Endocrine Abstracts

Introduction: Pregnancy is a test for the thyroid, which has many physiological adaptation mechanisms to increased hormonal needs and iodine depletion. These changes expose the pregnant woman to dysthyroidism not devoid of maternal and fetal consequences. The prevalence of clinical and subclinical thyroid insufficiency in pregnant women are 0.3 to 0.7% and 2.2 to 2.5%, respectively. The objective of this study is to evaluate the thyroid status in a population of diabetic pregnant women.

Patients and methods: Cross-sectional, descriptive study, concerning 145 pregnant women followed in gynecology for gestational diabetes. They provided:

• an interrogation: research of the personal and family antecedents of dysthyroidism.• a physical examination of the thyroid gland.• a biological examination: FT4 and TSHus assay. The evaluation of the thyroid status had referred to the recommendations established by the American Association of Clinical Endocrinologists in cooperation with the American Thyroid Association

Results: - 98% of patients have type 2 diabetes No personal or family history of dysthyroidism - Average age (years) = 32.6 ± 4.6 - The mean term of pregnancy (SA) = 25.69 ±7.52 - Distribution of parturients: 28% at T1, 47.7% at T2 and 49.5% at T3. - Average FT4 (pmol/l): 11.35 ± 1.94 (6.16-15.74) (12.35pmol/l at T1, 10.72pmol/l at T2 and 11.9 pmol/l at T3.) Mean TSHus (uIU/ml) = 2.01±0.96 (0.28-5.28) (1.52 uUI/ml at T1, 1.98 uUI/ml at T2 and 2.06 uUI/ml at T3.) Normal thyroid functio n =70% of cases; Hypothyroxinemia = 20.3% Mild hypothyroidism = 9% of cases; Patent hypothyroidism = 0.7%

Discussion: Dysthyroidism is common in our patients, they affected 30% of them. The most common thyroid disorder in our series is hypothyroxinemia, affecting 1 in 5 women. the prevalence of mild hypothyroidism is 9%. Hypothyroidism could have repercussions on the course of pregnancy, the fetal and intellectual development of the child. Currently, it is not recommended to screen for severe hypothyroidism associated with pregnancy, but our study showed a greatly increased prevalence in cases of gestational diabetes, which suggests a control on a larger scale.

Conclusion: Our results show an increased prevalence of unrecognized disorders in the case of gestational diabetes, thus underlining the interest of systematic screening in these women and raising the debate on the means of screening: TSH assay alone or combined with FT4.