Association of subclinical thyroid disorder in hypertensive pregnant women attending a tertiary care hospital

Fahmida Sultana Mili; Sumona Yesmin; Iftekhar Ahmed; Hlakhing Sen Shoma; Najmatun Jikria; Jesmine Ara Haque; Tasrina Akter

doi:10.18203/2320-1770.ijrcog20261254

Authors

Fahmida Sultana Mili Department of Obstetrics and Gynecology, Chittagong Medical College Hospital, Chittagong. Bangladesh
Sumona Yesmin 250 Bed General Hospital, Munshigan, Bangladesh
Iftekhar Ahmed Department of Orthopaedic Surgery, Chittagong Medical College Hospital, Chittagong, Bangladesh
Hlakhing Sen Shoma Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Dhaka, Bangladesh
Najmatun Jikria 250 Beded Sadar Hospital, Naogaon, Bangladesh
Jesmine Ara Haque Institute of Nuclear Medicine and Allied Sciences, Dhaka, Bangladesh
Tasrina Akter Department of Gynaecology and Obstetrics, Nottingham University Hospitals NHS Trust, City Campus Nottingham, United Kingdom

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20261254

Keywords:

Subclinical thyroid disorder, Hypertension in pregnancy, Thyroid dysfunction

Abstract

Background: Subclinical thyroid disorders have gained increasing attention because thyroid hormones play an important role in cardiovascular function and blood pressure regulation, and pregnancy-related physiological changes further complicate the assessment of thyroid function. The purpose of the present study was to evaluate the association between subclinical thyroid disorder and hypertension in pregnant women attending a tertiary care hospital.

Methods: This cross-sectional comparative study at the Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh (Feb 2020–Mar 2021), included 220 pregnant women (110 hypertensive, 110 normotensive) matched for age, parity, and gestational age. Socio-demographic, obstetric, and clinical data were collected, blood pressure measured, and serum TSH and FT4 analyzed using Siemens ADVIA Centaur XP CLIA with ATA trimester-specific ranges. Data were analyzed with SPSS 25 (p <0.05).

Results: Among 220 pregnant women (110 hypertensive, 110 normotensive), most were 18–25 years, 29–40 weeks gestation, and nulliparous, with no significant differences. Pre-eclampsia with severe features was most common (40%). Subclinical hypothyroidism was higher in hypertensive women (46.4% vs 14.5%, p=0.001) and associated with elevated BP. Hypertensive women had higher TSH (4.46 vs 2.28 µIU/ml) and lower FT4 (13.49 vs 15.78 pmol/l), most pronounced in pre-eclampsia (p≤0.001).

Conclusions: Subclinical hypothyroidism is the most common thyroid disorder in hypertensive pregnant women and is associated with higher blood pressure, suggesting early detection may help reduce the severity of pregnancy-related hypertension.

Metrics

Metrics Loading ...

References

Danzi S, Klein I. Thyroid hormone and blood pressure regulation. Curr hypertens rep. 2003;5(6):513-20. DOI: https://doi.org/10.1007/s11906-003-0060-7

Fantz CR, Dagogo-Jack S, Ladenson JH, Gronowski AM. Thyroid function during pregnancy. Clin Chem. 1999;45(12):2250-8. DOI: https://doi.org/10.1093/clinchem/45.12.2250

Ain KB, Mori Y, Refetoff S. Reduced clearance rate of thyroxine-binding globulin (TBG) with increased sialylation: a mechanism for estrogen-induced elevation of serum TBG concentration. J Clin Endocrinol Metab. 1987;65(4):689-96. DOI: https://doi.org/10.1210/jcem-65-4-689

Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. 2017 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. DOI: https://doi.org/10.1089/thy.2016.0457

Kim YA, Park YJ. Prevalence and risk factors of subclinical thyroid disease. Endocrinol metab. 2014;29(1):20-9. DOI: https://doi.org/10.3803/EnM.2014.29.1.20

Dhanwal DK, Bajaj S, Rajput R, Subramaniam KA, Chowdhury S, Bhandari R, et al. Prevalence of hypothyroidism in pregnancy: An epidemiological study from 11 cities in 9 states of India. Indian j endocrinol metab. 2016;20(3):387-90. DOI: https://doi.org/10.4103/2230-8210.179992

