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European Review For Medical and... 2015Thyroid disease is the second most common endocrine condition in women of childbearing age. Thyroid hormones are involved in control of menstrual cycle and in achieving... (Review)
Review
OBJECTIVE
Thyroid disease is the second most common endocrine condition in women of childbearing age. Thyroid hormones are involved in control of menstrual cycle and in achieving fertility affecting the actions of follicle-stimulating hormone and luteinizing hormone on steroid biosynthesis by specific triiodothyronine sites on oocytes; therefore, affect all aspects of reproduction. It remains controversial if pregnant women should be screened for thyroid dysfunction. Purpose of this review was to examine recent studies on the assessment of thyroid dysfunction in pregnancy, its treatment and newly perspective of thyroid autoimmunity in pregnant euthyroid women in achieving fertility.
METHODS
An electronic search was conducted using the internet medical databases: Medline/PubMed, EMBASE, EBSCO, and the Cochrane library.
RESULTS
Thyroid gland faces great challenge in pregnancy when many hormonal changes occur. Precondition for normal follicular development and ovulation is pulsate gonadothropin realizing hormone secretion. Thyroid dysfunction in pregnancy is classified as forms of hypothyroidism (positivity of thyroid autoantibody, isolated hypothyroidism, and subclinical or overt hypothyroidism), hyperthyroidism, and autoimmune disease, but also thyroid nodules and cancer, iodine insufficiency and postpartum thyroiditis. These conditions can cause adverse effects on mother and fetus including pregnancy loss, gestational hypertension, or pre-eclampsia, pre-term delivery, low birth weight, placental abruption and postpartum hemorrhage. There is an evidence that thyroid autoimmunity, in thyroid dysfunction adversely affects conception and pregnancy outcomes, but it is unclear what impact has isolated eumetabolic thyroid autoimmunity in achieving fertility, especially in women undergoing in vitro fertilization. Treatment of euthyroid pregnant women with positive thyroid peroxides antibodies is still controverse, but not few studies show that levothyroxine substitution is able to lower the chance of miscarriage and premature delivery.
CONCLUSIONS
Further randomized trials are needed to expand our knowledge of physiologic changes in thyroid function during the pregnancy and to reveal mechanisms by which thyroid autoimmunity in euthyroid women affect fertility, especially the success of assisted reproductive technology in achieving the same and validity of levothyroxine administration in thyroid autoimmunity positive women.
Topics: Adult; Autoimmune Diseases; Female; Follicle Stimulating Hormone; Humans; Hypothyroidism; Infertility, Female; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Randomized Controlled Trials as Topic; Reproductive Techniques, Assisted; Thyroid Diseases
PubMed: 25855922
DOI: No ID Found -
Nutrients Sep 2020Vitamin D is a steroid hormone traditionally connected to phosphocalcium metabolism. The discovery of pleiotropic expression of its receptor and of the enzymes involved... (Review)
Review
Vitamin D is a steroid hormone traditionally connected to phosphocalcium metabolism. The discovery of pleiotropic expression of its receptor and of the enzymes involved in its metabolism has led to the exploration of the other roles of this vitamin. The influence of vitamin D on autoimmune disease-namely, on autoimmune thyroid disease-has been widely studied. Most of the existing data support a relationship between vitamin D deficiency and a greater tendency for development and/or higher titers of antibodies linked to Hashimoto's thyroiditis, Graves' disease, and/or postpartum thyroiditis. However, there have also been some reports contradicting such relationships, thus making it difficult to establish a unanimous conclusion. Even if the existence of an association between vitamin D and autoimmune thyroid disease is assumed, it is still unclear whether it reflects a pathological mechanism, a causal relationship, or a consequence of the autoimmune process. The relationship between vitamin D's polymorphisms and this group of diseases has also been the subject of study, often with divergent results. This text presents a review of the recent literature on the relationship between vitamin D and autoimmune thyroid disease, providing an analysis of the likely involved mechanisms. Our thesis is that, due to its immunoregulatory role, vitamin D plays a minor role in conjunction with myriad other factors. In some cases, a vicious cycle is generated, thus contributing to the deficiency and aggravating the autoimmune process.
