Understanding the Thyroid and Pregnancy
|
|
- Jessie Wilcox
- 6 years ago
- Views:
Transcription
1 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, however cause increased thyroid hormone levels in the blood, making thyroid function tests during pregnancy difficult to interpret. The information below gives an overview of thyroid function and then shows the relationship between thyroid function and pregnancy. Physiology The function of the thyroid gland is to synthesize the thyroid hormones thyroxine (T4) and triiodothyronine (T3). Thyroid cells are the only cells in the body that can absorb the element iodine, which can be found in many foods. These cells combine iodine and the amino acid, tyrosine, to produce T3 and T4. The T3 and T4 hormones are then released into the bloodstream and are transported throughout the body where they play an important role in controlling metabolism. 1,2 The thyroid gland is controlled by the pituitary gland. When levels of T3 and T4 drop too low, the hypothalamus produces thyrotropin releasing hormone (TRH), which stimulates the pituitary gland to produce thyroid stimulating hormone (TSH). The TSH in turn stimulates the thyroid gland to produce more thyroid hormones (Figure). 1,2 Under the influence of TSH, the thyroid will manufacture and secrete T3 and T4, thereby raising their blood levels. The hypothalamus senses this change and responds by decreasing its TRH production (Figure). 1,2 Figure. Thyroid Physiology Hypothalamus TRH (thyroid-releasing hormone) Pituitary TSH Thyroid T 3 and T 4 to target cells throughout body issue 33 SP12872_FertilityNurses_0310_k.indd 1 4/8/10 10:53:31 AM
2 Thyroid Hormones Thyroid hormones are present in the circulation but are mainly bound to proteins. Approximately 75 percent to 80 percent are bound to thyroxine-binding globulin (TBG) (inactive), and about 20 percent are bound to albumin (less active). Because only a small fraction of thyroid hormones is unbound and biologically active, measuring free thyroid hormones is generally the most useful in determining thyroid function. 1 The TBG protein is generally increased by estrogens, and rises especially during pregnancy. Growing levels of estrogen leads to an increase in thyroid hormone binding. Less free hormones lead to the stimulation of TSH and further production of thyroid hormones. A normally functioning thyroid is able to adapt to these changes, and the level of free thyroid hormone is not altered. Thyroxine (T4) Thyroxine is a hormone referred to as T4 because it contains four iodine atoms. The normal thyroid gland produces about 80 percent of T4 and is its primary secretory product. To exert its effects, T4 is converted to T3 by the removal of an iodine atom. Predominantly bound by proteins, T4 is prevented from entering tissues. Free T4, however is able to enter tissues and exert its effects. This ability makes free T4 the most effective way to determine thyroid function. 1 Triiodothyronine (T3) Although the thyroid gland directly secretes about 20 percent of T3, this hormone is responsible for most of the thyroid action in the body. As previously stated, 80 percent of T3 comes from the conversion of T4. In addition, T3 is approximately four times more potent than T4. 1 Although measuring T3 may help diagnose hyperthyroidism, testing for T3 is rarely used to determine hypothyroidism. Thyroid Stimulating Hormone (TSH) Measuring TSH is the most effective way to initially test thyroid function. Although TSH is regulated by T4, this process happens only after T4 is converted to T3 in the pituitary cells. The measurement of T4 and TSH provide the most accurate assessment of thyroid function. 1,3 Thyroid Antibodies There are two common thyroid antibodies that damage the thyroid gland. These are 1) antithyroid peroxidase (anti- TPO) and 2) antithyroglobulin (anti-tg). Measuring these antibodies helps to diagnose the most common cause of hypothyroidism. 4 Common Disorders of the Thyroid Hypothyroidism Hypothyroidism occurs when the thyroid fails to produce adequate amounts of thyroid hormone. This condition is often present for a number of years before it is recognized and treated. 