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2020, Número 3

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Rev Cuba Endoc 2020; 31 (3)


Factores clínicos y bioquímicos asociados con la tirotropina en embarazadas aparentemente sanas

Leal CL, Gárate SAG, Domínguez AEM, Chávez GL, Chambilla AZ, Robles TE, Bina KD

Idioma: Español
Referencias bibliográficas: 40
Paginas: 1-12
Archivo PDF: 339.79 Kb.


RESUMEN

Introducción: Los valores de tirotropina (TSH) pueden modificarse marcadamente durante el embarazo, en relación con diversos factores clínicos y bioquímicos.
Objetivo: Identificar los factores clínicos y bioquímicos asociados con la tirotropina en embarazadas aparentemente sanas.
Métodos: Estudio descriptivo, transversal, con 247 gestantes aparentemente sanas del municipio Plaza de la Revolución., en el periodo comprendido de septiembre de 2015 a enero de 2019. Variables analizadas: edad materna y gestacional, trimestre del embarazo, color de la piel, paridad, hábito de fumar, antecedentes familiares de enfermedad tiroidea (APF), consumo de suplementos con yodo, índice de masa corporal (IMC), presencia de bocio al examen físico, TSH, tiroxina total (T4t) y libre (T4l), triyodotironina total (T3t) y libre (T3l), gonadotropina coriónica (hCG), anticuerpos contra la peroxidasa tiroidea (AcTPO) y la tiroglobulina (AcTg) y yoduria.
Resultados: La TSH (1,66 ± 0,91mUI/L) tuvo una asociación negativa con la edad materna (r = -0,17; p = 0,008), la paridad (nulíparas 1,80 ± 0,90 mUI/L, multíparas 1,45 ± 0,89 mUI/L; p = 0,003), los APF (positivos 1,56 ± 0,91 mUI/L, negativos 1,81 ± 0,89 mUI/L; p = 0,03), la T4t (r = -0,15; p = 0,02), la T4l (r = -0,23; p = 0,000) y la hCG (r = -0,52; p = 0,001). Mostraron una relación directa la edad gestacional (r = 0,25; p = 0,000) y el uso de suplementos yodados (consumo 1,96 ± 0,72mUI/L, no consumo 1,62 ± 0,93 mUI/L; p = 0,03).
Conclusiones: La tirotropina presenta una relación inversa con la edad materna, la paridad, los antecedentes familiares de enfermedad tiroidea, la T4 total y libre, y la gonadotropina coriónica, y una relación directa con la edad gestacional y el consumo de suplementos con yodo.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Medici M, Korevaar TI, Visser WE, Visser TJ, Peeters RP. Thyroid function in pregnancy: what is normal? Clin Chem. 2015;61(5):704-13.

  2. Hershman JM. The role of human chorionic gonadotropin as a thyroid stimulator in normal pregnancy. J Clin Endocrinol Metab. 2008;93(9):3305-6.

  3. Glinoer D. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocr Rev. 1997;18(3):404-33.

  4. Haddow JE, Knight GJ, Palomaki GE, McClain MR, Pulkkinen AJ. The reference range and within-person variability of thyroid stimulating hormone during the first and second trimesters of pregnancy. J Med Screen. 2004;11(4):170-4.

  5. Glinoer D, de Nayer P, Bourdoux P, Lemone M, Robyn C, van Steirteghem A, et al. Regulation of maternal thyroid during pregnancy. J Clin Endocrinol Metab. 1990;71(2):276-87.

  6. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017;27(3):315-89.

  7. McNeil AR, Stanford PE. Reporting Thyroid Function Tests in Pregnancy. Clin Biochem Rev. 2015;36(4):109-26.

  8. Dashe JS, Casey BM, Wells CE, McIntire DD, Byrd EW, Leveno KJ, et al. Thyroid - stimulating hormone in singleton and twin pregnancy: importance of gestational age-specific reference ranges. Obstet Gynecol. 2005;106(4):753-7.

  9. Walker JA, Illions EH, Huddleston JF, Smallridge RC. Racial comparisons of thyroid function and autoimmunity during pregnancy and the postpartum period. Obstet Gynecol. 2005;106(6):1365-71.