Topics: Graves Disease; Humans; Thyroiditis, Autoimmune; Vitamin D; Vitamin D Deficiency; Vitamins
PubMed: 32933065
DOI: 10.3390/nu12092791 -
Frontiers in Endocrinology 2021Hypothyroidism in the first trimester of pregnancy (T1) has great adverse effects on mothers and foetuses. However, few studies have investigated the influence on...
BACKGROUND
Hypothyroidism in the first trimester of pregnancy (T1) has great adverse effects on mothers and foetuses. However, few studies have investigated the influence on postpartum thyroid dysfunction. This study aimed to evaluate their long-term effect on postpartum thyroid function within one year after delivery.
METHODS
In total, 151 women were recruited from 1496 participants and were classified as newly diagnosed subclinical hypothyroidism (SCH) in T1 (ND-SCH, n=50), previously known SCH before pregnancy (PK-SCH, n=51) and previously known overt hypothyroidism (PK-OH, n=50). Their thyroid functions were dynamically monitored from pre-conception to one-year postpartum.
RESULTS
During pregnancy, the first thyroid functions' test time in T1 were 5-8 gestational weeks. After delivery, the prevalence of postpartum thyroiditis (PPT) was comparable in women with previously known and newly diagnosed hypothyroidism [ND-SCH 62.0% PK-SCH 64.7% PK-OH 64.0%, P=0.96]. For the ND-SCH group, PPT was significantly related with thyroid-stimulating hormone (TSH) >4.0 mU/L occurring at <8 gestational weeks [OR=8.06, 95% CI, 2.08-31.29] and TSH levels outside 1.0-2.5 mU/L near childbirth [OR=3.73, 95% CI, 1.04-13.41]. For patients with known hypothyroidism before pregnancy (PK-SCH and PK-OH), TSH>2.5 mU/L in T1 [OR=3.55, 95% CI, 1.43-8.81] and TPOAb≥300 μIU/mL [OR=6.58, 95% CI, 2.05-21.12] were associated with PPT. Regardless of whether SCH was diagnosed before pregnancy or in T1, the levothyroxine (LT4) treatment was discontinued at delivery. More than 50% of the patients had to face the hypothyroidism phase of postpartum and restarted LT4 treatment in the first-year follow-up. The logistic regression analysis revealed that TSH elevation occurring at <8 gestational weeks [OR=2.48, 95% CI, 1.09-5.6], TSH levels outside 1.0-2.5 mU/L near childbirth [OR=3.42, 95% CI, 1.45-8.05], and TPOAb≥300 μIU/mL [OR=6.59, 95% CI, 1.79-24.30] were the risk factors.
CONCLUSION
TSH elevation at <8 gestational weeks was associated with PPT after delivery in women with known and newly diagnosed hypothyroidism. Especially for SCH patients who stopped LT4 treatment at delivery, unsatisfactory TSH level at <8 gestational weeks and near childbirth, TPOAb≥300 μIU/mL were the risk factors for LT4 retreatment in one-year postpartum.
Topics: Adult; China; Female; Gestational Age; History, 21st Century; Hormone Replacement Therapy; Humans; Hypothyroidism; Postpartum Thyroiditis; Pregnancy; Pregnancy Complications; Pregnancy Trimester, First; Prenatal Diagnosis; Prevalence; Puerperal Disorders; Retrospective Studies; Thyroid Function Tests; Thyroxine; Young Adult
PubMed: 34899598
DOI: 10.3389/fendo.2021.746329 -
Frontiers in Endocrinology 2019The post-partum period is an immunologically peculiar period in a woman's life. Indeed, most of the pregnancy-related immune changes gradually revert in the 12 months... (Review)
Review
The post-partum period is an immunologically peculiar period in a woman's life. Indeed, most of the pregnancy-related immune changes gradually revert in the 12 months following delivery. Although the post-partum period has long been identified as a period of aggravation of autoimmune thyroid diseases, most of the currently available studies took into account the relationship between post-partum and autoimmune thyroiditis. More recently, the potential repercussions of the post-partum period on Graves' disease were also taken into account. The present mini review will briefly overview the most recent advances in our knowledge of the immunology of the post-partum period in relation with the potential repercussions on the clinical course of Graves' disease. Moreover, some peculiar aspects of post-partum Graves' disease in terms of clinical and biochemical presentation, diagnostic challenges, and specific therapeutic considerations also taking into account the recommendation of the latest clinical guidelines on the management of thyroid diseases in pregnancy will be overviewed.
