Tiroid Disfonksiyonu Olan Gebelerin Demografik Özelliklerinin Araştırılması- Ege Üniversitesi Örneklemi
Öz
Amaç: Tiroid hastalıkları maternal ve fetal olumsuzluklara neden olabilir ve gebelikte doğru tanı, takip
ve tedavi özel dikkat gerektirir. Gebelikte tiroid fonksiyonlarının değerlendirilmesinde öncelikle Tiroid
Stimulan Hormon (TSH), ile birlikte serbest tiroksin (FT4) kullanılır. Çalışmamızda, gebelikte tiroid
disfonksiyonunun prevalansını ve etkilerini araştırmayı amaçladık.
Gereç ve Yöntemler: Çalışmamız Ege Üniversitesi Endokrinoloji polikliniğinde Kasım 2017-Mayıs 2019
tarihleri arasında 960 gebeyi kapsayan prospektif bir çalışmadır. 960 gebe kadından tiroid disfonksiyonu
olan 100 gebe çalışmaya alındı. Anne yaşı, gestasyonel trimester, ailede tiroid hastalığı öyküsü, TSH FT4, serbest triiyodotironin (FT3), anti-tiroid peroksidaz antikoru (Anti-TPO), anti-tiroglobulin antikoru (Anti-TG), TSH reseptör antikoru (TRAb) ile ilgili bilgiler kaydedildi. TSH, FT4 ve FT3 arasındaki korelasyonlar incelendi.
Bulgular: Çalışmada gebelerin yaş ortalaması 29.33 ± 5.97 idi. Tüm gebelerin %18’inde anti-TPO antikor pozitifti ve %5’inde Anti-TG antikor pozitifti. 100 hastanın 24’ünde (%24) nodül vardı. Hipertiroidili 1 (%8.3) hasta da TRAb pozitifti. Nodülü olan ve olmayan hastalardaki yaş farklılıkları istatistiksel olarak anlamlı değildi. Hastaların 1’inde (%1) Graves hastalığı, 81’inde (%81) subklinik hipotiroidi, 7’sinde (%7) klinik
hipotiroidi, 11’inde (%11) gestasyonel tirotoksikoz vardı. Doğum yapan 45 gebenin verilerine göre 7 hastada (%15.6) prematürite saptandı.
Sonuç: Anti-TPO ve anti-TG pozitif olan gebelerde TSH düzeyleri, anti-TPO ve anti-TG negatif olan gebelere göre anlamlı derecede yüksekti. Ayrıca gebelerde tiroid hastalıkları ile nodül sıklığı, otoimmünite, erken doğum arasında ilişki saptanmadı. Daha kapsamlı çalışma serilerine ihtiyaç vardır.
Anahtar Kelimeler
Destekleyen Kurum
yok
Proje Numarası
yok
Kaynakça
- 1. Alexander EK; Pearce EN; Brent GA; Brown RS; Chen H; Dosiou C, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017;27(3):315-89.
- 2. Casey BM; Leveno KJ. Thyroid disease in pregnancy. Obstet Gynecol. 2006;108(5):1283-92.
- 3. Struve CW; Haupt S; Ohlen S. Influence of frequency of previous pregnancies on the prevalence of thyroid nodules in women without clinical evidence of thyroid disease. Thyroid. 1993;3(1):7-9.
- 4. Kung AW; Chau MT; Lao TT; Tam SC; Low LC. The effect of pregnancy on thyroid nodule formation. J Clin Endocrinol Metab. 2002;87(3):1010-4.
- 5. Marwaha RK; Chopra S; Gopalakrishnan S; Sharma B; Kanwar RS; Sastry A, et al. Establishment of reference range for thyroid hormones in normal pregnant Indian women. BJOG. 2008;115(5):602-6.
- 6. De Groot L; Abalovich M; Alexander EK; Amino N; Barbour L; Cobin RH, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(8):2543-65.
- 7. Dong AC; Stephenson MD; Stagnaro-Green AS. The Need for Dynamic Clinical Guidelines: A Systematic Review of New Research Published After Release of the 2017 ATA Guidelines on Thyroid Disease During Pregnancy and the Postpartum. Front Endocrinol (Lausanne). 2020;11:193.
- 8. Ballabio M; Poshychinda M; Ekins RP. Pregnancy-induced changes in thyroid function: role of human chorionic gonadotropin as putative regulator of maternal thyroid. J Clin Endocrinol Metab. 1991;73(4):824-31.
- 9. Goodwin TM; Montoro M; Mestman JH; Pekary AE; Hershman JM. The role of chorionic gonadotropin in transient hyperthyroidism of hyperemesis gravidarum. J Clin Endocrinol Metab. 1992;75(5):1333-7.
