Thyroid Diseases in Pregnancy

Objective To explore the correlation of the gene polymorphism of the two single nucleotide polymorphisms(SNPs)rs1443434 and rs925489 on forkhead box El(FOXE1)with the high normal thyroid stimulating hormone(TSH)level in Chinese Han population. Methods 1 400 subjects with normal serum TSH and thyroid peroxidase antibody(TPOAb)levels were included. According to TSH or TPOAb levels, the subjects were divided into high normal TSH group(H-TSH group, n=195)and normal TSH control group(TSH control group, n=1 205)or high normal TPOAb group(H-TPOAb group, n=711)and low normal TPOAb group(L-TPOAb group, n=689), respectively. The genotypes on the two SNPs of all the subjects were performed by whole-genome genotyping chips. Results There were significant differences in rs925489 genotypic distributions and allele frequencies between H-TSH group and TSH control group(both P<0.05). The genotype TT and allele T in H-TSH group were significantly higher than those in TSH control group(89.75% vs 83.15%, 94.62% vs 91.29%). The normal TSH levels were positively associated with rs925489 genotypic distributions after adjustment for sex, age, and high density lipoprotein cholesterol(P<0.01). There were no significant differences in rs1443434 genotypic distributions and allele frequencies between two TSH groups or two TPOAb groups. Conclusion FOXE1 rs925489 gene polymorphism may be correlated with the high normal TSH level in Chinese Han population. Key words: Forkhead box El; rs925489; Polymorphism, single nucleotide; TSH

Ensuring an intelligent India: Managing hypothyroidism in pregnancy

Thyroid peroxidase antibody titers, thyroid function, and iodine nutrition status of pregnant normotensive and preeclamptic women in Eastern Cape South Africa

Excessive iodine intake is known to induce hypothyroidism in people who have underlying thyroid disorders. However, few studies have been performed on subjects with normal thyroid function without a history of autoimmune thyroid disease. We hypothesized that high iodine intake may cause a subtle change in thyroid function even in subjects with normal thyroid function. We analyzed 337 subjects (64 men and 273 women; mean age, 49years) who showed normal levels of thyroid peroxidase antibodies (TPO-Ab) and thyroglobulin antibodies (Tg-Ab) by measuring the urinary iodine excretion, free T4 (FT4), and thyroid-stimulating hormone (TSH). The results showed urinary iodine excretion had negative correlation with FT4 (γ = -0.11, p = 0.043) and showed a positive trend with TSH (γ = 0.10, p = 0.068). We found that 61.7% of subjects had circulating TPO-Ab within normal reference range. In all subjects, TPO-Ab levels were negatively correlated with FT4 (γ = -0.17, p = 0.002) and positively with TSH (γ = 0.13, p = 0.021). In conclusion, high iodine intake can negatively affect thyroid hormone levels in subjects with normal thyroid function. Population-based study will be helpful for further clarification.

Association of thyroid peroxidase antibody with the RNF213 p.R4810K variant in ischemic stroke/transient ischemic attack