PubMed: 31920967
DOI: 10.3389/fendo.2019.00853 -
Neuro Endocrinology Letters Jul 2016The purpose of this literature review was to examine the available clinical studies performed during the last 15 years to identify if there is a causal relationship... (Meta-Analysis)
Meta-Analysis Review
The purpose of this literature review was to examine the available clinical studies performed during the last 15 years to identify if there is a causal relationship between the onset and course of autoimmune thyroid diseases (AITDs) and the hypothalamic-pituitary-adrenal (HPA) axis/sympathetic-adrenomedullary system (SAM) (dys)function in women. Using the PubMed, Web of Science and Scopus databases, a comprehensive search was performed, and 14 articles were finally identified. The majority of selected studies suggested a causal connection between Graves' Disease (GD) and stress, as well as between Hashimoto Thyroiditis (HT), with its variant postpartum thyroiditis, and stress. However, due to heterogeneity in the protocols, mainly based on the theoretical side effects of stress on the immune-neuroendocrine system, and the different modalities used to establish the impact of stress on individuals, no definitive conclusions could be reached to explain the mechanisms by which stress contributes to the onset of AITDs in women and to determine whether stress management could help in modifying the course of AITDs.
Topics: Female; Humans; Stress, Psychological; Thyroiditis, Autoimmune
PubMed: 27618605
DOI: No ID Found -
Clinical Endocrinology Dec 2021Postpartum women experience thyroid dysfunction at twice the prevalence of the general population. Adequate biosynthesis of thyroid hormones depends on three trace... (Observational Study)
Observational Study
OBJECTIVE
Postpartum women experience thyroid dysfunction at twice the prevalence of the general population. Adequate biosynthesis of thyroid hormones depends on three trace elements: iodine, selenium and iron. This study aimed to investigate thyroid dysfunction within a cohort of women at six months postpartum in relation to iodine, selenium and iron status.
DESIGN
This cross-sectional study was part of an observational longitudinal cohort Mother and Infant Nutrition Investigation; data obtained at six months postpartum are reported.
SUBJECTS
Mother-infant pairs (n = 87) were recruited at three months postpartum and followed up at six months postpartum (n = 78).
MEASUREMENTS
Thyroid hormones (free triiodothyronine, free thyroxine, thyroid-stimulating hormone) and thyroid peroxidase antibodies were measured. Urinary iodine concentration, breast milk iodine concentration, serum thyroglobulin, plasma selenium, serum ferritin and serum soluble transferrin receptors were determined. Nonparametric data were expressed as median (25th, 75th percentile).
RESULTS
Thyroid dysfunction was found in 18% of women, and 4% of women had iron deficiency. Median urinary iodine concentration was 85 (43, 134) µg/L, median breast milk iodine concentration was 59 (39, 109) µg/L, and median serum thyroglobulin at 11.4 (8.6, 18.6) µg/L, indicating iodine deficiency. Median plasma selenium concentration was 105.8 (95.6, 115.3) µg/L. Women with marginally lower plasma selenium concentration were 1.12% times more likely to have abnormal TSH concentrations (p = .001).
CONCLUSIONS
There was a high prevalence of thyroid dysfunction. Plasma selenium concentration was the only significant predictor of the likelihood that women had thyroid dysfunction within this cohort, who were iodine deficient and mostly had adequate iron status. Strategies are required to improve both iodine and selenium status to better support maternal thyroid function.
Topics: Cross-Sectional Studies; Female; Humans; Iodine; Iron; Nutritional Status; Postpartum Period; Prevalence; Selenium; Thyroid Gland; Thyrotropin; Thyroxine
PubMed: 34008190
DOI: 10.1111/cen.14502 -
Endocrine Practice : Official Journal... Jun 2022Women with hypothyroidism need to increase exogenous thyroid hormone levels during pregnancy to reduce adverse outcomes. Few studies have reported the effect of...
OBJECTIVE
Women with hypothyroidism need to increase exogenous thyroid hormone levels during pregnancy to reduce adverse outcomes. Few studies have reported the effect of gestational levothyroxine (LT4) variations on postpartum LT4 treatment.
