Hypothyroidism in pregnancy. Nor Shaffinaz Yusoff Azmi Jabatan Perubatan Hospital Sultanah Bahiyah Kedah
|
|
- John Marshall
- 6 years ago
- Views:
Transcription
1 Hypothyroidism in pregnancy Nor Shaffinaz Yusoff Azmi Jabatan Perubatan Hospital Sultanah Bahiyah Kedah
2 Agenda 1. Epidemiology and clinical characteristics of maternal hypothyroidism 2. Prevention and management of fetal hypothyroidism 3. Summary 2
3 How common is hypothyroidism during pregnancy? Up to 3% of pregnancies are complicated by hypothyroidism Most cases ( % of all pregnancies) are due to subclinical hypothyroidism % of cases are due to overt hypothyroidism Overt hypothyroidism Subclinical hypothyroidism 3 Männistö T. Expert Rev Endocrinol Metab 2013;8:
4 Trimester-specific reference ranges for TSH during pregnancy Local estimates of trimester-specific reference ranges for TSH should be available, as these vary between populations If no local reference range is available, international guidelines suggest the following: Trimester US guideline (reference range) EU guideline (upper limit of normal) 1st mu/l 2.5 mu/l 2 nd mu/l 3.0 mu/l 3 rd mu/l 3.5 mu/l 4 Stagnaro-Green A et al. Thyroid 2011;21: ; Lazarus J et al. Eur Thyroid J 2014;3:76-94.
5 Diagnosing hypothyroidism in pregnancy Local estimates of trimester-specific reference ranges for ft4 should also be available Overt hypothyroidism occurs where TSH is above the reference range (>2.5 mu/l) with reduced levels of ft4 TSH >10 mu/l signifies overt hypothyroidism whatever the T4 level Subclinical hypothyroidism occurs where TSH is >2.5 mu/l but <10 mu/l, with normal T4 Condition Overt hypothyroidism Subclinical hypothyroidism Diagnostic criteria TSH with reduced ft4 TSH >10 mu/l irrespective of ft4 TSH (but <10.0 mu/l) + normal ft4 5 Stagnaro-Green A et al. Thyroid 2011;21: ; Lazarus J et al. Eur Thyroid J 2014;3:76-94.
6 Thyroid adaption to pregnancy High oestrogen levels increase thyroxine binding globulin More thyroid hormone binding capacity in serum Transient decrease in free thyroid hormones increases TSH hcg levels peak near the end of the first trimester hcg has thyroid stimulating activity Passage of thyroid hormones through the placenta alters maternal thyroid hormone metabolism Deiodination by placental type 3 iodothyronine deiodinase Increased maternal T4 turnover Especially important during the second half of the pregnancy Stimulation of the mother s thyroid gland 25 50% increase in LT4 requirement during pregnancy Increased iodine requirement during pregnancy 6 Glinoer D. Best Pract Res Clin Endocrinol Metab 2004;18:
7 Main causes of hypothyroidism in pregnancy New diagnosis: Iodine-replete areas: autoimmune (Hashimoto s) thyroiditis Iodine-deficient areas: inadequate iodine intake Pre-existing thyroid disease: Inadequate iodine intake (iodine-deficient areas) Euthyroid Hashimoto s thyroiditis (5-15% of all women) Previous thyroid surgery Previous radioiodine therapy Secondary hypothyroidism (pituitary disease) 7 Männistö T. Expert Rev Endocrinol Metab 2013;8: ; Lazarus J et al. Eur Thyroid J 2014;3:76-94.
8 Complications of hypothyroidism during pregnancy Mother Pre-eclampsia Need for Caesarian Gestational diabetes Placental abruptions Infertility Miscarriage anemia Postpartum haemorrhage Goitre Child Malformations Respiratory problems Anaemia Sepsis Need for ICU treatment Large or small for gestational age Pre-term delivery Neurocognitive defects 8 Männistö T. Expert Rev Endocrinol Metab 2013;8: ; Lazarus J et al. Eur Thyroid J 2014;3:76-94.
9 Adverse consequences of maternal hypothyroidism for the foetus It has been recognised for decades that maternal hypothyroidism results in impaired neuropsychological outcome for the offspring Reduced IQ (long-term demonstrated at ages up to 9 y) Impaired performance on multiple neuropsychological tests Impaired psychomotor development Cretinism (associated with severe endemic hypothyroidism) Even subclinical hypothyroidism damages the developing foetus Mild increase in TSH in women predicted poorer function of offspring on all of 15 neuropsychological tests + average 7- point IQ reduction Low T4 levels in apparently healthy women predict impaired neuropsychological development in offspring Children of mothers with normal T4 but with anti-tpo antibodies are at risk of impaired neuropsychological development Increased risk of premature birth in mothers with subclinical hypothyroidism may contribute to impaired neuropsychological outcomes in offspring 9 Chan S et al. J Endocrinol 2000;165:1-8; Gharib H et al. Endocr Pract 1999;5:367-8; Casey BM et al. Obstet Gynecol 2005;105:
10 Maternal thyroid hormones and the child s developing brain The thyroid gland in the developing foetus does not become active until the second trimester Thus, maternal thyroid hormones are vital for supporting the development of the CNS in the foetus T 3 and T 4 are detectable in foetal brains before the developing thyroid gland becomes active Maternal T 4 remains correlated with T 4 in the foetal cerebro-cortical areas of the brain even after the foetus begins making its own T 4 30% of T 4 in cord blood at term is derived from the mother Intelligence of offspring in endemic hypothyroid areas correlates with the circulating T 4 level of the mother Compensatory mechanisms in the foetal brain are unlikely to counteract the adverse effect of maternal hypothyroidism on the developing brain Enhanced uptake of T 4 in the foetal brain Increased expression of deiodinases (which convert T 4 to activet 3 ) 10 Chan S et al. J Endocrinol 2000;165:1-8; Gharib H et al. Endocr Pract 1999;5:367-8.
