The influence of selenium supplementation on postpartum thyroid status in pregnant women with thyroid peroxidase autoantibodies.

CONTEXT: Pregnant women who are positive for thyroid peroxidase antibodies [TPOAb(+)] are prone to develop postpartum thyroid dysfunction (PPTD) and permanent hypothyroidism. Selenium (Se) decreases thyroid inflammatory activity in patients with autoimmune thyroiditis. OBJECTIVE: We examined whether Se supplementation, during and after pregnancy, influences the thyroidal autoimmune pattern and function. DESIGN: This was a prospective, randomized, placebo-controlled study. SETTING: The study was conducted in the Department of Obstetrics and Gynecology and Department of Endocrinology. PATIENTS: A total of 2143 euthyroid pregnant women participated in the study; 7.9% were TPOAb(+). INTERVENTIONS: During pregnancy and the postpartum period, 77 TPOAb(+) women received selenomethionine 200 microg/d (group S1), 74 TPOAb(+) women received placebo (group S0), and 81 TPOAb(-) age-matched women were the control group (group C). MAIN OUTCOME MEASURES: We measured the prevalence of PPTD and hypothyroidism. RESULTS: PPTD and permanent hypothyroidism were significantly lower in group S1 compared with S0 (28.6 vs. 48.6%, P<0.01; and 11.7 vs. 20.3%, P<0.01). CONCLUSION: Se supplementation during pregnancy and in the postpartum period reduced thyroid inflammatory activity and the incidence of hypothyroidism.

Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications.

CONTEXT: Euthyroid women with autoimmune thyroid disease show impairment of thyroid function during gestation and seem to suffer from a higher rate of obstetrical complications. OBJECTIVE: We sought to determine whether these women suffer from a higher rate of obstetrical complications and whether levothyroxine (LT(4)) treatment exerts beneficial effects. DESIGN: This was a prospective study. SETTING: The study was conducted in the Department of Obstetrics and Gynecology. PATIENTS: A total of 984 pregnant women were studied from November 2002 to October 2004; 11.7% were thyroid peroxidase antibody positive (TPOAb(+)). INTERVENTION: TPOAb(+) patients were divided into two groups: group A (n = 57) was treated with LT(4), and group B (n = 58) was not treated. The 869 TPOAb(-) patients (group C) served as a normal population control group. MAIN OUTCOME MEASURES: Rates of obstetrical complications in treated and untreated groups were measured. RESULTS: At baseline, TPOAb(+) had higher TSH compared with TPOAb(-); TSH remained higher in group B compared with groups A and C throughout gestation. Free T(4) values were lower in group B than groups A and C after 30 wk and after parturition. Groups A and C showed a similar miscarriage rate (3.5 and 2.4%, respectively), which was lower than group B (13.8%) [P < 0.05; relative risk (RR), 1.72; 95% confidence interval (CI), 1.13-2.25; and P < 0.01; RR = 4.95; 95% CI = 2.59-9.48, respectively]. Group B displayed a 22.4% rate of premature deliveries, which was higher than group A (7%) (P < 0.05; RR = 1.66; 95% CI = 1.18-2.34) and group C (8.2%) (P < 0.01; RR = 12.18; 95% CI = 7.93-18.7). CONCLUSIONS: Euthyroid pregnant women who are positive for TPOAb develop impaired thyroid function, which is associated with an increased risk of miscarriage and premature deliveries. Substitutive treatment with LT(4) is able to lower the chance of miscarriage and premature delivery.

Rosiglitazone effects on blood pressure and metabolic parameters in nondipper diabetic patients.

The class of antidiabetic drugs called thiazolidinediones (TZD), possesses as its main feature, the ability to ameliorate insulin sensitivity. As diabetes and hypertension share common ground in insulin resistance, the aim of this study was to evaluate if Rosiglitazone (RSG) may exert antihypertensive properties. Diabetic patients selected for the study were free from complications and/or other diseases. They were not known hypertensives, not on any antihypertensive treatment and they were on up to 2550 mg of metformin per day. Twenty-four hour blood pressure (24-h BP) measurements were recorded and monitored. Thirty-eight patients with a nocturnal decline in BP less than 10% (nondippers) participated in the study. Patients were randomly assigned to metformin+placebo (19 patients: group A) or to metformin+RSG 4 mg b.i.d. (19 patients: group B). Patients from both groups continued to take the same dosage of metformin during the study period. After 12 months of treatment, 24-h BP measurements were recorded. Fasting blood glucose, insulin, HbA1c, total cholesterol and trigliceryde levels were taken at the beginning and again at the end of the study. After 12 months of treatment with RSG+metformin we observed an amelioration of metabolic parameters (reduction of HOMA index, glucose, insulin, HbA1c, total cholesterol and triglycerides); an increase in body weight and BMI; a significant reduction of systolic and diastolic BP values both during the day and night and variations in the HOMA index were positively related to the reduction of diurnal and nocturnal BP (HOMA index versus diurnal systolic BP (P<0.001; r2=0.727); versus diastolic BP (P<0.001; r2=0.757); versus nocturnal systolic BP (P<0.001; r2=0.842), versus diastolic BP (P<0.001; r2=0.773)). These findings indicate firstly that RSG is able to induce a reduction of BP and secondly the amelioration of insulin sensitivity is associated with the reduction of BP.

Levothyroxine treatment in thyroid peroxidase antibody-positive women undergoing assisted reproduction technologies: a prospective study.

BACKGROUND: Infertile women positive for thyroid antibodies suffer from a poor pregnancy/delivery outcome, although conflicting data have been published. Our objective was to investigate if levothyroxine (LT4) exerts any effect on pregnancy and/or delivery rates in thyroid peroxidase antibody (TPOAb)-positive (+) women undergoing assisted reproductive technologies. METHODS: Patients undergoing treatment were screened for TPOAb, thyroid-stimulating hormone (TSH) and free thyroxine (FT4). A total of 72 (15%) out of the 484 euthyroid women selected were TPOAb (+). These 72 patients were randomly divided into two groups: group A (n = 36) underwent LT4 treatment, group B (n = 36) placebo. Group C consisted of 412 women (85%) who were TPOAb negative (-). All patients received controlled ovarian stimulation. The endpoints of treatment were pregnancy rate, miscarriage rate and delivery rate. RESULTS: No differences in pregnancy rate were observed between the three groups. Miscarriage rate was higher in TPOAb (+) in comparison to TPOAb (-) [relative risk: 2.01 (95% CI = 1.13-3.56), P = 0.028]. CONCLUSIONS: The pregnancy rate is not affected either by presence of TPOAb or treatment with LT4. However, TPOAb (+) women show a poorer delivery rate compared to TPOAb (-). LT4 treatment in TPOAb (+) does not affect the delivery rate.