METHODS
Women were classified as having subclinical hypothyroidism (SCH) (n = 101), overt hypothyroidism (OH) caused by autoimmune thyroiditis (AIT-OH), OH following thyroidectomy for benign thyroid disease (BA-OH) (n = 66), and OH after surgery for papillary thyroid cancer (PTC-OH) (n = 46). Thyroid function was monitored, and LT4 therapy was adjusted accordingly.
RESULTS
After delivery, all women with SCH stopped LT4 treatment, and 57.4% of them restarted LT4 treatment in the following 1 year, independently of the gestational LT4 variations. Among patients with OH, after adjusted by gestational body weight, 49.1% of them had LT4 doses less than the prepregnancy dose (baseline) in late pregnancy, leading to LT4 reduction in postpartum. The LT4 dose was reduced to approximately 50% baseline for women with AIT-OH and BA-OH and reduced by 27% for women with PTC-OH. The reduction reasons for AIT-OH and BA-OH were thyroid-stimulating hormone levels of <2.5 mU/L during pregnancy and postpartum thyrotoxicosis occurrence (39.4%), and for PTC-OH, the reason was thyroid-stimulating hormone overinhibition (<1.0 mU/L) before delivery.
CONCLUSION
For patients with SCH, postpartum LT4 treatment could initially be suspended. For women with OH, if the LT4 dose in late pregnancy was less than baseline, a prepregnancy dose reduced by 50%, 50%, and 27% should be applied after delivery for women with AIT-OH, BA-OH, and PTC-OH, respectively.
Topics: Female; Humans; Hypothyroidism; Postpartum Period; Pregnancy; Pregnancy Complications; Thyroid Neoplasms; Thyrotropin; Thyroxine
PubMed: 35278704
DOI: 10.1016/j.eprac.2022.03.002 -
Endocrine Practice : Official Journal... Jan 2019To review the diagnosis and management of thyrotoxicosis in women who are preconception, pregnant, and in the postpartum period.
OBJECTIVE
To review the diagnosis and management of thyrotoxicosis in women who are preconception, pregnant, and in the postpartum period.
METHODS
Literature review of English-language papers published between 1980 and 2018.
RESULTS
Overt thyrotoxicosis occurs in 0.2% of pregnancies and subclinical thyrotoxicosis in 2.5%. Hyperthyroidism in women of childbearing age most frequently is caused by Graves disease (GD). Gestational thyrotoxicosis, transient human chorionic gonadotropin (hCG)-mediated hyperthyroidism, may develop in the first trimester. In the first year following delivery, postpartum thyroiditis, which frequently includes a thyrotoxic phase, occurs in 5% of women. Hyperthyroidism from nodular autonomy is uncommon in women of childbearing age. It is essential to understand the underlying etiology for thyrotoxicosis in order to recommend appropriate treatment. Gestational thyrotoxicosis requires supportive care, without antithyroid drug therapy. GD may be treated with antithyroid drugs, radioactive iodine, or thyroidectomy. Pregnancy, plans for pregnancy, and lactation have important implications for the choice of GD treatment. When thyrotoxicosis presents following delivery, postpartum thyroiditis must be differentiated from GD.
CONCLUSION
The diagnosis and management of thyrotoxicosis in the peripregnancy period present specific challenges. In making management decisions, it is essential to weigh the risks and benefits of treatments not just for the mother but also for the fetus and for breastfed infants. A team approach to management is critical, with close collaboration among endocrinologists, maternal-fetal medicine specialists, and neonatologists.
ABBREVIATIONS
GD = Graves disease; hCG = human chorionic gonadotropin; MMI = methimazole; PPT = postpartum thyroiditis; PTU = propylthiouracil; T3 = triiodothyronine; T4 = thyroxine; TBG = thyroxine-binding globulin; TRAb = TSH receptor antibody; TSH = thyroid-stimulating hormone.
Topics: Antithyroid Agents; Female; Graves Disease; Humans; Postpartum Period; Pregnancy; Pregnancy Complications; Thyrotoxicosis; Thyroxine
PubMed: 30289300
DOI: 10.4158/EP-2018-0356 -
Journal of Thyroid Research 2018Different types of thyroiditis may share some parallel clinical and biochemical features. Timely intervention can significantly reduce morbidity and mortality.
INTRODUCTION
Different types of thyroiditis may share some parallel clinical and biochemical features. Timely intervention can significantly reduce morbidity and mortality.