11 Influence of iodide supply on neurocognitive development 10 y follow-up for prevalence of attention deficit/ hyperactivity disorder (ADHD) in regions with moderate vs. mild iodine deficiency 1 : 69% in an area of moderate iodine deficiency 0% in an area of mild iodine deficiency Also, IQ was18 points lower for moderate vs. mild iodine deficiency Prevalence of developmental delay a in offspring of mothers with mildly reduced T4 measured at age 18 mo determined according to when received iodine supplementation 2 : Iodine supplement at 4 6 gestational weeks: 0% Iodine supplement at gestational weeks: 25% Iodine supplement delivery: 37% aneurocognitive performance measured using the Brunet-Lézine scale Vermiglio F et al. J Clin Endocrinol Metab 2004;89: ; 2. Berbel P et al. Thyroid 2009;19:511-9.
12 Thyroid disease in pregnancy Prevention and management of maternal hypothyroidism
13 Two worlds 1. Iodine replete regions Developed nations Effective salt iodization where necessary E.g. >90% of US households consume iodized salt 2. Iodine deficient regions About 2 billion individuals live in iodine-deficient regions Often in developing nations Leading cause of hypothyroidism in these regions Salt iodization programmes help, but it is difficult to reach remote areas Continuing problem of endemic goitre and cretinism Iodine deficiency is believed to be responsible for a loss of 13.5 IQ points in iodine-deficient regions Iodine deficiency is the most common form or preventable brain damage in children 13 World Health Organisation (2004).
14 Iodine requirements in pregnancy Recommended levels of iodine intake for a woman who is pregnant, breast feeding or planning a pregnancy are: Population ATA/AACE WHO and ETA ES Planning pregnancy 150 g/day 250 g/day 250 g/day Pregnant 220 g/day 250 g/day 250 g/day Breast-feeding 290 g/day 250 g/day 250 g/day AACE: American Association of Clinical Endocrinologists ATA: American Thyroid Association ES: Endocrine Society ETA: European thyroid Association WHO: World Health Organisation 14 Stagnaro-Green A et al. Thyroid 2011;21: ; Lazarus J et al. Eur Thyroid J 2014;3:76-94; De Groot L et al. J Clin Endocrinol Metab, 2012;97:
15 Iodine supplementation in iodine-deficient regions European Thyroid Association: g/day of iodine via a potassium iodide supplement 50 g/day of iodine via a potassium iodide supplement where salt iodization has been implemented successfully Do not exceed 500 g/day iodine intake American Thyroid Association/American Association of Clinical Endocrinologists: mg/day of iodine (potassium iodide) for all pregnant or lactating women This is not widely achieved in the USA Supplementation needs vary outside the USA according to the level of natural environmental iodide and salt iodization Endocrine Society 250 mg/day of iodine (iodide or iodate) for all pregnant or lactating women Indication for a potassium iodide supplement in pregnancy or lactation: mg/day of iodine (iodide) 15 Stagnaro-Green A et al. Thyroid 2011;21: ; Lazarus J et al. Eur Thyroid J 2014;3:76-94 De Groot L et al. J Clin Endocrinol Metab, 2012;97: Jodid Prescribing Information.
16 Hypothyroidism: recommendations for pregnancy from ATA/AACE Use trimester-specific TSH ranges where available (see earlier slide) Treat overt hypothyroidism in pregnancy But do not treat isolated hypothyroxinaemia Treat pregnant women with subclinical hypothyroidism only if they are positive for TPO Abs Monitor patients with subclinical hypothyroidism regularly for progression to overt hypothyroidism Use oral levothyroxine (not T3 or desiccated thyroid preparations) Treat to normalise trimester-specific TSH Women on levothyroxine should increase their dose by about 25 30% as soon as they suspect they are pregnant Monitor TSH 4-weekly during the first half of the pregnancy ( once at w) Revert to the preconception dose after delivery Measure TSH at about 6 w post-partum Selenium supplementation is for TPO-Ab positive patients is not supported 16 Stagnaro-Green A et al. Thyroid 2011;21:
17 Prescribing levothyroxine in pregnancy according to US guidelines Treat pregnant patients with overt hypothyroidism (or subclinical hypothyroidism with anti- TPO antibodies) with levothyroxine tablets 50 80% of women receiving oral levothyroxine need to increase their dosage during pregnancy More likely for women without functional thyroid tissue (e.g. after radioablation of the thyroid) Prescribe 9 tablets/week instead of 7/week when pregnancy is first detected for women already receiving levothyroxine E.g. after the first missed menstrual period or positive pregnancy test This strategy provides a 29% increase in dose Avoids hypothyroidism in the first trimester Mimics the natural increase in T 4 during a normal pregnancy Conduct confirmatory thyroid hormone testing immediately 17 Stagnaro-Green A et al. Thyroid 2011;21:
18 Summary 1. Physiological changes during pregnancy requires more iodine for synthesis of thyroxine 2. Hypothyroidism causes both fetal and maternal complications 3. Thyroxine in the developing fetal brain is mainly by the maternal source until delivery 4. Cretinism and lower IQ in the child can be prevented by ensuring adequate iodine intake and normal range of TSH and FT4 during prepregnancy, pregnancy and lactation period 18
19 19 THANK YOU FOR YOUR ATTENTION
Lecture title. Name Family name Country
Lecture title Name Family name Country Nguyen Thy Khue, MD, PhD Department of Endocrinology HCMC University of Medicine and Pharmacy, MEDIC Clinic Hochiminh City, Viet Nam Provided no information regarding
More informationLothian Guidance for Diagnosis and Management of Thyroid Dysfunction in Pregnancy
Lothian Guidance for Diagnosis and Management of Thyroid Dysfunction in Pregnancy Early diagnosis and good management of maternal thyroid dysfunction are essential to ensure minimal adverse effects on
More informationShould every pregnant woman be screened for thyroid disease?
