A prospective clinical trial to evaluate the prevalence of thyroid disorder among pregnant women and obstetrical and fetal outcome in a tertiary health centre located in central India

Background: A prospective clinical trial to evaluate the prevalence of thyroid disorder among pregnant women and obstetrical and fetal outcome was done in a tertiary health centre (RKDF Medical College and Research Centre, Bhopal) located in central India.Methods: This prospective study was carried out in antenatal women in their first trimester attending antenatal OPD in RKDF Medical College and Research Centre, Bhopal, Madhya Pradesh to know the prevalence of thyroid disorder and its association with pregnancy outcome.Results: In this study prevalence of thyroid disorder was 12.4%, subclinical hypothyroidism 7.2%, overt hypothyroidism 3.4%, subclinical hyperthyroidism 1.4%, overt hyperthyroidism 0.4%. Thyroid disorder is responsible for several obstetrical and fetal complication like pre-eclampsia, preterm delivery, abortion, IUGR and low birth weight.Conclusions: Thyroid disorder associated with poor obstetrical outcome and fetal complication. so timely diagnosis and treatment is required. Universal screening should be preferred over high-risk screening because of high prevalence of the disease in India.

Prevalence of thyroid dysfunction in women with abnormal uterine bleeding in reproductive age

Background: Abnormal uterine bleeding (AUB) is one of the commonest presentations encountered in gynecological outpatient department. Menstruation is also regulated by many mechanisms, including thyroid hormone. So, for definitive management of AUB, it becomes imperative to assess thyroid status in those with abnormal uterine bleeding.Methods: Cross sectional study was conducted on all woman attending to OPD at Sri Siddhartha Medical College, Tumukuru, with complaints of abnormal uterine bleeding (AUB). Thyroid test was done for those who were eligible under inclusion criteria. Incidence of thyroid disorders among AUB and type of abnormal menstrual pattern associated with specific type of thyroid dysfunction were noted in this study.Results: Total of 522 presented with AUB. AUB was most common among woman age >40 years at 49.23% (257 of total 522 cases). AUB was more common in Multipara at 61.49% (321 of 522 cases). Menorrhagia was commonest pattern in AUB accounting for 51.34% (268 of 522cases). Thyroid dysfunction was present in 12.27% (64 of 522) of cases with AUB. Among them hypothyroid was most common accounting for 8.81% (46 of 522 cases). Hyperthyroidism was present in 3.44% (18 of 522 cases). Menorrhagia was most common pattern in Hypothyroidism at 65.21% (30 of 46 cases, followed by polymenorrhea at 17.39% (8 of 46 cases). Oligomenorrhea was most common in hyperthyroid group at 55.54% (10 of 18 cases) closely followed by hypomenorrhea at 44.44% (8 of 18 cases).Conclusions: Abnormal uterine bleeding (AUB) is one of the commonest gynecological complaint at gynecological OPD.  Thyroid dysfunction is noted consistently in cases of AUB. So, evaluation of thyroid profile should be part of evaluation of AUB, especially during perimenopause.

Study Of Thyroid Disorders In Pregnancy & Its Effect On Maternal & Perinatal Outcomes At A Tertiary Care Centre

Background: Thyroid disorders are reported at high prevalence during pregnancy, affecting ~5% of all pregnancies. Maternal thyroid disorders are implicated to influence foeto–maternal outcomes. Objective: To estimate prevalence of thyroid disorders in pregnant women and study the maternal and perinatal outcome with thyroid disorders. Methodology: 864 pregnant women were screened for thyroid disorders & were evaluated for maternal & foetal complications by predefined outcome measures. Observations: Of 864 patients screened, 105 were diagnosed with thyroid abnormality and followed up till delivery, with newborn thyroid profile on day 7. Of 105 participants having thyroid abnormalities; 88 had subclinical hypothyroid (83.8%), 14 (13.3%) had overt hypothyroidism. Significant associations were noted between various maternal & foetal complications and thyroid disorders. Conclusion: Thyroid disorders were more commonly associated with maternal and foetal complications.

