IS THERE ANY ADVERSE EFFECT OF SUBCLINICAL HYPOTHYROIDISM ON PREGNANCY OUTCOME? SCREENING OF ALL PREGNANT WOMEN: IS IT NECESSARY?

Yıl 2012, Cilt: 9 Sayı: 36, 1487 - 1491, 01.10.2012

Metin Kaba Mehmet Şimşek Ömür Taşkın

Öz

Aim: To investigate the effect of the subclinical hypothyroidism on pregnancy and fetus. Materials and Method: In this study, we include the pregnant women who been followed up at Mediterrenean University Department of Obstetrics & Gynecology Antenatal Clinics between January 2002 and June 2006. We analyzed the data of the pregnants who delivered after 20th gestational week. We divided the pregnant patients into two groups having :normal thyroid hormon test results and subclinical thyroid disease. After analyzing the patient data, we included 24 pregnant women as the patient group and 48 pregnant women as controls. The pregnants were searched for gestational hypertension, preeclampsia, eclampsia, preterm delivery, intrauterine death, intrauterine growth retardation and ablatio placentae. The neonates were searched for gestational age at birth, birthweight, 5t minute Apgar score, neonatal death, neonatal intensive care admission, major malformation, respiratory distress syndrome, necrotizing enterocolitis, intraventricular bleeding. Result: There was no difference between both groups in respect of the pregnancy complications and neonatal complications. Conclusion: Subclinical hypothyroidism had been reported to have adverse effects on pregnancy and fetus; however, due to small sampling size, we were unable to reach a definite conclusion.

Anahtar Kelimeler

Thyroid disease, hypothyroidism, preg- nancy complications, neonatal mortality.

SUBKLİNİK HİPOTİROİDİNİN GEBELİK ÜZERİNE OLUMSUZ ETKİSİ VAR MI? TÜM GEBELERE TARAMA YAPMAK GEREKİR Mİ?

Öz

Amaç: Subklinik Hipotiroidinin gebelik ve fetüs üzerinde etkilerini araştırmak. Gereçler ve Yöntem: Çalışmaya Ocak 2002 - Haziran 2006 tarihleri arasında Akdeniz Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniği’nde takip edilen ve klinikte doğum yapmış olan gebeler alındı. Doğum kayıtlarında 20. gebelik haftasından sonra doğum yapmış olan gebelerin kayıtları inceledi. Gebeler tiroid fonksiyon testlerine TFT göre subklinik hi- potiroidi olanlar hasta grubuna ve normal TFT olanlar arasından kontrol grubu seçildi. Hasta grubundan 24 ve kontrol grubundan 48 gebe çalışmaya alındı. Gruplar gebelik komplikasyonu olan gestasyonel hipertansiyon, preeklampsi, eklampsi, preterm eylem, intrauterin ölüm, intrauterin gelişme geriliği ve ablasyo plasenta yönünden; yeni doğanları doğum haftası, doğum ağırlı- ğı, 5. dakika Apgar skoru, neonatal ölüm, doğum sonrası yeni doğan yoğun bakım desteği alma, majör malformasyon, respiratuvar distress sendromu, nekrotizan enterokolit, intraventriküler kanama komplikayonu gelişmesi yönünden karşılaştırıldı. Bulgular: Araştırma sonucunda iki grup arasında gebelik ve yenidoğan komplikasyonları yönünden fark gözlenmedi. Sonuç: Subklinik hipotiroidinin gebelik seyri ve fetüs üzerine olumsuz etkisinin olup olmadığı henüz açıklığa kavuşmamış bir konudur. Yakın zamanda yapılan çakışmalarda subklinik hipotiroidinin gebelik seyri ve fetüs üzerine olumsuz etkisinin olduğu bildirilmektedir. Bizim çalışmamızda olumsuz etki gözlenmemiş olması hasta sayısının az olmasından kaynaklanıyor olabilir.