- 10. Hershman JM. Human chorionic gonadotropin and the thyroid: hyperemesis gravidarum and trophoblastic tumors. Thyroid. 1999;9(7):653-7. 11. Wen BH; Teng WP; Shan ZY; Li YB; Li J; Gao B, et al. [A clinical study on gestational transient thyrotoxicosis]. Zhonghua Nei Ke Za Zhi. 2008;47(12):1003-7. 12. Cooper DS; Laurberg P. Hyperthyroidism in pregnancy. Lancet Diabetes Endocrinol. 2013;1(3):238-49.
- 13. Mestman JH. Hyperthyroidism in pregnancy. Endocrinol Metab Clin North Am. 1998;27(1):127-49.
- 14. Bahn RS; Burch HB; Cooper DS; Garber JR; Greenlee MC; Klein I, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pract. 2011;17(3):456-520.
- 15. Tagami T; Hagiwara H; Kimura T; Usui T; Shimatsu A; Naruse M. The incidence of gestational hyperthyroidism and postpartum thyroiditis in treated patients with Graves' disease. Thyroid. 2007;17(8):767-72.
- 16. Krassas G; Karras SN; Pontikides N. Thyroid diseases during pregnancy: a number of important issues. Hormones (Athens). 2015;14(1):59-69.
- 17. Shields BM; Knight BA; Hill AV; Hattersley AT; Vaidya B. Five-year follow-up for women with subclinical hypothyroidism in pregnancy. J Clin Endocrinol Metab. 2013;98(12):E1941-5.
- 18. Korevaar TI; Schalekamp-Timmermans S; de Rijke YB; Visser WE; Visser W; de Muinck Keizer-Schrama SM, et al. Hypothyroxinemia and TPO-antibody positivity are risk factors for premature delivery: the generation R study. J Clin Endocrinol Metab. 2013;98(11):4382-90.
- 19. Schneuer FJ; Nassar N; Tasevski V; Morris JM; Roberts CL. Association and predictive accuracy of high TSH serum levels in first trimester and adverse pregnancy outcomes. J Clin Endocrinol Metab. 2012;97(9):3115-22.
- 20. Moreno-Reyes R; Glinoer D; Van Oyen H; Vandevijvere S. High prevalence of thyroid disorders in pregnant women in a mildly iodine-deficient country: a population-based study. J Clin Endocrinol Metab. 2013;98(9):3694-701.
- 21. Negro R; Formoso G; Mangieri T; Pezzarossa A; Dazzi D; Hassan H. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab. 2006;91(7):2587-91.
Investigation on Demographic Characteristics of Pregnant Patients with Thyroid Dysfunction- Ege University Sample
Öz
Aim: Thyroid diseases can cause maternal and fetal adversities, and proper diagnosis, follow-up and
treatment during pregnancy requires special attention. In the evaluation of thyroid functions during
pregnancy, free thyroxine (FT4) is used primarily with thyroid-stimulating hormone (TSH). Our aim is to
investigate the prevalence and the effects of thyroid dysfunction during pregnancy.
Material and Methods: Our study is a prospective study including 960 pregnant women and spanning
from November 2017 to May 2019 in Ege University Endocrinology outpatient clinic.100 pregnant
women with thyroid dysfunction out of 960 pregnant women were included in the study. Maternal
age, gestational trimester, family history of the thyroid disorder, TSH, FT4, free triiodothyronine (FT3),
anti-thyroid peroxidase antibody (Anti-TPO), anti-thyroglobulin antibody (Anti-TG), thyrotropin (TSH)
receptor antibody (TRAb) were collected. The correlations between TSH, FT3 and FT4 were examined.
Results: In the study, the mean age of pregnant patients was 29.33 ± 5.97. Anti-TPO was positive %18 and
Anti-TG was positive (5%). 24 of 100 (24%) patients had nodules. 1 (8.3%) patient with hyperthyroidism
was positive for TRAb. Age differences in patients with or without nodule were not statistically significant.
1 (1%) of the patient had Graves disease, 81 (81%) had subclinical hypothyroidism, 7 (7%) had clinical
hypothyroidism, 11 (11%) had gestational thyrotoxicosis. The frequency of prematurity was determined
in 7 patients (15.6%) by the data of 45 pregnant women who gave birth.
Conclusion: TSH levels in pregnant patients with positivity for anti-TPO and anti-TG were significantly
higher than pregnant patients with negativity for anti-TPO and anti-TG. In addition, the relationship
between thyroid diseases and nodule frequency, autoimmunity, premature birth in pregnant women
were not detected. More comprehensive study series are needed.