2 A typical person with an underactive thyroid will have elevated TSH levels with low, free T4. The most common cause of hypothyroidism is thyroiditis, which includes a group of individual disorders that cause thyroidal inflammation resulting in different clinical presentations. Hashimoto s disease is the most common autoimmune thyroid disorder. It increases with age and occurs more frequently in women or persons with a family history of thyroid disease. Hashimoto s disease typically targets women and is characterized by high thyroid antibody titers along with increased TSH and low, free T4. 1,2 Synthetic T4 is the most effective treatment for Hashimoto s disease. Levothyroxine is a drug that can be prescribed with a wide range of doses. It is used to treat low thyroid activity and to treat or suppress different types of goiters. It is recommended to take levothyroxine on an empty stomach approximately 30 minutes before or two hours after meals. It is important to space this drug at least four hours apart from other medications, including iron (e.g., prenatal vitamins) and antacids which can impair absorption. 1,2 2 SP12872_FertilityNurses_0310_k.indd 2 4/8/10 10:53:31 AM
3 Hyperthyroidism Hyperthyroidism occurs when there is an overabundance of thyroid hormone being produced. A typical person with an overactive thyroid will have decreased TSH levels and high, free T4. 1,2 The most common cause of hyperthyroidism is Graves disease, an autoimmune disorder. The antibodies in this case stimulate the thyroid gland. Graves disease is characterized by an enlarged thyroid that produces an overabundance of thyroid hormone. This overproduction occurs more often in women between their 30s and 40s and tends to run in families. 1,2,4 The treatment for hyperthyroidism may include the use of anti-thyroid drugs such as methimazole or propylthiouracil (PTU)/6-N-propylthiouracil (PROP). These medications provide prompt relief but cannot be used as permanent treatment. Beta blockers, such as propranolol may be used to treat symptoms including tremors or palpations. Radioactive iodine is the most widely recommended, permanent treatment. Women should avoid pregnancy for six to 12 months post-treatment, and men should consider sperm banking prior to treatment with radioactive iodine. 2,3 Thyroid Dysfunction in Pregnancy Thyroid function is especially important during the first weeks of pregnancy when fetal brain development is dependent on maternal thyroid hormone (Table). Table. Thyroid Dysfunction in Pregnancy 3,5 Hypothyroidism Maternal increased risks Preeclampsia Pre-term delivery Placental abruption Postpartum hemorrhage Spontaneous abortion (SAB) Neonatal increased risks Low birth weight Perinatal death/stillbirth Children born with: Adverse effects in cognition, intellect and motor development Impairment in neuropsychological development indices, IQ scores and school learning abilities Hyperthyroidism Heart failure Low birth weight Neonatal thyroid dysfunction Perinatal death/stillbirth Placental abruption Preeclampsia Pre-term delivery SAB Thyroid storm Thyroid function test results change during pregnancy due to the hcg and estrogen hormones. Being a glycoprotein hormone, hcg is produced during pregnancy by the developing embryo soon after conception and later by the syncytiotrophoblast. This hormone acts as a weak thyroid stimulator, causing a drop in TSH in the first trimester. After this happens, TSH returns to normal throughout 3 SP12872_FertilityNurses_0310_k.indd 3 4/8/10 10:53:31 AM
4 the duration of pregnancy. If TSH is above 2.3 miu/l in early pregnancy, it may be indicative of subclinical hypothyroidism, which can be defined as an elevated TSH with normal, free T4. Because there are no universal reference ranges for thyroid function tests in pregnancy, TSH may be in the nonpregnant, normal range. However, the normal drop in TSH with pregnancy needs to be taken into consideration. 3,6 Women who are already on T4 treatment prior to pregnancy usually need to increase their replacement dose by 30 percent to 50 percent during pregnancy. They also need to recheck their TSH every four weeks until it is normalized, and then every six to eight weeks after that. The goal for these women is to maintain a TSH level of at least 2.3 miu/l in the first trimester. 