Anahtar Kelimeler

Tiroid hastalıkları, hipotiroidizm, gebelik komplikasyonları, yeni doğan ölümü

Kaynakça

• 1. Anselmo J, Cao D, Karrison T, Weiss RE, Refetoff S. Fetal loss associated with excess thyroid hormone exposure. JAMA. 2004;292(6):691-5.
• 2. GyamfiBannerman C. Basic science and clinical evidence regarding treatment of subclinical hypothyroidism during pregnancy. Clin Obstet Gynecol. 2011;54(3):488-92.
• 3. Fisher DA. Fetal thyroid function: diagnosis and management of fetal thyroid disorders. Clin Obstet Gynecol. 1997;40(1):16-31.
• 4. Wier FA, Farley CL. Clinical contro versies in screening women for thyroid disorders during pregnancy. J Midwifery Womens Health. 2006;51(3):152-8
• 5. Casey BM, Leveno KJ. Thyroid Disease in Pregnancy. Obstet Gynecol 2006; 108(5): 1283 -92.
• 6. Cooper DS, Biondi B. Subclinical thyroid disease. Lancet. 2012;379(9821):1142-54.
• 7. Ross DS. Serum thyroid-stimulating hormone measurement for asessment of thyroid function and disease. Endocrinol Metab Clin North Am 2001; 30(2): 245-64.
• 8. Fitzpatrick DL, Russell MA. Diagnosis and management of thyroid disease in pregnancy. Obstet Gynecol Clin North Am. 2010;37(2):173-93.
• 9. Gharib H, Tuttle RM, Baskin HJ, Fish LH, Singer PA, Mc Dermott MT. Consessus Statement: Subclinical Thyroid Dys function: A Joint Statement on Management from The American Association of Clinic Endocrinologists, The American Thyroid Association, and The Endocrine Sociaty. J.Clin Endocrinol Metab. 2005; 90(1): 581-5.
• 10. Royland JE, Parker JS, Gilbert ME. A genomicanalysis of subclinical hypothyroidism in hippocampus and neocortex of the developing ratbrain. J Neuroendocrinol. 2008;20(12):1319-38.
• 11. Pop VJ, Kujipens JL, vanBaar AL, Verkerk G, van Son MM, de Vijlder JJ, et al. Low maternel free thyroxine concentrations during early pregnancy are associated with impaired psychomotor development in infancy. Clin Endocrinol (Oxf) 1999;50(2): 149-55.
• 12. Haddow J, Palomaki G, Allan WC. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 1999; 341(8): 549–55.
• 13. Koistra L, Crawford S, vanBaar AL, Brouwers EP. Pop JV. Neonatal effect of maternal hypothyroxinemia during early pregnancy. Pediatrics. 2006; 117(1): 161-7.
• 14. Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd W, Kenneth J, et al. Subclinical hypothyroidism and pregnancy out comes. Am Coll Obstet Gynecol 2005; 105(2): 239-44.
• 15. Breathnach FM, Donnelly J, Cooley S, Said S, Geary M, Malone FD. Subclinical hypothyroidism in a low-risk primigravid population. Am J Obstet Gynecol. 2006;195(6): 94.
• 16. Wilson KL, Casey BM, Mc Intire DD, Halvorson LM, Cunningham FG. Subclinical thyroid disease and the incidence of hypertension in pregnancy. Obstet Gynecol. 2012;119(2 Pt 1):315-20.
• 17. Lazarus JH, Bestwick JP, Channon S, Paradice R, Maina A, Rees R, et al. Antenatal thyroid screening and childhood cognitive function. N Engl J Med. 2012;366(6):493-501.
• 18. Momotani N, Iwama S, Momotani K. Neurodevelopment in Children Born to Hypothyroid Mothers Restored to Normal Thyroxine (T4) Concentration by Late Pregnancy in Japan: No Apparent Influence of Maternal T4 Deficiency. J Clin Endocrinol Metab 2012;97:1104–8
• 19. Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH et al. Subclinical hyroid disease: scientific review and guidelines for diagnosis and management. JAMA. 2004;291(2):228-38.
• 20. Vaidya B, Anthony S, Bilous M, Shields B, Drury J, Hutchison S et al. Detection of thyroid dysfunction in early pregnancy: universal screening or targeted high-risk case finding? J Clin Endocrinol Metabol. 2007;92(1): 203-7.
• 21. Cooper DS, Biondi B. Subclinical thyroid disease. Lancet. 2012;379(9821):1142-54.
• 22. van den Boogaard E, Vissenberg R, Land JA, vanWely M, van der Post JA, Goddijn M, et al. Significance of (sub)clinical thyroid dysfunction and thyroid auto immunity before conception and in early pregnancy: a systematic review. Hum Reprod Update. 2011;17(5):605-19.
• 23. Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev. 2010;31(5):702-55
• 24. Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011;21(10):1081-25
• 25. Biondi B. Natural history, diagnosis and management of subclinical thyroid dys function. Best Pract Res Clin Endocrinol Metab. 2012;26(4):431-46
• 26. Thung SF, Funai EF, Grobman WA. The cost-effectiveness of universal screening in pregnancy for subclinical hypothyroidism. Am J Obstet Gynecol. 2009;200(3): 267.e1-7
• 27. Cooper DS, BiondiB.Subclinical thyroid disease. Lancet. 2012;379:1142-54.
• 28. De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, Eastman CJ, Lazarus JH, Luton D, Mandel SJ, Mestman J, Rovet J, Sullivan S. Management of Thyroid Dys function during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2012;97(8):2543-65.