Should every pregnant woman be screened for thyroid disease? Tal Biron-Shental Rinat Gabbay-Benziv Is there a debate? Thyroid screening Guidelines Targeted case finding criteria Age > 30 years Personal
More informationLothian Guidance for Diagnosis and Management of Thyroid Dysfunction in Pregnancy.
Lothian Guidance for Diagnosis and Management of Thyroid Dysfunction in Pregnancy. Early diagnosis and good management of maternal thyroid dysfunction is essential to ensure minimal adverse effects on
More informationIodine and Thyroid Hormones
Iodine and Thyroid Hormones Iodine and Thyroid Hormones feed-back Iodine Deficiency Characteristics Iodine Deficiency None Mild Mode Severe Median urine iodine >100 50-99 20-49
More informationThyroid Disease in Pregnancy: The Essentials. Elizabeth N. Pearce, MD, MSc
Thyroid Disease in Pregnancy: The Essentials Elizabeth N. Pearce, MD, MSc None Disclosures Case 1 A 31-year-old woman from Massachusetts is practicing a vegan diet. She is currently planning a pregnancy.
More informationThe Number Games and Thyroid Function Arshia Panahloo Consultant Endocrinologist St George s Hospital
The Number Games and Thyroid Function Arshia Panahloo Consultant Endocrinologist St George s Hospital Presentation Today: Common thyroid problems and treatments Pregnancy related thyroid problems The suppressed
More informationUpdate on Gestational Thyroid Disease. Aidan McElduff The Discipline of Medicine, The University of Sydney
IADPSG 2016 Update on Gestational Thyroid Disease Aidan McElduff The Discipline of Medicine, The University of Sydney IADPSG 2016 DISCLOSURES and AIM Nil to disclose Aim: to provide an overview 2017 Guidelines
More informationTHE TREATMENT OF HYPOTHYROIDISM IN PREGNANCY
2017 ILEX PUBLISHING HOUSE, Bucharest, Roumania http://www.jrdiabet.ro Rom J Diabetes Nutr Metab Dis. 24(2):155-160 doi: 10.1515/rjdnmd-2017-0020 THE TREATMENT OF HYPOTHYROIDISM IN PREGNANCY Rucsandra
More informationEsther Briganti. Fetal And Maternal Health Beyond the Womb: hot topics in endocrinology and pregnancy. Endocrinologist and Clinician Researcher
Fetal And Maternal Health Beyond the Womb: hot topics in endocrinology and pregnancy Esther Briganti Endocrinologist and Clinician Researcher Director, Melbourne Endocrine Associates Associate Professor,
More informationThyroid function testing in pregnancy: 2017 ATA guidelines update. Dr Simon Forehan
Thyroid function testing in pregnancy: 2017 ATA guidelines update Dr Simon Forehan Several factors are known to tax gravid thyroid economy: Increased plasma volume TBG pool increased Renal clearance Feto-placental
More informationThis is the author s final accepted version.
Carty, D. M., Doogan, F., Welsh, P., Dominiczak, A. F., and Delles, C. (2017) Thyroid stimulating hormone (TSH) 2.5mU/l in early pregnancy: prevalence and subsequent outcomes. European Journal of Obstetrics
More informationThyroid function in pregnancy
Published Online December 23, 2010 Thyroid function in pregnancy John H. Lazarus * Centre for Endocrine and Diabetes Sciences, Cardiff University School of Medicine, University Hospital of Wales, Heath
More informationThyroid. Dr Jessica Triay November 2018
Thyroid Dr Jessica Triay November 2018 Hypothyroidism in Pregnancy Clinical update: Hypothyroidism in Pregnancy Take home messages Additional evidence supportive for more relaxed TSH targets for those
More informationMaternal and perinatal outcome in antenatal women with hypothyroidism
Original Research Article Maternal and perinatal outcome in antenatal women with hypothyroidism Polumuru Usha Devi 1, Gundu Vanaja 1* 1 Assistant Professor of Obstetrics and Gynecology, Andhra Medical
More informationHow to manage hypothyroid disease in pregnancy
For mass reproduction, content licensing and permissions contact Dowden Health Media. FIRST OF 2 PARTS How to manage hypothyroid disease in pregnancy Pregnancy complicated by hypothyroidism puts mother
More informationThe Thyroid and Pregnancy OUTLINE OF DISCUSSION 3/19/10. Francis S. Greenspan March 19, Normal Physiology. 2.