Objective: To find the frequency of subclinical hypothyroidism in females with subfertility Methods: This was a descriptive cross-sectional study Department of Obstetrics and Gynecology, CMH Hospital Kharan, for 6 months (1st Jan 2023 to 30th June 2023). A total of 159 females meeting inclusion criteria were included after taking informed consent. Females were enquired about infertility status and their thyroid status was measured in terms of thyroid stimulating hormone (TSH) and free thyroxine (FT4). Mean and Standard Deviation were used for quantitative variables whereas frequency and percentages were used for categorical variables. Results: The mean age of females in this study was 27.86±7.58 years. The mean weight, height and BMI were 72.87 ± 13.31 kg, 1.64 ± 0.06 m, and 27.23 ± 4.90 respectively. Fifty-three (33.33%) females were obese and 106(66.67%) females were non-obese. The mean level of TSH was found to be 2.51 ± 2.29 mIU/mL with huge variation as the minimum TSH level was 0.1 and the maximum was 7.90 mIU/mL. The mean FT4 was 1.29±0.4 ng/dl with a minimum and maximum FT4 level of 0.70 and 1.90 ng/dl respectively. There were 43 (27%) females with subclinical hypothyroidism whereas, 116 (73%) did not have subclinical hypothyroidism. There was an association between subclinical hypothyroidism and obesity, p-value &lt; 0.05. Conclusion: This study concludes that the prevalence of subclinical hypothyroidism was found to be greater in infertile women and hence routine screening of subclinical hypothyroidism among females with subfertility should be practiced. We also found an association of SCH with obesity in these females. REFERENCES: Abangah G, Rashidian T, Nasirkandy MP, Azami M. A meta-analysis of the prevalence and etiology of infertility in Iran. International Journal of Fertility &amp; Sterility. 2023;17(3):160-73. Carrell DT, Peterson CM. Reproductive endocrinology and infertility. Springer Sci+ Busin Med. 2010;345. Bala R, Singh V, Rajender S, Singh K. Environment, lifestyle, and female infertility. Reproductive sciences. 2021;28:617-38. World Health Organization. Infertility prevalence estimates: 1990–2021. 2023 [Online available from]: https://www.who.int/publications/i/item/978920068315. Retrieved from 18th Sep 2023 Shafierizi S, Basirat Z, Nasiri-Amiri F, Kheirkhah F, Chehrazi M, Pasha H, et al. The prevalence of adjustment disorder and predisposing factors in infertile women. BMC psychology. 2023;11(1):142. Maaherra Armstrong P, Augustin H, Bärebring L, Osmancevic A, Bullarbo M, Thurin-Kjellberg A, et al. Prevalence of Vitamin D Insufficiency and Its Determinants among Women Undergoing In Vitro Fertilization Treatment for Infertility in Sweden. Nutrients. 2023;15(12):2820. Verma I, Sood R, Juneja S, Kaur S. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. International journal of applied and basic medical research. 2012;2(1):17-9. Priya DM, Akhtar N, Ahmad J. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Indian journal of endocrinology and metabolism. 2015;19(4):504-6. Cooper DS. Subclinical hypothyroidism. New England Journal of Medicine. 2001;345(4):260-5. Biradar SM, Poornima R, Sonagra AD, Jayaprakash Murthy D. Thyroid dysfunction in infertile women. Int J Pharm Bio Sci. 2012;2:53-8. Mahadik K, Choudhary P, Roy P. Study of thyroid function in pregnancy, its feto-maternal outcome; a prospective observational study. BMC pregnancy and childbirth. 2020;20(1):1-7. Ratnaparkhe V, Shah H, Upadhyay K. Link between infertility, overweight and subclinical hypothyroidism. Int J Health Sci Res. 2020;10(2):10-7. Sadbhawna D, Sonia S, Nitin G. Prevalence of subclinical hypothyroidism among females with menstrual disorders. International Journal of Health Sciences &amp; Research. 2019;9(8):110-5. Ali T, Bahadur A, Bashir B, Hassan T, Ishaq B, Qasim M. Prevalence of Hypothyroidism in Pregnancies and its Obstetric Outcomes. Pakistan Journal of Medical &amp; Health Sciences. 2022;16(03):1184-6. Onwubuariri M, Bassey G, Kasso T, Nyengidiki T. A-Case Control Analysis of Thyroid Disorders in Infertile Women at the University of Port Harcourt Teaching Hospital, Nigeria. Asian Journal of Pregnancy and Childbirth. 2020;3(1):1-9. Mohadure DS, Fating L. Case Report on Hypothyroidism in Infertile Woman with IVF Conception. Journal of Pharmaceutical Research International. 2021;33(35B):148-51. Jagun OE, Andu BA, Olawale OO. Subclinical hypothyroidism among infertile women at a tertiary hospital in South-West Nigeria. Afr Health Sci. 2022;22(2):444-50. So S, Tawara F. Risk factors of subclinical hypothyroidism and the potential contribution to miscarriage: A review. Reproductive medicine and biology. 2020;19(3):232-42. Kant R, Barnwal S, Yadav P, Tendulkar P, Bairwa M. Subclinical hypothyroidism in community perspective: Treat or not to treat? J Prevent Med Holistic Health 2023; 7(1): 19-22 Kaur G, Kaur S, Mahajan M, Kaur A. To Study Prevalence of Infertility in Patients of Hypothyroidism. Indian Journal of Clinical Biochemistry. 2022;30(S1):S63-S. Amer MH, Thuwain MM, AL-Snafi A. Investigation of thyroids dysfunction among infertile women in Nasiriyah city. Int J Curr Pharm Res. 2020;12(5):31-4. Dhillon-Smith RK, Tobias A, Smith PP, Middleton LJ, Sunner KK, Baker K, et al. The prevalence of thyroid dysfunction and autoimmunity in women with history of miscarriage or subfertility. The Journal of Clinical Endocrinology &amp; Metabolism. 2020;105(8):2667-77. Bendary AA, El Hodiby ME. Study of thyroid immunological and functional disorders in women with unexplained infertility 2022; 2(63): 1-6 Wali AA-E-D, Abdelfattah W, Abd-El-Fatah SM. Prevalence of thyroid dysfunction and thyroid autoimmunity in infertile women. Evidence Based Women's Health Journal. 2020;10(4):308-15. Jagun OE, Andu BA, Olawale OO. Subclinical hypothyroidism among infertile women at a tertiary hospital in South-West Nigeria. African Health Sciences. 2022;22(2):444-50. Zhang Y, Wu W, Liu Y, Wang X, Guan Y, Jia L. Analysis of basal serum TSH, FT3, and FT4 levels based on age, sampling time in women with infertility. BMC Women's Health. 2021;21(1):317. Zhang B, Wang J, Shen S, Liu J, Sun J, Gu T, et al. Subclinical hypothyroidism is not a risk factor for polycystic ovary syndrome in obese women of reproductive age. Gynecol Endocrinol. 2018;34(10):875-9. Ratnaparkhe V, Shah H, Upadhyay K. Link between infertility, overweight and subclinical hypothyroidism. Int J Health Sci Res. 2020;10(2):10-7.

