitamin D deficiency and careful vitamin D supplementation, when required, may be recommended for patients with HT.

Laboratory Testing in Thyroid Conditions - Pitfalls and Clinical Utility

Thyroid disorders are common, affecting more than 10% of people in the US, and laboratory tests are integral in the management of these conditions. The repertoire of thyroid tests includes blood tests for thyroid-stimulating hormone (TSH), free thyroxine, free triiodothyronine, thyroglobulin (Tg), thyroglobulin antibodies (Tg-Ab), thyroid peroxidase antibodies (TPO-Ab), TSH receptor antibodies (TRAb), and calcitonin. TSH and free thyroid hormone tests are frequently used to assess the functional status of the thyroid. TPO-Ab and TRAb tests are used to diagnose Hashimoto's thyroiditis and Graves' disease, respectively. Tg and calcitonin are important tumor markers used in the management of differentiated thyroid carcinoma and medullary thyroid carcinoma (MTC), respectively. Procalcitonin may replace calcitonin as a biomarker for MTC. Apart from understanding normal thyroid physiology, it is important to be familiar with the possible pitfalls and caveats in the use of these tests so that they can be interpreted properly and accurately. When results are discordant, clinicians and laboratorians should be mindful of possible assay interferences and/or the effects of concurrent medications. In addition, thyroid function may appear abnormal in the absence of actual thyroid dysfunction during pregnancy and in critical illness. Hence, it is important to consider the clinical context when interpreting results. This review aims to describe the above-mentioned blood tests used in the diagnosis and management of thyroid disorders, as well as the pitfalls in their interpretation. With due knowledge and care, clinicians and laboratorians will be able to fully appreciate the clinical utility of these important laboratory tests.

Relationship of hypothyroxinemia to gestational diabetes mellitus during early pregnancy / 中华内分泌代谢杂志

Objective To investigate the relationship of hypothyroxinemia to gestational diabetes mellitus during early pregnancy. Methods A total of 11 365 cases of women with early singleton pregnancies were collected from Chongqing Health Center for Women and Children. The screening of thyroid function was performed. The postload glucose concentrations and the risks of gestational diabetes mellitus in hypothyroxinemia were investigated. The relationship of thyroid hormones to postload glucose concentration was evaluated. The association between thyroid peroxidase antibodies(TPOAb) and gestational diabetes mellitus was analyzed. Results Early pregnancy women with hypothyroxinemia had a higher postload glucose concentration. Comparing to normal pregnancy women, the prevalence of gestational diabetes mellitus in hypothyroxinemia was higher(42.2%vs18.4%, P<0.05). Free thyroxine(FT4) was significantly negatively correlated with postload glucose concentration. FT4 was associated with gestational diabetes mellitus. The risk of gestational diabetes mellitus was greater when FT4 was lower. The prevalence of gestational diabetes mellitus in early pregnancy women with TPOAb levels ≥500 IU/ml was significantly higher than that in normal pregnancy women (31.2%vs 18.4%, P<0.05). Conclusion Early pregnancy women with hypothyroxinemia and TPOAb≥500 IU/ml were related to the risk of gestational diabetes mellitus. Lower FT4 was the risk factor of gestational diabetes mellitus.

Thyroid function/antibodies in sudanese women with polycystic ovarian disease

OBJECTIVE: To evaluate thyroid function and hormonal profile in women with polycystic ovary syndrome (PCOS). METHODS: A case-control study was conducted at Saad Abualila Center, Khartoum, Sudan. The cases were women with confirmed PCOS based on Rotterdam criteria. The controls were infertile women with no evidence of PCOS. The socio-demographic characteristics and medical history were gathered using a questionnaire. Thyroid hormones (thyroid-stimulating hormone, free tri-iodothyronine, and free thyroxine), anti-thyroid peroxidase, and anti-thyroglobulin antibodies were measured. RESULTS: While there were no significant differences in the age and haemoglobin levels of the two studied groups (55 women in each arm), body mass index was significantly higher in women with PCOS. There were no significant differences in the levels of thyroid-stimulating hormone, luteinizing hormone, follicle stimulating hormone, luteinizing hormone/follicle stimulating hormone, anti-thyroid peroxidase, anti-thyroglobulin antibodies, cholesterol, triglycerides and low-density lipoprotein cholesterol between the cases and the controls. The mean±standard deviation of free tri-iodothyronine (3.50±0.2 vs. 3.38±0.3 pg/mL, P=0.040) and median (interquartile) high-density lipoprotein cholesterol (37.0 [34.0 to 42.0] vs. 35.80 [29.0 to 41.0] mg/dL, P=0.015) were significantly higher in PCOS patients compared with the control group. In linear regression, PCOS (0.151 pg/mL, P=0.023) and anti-thyroid peroxidase levels (-0.078 pg/mL, P=0.031) were significantly associated with free tri-iodothyronine. CONCLUSION: Free tri-iodothyronine was a significantly higher among PCOS patients compared with the control group.