Survey of pregnant women's understanding of thyroid diseases and analysis of influence factors / 上海交通大学学报（医学版）

Objective · To explore ways to improve screening conditions for thyroid disorders during pre-pregnancy period and the first trimester.Methods · 1212 cases of hospitalized expectant mothers from Jan 2016 to Dec 2016 in the First People's Hospital of Lianyungang were studied. As required, these subjects were filled in the questionnaires, including the pregnant women's basic situation, the way of obtaining the information, their understanding level of thyroid disorders, and their experience of thyroid function screening and screening time. The clinical data was analyzed after collected. Results · Among 1212 subjects, merely 214 (17.66%) subjects knew the thyroid disorders and considered it harmful to themselves during their pregnancy, and 659 (54.37%) subjects knew less about thyroid disorders, and 339 (27.97%) knew nothing about the two situations mentioned above.Among all the pregnant women in this study, 29 (2.39%) underwent thyroid function screening before pregnancy, 185 (15.26%) in the first-trimester, 635 (52.39%) during the second and third trimesters, and 363 (29.95%) didn't get thyroid function screening at all. The level of knowing thyroid disorders has a positive correlation to screening ratio in total and the pre-pregnant and first-trimester screening ratio (r=0.57, r=0.15, P=0.000). Conclusion · Raising childbearing-aged women's awareness of thyroid disorders and their harms to pregnancy will be helpful for improving thyroid function screening ratio in pregnancy.

Survey of pregnant women's understanding of thyroid diseases and analysis of influence factors / 上海交通大学学报（医学版）

Objective · To explore ways to improve screening conditions for thyroid disorders during pre-pregnancy period and the first trimester.Methods · 1212 cases of hospitalized expectant mothers from Jan 2016 to Dec 2016 in the First People's Hospital of Lianyungang were studied. As required, these subjects were filled in the questionnaires, including the pregnant women's basic situation, the way of obtaining the information, their understanding level of thyroid disorders, and their experience of thyroid function screening and screening time. The clinical data was analyzed after collected. Results · Among 1212 subjects, merely 214 (17.66%) subjects knew the thyroid disorders and considered it harmful to themselves during their pregnancy, and 659 (54.37%) subjects knew less about thyroid disorders, and 339 (27.97%) knew nothing about the two situations mentioned above.Among all the pregnant women in this study, 29 (2.39%) underwent thyroid function screening before pregnancy, 185 (15.26%) in the first-trimester, 635 (52.39%) during the second and third trimesters, and 363 (29.95%) didn't get thyroid function screening at all. The level of knowing thyroid disorders has a positive correlation to screening ratio in total and the pre-pregnant and first-trimester screening ratio (r=0.57, r=0.15, P=0.000). Conclusion · Raising childbearing-aged women's awareness of thyroid disorders and their harms to pregnancy will be helpful for improving thyroid function screening ratio in pregnancy.

Association of Cognitive Dysfunction with Thyroid Autoantibody / 정신신체의학

OBJECTIVES: The aims of this study were to know the frequency of cognitive dysfunction among patients with autoimmune thyroid disorders, and to reveal influencing factors on it, especially to clarify association with autoimmune thyroid antibodies. METHODS: From sixty-five female patients with autoimmune thyroid disorders, demographic data were obtained by structured interview. Their cognitive funtions were measured using the MMSE-K and the MoCA-K tests. Depression was evaluated by the K-HDRS. RESULTS: 1) Among patients with autoimmune thyroid disorders, 7.69% of them were below 24 on the MMSE-K, while 10.77% were below 22 on the MoCA-K. The frequency of cognitive deficit was not significantly different according to having positivity to antimicrosomal antibodies or not. 2) The antimicrosomal antibody-positive patients had significantly higher antithyroglobulin antibody titers, antimicrosomal antibody titers, and TSH concentration, while had significantly lower free T4 levels(p<0.05, respectively). 3) The total scores of the MMSE-K and the MoCA-K had significant correlation with age, marital status, antithyroglobulin antibody titers and K-HDRS(p<0.05, respectively). 4) The regression analysis revealed that variables such as age, education, autoimmune thyroid antibodies, thyroid function and depression did not influence on cognitive function of patients with autoimmune thyroid disorders. CONCLUSIONS: Our results could not support that cognitive function of patients with autoimmune thyroid disorders had correlation with autoimmune thyroid antibodies.