BackgroundPregnancy is a stress test of maternal thyroid function. The prevalence of thyroid dysfunction in pregnant women is high. Subclinical hypothyroidism occurs in 10% of all pregnancies. Effects of hypothyroidism in pregnancy are anemia, low birth weight and mental retardation in neonate. This study is aimed to evaluate maternal and fetal outcomes in pregnant women with deranged thyroid profile. The relevance of this study is to document the association of hypothyroidism and its adverse effects on mother and fetus.MethodsThis prospective observational study was carried out at R.D. Gardi Medical College, Ujjain, India. Subjects of this study were 198 antenatal women in third trimester with singleton pregnancy admitted in the obstetric ward, and informed consent was obtained. Women were chosen irrespective of age, parity, residence and socioeconomic status. Women with multiple pregnancy, a known case of thyroid disorder, or any pre-existing medical disorder were excluded. Routine hematological parameters and estimation of T3, T4 and TSH was conducted. Patients with deranged thyroid profile were subsequently assessed for maternal and fetal complications. History of infertility, family history of thyroid disease, menstrual pattern, recurrent abortion, hemoglobin level and fetal outcome were the main study variables. Data was analysed in SPSS software for statistical co-relation.ResultsPrevalence of thyroid disorder is 11%; with subclinical hypothyroidism, overt hypothyroidism and subclinical hyperthyroidism occurring in 5.6, 3.5 and 1.5% of subjects respectively. In women with subclinical and overt hypothyroidism, anemia was present in 26.3% being significantly associated with hypothyroidism (p = 0.008). With respect to fetal outcome, LBW 31.6% (p = 0.001), NICU admission 42.1%, (p = 0.000) and low APGAR Score (21.1%, p = 0.042) were statistically associated with hypothyroidism. Risk of anemia, Low Birth weight, NICU admissions, and low APGAR score was 4.8, 6.3, 0.14 and 3.64 times higher respectively in women with hypothyroidism than in women who are euthyroid.ConclusionPrevalence of subclinical hypothyroidism is 5.6% in 3rd trimester of pregnancy. Anemia, pre-eclampsia, high caesarean rates and neonatal morbidities is significantly associated with hypothyroidism.

