Effect of maternal hyperthyroidism during late pregnancy on the risk of neonatal low birth weight.

OBJECTIVE: Hyperthyroidism in pregnancy occurs with a prevalence of 0.05--0.2% and has been shown to affect neonatal outcomes. Fetal weight increases markedly during the third trimester of pregnancy. This retrospective study was performed to examine the effect of maternal hyperthyroidism during late pregnancy on neonatal birth weight (NBW). DESIGN: Medical and obstetric records of 293 pregnant women with present and past history of hyperthyroidism were retrospectively reviewed. PATIENTS: There were 188 records of 181 patients with adequate data for inclusion in the analysis. The patients were divided into two groups according to the maternal thyroid function during the third trimester of pregnancy: hyperthyroidism (HT; 35 cases) and euthyroidism (ET; 153 cases). MEASUREMENTS: Maternal thyroid function tests were periodically evaluated before and during the third trimester of pregnancy. Neonatal thyroid function tests and birth weight of the newborn infants were also assessed. RESULTS: There was no significant difference of maternal age between HT and ET groups mean +/- SD (27.6 +/- 5.5 vs. 29.2 +/- 5.4 years). The NBW of the HT group was not significantly different from that of the ET group (2880 +/- 590 vs. 3019 +/- 426 g). However, the prevalence of infants with low birth weight (LBW) defined as NBW of lower than 2500 g in HT group was 22.9% which was significantly higher than the 9.8% in the ET group (P = 0.039, OR = 2.7, 95%CI = 1.1--7.1) and 9.7% of infants born to healthy mothers at Siriraj Hospital (control group) between 1991 and 1995 (P = 0.01, OR = 2.7, 95%CI = 1.3--6.1). The 90% CI for the true difference between the prevalence of LBW infants born to ET and HT mothers was 0.7--25.4. There was no significant difference in the prevalence of LBW infants in ET and control groups. Multiple logistic regression analyses showed that maternal hyperthyroidism during the third trimester of pregnancy was an independent factor associated with increased prevalence of LBW infants (P = 0.037, OR = 4.1, 95%CI = 1.1--15.0). CONCLUSIONS: Maternal hyperthyroidism during the third trimester of pregnancy independently increases the risk of low birth weight by 4.1-fold. Appropriate management of hyperthyroidism throughout pregnancy is essential in the prevention of this undesirable neonatal outcome.

Prolonged intravenous infusion of labelled iodocompounds in the rat: [125I]iodide metabolism and effects of moderate dietary iodine deficiency.

Radio-iodide was administered by prolonged continuous intravenous infusion to rats maintained under iodine-replete conditions and in moderate iodine deficiency. A close approximation to equilibrium labelling was thereby achieved. Labelled iodocompounds extracted from various tissues were analysed by thin-layer chromatography. Moderate iodine deficiency resulted in a slight increase in the ratio of mono-iodotyrosine to di-iodotyrosine in the thyroid. No change in the ratio of tri-iodothyronine (T3) to thyroxine (T4) was found in thyroid, plasma or skeletal muscle. Faecal excretion of T3 declined appreciably relative to that of T4. Under iodine-replete conditions the ratio of thyroidal secretion rates of T3 and T4 was estimated to be more than three times higher than the ratio of these iodocompounds within the thyroid. Heterogeneity of thyroglobulin structure and function may explain these observations.

Prolonged intravenous infusion of labelled iodocompounds in the rat: [125I]thyroxine and [125I]tri-iodothyronine metabolism and extrathyroidal conversion of thyroxine to tri-iodothyronine.

Extrathyroidal tissues of the rat were labelled to steady state by prolonged continuous intravenous infusion of 125I-labelled thyroxine (T4) or tri-iodothyronine (T3). Labelled iodocompounds extracted from various tissues were analysed by thin-layer chromatography. Signifficant amounts of labelled T3 were found in all tissues examined after infusion of [125I]T4, confirming that conversion of T4 to T3 occurs in extrathyroidal tissues of the rat. Faecal excretion of labelled T3 after [125I]T4 infusion provided an assessment of the extent of extrathyroidal conversion: about a third of the T4 was metabolized by this pathway. Extrathyroidal conversion was independently estimated to account for about a third of the total production of T3. The site of extrathyroidal conversion was established by comparing the distribution of labelled T3 after the two types of infusion: kidney and liver were both prominent sites of conversion of T4 to T3.