3,6,7 Infertility as a Risk Factor Infertility is considered to be a risk factor for thyroid dysfunction. Checking TSH levels with a second hcg pregnancy test may be beneficial for detecting early thyroid dysfunction. A TSH level greater than miu/l during early pregnancy may indicate subclinical hypothyroidism and treatment may be warranted. This is because pregnancy unmasks an incipient, hypothyroid state that would eventually become clinically evident. Thyroid antibody testing may also be useful in determining if the woman is at risk for developing hypothyroidism in the future. 3,8 Because the fetus relies on maternal thyroid hormone and iodine is necessary for the production of thyroid hormones, it is important that pregnant women have adequate iodine in their prenatal vitamin. Iodine is recommended at 150 mcg mcg in the form of potassium iodide. This dose is especially important for women who use sea salt (noniodized) or follow vegan, low-sodium or dairy-free diets, as these diets are iodine-deficient. 2,3 Screening Infertile Patients for Thyroid Dysfunction Abnormal thyroid function can alter levels of sex hormonebinding globulin (SHBG), prolactin and gonadotropinreleasing hormone (GnRH), which can all lead to menstrual dysfunction. One of the beneficial effects of T4 treatment for hypothyroidism is the restoration of regular menstrual cyclicity. The presence of thyroid antibodies is also associated with increased risk of miscarriage. Many studies propose the upper limit of normal TSH for fertility patients as 2.5 miu/l, but further research is needed. Increased estrogen from ovarian stimulation or pregnancy may place too high a strain on the thyroid gland in women who already have thyroid autoimmunity. Negro R, et al. demonstrated a decrease in spontaneous miscarriages and premature deliveries in euthyroid, anti-tpo positive, pregnant women treated with thyroxine. 6,9 Women with positive thyroid antibodies but normal TSH levels may benefit from treatment to stop or slow the progression to hypothyroidism, but further research is needed. 3 Studies report an increase in prevalence of autoimmune thyroid disease in infertile women. Screening infertility patients could help detect and prevent an evolution to overt thyroid dysfunction after ovarian stimulation in women with autoimmune disease. Treatment with T4 is recommended when subclinical hypothyroidism is present in women with infertility, irregular menses or after ovarian stimulation. 3,8 Summary In conclusion, TSH and free T4 are useful, initial laboratory markers for determining thyroid function. Common disorders among women of reproductive age include hypothyroidism as well as hyperthyroidism. The presence of thyroid antibodies is associated with a risk of miscarriage. Screening for thyroid dysfunction and autoimmunity should be considered as part of the general work up in women facing infertility issues. 4 SP12872_FertilityNurses_0310_k.indd 4 4/8/10 10:53:31 AM
5 References About the author: Tamara Tobias, ARNP received her nursing degree from the College of St. Benedict in St. Joseph, Minnesota, nurse practitioner training at Harbor-UCLA Medical Center, Torrance, California, and Master of Science degree in nursing from California State University, Long Beach, California. She is currently a certified women s health care nurse practitioner with Seattle Reproductive Medicine in Seattle, Washington. Ms. Tobias was a founding member of the Reproductive Nursing Association of San Diego and Southern Orange County, California, as well as the Seattle Tacoma Area Reproductive Society. She is an active member of the American Society for Reproductive Medicine (ASRM). She has also served as a speaker at ASRM conferences, as well as at various other nursing meetings. 1. Speroff L, Glass R, Kase N. Clinical Gynecologic Endocrinology and Infertility. 6th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 1999: The American Thyroid Association Web site. Accessed January 27, Abalovich M, Amino N, Barbour L, et al. Clinical practice guideline, management of thyroid dysfunction during pregnancy and postpartum: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2007;92(8 Suppl):S1-S Singer P, Cooper D, Levy E, et al. Treatment guidelines for patients with hyperthyroidism and hypothyroidism. JAMA. 1995;273(10): Loh J, Wartofsky L, Jonklaas J, Burman K. The Magnitude of increased levothyroxine requirements in hypothyroid pregnant women depends upon the etiology of the hypothyroidism. Thyroid. 2009;19(3): Negro R, Gormoso 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): AACE Thyroid Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract. 2002;8(6): Poppe K, Velkeniers B, Glinoer D. Thyroid disease and female reproduction. Clin Endocrinol. 2007;66(3): SP12872_FertilityNurses_0310_k.indd 5 4/8/10 10:53:32 AM