The management of papillary thyroid carcinoma (PTC) concurrent with Hashimoto’s thyroiditis (HT) lacks standardized guidelines, especially concerning surgical strategies. This study aimed to compare unilateral thyroidectomy (UT) with total thyroidectomy (TT) in PTC-HT patients to optimize clinical management and improve postoperative outcomes. This retrospective study included PTC-HT patients undergoing thyroid surgery at a tertiary academic medical institution from January 2018 to August 2023. The patients were grouped according to the quartiles of preoperative thyroid peroxidase antibody (TPOAB) levels at the last follow-up. Additionally, patients were divided into UT and TT groups, with propensity score matching (PSM) to ensure comparability. Patients were also stratified by TPOAB levels (L: 100–400, M: 400–1000, H: >1000). Patient-reported outcomes (PROMs), including quality of life and fatigue, were compared between UT and TT groups within each TPOAB subgroup (ΔPROMs = UT-TT). 246 patients were included. Those with higher TPOAB levels at the last follow-up reported increased physical fatigue scores. After PSM, there were no significant demographic differences between UT and TT groups. During a median follow-up of 16 months for UT and 20 months for TT, no recurrence or metastasis occurred. Compared to the UT group, the TT group exhibited lower TPOAB levels at the last follow-up (65.7 ± 78 vs. 374.6 ± 331.9, p < 0.001), and lower physical fatigue scores (3.6 ± 2.5 vs. 4.5 ± 2.8, p = 0.039). However, TT was associated with a higher incidence of transient hypoparathyroidism (7.8% vs. 1.1%, p = 0.030). Stratified analysis by preoperative TPOAB levels revealed significant differences in ΔPROMs (Physical fatigue) between L and H groups (0.2 ± 3.5 vs. 4.6 ± 2, p = 0.004) and between M and H groups (0.6 ± 4.5 vs. 4.6 ± 2, p = 0.037). ΔPROMs (Mental fatigue) also significantly differed between L and H groups (0 ± 1.8 vs. 1.6 ± 0.9, p = 0.026). For PTC-HT patients, particularly those with high preoperative TPOAB levels, TT offers advantages in alleviating fatigue symptoms but carries a higher risk of complications. Therefore, clinical decision-making should consider patient-specific factors, particularly preoperative TPOAB levels, to determine the optimal surgical approach.Trial registration: Chinese Clinical Trial Registry. ID ChiCTR2300069240.

Background:Prevalence of subclinical hypothyroidism (SCH) in pregnancy varies widely in different parts of our country, but it has multiple adverse outcomes in both the mother and fetus.Objectives:This study was conducted to evaluate the prevalence of SCH in pregnant women during the first trimester and to identify the prevalence of thyroid autoimmunity in pregnant women.Materials and Methods:This cross-sectional study (March 2014 to February 2015) was conducted among the pregnant women attending antenatal clinic in their first trimester at a tertiary care center. Morning samples of study participants were analyzed for free thyroxin (FT4), thyroid stimulating hormone (TSH), and thyroid peroxidase antibody (TPO Ab). Data expressed as mean ± standard deviation and percentage (%) as applicable.Results:Of the 510 subjects, 168 had TSH value >2.5 μIU/ml (32.94%) with normal FT4 and they were diagnosed as SCH. TSH level >4.5 μIU/ml was estimated in 13.92% (71) of the subjects. TPO Ab was positive in 57 (33.93%) of subclinical hypothyroid and 5 (1.47%) of normal subjects. 70.42% (50) of the subjects with TSH >4.5 μIU/ml had positive TPO Ab.Conclusions:Prevalence of SCH is high in South Bengal and routine thyroid screening at the first antenatal visit should be done to reduce the social and financial burden caused by SCH.