The Thyroid and Pregnancy Francis S. Greenspan March 19, 2010 OUTLINE OF DISCUSSION 1. Normal Physiology 2. Hypothyroidism 3. Hyperthyroidism 4. Thyroid Nodules and Cancer NORMAL PHYSIOLOGY Iodine Requirements:
More informationHypothyroidism. Definition:
Definition: Hypothyroidism Primary hypothyroidism is characterized biochemically by a high serum thyroidstimulating hormone (TSH) concentration and a low serum free thyroxine (T4) concentration. Subclinical
More informationHypothyroidism in Pregnancy
Chapter 2 Hypothyroidism in Pregnancy Baha Zantour, Wafa Alaya, Hela Marmouch and Wafa Chebbi Additional information is available at the end of the chapter http://dx.doi.org/10.5772/54745 1. Introduction
More informationPregnancy & Thyroid. Zohreh Moosavi Associate professor of Endocriology Imam Reza General Hospital Mashad University. Imam Reza weeky Conferance
Pregnancy & Thyroid Zohreh Moosavi Associate professor of Endocriology Imam Reza General Hospital Mashad University Imam Reza weeky Conferance Objectives Thyroid Disorders & Pregnancy Normal thyroid phsyiology
More informationStatus of Thyroid Peroxidase Antibodies in Pregnant Women and Association with Obstetric and Perinatal Outcomes in Tertiary Care Center
DOI: 10.7860/NJLM/2017/29019:2255 Obstetrics and Gynaecology Section Original Article Status of Thyroid Peroxidase Antibodies in Pregnant Women and Association with Obstetric and Perinatal Outcomes in
More informationSouthern Derbyshire Shared Care Pathology Guidelines. Hypothyroidism
Southern Derbyshire Shared Care Pathology Guidelines Hypothyroidism Purpose of Guideline The management and referral criteria of patients with newly diagnosed hypothyroidism in adults. Background Hypothyroidism
More information344 Thyroid Disorders
344 Thyroid Disorders Definition/Cut-Off Value Thyroid dysfunctions that occur in pregnant and postpartum women, during fetal development, and in childhood are caused by the abnormal secretion of thyroid
More informationBELIEVE MIDWIFERY SERVICES
TITLE: THYROID DISEASE IN PREGNANCY EFFECTIVE DATE: July, 2013 POLICY STATEMENT: Pregnancy changes significantly the values influenced by the serum thyroid binding hormone level (i.e., total thyroxine,
More informationTimothy Bilash MD MS OBG Northern Inyo Hospital, Bishop, CA October 20, :30 PM
Thyroxine Deficiency in Pregnancy Timothy Bilash MD MS OBG Northern Inyo Hospital, Bishop, CA October 20, 2006 1:30 PM WHI Estrogen recap In http://courses.washington.edu/bonephys/opestrogen.html. from:
More informationHyperthyroidism and Hypothyroidism in Pregnancy Guideline
Aneurin Bevan University Health Board Hyperthyroidism and Hypothyroidism in Pregnancy Guideline N.B. Staff should be discouraged from printing this document. This is to avoid the risk of out of date printed
More informationThyroid function in pregnancy
Review Article Page 1 of 16 Thyroid function in pregnancy Ilaria Muller #, Peter N. Taylor #, John H. Lazarus Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine,
More information2004 Where Do We Go from Here? Summary of Working Group Discussions on Thyroid Function and Gestational Outcomes
THYROID Volume 15, Number 1, 2005 Mary Ann Liebert, Inc. 2004 Where Do We Go from Here? Summary of Working Group Discussions on Thyroid Function and Gestational Outcomes Joseph G. Hollowell, 1 Stephen
More informationThyrotoxicosis in Pregnancy: Diagnose and Management
Thyrotoxicosis in Pregnancy: Diagnose and Management Yuanita Asri Langi email: meralday@yahoo.co.id Endocrinology & Metabolic Division, Internal Medicine Department, Prof.dr.R.D. Kandou Hospital/ Sam Ratulangi
More informationPrevalence of thyroid disorder in pregnancy and pregnancy outcome
Original Research Article Prevalence of thyroid disorder in pregnancy and pregnancy outcome Praveena K.R. 1, Pramod Kumar K.R. 2*, Prasuna K.R. 3, Krishna Kumar TV 4 1 Assistant Professor, Department of
More informationScreening and subsequent management for thyroid dysfunction pre-pregnancy and during pregnancy for improving maternal and infant health(review)
Cochrane Database of Systematic Reviews Screening and subsequent management for thyroid dysfunction pre-pregnancy and during pregnancy for improving maternal and infant health(review) SpencerL,BubnerT,BainE,MiddletonP
More informationMonitoring Levothyroxine Dose during Pregnancy: A Prospective Study
American Journal of Infectious Diseases 7 (3): 75-79, 2011 ISSN 1553-6203 2011 Science Publications Monitoring Levothyroxine Dose during Pregnancy: A Prospective Study 1 Juhi Agarwal, 1 Sirimavo Nair and
More informationTHE PHARMA INNOVATION - JOURNAL Assessment of Antithyroperoxidase Antibodies and Thyroid Hormones Among Sudanese Pregnant Women