6 9. Negro R, Mangieri T, Coppola L, et al. Levothyroxine treatment in thyroid peroxidase antibody positive women undergoing assisted reproduction technologies: a prospective study. Hum Reprod. 2005;20(6): Resources Beckmann C, Ling F, Barzansky B, et al. Obstetrics and Gynecology. 2nd Ed.;1995: Bussen S, Steck T, Dietl J. Increased prevalence of thyroid antibodies in euthryoid women with a history of recurrent in-vitro fertilization failure. Hum Reprod. 2000;15(3): Geva E, Vardinon N, Lessing JB, et al. Organspecific autoantibodies are possible markers for reproductive failure: A Prospective Study in an In Vitro Fertilization-Embryo Transfer Program. Hum Reprod. 1996;11(8): Kim CH, Chae HD, Kang BM, Chang YS. Influence of antithyroid antibodies in euthryoid women on in vitro fertilization-embryo transfer outcome. Am J Reprod Immunol. 1998;40(1):2-8. Poppe K, Glinoer D, Tournaye H, et al. Assisted reproduction and thyroid autoimmunity: An unfortunate combination? J Clin Endocrinol Metab. 2003;88(9): Poppe K, Velkeniers B, and Glinoer D. The role of thyroid autoimmunity in fertility and pregnancy. Nat Clin Pract Endocrinol Metab. 2008;4(7): Poppe, K, Glinoer D, Tournay H, Schiettecatte J, Haentjens P, Velkeniers B. Thyroid function after assisted reproductive technology in women free of thyroid disease. Fertil Steril. 2005;83(6): Singh A, Dntas ZN, Stone SC, Asch RH. Presence of thyroid antibodies in early reproductive failure: biochemical versus clinical pregnancies. Fertil Steril. 1995;63(2): Vaidya B, Anthony S, Bilous M, et al. Detection of thyroid dysfunction in early pregnancy: universal screening or targeted high-risk case finding. J Clin Endocrinol Metab. 2007;92(1): Kutteh WH, Schoolcraft WB, Scott Jr RT. Antithyroid antibodies do not affect pregnancy outcome in women undergoing assisted reproduction. Hum Reprod. 1999;14(11): Ladenson P, Singer P, Ain K, et al. American Thyroid Association Guidelines for Detection of Thyroid Dysfunction. Arch Intern Med. 2000;160(11): Muller AF, Verhoeff A, Mantel MJ, Berghout A. Thyroid autoimmunity and abortion: A prospective study in women undergoing in vitro fertilization. Fertil Steril. 1999;71(1): Panesar N, Li C, Rogers M. Reference intervals for thyroid hormones in pregnant chinese women. Ann of Clin Biochem. 2001;38(Pt 4): SP12872_FertilityNurses_0310_k.indd 6 4/8/10 10:53:32 AM
7 Walgreens is proud to be part of the following upcoming fertility events for 2010: Pacific Coast Reproductive Society (PCRS) April 14-18, 2010 Renaissance Esmeralda Resort Indian Wells, CA Michigan Reproductive Nurses Association April 17, 2010 Eagle Crest, Marriott Ypsilanti, MI 7.5 REI CEU $70.00 The Midwest Reproductive Symposium and MRS Nurse Practicum June 3-5, 2010 The Drake Hotel Chicago, IL Walgreens is pleased to be the official provider for nurse accreditation at this year s event. UCLA-Santa Barbara Meeting July 11-14, 2010 Four Seasons Biltmore Santa Barbara, CA American Society for Reproductive Medicine Annual Meeting October 23-27, 2010 Colorado Convention Center Denver, CO 7 SP12872_FertilityNurses_0310_k.indd 7 4/8/10 10:53:32 AM
8 This publication does not constitute professional medical advice. Although it is intended to be accurate, neither the publisher nor any other party assumes liability for loss or damage due to reliance on this material. If you have a medical question, consult your medical professional. Brand names are the property of their respective owners. SP SP12872_FertilityNurses_0310_k.indd 8 4/8/10 10:53:32 AM
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 informationHypothyroidism in pregnancy. Nor Shaffinaz Yusoff Azmi Jabatan Perubatan Hospital Sultanah Bahiyah Kedah
Hypothyroidism in pregnancy Nor Shaffinaz Yusoff Azmi Jabatan Perubatan Hospital Sultanah Bahiyah Kedah Agenda 1. Epidemiology and clinical characteristics of maternal hypothyroidism 2. Prevention and