Anahtar Kelimeler
Proje Numarası
yok
Kaynakça
- 1. Alexander EK; Pearce EN; Brent GA; Brown RS; Chen H; Dosiou C, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017;27(3):315-89.
- 2. Casey BM; Leveno KJ. Thyroid disease in pregnancy. Obstet Gynecol. 2006;108(5):1283-92.
- 3. Struve CW; Haupt S; Ohlen S. Influence of frequency of previous pregnancies on the prevalence of thyroid nodules in women without clinical evidence of thyroid disease. Thyroid. 1993;3(1):7-9.
- 4. Kung AW; Chau MT; Lao TT; Tam SC; Low LC. The effect of pregnancy on thyroid nodule formation. J Clin Endocrinol Metab. 2002;87(3):1010-4.
- 5. Marwaha RK; Chopra S; Gopalakrishnan S; Sharma B; Kanwar RS; Sastry A, et al. Establishment of reference range for thyroid hormones in normal pregnant Indian women. BJOG. 2008;115(5):602-6.
- 6. De Groot L; Abalovich M; Alexander EK; Amino N; Barbour L; Cobin RH, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(8):2543-65.
- 7. Dong AC; Stephenson MD; Stagnaro-Green AS. The Need for Dynamic Clinical Guidelines: A Systematic Review of New Research Published After Release of the 2017 ATA Guidelines on Thyroid Disease During Pregnancy and the Postpartum. Front Endocrinol (Lausanne). 2020;11:193.
- 8. Ballabio M; Poshychinda M; Ekins RP. Pregnancy-induced changes in thyroid function: role of human chorionic gonadotropin as putative regulator of maternal thyroid. J Clin Endocrinol Metab. 1991;73(4):824-31.
- 9. Goodwin TM; Montoro M; Mestman JH; Pekary AE; Hershman JM. The role of chorionic gonadotropin in transient hyperthyroidism of hyperemesis gravidarum. J Clin Endocrinol Metab. 1992;75(5):1333-7.
- 10. Hershman JM. Human chorionic gonadotropin and the thyroid: hyperemesis gravidarum and trophoblastic tumors. Thyroid. 1999;9(7):653-7. 11. Wen BH; Teng WP; Shan ZY; Li YB; Li J; Gao B, et al. [A clinical study on gestational transient thyrotoxicosis]. Zhonghua Nei Ke Za Zhi. 2008;47(12):1003-7. 12. Cooper DS; Laurberg P. Hyperthyroidism in pregnancy. Lancet Diabetes Endocrinol. 2013;1(3):238-49.
- 13. Mestman JH. Hyperthyroidism in pregnancy. Endocrinol Metab Clin North Am. 1998;27(1):127-49.
- 14. Bahn RS; Burch HB; Cooper DS; Garber JR; Greenlee MC; Klein I, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pract. 2011;17(3):456-520.
- 15. Tagami T; Hagiwara H; Kimura T; Usui T; Shimatsu A; Naruse M. The incidence of gestational hyperthyroidism and postpartum thyroiditis in treated patients with Graves' disease. Thyroid. 2007;17(8):767-72.
- 16. Krassas G; Karras SN; Pontikides N. Thyroid diseases during pregnancy: a number of important issues. Hormones (Athens). 2015;14(1):59-69.
- 17. Shields BM; Knight BA; Hill AV; Hattersley AT; Vaidya B. Five-year follow-up for women with subclinical hypothyroidism in pregnancy. J Clin Endocrinol Metab. 2013;98(12):E1941-5.
- 18. Korevaar TI; Schalekamp-Timmermans S; de Rijke YB; Visser WE; Visser W; de Muinck Keizer-Schrama SM, et al. Hypothyroxinemia and TPO-antibody positivity are risk factors for premature delivery: the generation R study. J Clin Endocrinol Metab. 2013;98(11):4382-90.
- 19. Schneuer FJ; Nassar N; Tasevski V; Morris JM; Roberts CL. Association and predictive accuracy of high TSH serum levels in first trimester and adverse pregnancy outcomes. J Clin Endocrinol Metab. 2012;97(9):3115-22.
- 20. Moreno-Reyes R; Glinoer D; Van Oyen H; Vandevijvere S. High prevalence of thyroid disorders in pregnant women in a mildly iodine-deficient country: a population-based study. J Clin Endocrinol Metab. 2013;98(9):3694-701.
- 21. Negro R; Formoso G; Mangieri T; Pezzarossa A; Dazzi D; Hassan H. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab. 2006;91(7):2587-91.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Proje Numarası | yok |
| Yayımlanma Tarihi | 27 Aralık 2022 |
| Kabul Tarihi | 21 Ağustos 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 6 Sayı: 3 |
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