Received: 01-09-2013 Accepted: 30-09-2013 ISSN: 2277-7695 CODEN Code: PIHNBQ ZDB-Number: 2663038-2 IC Journal No: 7725 Vol. 2 No. 9 2013 Online Available at www.thepharmajournal.com THE PHARMA INNOVATION
More informationClinical efficacy of therapeutic intervention for subclinical hypothyroidism during pregnancy
Clinical efficacy of therapeutic intervention for subclinical hypothyroidism during pregnancy R. Ju 1, L. Lin 2, Y. Long 2, J. Zhang 2 and J. Huang 2 1 Gynaecology and Obstetrics Department, Beijing Chuiyangliu
More informationPrevalence of thyroid disorder in pregnancy and pregnancy outcome
Original Research Article Prevalence of thyroid disorder in pregnancy and pregnancy outcome Rama Saraladevi 1*, T Nirmala Kumari 1, Bushra Shreen 2, V. Usha Rani 3 1 Associate Professor, 2 Senior Resident,
More informationThyroid disorders in antenatal women in a rural hospital in central India
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Mahajan KS et al. Int J Reprod Contracept Obstet Gynecol. 2016 Jan;5(1):62-67 www.ijrcog.org pissn 2320-1770 eissn 2320-1789
More informationTo evaluate the influence of ferritin on thyroid hormones in second trimester antenatal cases in Perambalur District
Original Research Article To evaluate the influence of ferritin on thyroid hormones in second trimester antenatal cases in Perambalur District Nageshwari A 1, G. Kavitha 2* 1 Final year Postgraduate student,
More informationTSH should be measured in any women with symptoms of hypothyroidism. Screening of asymptomatic women is reviewed below. (See 'Screening' below.
Official reprint from UpToDate www.uptodate.com 2017 UpToDate Hypothyroidism during pregnancy: Clinical manifestations, diagnosis, and treatment Author: Douglas S Ross, MD Section Editors: David S Cooper,
More informationOvert and subclinical hypothyroidism among Bangladeshi pregnant women and its effect on fetomaternal outcome
Bangladesh Med Res Counc Bull 21; : 52-57 Overt and subclinical hypothyroidism among Bangladeshi pregnant women and its effect on fetomaternal outcome Sharmeen M, Shamsunnahar A, Laita TR, Chowdhury SB
More informationB-Resistance to the action of hormones, Hormone resistance characterized by receptor mediated, postreceptor.
Disorders of the endocrine system 38 Disorders of endocrine system mainly are caused by: A-Deficiency or an excess of a single hormone or several hormones: - deficiency :can be congenital or acquired.
More informationNEWBORN FEMALE WITH GOITER PAYAL PATEL, M.D. PEDIATRIC ENDOCRINOLOGY FELLOW FEBRUARY 12, 2015
NEWBORN FEMALE WITH GOITER PAYAL PATEL, M.D. PEDIATRIC ENDOCRINOLOGY FELLOW FEBRUARY 12, 2015 CHIEF COMPLAINT 35 6/7 week F with goiter, born to a mother with Graves disease (GD) HPI 35 6/7 week F born
More informationTable 1: Thyroid panel. Result (reference interval) TSH 89.5 miu/l ( ) Total T4 5.2 µg/dl ( ) T3 uptake 39% (22-35)
Introduction Thyroid disease is the second most common endocrine disorder (behind diabetes), and its prevalence increases with increasing age. The incidence of newly diagnosed thyroid cancer is increasing
More informationUpdate In Hypothyroidism
Update In Hypothyroidism CME Away India & Sri Lanka March 23 - April 7, 2018 Richard A. Bebb MD, ABIM, FRCPC Consultant Endocrinologist Medical Subspecialty Institute Cleveland Clinic Abu Dhabi Copyright
More informationMichaela Granfors, Helena Åkerud, Anna Berglund, Johan Skogö, Inger Sundström-Poromaa, and Anna-Karin Wikström
ORIGINAL ARTICLE Endocrine Care Thyroid Testing and Management of Hypothyroidism During Pregnancy: A Population-based Study Michaela Granfors, Helena Åkerud, Anna Berglund, Johan Skogö, Inger Sundström-Poromaa,
More informationT H E B E T T E R H E A L T H N E W S
W H O L E H E A L T H A M E R I C A. C O M Dr. Paul G. Varnas & WholeHealthAmerica.com present S E P T E M B E R, 2 0 1 3 V O L U M E 1 0, I S S U E 9 T H E B E T T E R H E A L T H N E W S I O D I N E
More informationJMSCR Vol 06 Issue 11 Page November 2018
www.jmscr.igmpublication.org Impact Factor (SJIF): 6.379 Index Copernicus Value: 79.54 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v6i11.40 Prevalence of Thyroid autoimmunity
More informationHolistic Medicine for the 21 st Century
Holistic Medicine for the 21 st Century David Brownstein, M.D. Center for Holistic Medicine 5821 W. Maple Rd. Ste. 192 West Bloomfield, MI 48322 248.851.1600 www.drbrownstein.com Overcoming Thyroid Disorders
More informationClinical THYROIDOLOGY
Clinical THYROIDOLOGY Editor-in Chief Jerome M. Hershman, MD Distinguished Professor of Medicine UCLA School of Medicine and VA Greater Los Angeles Healthcare System Endocrinology 111D, 11301 Wilshire
More informationThyroid Disease & Pregnancy Updates and Ongoing Questions
Thyroid Disease & Pregnancy - 2018 Updates and Ongoing Questions Erik K. Alexander, MD Chief, Thyroid Section, Division of Endocrinology Brigham & Women s Hospital Professor of Medicine, Harvard Medical