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 informationThyroid function after assisted reproductive technology in women free of thyroid disease
Thyroid function after assisted reproductive technology in women free of thyroid disease Kris Poppe, M.D., a Daniel Glinoer, M.D., Ph.D., b Herman Tournaye, M.D., Ph.D., c Johan Schiettecatte, c Patrick
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 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 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 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 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 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 TSH Analyte Information
Thyroid Function TSH Analyte Information 1 2013-05-01 Thyroid-stimulating hormone (TSH) Introduction Thyroid-stimulating hormone (thyrotropin, TSH) is a glycoprotein with molecular weight of approximately
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 informationDecoding Your Thyroid Tests and Results
Decoding Your Thyroid Tests and Results Wondering about your thyroid test results? Learn about each test and what low, optimal, and high results may mean so you can work with your doctor to choose appropriate
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 informationApproach to thyroid dysfunction
Approach to thyroid dysfunction Alice Y.Y. Cheng, MD, FRCPC Twitter: @AliceYYCheng Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or
More informationThe e-supplementary online content file_1: The Study Protocol
The e-supplementary online content file_1: The Study Protocol Supplement1_English: English Version of the Study Protocol Supplement1_Chinese: Chinese Version of the Study Protocol Supplement1_Ethical Approval:
More informationDISORDERS OF THE THYROID GLAND SIGNS, SYMPTOMS, & TREATMENT ENDOCRINE SYSTEM AT A GLANCE OBJECTIVES ANATOMY OF THE THYROID
OBJECTIVES DISORDERS OF THE THYROID GLAND SIGNS, SYMPTOMS, & TREATMENT Stephanie Blackburn, MHS, MLS(ASCP) CM LSU Health Shreveport Clinical Laboratory Science Program Discuss the synthesis and action
More informationChapter I.A.1: Thyroid Evaluation Laboratory Testing
Chapter I.A.1: Thyroid Evaluation Laboratory Testing Jennifer L. Poehls, MD and Rebecca S. Sippel, MD, FACS THYROID FUNCTION TESTS Overview Thyroid-stimulating hormone (TSH) is produced by the anterior
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 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 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 informationThyroid Disorders. January 2019
Thyroid Disorders January 2019 What is the Thyroid? The thyroid is a small butterfly-shaped gland inside the neck, located in front of the trachea (windpipe) and below the larynx (voicebox). It produces
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 informationThyroid function after controlled ovarian hyperstimulation in women with and without the hyperstimulation syndrome
Thyroid function after controlled ovarian hyperstimulation in women with and without the hyperstimulation syndrome Kris Poppe, M.D., Ph.D., a David Unuane, M.D., a Miguel D Haeseleer, M.D., a Herman Tournaye,
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 informationLABORATORY TESTS FOR EVALUATION OF THYROID DISORDERS
LABORATORY TESTS FOR EVALUATION OF THYROID DISORDERS Maryam Tohidi Anatomical & clinical pathologist Research Institute for Endocrine Sciences THYROID GLAND (15-25 gr), (12-20 gr), 2 lobes connected by
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 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 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 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 informationThyroxine treatment may be useful for subclinical hypothyroidism in patients with female infertility
Endocrine Journal 2015, 62 (1), 87-92 Original Thyroxine treatment may be useful for subclinical hypothyroidism in patients with female infertility Waka Yoshioka, Nobuyuki Amino, Akane Ide, Shino Kang,
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 informationThyroid dysfunction and subfertility
REVIEW pissn 2233-8233 eissn 2233-8241 Clin Exp Reprod Med 2015;42(4):131-135 Thyroid dysfunction and subfertility Moon Kyoung Cho Department of Obstetrics and Gynecology, Chonnam National University Medical
