medigraphic.com

2020, Number 3

<< Back

Rev Cuba Endoc 2020; 31 (3)

Clinical and biochemical factors associated with thyrotropin in seemingly healthy pregnant women

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

Language: Spanish
References: 40
Page: 1-12
PDF size: 339.79 Kb.


ABSTRACT

Introduction: Thyrotropin (TSH) values can be sharply modified during pregnancy, in relation to various clinical and biochemical factors.
Objective: Identify clinical and biochemical factors associated with thyrotropin in seemingly healthy pregnant women.
Methods: Descriptive, cross-sectional study with 247 seemingly healthy pregnant women from Plaza de la Revolution municipality in the period from September 2015 to January 2019. Variables analyzed: maternal and gestational age, trimester of pregnancy, skin color, pregnancies, smoking habit, family history of thyroid disease (APF), consumption of iodine supplements, body mass index (BMI), presence of goiter to physical examination, TSH, total and free (T4l) thyroxine (T4t), total (T3t) and free (T3l) triiodothyronine, chorionic gonadotropin (hCG), antibodies against thyroid peroxidase (AcTPO) and thyroglobulin (AcTg) and urinary iodine.
Results: TSH (1.66 ± 0.91mUI/L) had a negative association with maternal age (r = -0.17; p x 0.008), pregnancy (nulliparas 1.80 ± 0.90 mUI/L, 1.45 ± 0.89 mUI/L; p x 0.003), APF (positive 1.56 ± 0.91 mUI/L, negative 1.81 ± 0.89 mUI/L; p x 0.03), the T4t (r = -0.15; p s 0.02), the T4l (r = -0.23; p x 0.000) and the hCG (r = -0.52; p x 0.001). They showed a direct relationship with gestational age (r x 0.25; p x 0.000) and the use of iodine supplements (consumption 1.96 ± 0.72mUI/L, not consumption 1.62 ± 0.93 mUI/L; p x 0.03).
Conclusions: Thyrotropin has an inverse relationship with maternal age, pregnancies, family history of thyroid disease, total and free T4, and chorionic gonadotropin, and a direct relationship with gestational age and consumption of iodine supplements.


REFERENCES

  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.




2020     |     www.medigraphic.com