More informationThe Presence of Thyroid Autoantibodies in Pregnancy
The Presence of Thyroid Autoantibodies in Pregnancy Dr. O Sullivan does not have any financial relationships with any commercial interests. KATIE O SULLIVAN, MD FELLOW, ADULT/PEDIATRIC ENDOCRINOLOGY ENDORAMA
More informationThyroid Disease: The Subtle, the Controversial, and the Complex
Thyroid Disease: The Subtle, the Controversial, and the Complex Learning Objectives After participating in this educational activity, participants should be better able to 1. Recognize the common and less
More informationManagement of gestational hypothyroidism: results of a Brazilian survey
original article Management of gestational hypothyroidism: results of a Brazilian survey 1 Endocrinologia e Metabolismo, Pontifícia Universidade Católica de Campinas (PUC-Campinas). Laboratório de Genética
More informationInternational Journal of Research and Review E-ISSN: ; P-ISSN:
International Journal of Research and Review www.gkpublication.in E-ISSN: 2349-9788; P-ISSN: 2454-2237 Original Research Article Thyroid Dysfunction and Possible Role of Anti-TPO in Infertility Sunita
More informationMaternal outcome in thyroid dysfunction
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Manju VK et al. Int J Reprod Contracept Obstet Gynecol. 2017 Jun;6(6):2361-2365 www.ijrcog.org DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20172313
More informationReview Article Levothyroxine Treatment in Pregnancy: Indications, Efficacy, and Therapeutic Regimen
SAGE-Hindawi Access to Research Journal of Thyroid Research Volume 2011, Article ID 843591, 12 pages doi:10.4061/2011/843591 Review Article Levothyroxine Treatment in Pregnancy: Indications, Efficacy,
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 4,100 116,000 120M Open access books available International authors and editors Downloads Our
More informationScreening Babies at risk of Congenital Hyperthyroidism GL354
1 Screening Babies at risk of Congenital Hyperthyroidism GL354 Approval and Authorisation Approved by Job Title Date Paediatric Clinical Governance Chair of paediatric Clinical Governance March 2016 Change
More informationA descriptive study of the prevalence of hypothyroidism among antenatal women and foetal outcome in treated hypothyroid women
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Prasad DR et al. Int J Reprod Contracept Obstet Gynecol. 2016 Jun;5(6):1892-1896 www.ijrcog.org pissn 2320-1770 eissn 2320-1789
More informationDRUGS. 4- Two molecules of DIT combine within the thyroglobulinto form L-thyroxine (T4)' One molecule of MIT & one molecule of DIT combine to form T3
THYROID HORMONEs & ANTITHYROID The thyroid secretes 2 types of hormones: DRUGS 1- Iodine containing amino acids (are important for growth, development and metabolism) and these are: triodothyronine, tetraiodothyronine,(
More informationObjectives. Medical Complications of Pregnancy. Potential Conflicts: None. Common Complicating Medical Conditions that Precede Pregnancy
Medical Complications of Potential Conflicts: None Ellen W. Seely, M.D. Director of Clinical Research Endocrine-Hypertension Division Brigham and Women s Hospital Professor of Medicine Harvard Medical
More informationLow Concentrations of Maternal Thyroxin During Early Gestation :A Risk Factor of Breech Presentation
Negative feedback CONCENTRATIONS THE IRAQI POSTGRADUATE OF MEDICAL MATERNAL JOURNAL THYROXIN Low Concentrations of Maternal Thyroxin During Early Gestation :A Risk Factor of Breech Presentation Nada Salih
More informationThyroid Disease in Pregnancy. Justin Moore, MD
Thyroid Disease in Pregnancy Justin Moore, MD Case 1 22 yr old G1P0 female at 14 2/7 weeks presents with tremor Weight stable since first positive pregnancy test Some nausea, rare vomiting TSH 0.02 miu/l,
More informationDAGNOSIS AND TREATMENT OF THYROID GLAND DISEASES IN PREGNANCY GUIDELINE AND RECOMMENDATIONS
Svetlana Spremovic-Radjenovic 1 DAGNOSIS AND TREATMENT OF THYROID GLAND DISEASES IN PREGNANCY GUIDELINE AND RECOMMENDATIONS The field referred to thyroid gland diseases and pregnancy has recorded the fast
More informationSanjay B. Dixit, M.D. BHS Endocrinology Associates November 11, 2017
Sanjay B. Dixit, M.D. BHS Endocrinology Associates November 11, 2017 I will not be discussing this Outline of discussion Laboratory tests for thyroid function Diagnosis of hypothyroidism Treatment of
More informationVI.2 Elements for a public summary VI.2.1 Overview of disease epidemiology
VI.2 Elements for a public summary VI.2.1 Overview of disease epidemiology The most common forms of hyperthyroidism include Graves disease, Plummer disease, and toxic adenoma; but approximately 1-2% of