  10. La'ulu SL, Roberts WL. Ethnic differences in first trimester thyroid reference intervals. Clin Chem. 2011;57(6):913-5.

  11. Sawicka-Gutaj N, Gutaj P, Sowioski J, Wender-Ozegowska E, Czarnywojtek A, Brazert J, et al. Influence of cigarette smoking on thyroid gland-an update. Endokrynol Pol. 2014;65(1):54-62.

  12. Bivolarska A, Gatseva P, Nikolova J, Argirova M, Atanasova V. Effect of thiocyanate on iodine status of pregnant women. Biol Trace Elem Res. 2015;172(1):101-7.

  13. Pearce EN, Oken E, Gillman MW, Lee SL, Magnani B, Platek D, Braverman LE. Association of first-trimester thyroid function test values with thyroperoxidase antibody status, smoking, and multivitamin use. Endocr Pract. 2008;14(1):33-9.

  14. Kumar S, Chiinngaihlun T, Rameswar Singh M, Punyabati O. Correlation of Body Mass Index (BMI) with Thyroid Function in Euthyroid Pregnant Women in Manipur, India. J Clin Diagn Res. 2017;11(4):13-15.

  15. Mosso L, Martínez A, Rojas MP, Latorre G, Margozzini P, Lyng T, et al. Early pregnancy thyroid hormones reference ranges in Chilean women: influence of body mass index. Clin Endocrinol (Oxf). 2016;85(6):942-8.

  16. Laurberg P, Linding S, Hindersson P, Nohr EA, Olsen J. Dynamics and Predictors of Serum TSH and fT4 Reference Limits in Early Pregnancy: A Study Within the Danish National Birth Cohort J Clin Endocrinol Metab. 2016;101(6):2484-92.

  17. Pearce EN, Lazarus JH, Moreno-Reyes R, Zimmermann MB. Consequences of iodine deficiency and excess in pregnant women: an overview of current knowns and unknowns. Am J Clin Nutr. 2016;104(S3):918-23.

  18. Abel MH, Korevaar TIM, Erlund I, Villanger GD, Caspersen IH, Arohonka P, et al. Iodine Intake is Associated with Thyroid Function in Mild to Moderately Iodine Deficient Pregnant Women. Thyroid. 2018;28(10):1359-71.

  19. Korevaar TIM, Medici M, Visser TJ, Peeters RP. Thyroid disease in pregnancy: new insights in diagnosis and clinical management. Nat Rev Endocrinol. 2017;13(10):610-22.

  20. Lambert-Messerlian G, McClain M, Haddow JE, Palomaki GE, Canick JA, Cleary-Goldman J, et al. FaSTER Research Consortium. First- and second trimester thyroid hormone reference data in pregnant women: a FaSTER (First- and Second-Trimester Evaluation of Risk for aneuploidy) Research Consortium study. Am J Obstet Gynecol. 2008;199(3):62.e1-6.

  21. Pekonen F, Alfthan H, Stenman UH, Ylikorkala O. Human chorionic gonadotropin (hCG) and thyroid function in early human pregnancy: circadian variation and evidence for intrinsic thyrotropic activity of hCG. J Clin Endocrinol Metab. 1988;66(4):853-6.

  22. Thienpont LM, Van Uytfanghe K, Beastall G, Faix JD, Ieiri T, Miller WG, et al. Report of the IFCC Working Group for Standardization of Thyroid Function Tests; Part 1: Thyroid-stimulating hormone. Clin Chem. 2010;56:902-11.

  23. Carmenate Milián L, Moncada Chévez FA, Borjas Leiva EW. Manual de medidas antropométricas. Costa Rica: SALTRA; 2014.

  24. World Health Organization, United Nations Children's Fund, International Council for the Control of Iodine Deficiency Disorders. Indicators for assessment of iodine deficiency disorders and their control programmes: Report of a joint WHO/UNICEF/ICCIDD Consultation. Geneva: World Health Organization; 1993.

  25. Dunn JT, Crutchfield HE, Gutekunst R, Dunn A. Two simple methods for measuring iodine in urine. Thyroid. 1993;3(2):119-23.