Thyroid autoantibodies and thyroid dysfunction in rheumatoid arthritis / 대한내과학회지

BACKGROUND: Autoimmune thyroid diseases have been shown to occur in association with connective tissue disorders. This study was undertaken to elucidate the prevalence of thyroid autoantibodies and thyroid dysfunction in Korean patients with rheumatoid arthritis (RA). METHODS: We have compared the prevalence of thyroid autoantibodies in 108 RA patients with 81 age-matched controls. Antimicrosomal antibody (AMA) and antithyroglobulin antibody (ATA) were measured by passive hemagglutinin assay. T3, T4, Free T4, and TSH were measured by chemiluminescence method. Rheumatoid factor was measured by nephelometry. Statistical analysis was performed by chi-square, Fisher's exact test, and Pearson correlation test. RESULTS: 1) The presence of AMA/ATA in patients with RA was significantly higher (28.7%/26.7% in 108 patients) than that of controls (11.1%/9.9% in 81 controls). The positive rates of AMA/ATA in female patients were also higher (28.9%/28.9% in 97 patients) than those of female controls (15.5%/12.1% in 58 controls). 2) Thirty three (17.6%) of 187 patients with RA had the abnormalities of thyroid function; 14 (7.5%) revealed subclinical hypothyroidism, 5 (2.7%) revealed biochemical primary hypothyroidism, 7 (3.7%) revealed sick euthyroid syndrome, and 7 (3.7%) revealed hyperthyroidism. CONCLUSION: These results suggest that autoimmune thyroiditis is highly associated with RA in Korean patients, showing the increased prevalence of thyroid autoantibodies and thyroid dysfunctions.

A Study on Subtypes of Thyroid Disorders Detected by Neonatal Screening Test / 대한소아내분비학회지

PURPOSE:The project of the neonatal mass screening test for inborn errors of metabolism are just at the beginning in Korea and there was a few reports about the overall incidence and subtypes of congenital hypothyroidism. METHODS:In this study, we analysed the 97 cases of newborns with hyperthyrotropinemia who were detected by neonatal screening test to identify the incidence and early clinical manifestations of each subtypes of congenital hypothyroidism. Thyroid function were measured by thyrotropin(TSH) level, T4, T3, Free T4, Free T3, thyroglobulin, T3 resin uptake, TBII, TBG in serum, thyroid ultrasonography and 99mTc thyroid scan. We reanalysed the thyroid functions 1 week after discontinuance of L-thyroxine treatment for 1 year. RESULTS: 1) The time of neonatal screening test were between 3 and 7 days after birth in 46 cases(47.4%) and 8 and 14 days after birth in 35 cases(36.1%). Two cases (2.1%) were done neonatal screening test at the age of 2 days old. 2) The major cause of thyroid disorders were primary hypothyroidism in 45 cases of the total due to thyroid aplasia(7 cases), thyroid hypoplasia(17 cases), ectopic thyroid gland(12 cases) and dyshormonogenesis(9 cases). Other causes of thyroid disorders were TBG deficiency(11 cases), TBG dysfuction(1 case), transient hyperthyrotropinemia(28 cases) and transient hypothyroidism(12 cases). 3) Serum level of thyrotropin(TSH) at diagnosis were 223.5+/-229.6microU/ml in thyroid aplasia, 41.6+/-42.9microU/ml in thyroid hypoplasia, 52.4+/-55.6microU/ml in ectopic thyroid gland. TSH levels were significantly high in thyroid aplasia. T4 levels in thyroid aplasia are 1.7+/-2.0microg/dl and this is significantly lower than other types of thyroid disorders. T3 levels were within normal range except in thyroid aplasia and TBG deficiency. 4) Prolongation of physiologic jaundice was the most common clinical manifestation(33.3%) in patients with primary hypothyroidism and macroglossia, hypothermia, umbilical hernia and cold skin were the next commom clinical manifestations in order to present. 5) Osseous development was normal in 57 cases(82.6%) out of 69 cases who accomplished roentgenographic examination of knees. Only 12 cases(17.4%) showed retardation of osseous development, but there was no significant differences between types of thyroid disorders. 6) Most of the newborn(93.3%) with primary hypothyroidism started to treatment within 8 weeks of age. 7) Initial dosage of L-thyroxine was 10microg/kg/day and decreased 6 to 12 months after treatment. 8) There was significantly decreased thyroid uptake of 99mTc after 1 year follow-up in 5 cases of dyshormonogenesis. 9) The serum TSH levels returned to normal ranges within 6 month after treatment in transient hypothyroidism and transient hyperthyrotropinemia. CONCLUSIONS:Special attention should be paid to transient hyperthyrotropinemia and transient hypothyroidism because many of the congenital thyroid disorders showed transient type and it is necessary to establish the diagnostic guideline to early detect these transient types of congenital thyroid disorders.