More informationUniversal TSH screening to detect hypothyroidism in pregnancy : a comprehensive review
The University of Toledo The University of Toledo Digital Repository Master s and Doctoral Projects Universal TSH screening to detect hypothyroidism in pregnancy : a comprehensive review Andrea M. Fox
More informationInternational Journal of Health Sciences and Research ISSN:
International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Thyroid Status in First Trimester of Pregnancy-A Hospital Based Study Saurabh Borkotoki 1*,
More informationThyroid diseases in pregnancy: The importance of anamnesis
Original Article Thyroid diseases in pregnancy: The importance of anamnesis Necati Bulmus 1, Isik Ustuner 2, Emine Seda Guvendag Guven 3, Figen Kir Sahin 4, Senol Senturk 5, Serap Baydur Sahin 6 Open Access
More informationThyroid and Antithyroid Drugs. Munir Gharaibeh, MD, PhD, MHPE Faculty of Medicine April 2014
Thyroid and Antithyroid Drugs Munir Gharaibeh, MD, PhD, MHPE Faculty of Medicine April 2014 Anatomy and histology of the thyroid gland Located in neck adjacent to the 5 th cervical vertebra (C5). Composed
More informationUnderstanding the Thyroid and Pregnancy
FERTILITY nurses first Understanding the Thyroid and Pregnancy Tamara Tobias, ARNP Human chorionic gonadotropin (hcg) and estrogen are two hormones that play an important role during pregnancy. They can,
More informationHypothyroidism in pregnancy
Review Article Page 1 of 8 Hypothyroidism in pregnancy Fahimeh Ramezani Tehrani, Samira Behboudi-Gandevani Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid
More informationMaternal overt and Subclincal hypothyroidism, and the risk of miscarriage in Iraq
International Journal of Advanced Research in Biological Sciences ISSN: 2348-8069 www.ijarbs.com DOI: 10.22192/ijarbs Coden: IJARQG(USA) Volume 5, Issue 5-2018 Research Article DOI: http://dx.doi.org/10.22192/ijarbs.2018.05.05.014
More informationCROSS TOWN ENDOCRINE CLUB. Alex S. Stagnaro-Green, M.D. THURSDAY, OCTOBER 22, 2009
CROSS TOWN ENDOCRINE CLUB Alex S. Stagnaro-Green, M.D. Professor of Medicine, Professor of Obstetrics & Gynecology Touro University College of Medicine Hackensack, New Jersey USC School of Medicine Visiting
More informationIncreased Pregnancy Loss Rate in Thyroid Antibody Negative Women with TSH Levels between 2.5 and 5.0 in the First Trimester of Pregnancy
JCEM ONLINE Brief Report Endocrine Care Increased Pregnancy Loss Rate in Thyroid Antibody Negative Women with TSH Levels between 2.5 and 5.0 in the First Trimester of Pregnancy Roberto Negro, Alan Schwartz,
More informationAssessment of Knowledge of Women Regarding Iodine Nutrition during Pregnancy and Lactation at a Tertiary Care Centre
Original Research Article Assessment of Knowledge of Women Regarding Iodine Nutrition during Pregnancy and Lactation at a Tertiary Care Centre Kahkashan Jamshed Alam 1*, Manju Datta 2 1*MBBS, MS (Obstetrics
More informationRole of anti-thyroid peroxidase antibodies in adverse pregnancy outcomes
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Gupta A et al. Int J Reprod Contracept Obstet Gynecol. 2016 Sept;5(9):3001-3005 www.ijrcog.org pissn 2320-1770 eissn 2320-1789
More informationClinical Guideline MANAGEMENT OF INFANTS BORN TO MOTHERS WITH GRAVES DISEASE AND AT RISK OF THYROTOXICOSIS
Clinical Guideline MANAGEMENT OF INFANTS BORN TO MOTHERS WITH GRAVES DISEASE AND AT RISK OF THYROTOXICOSIS Date of First Issue 18/07/2016 Approved 28/09/2017 Current Issue Date 16/06/2017 Review Date 01/09/2019
More informationThyroid Function. Thyroid Antibodies. Analyte Information
Thyroid Function Thyroid Antibodies Analyte Information - 1-2013-04-30 Thyroid Antibodies Determination of thyroid autoantibodies are, besides TSH and FT4, one of the most important diagnostic parameters.
More informationRequesting and Management of abnormal TFTs.
Requesting and Management of abnormal TFTs. At the request of a number of GPs I have produced summary guidelines surrounding thyroid testing. These have been agreed with our Endocrinology leads Dr Bell
More informationCécile Brachet Endocrinologie Pédiatrique Hôpital Universitaire des Enfants Reine Fabiola U.L.B. Bruxelles
Des effets secondaires de l Iso Bétadine (PVP-I) chez le foetus et le nouveau-né via un traitement maternel à l accouchement Neonatal side Effects of povidone-iodine disinfection of pregnant or lactating
More informationJMSCR Vol 04 Issue 03 Page March 2016
www.jmscr.igmpublication.org Impact Factor 5.244 Index Copernicus Value: 5.88 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: http://dx.doi.org/10.18535/jmscr/v4i3.60 Thyroid Dysfunction and Pregnancy Outcome
More informationAdverse pregnancy outcome in Saudi women diagnosed with overt hypothyroidism during pregnancy, with and without thyroid peroxidase antibodies.