Effect of selenium on the Hashimoto thyroiditis / 中华内分泌代谢杂志

A total of 115 patients with Hoshimoto thyroiditis were classified under 2 groups: one group being treated with selenium and L-throxine (L-T4) and other group with L-T4 alone.All patients were followed up for 3 months.In the selenium treated group thyroid peroxidase antibody level was decreased in 33 patients (56%) and thyroglobulin antibody level was decreased in cases.

An epidemiologic survey of hypothyroidism during the first half of pregnancy / 中华内分泌代谢杂志

Objective To investigate the prevalence of hypothyrodism during the first half of pregnancy in the Han nationality women in iodine-adequate area. Methods TSH, FT4 and thyroid peroxidase antibody (TPOAb) levels were detected in 4 800 pregnant women during the first half of pregnancy. Both gestational age-specific reference intervals and population-based reference intervals of thyroid function were applied and the corresponding prevalences of hypothyroidism were compared with each other. Results Based on the gestational age-specific reference intervals, the prevalences of overt hypothyroidism at 4th and 8th weeks of gestation were 1.03%, 0.37% respectively. At 4th, 8th, 12th, 16th and 20th weeks of gestation, the prevalences of subclinical hypothyroidism were 4.59%, 6.15% , 4.68%, 4.53%, 5.96% respectively, while those of hypothyroxinemia were 3.69%, 1.11%, 2.92% , 1.29%, 2.29%, respectively. According to the pepulation-based reference intervals, the rates of missed diagnosis of subclinical hypothyroidism were 0.18%, 2.85%, 4.10%, 3.24%, 3.21% while those of hypothyroxinemia were 3.45%, 0.66%, 2.34%, 1.29%, 1.83%, respectively. During 4th, 8th, 16th weeks of gestation, the positive rates of TPOAb in the group with subclinical hypothyroidism were significantly higher than those with euthyroidism. The prevalences of subclinical hypothyroidism in TPOAb positive group were obviously higher than those in TPOAb negative group at 4th, 8th, 12th, 16th gestational weeks. Conclusion The rates of missed diagnosis of subclinical hypothyroidism and hypothyroxinemia during the first half of pregnancy were decreased by applying the gestational age-specific reference intervals in this prospective study. Positive TPOAb is a risk factor for subclinical hypothyroidism during the first half of pregnancy.

Effect of maternal subclinical thyroid abnormalities on offspring's intellectual development / 中华内分泌代谢杂志

Objective To study the effect of maternal subclinical thyroid abnormalities [including subclinical hypothyroidism, hypothyroxinemia and positive anti-thyroid peroxidase antibody (TPOAb) with normal thyroid function] in women during 16-20 weeks of gestation on offspfing's intellectual development and motor function. Methods Sera from 1 268 women during 16-20 weeks of gestation (collected 2 years ago) were obtained and thyroid stimulating hormone (TSH), total thyroxine (TT4), free thyroxine (FT4) and TPOAb levels were measured. Pregnant specific thyroid function reference ranges were used to screen for subclinical hypothyroidism (18 cases), hypothyroxinemia (19 cases) and positive TPOAb (34 cases). From the same cohort, a total of 142 pregnant women who were euthyroid with negative TPOAb were selected as controls (a case: control ratio of 1 : 2). Intellectual and motor development score evaluations were performed in their children at 25-30 months of age. Results In the group of pregnant women with subclinical hypothyroidism, the offspring' s intelligence score was (109.89±13.81) points, which was 8.88 points lower than in the control group (P < 0.01). Similarly, the motor score of the offspring was (108.11±9.93) points, which was 9.98 points lower than in the control group (P < 0.01). In the pregnant women with hypothyroxinemia, the offspring's intelligence score was (112.32±15.10) points, 9.30 points lower than in the control group (P <0.01); the motor score was (112.21±12.26) points, 7.57 points lower than in the control group (P < 0.01). In the pregnant women with positive TPOAb and euthyroid function, the offspring's intelligence score was (112.70±20.64) points, 10.56 points lower than in the control group (P < 0.01); the motor score was (110.64±12.49) points, 9.03 points lower than in the control group (P < 0.01). Conclusion Maternal subclinical thyroid abnormality between 16-20 weeks of gestation adversely may affect offspring intellectual and motor development, suggesting the necessity for screening and treatment of maternal subclinical thyroid abnormality in the early stages of pregnancy.