Thyroid Functions Of Infants Born To Mothers With Thyroid Disease

Yıl 2015, Cilt: 12 Sayı: 3, 101 - 105, 01.05.2015

Nilgün Altuntaş Serdar Beken Hülya Koçak Canan Türkyılmaz Ferit Kulalı Sezin Ünal İbrahim Murat Hirfanoğlu Esra Önal Ebru Ergenekon Esin Koç Yildiz Atalay

Öz

Aim: Thyroid function abnormalities in pregnancy bear various risks for the mother, fetus and newborn. In this study, thyroid function tests of infants born to mothers with thyroid disease were evaluated.Material and Methods: 237 mothers with thyroid disease hospitalized for birth between 2008 and 2010 and 237 newborn were included in this study. Of these cases, medical history, clinical features and laboratory values were retrospectively recorded.Results: In the course of pregnancy, 95 mothers 40.1% received thyroid replacement therapy for hypothyroidism, 5 mothers 2.1% received anti-thyroid agents because of hyperthyroidism and 137 mothers 57.8% were euthyroid, subclinical hypothyroidism or subclinical hyperthyroidism and did not receive any treatment. These 137 mothers were diagnosed with thyroid disorder and were received therapy before pregnancy. Postnatal first thyroid function tests showed TSH>20 μIU/mL 20-30 μIU/mL in 5 cases. In 3 of these 5 cases, the thyroid function tests returned to normal values after the first week and 2 of them 0.8% were diagnosed as congenital hypothyroidism temporary or persistent and received thyroid hormone replacement therapy in the first 2 weeks. In cases of TSH levels between 5-20 μIU/mL in the first week, there was no increase in the second week and neither hyperthyroidism nor hypothyroidism was detected.Conclusion: Thyroid disease is most common in babies of mothers with thyroid disease. Examination of thyroid function in these infants in addition to the neonatal screening in the first week is important. Thus, treatment can be started earlier.

Anahtar Kelimeler

Thyroid disease, newborn, neonatal screening

Tiroid Hastalıklı Anne Bebeklerinin Tiroid Fonksiyonları

Öz

Amaç: Gebelikte tiroid fonksiyon anormallikleri anne, fetüs ve yenidoğan için çeşitli riskler taşımaktadır. Bu çalışmada tiroid hastalıklı annelerin bebeklerinin tiroid fonksiyonları değerlendirildi.Gereç ve Yöntemler: İki yıllık dönemde doğum için hastaneye başvuran 237 tiroid hastalıklı anne ve onların yeni doğmuş bebekleri n: 237 çalışmaya alındı. Bu olguların tıbbi hikayeleri, klinik özellikleri ve laboratuvar değerleri geriye dönük olarak incelendi.Bulgular: Gebelik süresince 95 annenin %40.1 hipotroidi nedeniyle tiroid replasman tedavisi, 5 annenin %2.1 hipertroidi nedeniyle antitiroid tedavi aldığı, 137 annenin %57.8 ise gebelikte ötiroid, subklinik hipotiroidi veya hipertiroidi oldukları ve tedavi almadıkları tespit edildi. Bu 137 anneye gebelik öncesinde tiroid hastalığı tanısı konmuş ve tedavi verilmişti. Doğum sonrası alınan ilk tiroid fonksiyon testlerinde, 5 olguda TSH>20 μIU/mL 20-30 μIU/mL saptandı. Ancak bu 5 olgunun 3’ünün tiroid fonksiyon testleri bir hafta sonra normale dönerken, ikisine %0.8 konjenital hipotiroidi geçici veya kalıcı tanısıyla tiroid hormon replasman tedavisi başlandı. İlk hafta TSH düzeyleri 5-20 μIU/mL arasında olan hiçbir olguda ikinci hafta TSH düzeylerinde artış olmadı ve bu olgularda hipertiroidi veya hipotiroidi tespit edilmedi.Sonuç: Tiroid hastalıklı anne bebeklerinde tiroid fonksiyon bozukluğu daha yaygındır. Yenidoğan tarama programına ek olarak bu bebeklerde ilk hafta içinde tiroid fonksiyonlarının değerlendirilmesi önemlidir. Böylece tedaviye daha erken başlanabilecektir.