Adverse pregnancy outcome in Saudi women diagnosed with overt hypothyroidism during pregnancy, with and without thyroid peroxidase antibodies. Inass Taha Department of Medicine, Medical Collage, Taibah
More informationEffect of mildly elevated thyroid-stimulating hormone during the first trimester on adverse pregnancy outcomes
Li et al. BMC Endocrine Disorders (2018) 18:64 https://doi.org/10.1186/s12902-018-0294-7 RESEARCH ARTICLE Open Access Effect of mildly elevated thyroid-stimulating hormone during the first trimester on
More informationManagement of thyroid diseases in pregnancy
34 Review Management of thyroid diseases in pregnancy 1 2010; 32: 34-38 Introduction Thyroid dysfunction is a common medical problem in pregnancy. Early recognition and optimal management leads to better
More informationmeta-analysis of randomised
To cite: Yamamoto JM, Benham JL, Nerenberg KA, et al. Impact of levothyroxine therapy on obstetric, neonatal and childhood outcomes in women with subclinical hypothyroidism diagnosed in pregnancy: a systematic
More informationClinical and Biological Consequences of Iodine Deficiency during Pregnancy
Disorders of Thyroid Function Van Vliet G, Polak M (eds): Thyroid Gland Development and Function. Endocr Dev. Basel, Karger, 2007, vol 10, pp 62 85 Clinical and Biological Consequences of Iodine Deficiency
More informationSubclinical Hypothyroidism
Subclinical Hypothyroidism Key Clinical Points Subclinical hypothyroidism is defined as an elevated thyrotropin level with a normal free thyroxine (T 4 ) level. To confirm the diagnosis, a transient increase
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 4,100 116,000 120M Open access books available International authors and editors Downloads Our
More informationHYPOTHYROIDISM IN CHILDREN. IAP UG Teaching slides
HYPOTHYROIDISM IN CHILDREN 1 OBJECTIVES Introduction Congenital hypothyroidism Etiology, clinical features, diagnosis, approach, treatment and prognosis Acquired hypothyroidism Etiology, clinical features,
More informationNIH Public Access Author Manuscript Ther Drug Monit. Author manuscript; available in PMC 2013 April 14.
NIH Public Access Author Manuscript Published in final edited form as: Ther Drug Monit. 2006 February ; 28(1): 8 11. Thyroid Function Testing in Pregnancy and Thyroid Disease: Trimester-specific Reference
More informationThyroid autoimmunity in pregnancy a problem of mother and child
Archives of Perinatal Medicine 18(2), 86-91, 2012 REVIEW PAPER Thyroid autoimmunity in pregnancy a problem of mother and child MAREK RUCHAŁA, ARIADNA ZYBEK, BARBARA BROMIŃSKA, EWELINA SZCZEPANEK-PARULSKA
More informationGrave s disease (1 0 )
THYROID DYSFUNCTION Grave s disease (1 0 ) Autoimmune - activating AB s to TSH receptor High concentrations of circulating thyroid hormones Weight loss, tachycardia, tiredness Diffuse goitre - TSH stimulating
More informationNeonatal Thyrotoxicosis Management of babies born to mothers with a history of hyperthyroidism (Grave s Disease)
MCN for Neonatology West of Scotland Neonatal Guideline Neonatal Thyrotoxicosis Management of babies born to mothers with a history of hyperthyroidism (Grave s Disease) This document is applicable to all
More informationuniversity sciences of Isfahan university Com
Introduce R. Gholamnezhad Lecturer of school of nursing & midwifery of Iran university Ph.D student tof Immunology, Sh School of medical sciences of Isfahan university E-Mail: Gholami278@gmail. Com Interpreting
More informationEpidemiology of thyroid diseases
Faculty of Medicine Epidemiology of thyroid diseases By Hatim Jaber MD MPH JBCM PhD 19-12- 2018 1 Presentation outline Time Introduction : Epidemiology and Overview of Thyroid Dysfunction 11:00 11:10 Risk
More informationThyroid Dysfunction during Pregnancy: A Review of the Current Guidelines
, pp: 130-136 (ISSN: 2455-1716) Impact Factor 2.4 MARCH-2016 Review Article (Open access) Thyroid Dysfunction during Pregnancy: A Review of the Current Guidelines Mustafa Al Abousi* Department of Endocrinology,
More informationReview Article Think Thyroid - Think Life: Pregnancy with Thyroid Disorders
Chettinad Health City Medical Journal Muthukumaran Jayapaul* Consultant Endocrinologist, Arka Center for Hormonal Health, Chennai, India Dr. Muthu Kumaran Jayapaul is a Consultant Endocrinologist and also
More informationClinical Study Further Evidence on the Role of Thyroid Autoimmunity in Women with Recurrent Miscarriage
International Endocrinology Volume 2012, Article ID 717185, 4 pages doi:10.1155/2012/717185 Clinical Study Further Evidence on the Role of Thyroid Autoimmunity in Women with Recurrent Miscarriage Natalia
More informationDetermination of reference intervals of thyroid markers during pregnancy in Urban area of District Rawalpindi Pakistan
1488 RESEARCH ARTICLE Determination of reference intervals of thyroid markers during pregnancy in Urban area of District Rawalpindi Pakistan Mehwish Gilani, 1 Naveed Asif, 2 Ammad Akram, 3 Mehreen Gilani,
More information