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 informationSlide notes: This presentation provides information on Graves disease, a systemic autoimmune disease. Epidemiology, pathology, complications,
1 This presentation provides information on Graves disease, a systemic autoimmune disease. Epidemiology, pathology, complications, including ophthalmic complications, treatments (both permanent solutions
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 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 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 informationThe interpretation and management of thyroid disorders
Journal of Endocrinology, Metabolism and Diabetes of South Africa 2015 ; 20(2) http://dx.doi.org/10.1080/16089677.2015.1056468 Open Access article distributed under the terms of the Creative Commons License
More informationSample Type - Serum Result Reference Range Units. Central Thyroid Regulation Surrey & Activity KT3 4Q. Peripheral Thyroid D Function mark
Thyroid Plus Sample Type - Serum Result Reference Range Units Central Thyroid Regulation Surrey & Activity KT3 4Q Total Thyroxine (T4)
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 informationThyroid and Antithyroid Drugs. Dr. Alia Shatanawi Feb,
Thyroid and Antithyroid Drugs Dr. Alia Shatanawi Feb, 24 2014 Anatomy and histology of the thyroid gland Located in neck adjacent to the 5 th cervical vertebra (C5). Composed of epithelial cells which
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 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 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 informationLevothyroxine treatment in thyroid peroxidase antibody-positive women undergoing assisted reproduction technologies: a prospective study
Human Reproduction Vol.20, No.6 pp. 1529 1533, 2005 Advance Access publication May 5, 2005 doi:10.1093/humrep/deh843 Levothyroxine treatment in thyroid peroxidase antibody-positive women undergoing assisted
More informationTHYROID HORMONES: An Overview
1 SCHOOL OF MEDICINE AND HEALTH SCIENCES DIVISION OF BASIC MEDICAL SCIENCES DISCIPLINE OF BIOCHEMISTRY AND MOLECULAR BIOLOGY PBL SEMINAR MBBS III; BMLS & BDS Year 3 What are the Thyroid Hormones? THYROID
More informationHyperthyroidism Diagnosis and Treatment. April Janet A. Schlechte, M.D.
Hyperthyroidism Diagnosis and Treatment Family Practice Refresher Course April 2015 Janet A. Schlechte, M.D. Disclosure of Financial Relationships Janet A. Schlechte, M.D. has no relationships with any
More informationThyroid Plus. Central Thyroid Regulation & Activity. Peripheral Thyroid Function. Thyroid Auto Immunity. Key Guide. Patient: DOB: Sex: F MRN:
Thyroid Plus Patient: DOB: Sex: F MRN: Order Number: Completed: Received: Collected: Sample Type - Serum Result Reference Range Units Central Thyroid Regulation & Activity Total Thyroxine (T4) 127 127
More informationUnderstanding Thyroid Labs
Understanding Thyroid Labs Chris Sadler, MA, PA-C, CDE, DFAAPA Senior Medical Science Liaison CVM Janssen Scientific Affairs Diabetes and Endocrine Associates La Jolla, CA Disclosures Employee of Janssen
More informationTHYROID DISEASE IN PREGNANCY
THYROID DISEASE IN PREGNANCY https://www.wddty.com/magazine/2016/june/depression-its-not-your-brain-its-your-thyroid.html Grand Rounds December 5, 2018 Maria Kolojeski, DO (PGY3) REVIEW OF THYROID HORMONES
More informationNone. Thyroid Potpourri for the Primary Care Physician. Evaluating Thyroid Function. Disclosures. Learning Objectives
Thyroid Potpourri for the Primary Care Physician Ramya Vedula DO, MPH, ECNU Endocrinology, Diabetes and Metabolism Princeton Medical Group Assistant Professor of Clinical Medicine Rutgers Robert Wood Johnson
More informationEvaluation of maternal thyroid function during pregnancy: the importance of using gestational age-specific reference intervals
European Journal of Endocrinology (2007) 157 509 514 ISSN 0804-4643 CLINICAL STUDY Evaluation of maternal thyroid function during pregnancy: the importance of using gestational age-specific reference intervals
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 informationThyroid autoimmunity and miscarriage
European Journal of Endocrinology (2004) 150 751 755 ISSN 0804-4643 INVITED REVIEW Thyroid autoimmunity and miscarriage Mark F Prummel and Wilmar M Wiersinga Department of Endocrinology and Metabolism,