A clinical study on thyroid disorder in chilhood

The author studied 294 cased of childhood thyroid disorder at Pediatrics Department in Pusan National University Hospital from Jan. 1984 to Dec. 1991. The patients with grouped according to thyroid function and disease entity, and were evaluated symptoms and signs, laboratory findings and treatment. The results were summarized as follow 1) The childhood thyroid disorder was the most common in the older children, but congenital hypothyroidism was the most frequent in the early infancy. The ratio of male and female was 1:4.6, but in congenital hypothyroidism, it was 1:1.7. 2) In classification of thyroid disorder according to thyroid function, euthyroidism was the most common with 73% of the patients, hypothyroidism was 15% and hyperthyroidism was 12% in order. in hypothyroidism. the majority was Graves' disease and a few cases were Hashimoto's thyroiditis. In Euthyroidism, simple goiter was the most common with 72%, Hashimoto's thyroiditis was 24%,and 3 cases were thyroid cancer. In hypothyroidism. congenital hypothyroidism was 44% and Hashimoto's thyroiditis was the most common cause of congenital hypothyroidism. 3) The clinical manifestation at first visit hypothyroidism included thyroid enlargement which was seen in all cases, cold sweating,palpitation and nervousness. In Euthyroidism, there was no specific complaints except thyroid enlargement. Growth retardation, constipation and mental retardation were visible in congenital hypothyroidism. In acquired hypothyroidism, the patents complained thyroid enlargement, lethargy, anorexia. The causes of congenital hypothyroidism was ectopic thyroid, aplasia or hypoplasia of thyroid and dyshormonogensis with similar frequency. 4) In most cases of hyperthyroidism, propylthiouracil was administerd. The half of the patients were recovered at 4 weeks after treatment, and 92% of them were recoverd at 3 months later after treatment. The side effects were rare. In a few of them surgical method was underwent. In hypothyroidism. L-thyroxine was adminisetered, and the result was excellent.

Association of CD40 gene 5′UTR C(-1)T,-58038T and C64610G polymorphism with autoimmune thyroid disorders / 西安交通大学学报(医学版)

Objective To investigate polymorphism of CD40 gene and its relation with autoimmune thyroid disorders(AITD) in China's Northwest region.Methods The study recruited 372 subjects: 165 Graves' disease(GD) and 113 Hashimoto's thyroiditis(HT) and 93 healthy subjects as controls.① Using PCR-restriction fragment length polymorphism(PCR-RFLP) to analyze the C/T polymorphism in the 5′UTR and the-58038T point mutation in exon3.② Using amplification refractory mutation system-PCR(ARMS-PCR) to analyze the C64610G point mutation in exon9.Results ① There were significant differences in allele frequencies of C and genotype CC between GD group and control group in 5′UTR C(-1)T(P