AIM
Aim of this study is to find the frequency of various thyroiditis, study the cytomorphological features and correlate with clinical findings including radiological findings, thyroid function test, and anti-thyroid peroxidase antibodies (Anti-TPO antibodies).
MATERIALS AND METHODS
The study included consecutive 110 cases of thyroiditis. Detailed cytomorphological features were studied and correlated with ultrasonography findings, thyroid function test, anti-thyroid peroxidase antibodies (anti-TPO) and histopathological features where thyroidectomy specimens were received for histopathological examination.
RESULTS
The majority were Hashimoto's thyroiditis ( = 100) and females ( = 103). Other forms of thyroiditis were Hashimoto's thyroiditis with colloid goiter ( = 5), De Quervain's thyroiditis ( = 3), and one case each of postpartum thyroiditis and Hashimoto's thyroiditis with associated malignancy. The majority of patients were in the age group of 21-40 ( = 70) and the majority ( = 73) had diffuse enlargement of thyroid. The majority of patients were hypothyroid ( = 52). The serum anti-TPO antibodies were elevated in 47 patients out of 71 patients. In the 48 patients who underwent ultrasonography, 38 were diagnosed as having thyroiditis. The most consistent cytomorphological features seen in fine-needle aspiration smears of Hashimoto's thyroiditis were increased background lymphocytes, lymphocytic infiltration of thyroid follicular cell clusters, and Hurthle cells.
CONCLUSION
The diagnostic cytological features in Hashimoto's thyroiditis are increased background lymphocytes, lymphocytic infiltration of thyroid follicular cell clusters, and Hurthle cells. FNAC remains the "Gold Standard" for diagnosing Hashimoto's thyroiditis. Clinical history, thyroid function, and biochemical parameters are the key for diagnosis of other forms of thyroiditis.
PubMed: 29686830
DOI: 10.1155/2018/5246516 -
Human Immunology Oct 2023Autoimmune thyroid disease (AITD) is a T lymphocytes-mediated autoimmune disorder affecting pregnant women. The current study sought to determine the correlations...
Th1 or Th2 cytokines are correlated with Tregs and T cell subsets and pregnancy outcomes in patients with autoimmune thyroid disease during early, middle, late pregnancy, and postpartum period.
Autoimmune thyroid disease (AITD) is a T lymphocytes-mediated autoimmune disorder affecting pregnant women. The current study sought to determine the correlations between T helper-1 (Th1)/T helper-2 (Th2) cytokines and regulatory T cells (Tregs) and T cell subsets and pregnancy outcomes in AITD patients during early pregnancy (T1), middle pregnancy (T2), late pregnancy (T3), and postpartum period (PP). A total of 60 patients with Graves' disease, 60 patients with Hashimoto's thyroiditis, and 30 healthy pregnant women were initially enrolled in the study. Thyroid hormones and antibodies, Th1 or Th2 cytokines, transforming growth factor-β, Tregs, CD4 T helper cells (CD4), CD8 T helper cells (CD8) levels were determined by means of Maglumi2000 automatic chemiluminescence instrument, enzyme-linked immunosorbent assay, and flow cytometry. Our findings demonstrated higher IFN-γ and IL-2 levels, along with lower IL-4, IL-10, TGF-β, Treg, and CD4/CD8 levels in AITD patients during T1, T2, T3, and PP. Furthermore, the TGF-β, Treg, and CD4/CD8 levels were lower in the IFN-γ/IL-2 high expression group but higher in the IL-4/IL-10 high expression group. The IFN-γ and IL-2 levels were higher, while IL-4 and IL-10 level were lower in AITD patients with adverse pregnancy outcomes. Lastly, Th1 cytokines were higher and Th2 cytokines were lower in AITD patients and elicited correlation with Tregs and CD4/CD8 levels. Collectively, our findings highlighted that up-regulation of Th1 cytokines may increase the percentage of adverse pregnancy outcomes in AITD patients.
Topics: Humans; Female; Pregnancy; Cytokines; Interleukin-10; Interleukin-2; Th1 Cells; Pregnancy Outcome; Interleukin-4; T-Lymphocyte Subsets; Hashimoto Disease; T-Lymphocytes, Regulatory; Graves Disease; Th17 Cells; Postpartum Period; Transforming Growth Factor beta
PubMed: 37563064
DOI: 10.1016/j.humimm.2023.07.002