More informationHYPERTHYROIDISM. Hypothalamus. Thyrotropin-releasing hormone (TRH) Anterior pituitary gland. Thyroid-stimulating hormone (TSH) Thyroid gland T4, T3
HYPERTHYROIDISM Hypothalamus Thyrotropin-releasing hormone (TRH) Anterior pituitary gland Thyroid-stimulating hormone (TSH) Thyroid gland T4, T3 In hyperthyroidism, there is an increased production of
More informationLimits of Liability/Disclaimer of Warranty
Page 0 of 8 Limits of Liability/Disclaimer of Warranty The author, Brad Shook has made their best effort to produce a high quality and informative reference. The author makes no representation or warranties
More informationEndocrine part two. Presented by Dr. Mohammad Saadeh The requirements for the Clinical Chemistry Philadelphia University Faculty of pharmacy
Endocrine part two Presented by Dr. Mohammad Saadeh The requirements for the Clinical Chemistry Philadelphia University Faculty of pharmacy Cushing's disease: increased secretion of adrenocorticotropic
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 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 informationEvaluation of anti-thyroglobulin antibodies and thyroid stimulating hormone level in cases of recurrent early pregnancy loss
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Elmahdy M et al. Int J Reprod Contracept Obstet Gynecol. 2016 Oct;5(10):3312-3316 www.ijrcog.org pissn 2320-1770 eissn 2320-1789
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 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 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 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 informationGraves Disease. What is Graves disease?
Graves Disease What is Graves disease? The thyroid gland s production of thyroid hormones (T 3 and T 4 ) is triggered by thyroidstimulating hormone (TSH), which is made by the pituitary gland. Graves disease,
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 informationEndocrine secretion cells secrete substances into the extracellular fluid
Animal Hormones Concept 30.1 Hormones Are Chemical Messengers Endocrine secretion cells secrete substances into the extracellular fluid Exocrine secretion cells secrete substances into a duct or a body
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 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 informationTSH and AMH in Infertile Women
The Egyptian Journal of Hospital Medicine (October 2017) Vol.69 (2), Page 1814-1822 TSH and AMH in Infertile Women Hazem Mohamed Sammour, Wessam Magdi Abuelghar, Nermine Essam El-Din Abd El-Salam, Haitham
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 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 informationUnderstanding Your Blood Tests by Larry Levin, MD
Bulletin #42 GRAVES DISEASE & THYROID FOUNDATION Educate * Encourage * Empower P.O. Box 2793 Rancho Santa Fe, CA 92067 (877) 643-3123 www.gdatf.org info@gdatf.org Understanding Your Blood Tests by Larry
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 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 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 informationThyroid Disease. I have no disclosures. Overview TSH. Matthew Kim, M.D. July, 2012
Thyroid Disease I have no disclosures Matthew Kim, M.D. July, 2012 Overview Thyroid Function Tests Hyperthyroidism Hypothyroidism Subclinical Thyroid Disease Thyroid Nodules Questions TSH Best single screening
More informationHORMONES OF THE POSTERIOR PITUITARY
HORMONES OF THE POSTERIOR PITUITARY HORMONES OF THE POSTERIOR PITUITARY In contrast to the hormones of the anterior lobe of the pituitary, those of the posterior lobe, vasopressin and oxytocin, are not
More informationThyroid Gland 甲状腺. Huiping Wang ( 王会平 ), PhD Department of Physiology Rm C541, Block C, Research Building, School of Medicine Tel:
Thyroid Gland 甲状腺 Huiping Wang ( 王会平 ), PhD Department of Physiology Rm C541, Block C, Research Building, School of Medicine Tel: 88208292 Outline Thyroid Hormones Types Biosynthesis Storage and Release
More informationLESSON ASSIGNMENT. Thyroid, Antithyroid, and Parathyroid Preparations. After completing this lesson, you should be able to:
LESSON ASSIGNMENT LESSON 7 Thyroid, Antithyroid, and Parathyroid Preparations. LESSON ASSIGNMENT Paragraphs 7-1 through 7-12. LESSON OBJECTIVES After completing this lesson, you should be able to: 7-1.