Introduction: Thyroid disorders are among the most common endocrine disorders affecting pregnant women. About 2 to 3% of pregnant women are affected by subclinical hypothyroidism and about 0.3%-0.5% by overt hypothyroidism. Thyroid autoantibodies are found in 5-15% of women in childbearing age and have been associated with adverse pregnancy outcomes. Aim: To compare the pregnancy outcomes in thyroid peroxidase antibody positive and thyroid peroxidase antibody negative hypothyroid women. Materials and Methods: This was a retrospective study done in Dr TMA Pai Hospital, Udupi, Karnataka, India from January 2015 to December 2016. All singleton pregnant women with hypothyroidism were included and multiple pregnancy, pre-existing hypertensive or diabetic pregnancies were excluded. Serum Thyroid Stimulating Hormone (TSH) levels were estimated during booking visit for all pregnant women and if >2.5μIU/ml, free T3, T4, and Thyroid Peroxidase Antibody (TPO-Ab) levels were done. Data were retrieved from the hospital records and divided into TPO-Ab negative and TPO-Ab positive groups. The analysis was done using SAS v9.3. Chi-square test and Fisher- Exact test were used for testing equality of proportions. The p-value <0.05 was taken as significant. Results: 2385 antenatal women screened with TSH during the booking visit in study period, 169 (7.08%) were hypothyroid. 100 were TPO-Ab negative and 69 were TPO-Ab positive with 40.8% prevalence of TPO-Ab positivity among the hypothyroid pregnant women. The initial TSH and the average Levothyroxine requirement was 37% (p-value 0.206) and 16% (p-value 0.388) higher in the TPO-Ab positive group than in TPO-Ab negative group. Though the odds for having miscarriage was 2.36 (0.94,5.92), gestational hypertension was 2.71 (0.76, 9.69) and gestational diabetes was 2.88 (0.92,9.03) times higher in the TPO-Ab positive group as compared to TPO-Ab negative group, the p-value for miscarriage was 0.061, gestational hypertension was 0.125 and that for gestational diabetes was 0.062 and hence, statistically not significant. However, there was no difference in the preterm delivery rate in our study. Conclusion: Presence of thyroid peroxidase antibodies may slightly increase the risk of miscarriage, gestational hypertension and gestational diabetes mellitus in pregnancy in the Indian population.

Women with Hashimoto's thyroiditis (HT) have an increased risk of ovarian insufficiency. However, whether thyroid antibodies affect the ovarian reserve remains controversial. The aim of this study was to explore the possible relationship between anti-Müllerian hormone (AMH) and thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) levels in women of reproductive age. A total of 483 women between 18 and 45 years old who had their TPOAb, TgAb, thyroid-stimulating hormone (TSH), free thyroxine (FT4), and AMH levels measured on the same day were enrolled in this study. The levels of TSH, FT4, TPOAb, and TgAb, the prevalence of overt and subclinical hypothyroidism, and the positive rate of TPOAb and TgAb were compared between patients with low (below the 10th percentile), normal (10th to 90th percentile), and high (higher than the 90th percentile) AMH levels. The median AMH level was 1.72 (0.33-4.27) ng/mL. A total of 9.9% of patients had low AMH levels. The TgAb levels and the prevalence of TgAb positivity were higher in the low AMH group (37.62 (13.10-232.68) IU/mL, 35.42%) than in the normal (12.46 (10.0-67.04) IU/mL, 19.59%) and high (13.61 (10.0-95.74) IU/mL, 23.4%) AMH groups (p=0.001, p=0.040, respectively). Serum AMH levels were inversely correlated with TgAb levels (r = -0.114, p=0.013). The AMH of women of reproductive age is affected by HT. Furthermore, women with the lowest AMH level had higher levels of TgAb and a positive rate of TgAb, and high TgAb levels may cause autoimmune damage to the ovaries.