Anahtar Kelimeler

Tiroid hastalığı, yenidoğan, yenidoğan taraması

Kaynakça

• Burrow GN. Tyroid function and hyperfunction during gestation. Endocr Rev 1993; 14:194-202.
• Smith C, Thomsett M, Choong C, Rodda C, McIntyre HD, Cotterill AM. Congenital thyrotoxicosis in premature infants. Clin Endocrinol 2001; 54:371-376.
• Peleg D, Cada S, Peleg A, Ben Ami M. The relationship between maternal serum thyroid-stimulating immunoglobulin and fetal and neonatal thyro- toxicosis. Obstet Gynecol 2002; 99:1040-1043.
• Glinoer D. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocr Rev 1997; 18:404-433.
• Kamijo K, Saito T, Sato M, Yachi A, Mukai A, Fukusi M, et al. Transient subclinical hypothyroidism in early pregnancy. Endocrinol Jpn 1990; 37:397- 403.
• Klein RZ, Haddow JE, Faix JD, Brown RS, Hermos RT, Pulkkinen A, et al. Prevalence of thyroid deficiency in pregnant women. Clin Endocrinol (Oxf) 1991; 35:41-46.
• Montoro M, Collea JV, Frasier SD, Mestman JH. Successful outcome of pregnancy in women with hypothyroidism. Ann Intern Med 1981; 94:31- 34.
• Balen AH, Kurtz AB. Successful outcome of pregnancy with severe hy- pothyroidism. Case report and literature review. Br J Obstet Gynaecol 1990; 97:536-539.
• Nicholson JF, Pesce MA. Laboratory medicine and reference tables. In: Behrman RE, Kliegman RM, Arvin AM (eds). Nelson Textbook of Pediat- rics (15th ed). Philadelphia: WB Saunders 1996: 2031-2084.
• Mannistö T, Vaarasmaki M, Pouta A, Hartikainen AL, Ruokonen A, Sur- cel HM, et al. Perinatal Outcome of Children Born to Mothers with Thy- roid Dysfunction or Antibodies: A Prospective Population-Based Cohort Study. J Clin Endocrinol Metab 2009; 94:772-779.
• Wikner BN, Sparre LS, Stiller C, Källén B, Asker C. Maternal use of thy- roid hormones in pregnancy and neonatal outcome. Acta Obstet Gynecol Scand 2008; 87:617-627.
• Ogundele MO, Quinn MW, Salzmann M. Investigation of infants born to mothers with thyroid disorders: an ongoing search for consensus. J Eval Clin Pract 2010; 16:206-208.
• Brown RS, Bellisario RL, Botero D, Fournier L, Abrams CA, Cowger ML, et al. Incidence of transient congenital hypothyroidism due to maternal thyrotropin receptor-blocking antibodies in over one million babies. J Clin Endocrinol Metab 1996; 81:1147-1151.
• Pasquier S, Torresani T, Werder E, Gnehm HE. Transitory neonatal hypo- thyroidism caused by transplacental transfer of anti-receptor antibodies of hypophyseal thyroid stimulation: case report and estimated incidence. Schweiz Med Wochensch 1997; 127:1824-1828.
• Roti E, Gardini E, Magotti MG, Pilla S, Minelli R, Salvi M, et al. Are thyroid function tests too frequently and inappropriately requested? J Endocrinol Invest 1999; 22:184-190.
• Volpe, R. Rational use of thyroid function tests. Crit Rev Clin Lab Sci 1997; 34:405-438.
• Ogilvy-Stuart AL. Neonatal thyroid disorders. Arch Dis Child Fetal Neona- tal Ed 2002; 87:165-171.
• Higuchi R, Miyawaki M, Kumagai T, Okutani T, Shima Y, Yoshiyama M, et al. Central hypothyroidism in infants who were born to mothers with thyrotoxicosis before 32 weeks’ gestation: 3 cases. Pediatrics 2005; 115:623-625.
• Leung AS, Millar LK, Koonings PP, Montoro M, Mestman JH. Perinatal outcome in hypothyroid pregnancies. Obstet Gynecol 1993; 81:349-353.
• Momotani N, Noh JY, Ishikawa N, Ito K. Effects of propylthiouracil and methimazole on fetal thyroid status in mothers with Graves hyperthyroid- ism. J Clin Endocrinol Metab 1997; 82:3633-3636.
• Cheron RG, Kaplan MM, Larsen PR, Selenkow HA, Crigler JF. Neonatal thyroid function after propylthiouracil therapy for maternal Graves’s dis- ease. N Engl J Med 1981; 304: 525-528.
• Lian XL, Bai Y, Xun YH, Dai WX, Guo ZS. Effects of maternal hyper- thyroidism and antithyroid drug therapy on thyroid function of newborn infants. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2005; 27:756-60.
• Casey BM, Dashe JS, Wells CE, McIntire DD, Leveno KJ, Cunningham FG. Subclinical hyperthyroidism and pregnancy outcomes. Obstet Gyne- col 2006; 107:337-341.