More informationDisorders of Thyroid Function
Disorders of Thyroid Function Michael T. McDermott MD Director, Endocrinology and Diabetes Practice University of Colorado Hospital Michael.mcdermott@ucdenver.edu Thyroid Hormone Axis Hypothalamus TRH
More informationUnderactive Thyroid. Diagnosis, Treatment & Controversies
Underactive Thyroid Diagnosis, Treatment & Controversies Dr. Asif Malik Humayun Consultant Endocrinologist Milton Keynes University Hospital NHS Foundation Trust Thyroid Hormone Control of metabolism
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 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 informationNSC 830: Drugs Affecting the Thyroid BROOKE BENTLEY, PHD, APRN
NSC 830: Drugs Affecting the Thyroid BROOKE BENTLEY, PHD, APRN Hypothalamus-Pituitary-Thyroid Hormone Axis TSH: Normal = 0.5-5 mu/l Free T4: 1.3-3.8 ng/dl 1 Hypothyroidism: Thyroid Agents Natural Health
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 informationThyroid and Antithyroid Drugs
Thyroid and Antithyroid Drugs Dr. Yunita Sari Pane, MSi Department of Pharmacology HYPOTHALAMIC PITUITARY THYROID AXIS T3 and T4 are synthesized in the thyroid gland. Inorganic iodine is trapped with great
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 informationTHE THYROID GLAND AND YOUR HEALTH
THE THYROID GLAND AND YOUR HEALTH Your Thyroid is a gland located at the base of your neck, just below your Adam s apple. It is shaped like a butterfly each wing or lobe, of your thyroid lies on either
More informationTHYROID HORMONES & THYROID FUNCTION TESTS
THYROID HORMONES & THYROID FUNCTION TESTS SCHOOL OF MEDICINE AND HEALTH SCIENCES DIVISION OF BASIC MEDICAL SCIENCES DISCIPLINE OF BIOCHEMISTRY AND MOLECULAR BIOLOGY CLINICAL BIOCHEMISTRY LECTURE BMLS III
More informationHypothyroidism and Hyperthyroidism. Paul V. Tomasic, MD, MS, FACP, FACE Nevada AACE EFNE & Annual Meeting October 6, 2018
Hypothyroidism and Hyperthyroidism Paul V. Tomasic, MD, MS, FACP, FACE Nevada AACE EFNE & Annual Meeting October 6, 2018 Disclosures: None related to this program or presentation Objectives: Hypothyroidism
More informationSouthern Derbyshire Shared Care Pathology Guidelines. Hyperthyroidism
Southern Derbyshire Shared Care Pathology Guidelines Hyperthyroidism Purpose of Guideline The management and referral criteria of patients with newly diagnosed hyperthyroidism. Background Hyperthyroidism
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 informationTHYROID AWARENESS. By: Karen Carbone. January is thyroid awareness month. At least 30 million Americans
THYROID AWARENESS By: Karen Carbone January is thyroid awareness month. At least 30 million Americans have a thyroid disorder and half-15 million-are silent sufferers who are undiagnosed, according to
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 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 informationThyroid Gland. Patient Information
Thyroid Gland Patient Information Contact details for Endocrine and Thyroid Clinics Hawke s Bay Fallen Soldiers Memorial Hospital Villa 16 Phone: 06 8788109 ext 5891 Text: 0274 102 559 Email: endoclinic@hbdhb.govt.nz
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 informationSub-clinical hypothyroidism and hyperprolactinemia in infertile women: Bangladesh perspective after universal salt iodination
ISPUB.COM The Internet Journal of Endocrinology Volume 5 Number 1 Sub-clinical hypothyroidism and hyperprolactinemia in infertile women: Bangladesh perspective after universal salt iodination N Akhter,
More information