Endocrine Abstracts

Introduction: Thyroid disease in pregnancy is a common clinical problem, at least 2–3% of women have thyroid dysfunction, and it is estimated that about 5–20% of women of reproductive age suffer from autoimmune thyroid disease. Subclinical thyroid disease during pregnancy may be associated with adverse outcomes. In the first trimester, the ‘normal’ range for TSH is reduced to 0.1–2.5 mIU/l, and in the second and third trimester is 3.0 mIU/l.

Aim: The aim of this study is to analyse concentration of thyroid hormones and the presence of TPOAb, and determine thyroid function in relation to pregnancy outcome.

Matherial and methods: This study included 77 healthy pregnant women in the first trimester of pregnancy registered in Center for endocrinology CC Kragujevac. Blood samples were collected for fT4, TSH and TPOAb and measured by RIA method. As parameters of adverse outcomes we included: premature labor (before 37 gw., Low Apgar score (<8), neonatal malformations, respiratory complications, hypoglycemia, birth body weight> 4000 g or <2500 g, hyperbilirubinemia

Results: The mean age of patients was 30.8±4.7 years. The prevalence of autoimmune thyroid disease was 25.9%, positive family history for thyroid disorder was in 9%, smoking in 23.4% patients. The average serum level in patients with adverse outcomes (n=41) for fT4 was 10.7±2.46 pg/ml, for TSH was 2.52±1.1 mIU/l, and for TPOAb was 737, while in group with a favorable outcome (n=36) average serum level for fT4 was 10.2±2.1 pg/ml, for TSH was 2.25±1.2 mIU/l, and for TPOAb was 474. It has been shown that the number of risk factors significantly affect the outcome of pregnancy (P<0.005, χ² test), and that the presence of TPOAb as marker of autoimmune thyroid disease during pregnancy affect the outcome of pregnancy (24,4% patients with a favorable outcome and 27,7% patients with adverse outcomes had positive TPOAb). It has been shown that patients without TPOAb usually have a favorable outcome of pregnancy, and a growing number of pregnancies with an adverse outcome in patients with TPOAb.

Conclusion: This study demonstrates that the presence of TPOAb as marker of autoimmune thyroid disease during pregnancy predicts unfavorable adverse outcome.

Keywords: thyroid function, pregnancy, outcome