  26. Potlukova E, Potluka O, Jiskra J, Limanova Z, Telicka Z, Bartakova J, et al. Is age a risk factor for hypothyroidism in pregnancy? An analysis of 5223 pregnant women. J Clin Endocrinol Metab. 2012;97(6):1945-52.

  27. Ehrenkranz J, Bach PR, Snow GL, Schneider A, Lee JL, Ilstrup S, et al. Circadian and circannual rhythms in thyroid hormones: determining the TSH and free T4 reference intervals based upon time of day, age, and sex. Thyroid. 2015;25(8):954-61.

  28. Bliddal S, Boas M, Hilsted L, Friis-Hansen L, Tabor A, Feldt-Rasmussen U. Thyroid function and autoimmunity in Danish pregnant women after an iodine fortification program and associations with obstetric outcomes. Eur J Endocrinol. 2015;173(6):709-18.

  29. Fu J, Yang A, Zhao J, Zhu Y, Gu Y, Xu Y, et al. The relationship between iron level and thyroid function during the first trimester of pregnancy: A cross-sectional study in Wuxi, China, J Trace Elem Med Biol. 2017;43:148-52.

  30. De Oliveira NA, Almeida de Assis AS, Martins C, Ayres D, Martins T, Donner de Drummond C, et al. TSH range of pregnant women in Rio de Janeiro. Arch Endocrinol Metab. 2018;62(4):386-91.

  31. Sekhri T, Juhi JA, Wilfred R, Kanwar RS, Sethi J, Bhadra K, et al. Trimester specific reference intervals for thyroid function tests in normal Indian pregnant women. Indian J Endocr Metab. 2016;20(1):101-7.

  32. Han C, Li C, Mao J, Wang W, Xie X, Zhou W, et al. High Body Mass Index Is an Indicator of Maternal Hypothyroidism, Hypothyroxinemia, and Thyroid-Peroxidase Antibody Positivity during Early Pregnancy. BioMed Res Int. 2015;351-831.

  33. Collares FM, Korevaar TIM, Hofman A, Steegers EAP, Peeters RP, Jaddoe VWV, et al. Maternal Thyroid Function, Prepregnancy Obesity and Gestational Weight Gain - The Generation R Study: a prospective cohort study. Clin Endocrinol (Oxf). 2017;87(6):799-806.

  34. Korevaar TI, Medici M, de Rijke YB, Visser W, de Muinck Keizer-Schrama SM, Jaddoe VW, et al. Ethnic differences in maternal thyroid parameters during pregnancy: the Generation R study. J Clin Endocrinol Metab. 2013;98(9):3678-86.

  35. Pessah-Pollack R, Cocks Eschler D, Pozharny Z, Davies T. Apparent Insufficiency of Iodine Supplementation in Pregnancy. J Women's Health (Larchmt). 2014;23(1):51-6.

  36. Korevaar T, de Rijke YB, Chaker L, Medici M, Jaddoe VW, Steegers EA, et al. Stimulation of thyroid function by hCG during pregnancy: a risk factor for thyroid disease and a mechanism for known risk factors. Thyroid. 2017;27(3):440-50.

  37. Moncayo R, Zanonb B, Heimc K, Ortner K, Moncayo H. Thyroid function parameters in normal pregnancies in an iodine sufficient population. BBA Clinical. 2015;3:90-5.

  38. Leal Curí L, Bina Konaré D, Navarro Despaigne D, Terry Berro B, Domínguez Alonso E, Turcios Tristá SE, et al. Iodine nutrition, function, and volume of the thyroid gland in healthy pregnant women. Rev Mex Endocrinol Metab Nutr. 2019;6(1):5-12.

  39. Wolff J, Chaikoff IL, Goldberg RC, Meier JR. The temporary nature of the inhibitory action of excess iodide on organic iodine synthesis in the normal thyroid. Endocrinology. 1949;45(5):504-13.

  40. Salvatore D, Davies TF, Schlumberger MJ, Hay ID, Larsen PR. Thyroid Physiology and Diagnostic Evaluation of Patients With Thyroid Disorders. En: Melmed S, Polonsky KS, Reed Larsen P, Kronenberg HM, editors. Williams Textbook of Endocrinology. 13ed. Philadelphia: Elsevier; 2016. p. 334-68.




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