Peripheral nerves may be affected in subclinical hypothyroidism (SH). This study aimed to investigate the presence of common entrapment mononeuropathies in patients with SH. A prospective case-control study conducted between September 2022 and November 2023 at Adana City Training and Research Hospital, Adana, Türkiye. SH patients without neurological complaints and healthy individuals over the age of 18 were included. Serum levels of free T3, free T4, thyroid-stimulating hormone (TSH), thyroid peroxidase (TPO) antibody, and creatine kinase (CK) were measured. All participants underwent nerve conduction studies of the upper and lower extremities. Thirty patients with SH and 40 healthy individuals were included in the study. The percentage reduction in compound muscle action potential (CMAP) amplitude across the knee segment was 2.8 ± 3.5% in healthy individuals and 6.7 ± 6.6% in SH patients (P = 0.017). Apart from this significant difference, other nerve conduction study findings did not differ between the two groups. A positive correlation was observed between CK levels and the percentage reduction in peroneal nerve CMAP amplitude across the knee segment (P = 0.021, r = 0.421). Additionally, there was a positive correlation between TPO antibody levels and F-wave latency in both the median and ulnar nerves (P = 0.028 r = 0.400/P = 0.005 r = 0.501). Electrodiagnostic evaluations revealed carpal tunnel syndrome (CTS) in four patients, peroneal neuropathy at the fibular head (PNFH) in four patients, and ulnar neuropathy at the elbow (UNE) in one patient. This study suggests that patients with SH may develop subclinical CTS and PNFH, but not UNE. Accordingly, it highlights the importance of avoiding risk factors that may contribute to the development of CTS and PNFH. Serum CK and TPO antibody levels may be useful in monitoring subclinical neuropathy in SH.

The aim was to investigate the relationship between the vitamin D (VitD) level and the incidence rate of subclinical hypothyroidism in patients with gestational diabetes mellitus (GDM) in early pregnancy. Ninety eligible patients who underwent physical examination from March 2015 to September 2017 were selected. The levels of serum 25-hydroxyvitamin D (25-OH-VD), free thyroxine (FT4), free triiodothyronine (FT3), thyroid stimulating hormone (TSH), and thyroid peroxidase antibody (TPOAb) were measured. The correlations of VitD level with those of thyroid function-related indices were analyzed. The serum 25-OH-VD level was (17.82 ± 3.45) ng/mL in the 90 GDM patients in early pregnancy, including 64.44% patients in VitD deficiency group, 22.22% patients in VitD insufficiency group, and 13.33% in VitD sufficiency group. No significant differences in the levels of serum FT4, FT3, and TSH were found among different VitD groups (p > 0.05), but the level of TPOAb gradually decreased (p < 0.05). There was no significant difference in the incidence rate of subclinical hypothyroidism among different VitD groups (p > 0.05). VitD level was not correlated with those of FT4, FT3, and TSH (p > 0.05), but negatively correlated with that of TPOAb (p < 0.05). An increase of TPOAb level raised the risk of VitD deficiency in pregnant women (p < 0.05). Patients suffered from significant 25-OH-VD deficiency in spring and winter (p < 0.05). GDM patients in early pregnancy display VitD deficiency, and their serum 25-OH-VD level is affected by seasons and not significantly related to subclinical hypothyroidism. However, the increased level of TPOAb may raise the risk of VitD deficiency in pregnant women.

First trimester thyroid function in pregnant women residing in Saint Petersburg (Russia): reference values and risk of gestational diabetes

Babies born to mothers with thyroid disease