Radha KR, Sugunan N, Resmy CR. Cross sectional study in a rural tertiary care centre in Kerala, India, do we need to screen and treat pregnant women for Subclinical hypothyroidism?. Int J Reprod Contracept Obstet Gynecol. 2017;6(3):781-6. DOI: https://doi.org/10.18203/2320-1770.ijrcog20170470

Bateman BT, Shaw KM, Kuklina EV, Callaghan WM, Seely EW, Hernández-Díaz S. Hypertension in women of reproductive age in the United States: NHANES 1999-2008. PloS one. 2012;7(4):e36171. DOI: https://doi.org/10.1371/journal.pone.0036171

Magee LA, Pels A, Helewa M, Rey E, Von Dadelszen P. Canadian Hypertensive Disorders of Pregnancy Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. J Obstet Gynaecol Can. 2014;36(5):416-41. DOI: https://doi.org/10.1016/S1701-2163(15)30588-0

Report of the American College of Obstetricians and Gynecologists‟ task force on hypertension in pregnancy. Obstet gynecol. 2013;122(5):1122-31.

Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol. 2009;33(3):130-7. DOI: https://doi.org/10.1053/j.semperi.2009.02.010

Espinoza J, Vidaeff A, Pettker CM, Simhan H. Gestational hypertension and preeclampsia. Obstet Gynecol. 2019;133(1):E1-25.

Osungbade KO, Ige OK. Public health perspectives of preeclampsia in developing countries: implication for health system strengthening. J pregnancy. 2011;2011(1):481095. DOI: https://doi.org/10.1155/2011/481095

El Arifeen S, Hill K, Ahsan KZ, Jamil K, Nahar Q, Streatfield PK. Maternal mortality in Bangladesh: a Countdown to 2015 country case study. Lancet. 2014;384(9951):1366-74. DOI: https://doi.org/10.1016/S0140-6736(14)60955-7

Tunbridge WM, Evered DC, Hall R, Appleton D, Brewis M, Clark F, et al. Lipid profiles and cardiovascular disease in the Whickham area with particular reference to thyroid failure. Clin endocrinol. 1977;7(6):495-508. DOI: https://doi.org/10.1111/j.1365-2265.1977.tb01341.x

Nagasaki T, Inaba M, Kumeda Y, Hiura Y, Shirakawa K, Yamada S, et al. Increased pulse wave velocity in subclinical hypothyroidism. J Clin Endocrinol Metab. 2006;91(1):154-8. DOI: https://doi.org/10.1210/jc.2005-1342

Faber J, Petersen L, Wiinberg N, Schifter S, Mehlsen J. Hemodynamic changes after levothyroxine treatment in subclinical hypothyroidism. Thyroid. 2002;12(4):319-24. DOI: https://doi.org/10.1089/10507250252949450

Gumieniak O, Perlstein TS, Hopkins PN, Brown NJ, Murphey LJ, Jeunemaitre X, et al. Thyroid function and blood pressure homeostasis in euthyroid subjects. J Clin Endocrinol Metab. 2004;89(7):3455-61. DOI: https://doi.org/10.1210/jc.2003-032143

Gumieniak O, Hurwitz S, Perlstein TS, Ngumezi UC, Hopkins PN, Jeunemaitre X, et al. Aggregation of high-normal thyroid-stimulating hormone in hypertensive families. J Clin Endocrinol Metab. 2005;90(11):5985-90. DOI: https://doi.org/10.1210/jc.2005-0373

Knudsen N, Laurberg P, Perrild H, Ovesen L, Bulow I, Jorgensen T, et al. Elevated blood pressure is associated with small differences in TSH in a general population. Thyroid. 2005;15(1):S10.

Wilson KL, Casey BM, McIntire DD, Halvorson LM, Cunningham FG. Subclinical thyroid disease and the incidence of hypertension in pregnancy. Obstet Gynecol. 2012;119(2):315-20. DOI: https://doi.org/10.1097/AOG.0b013e318240de6a

Ashok Kumar AK, Ghosh BK, Murthy NS. Maternal thyroid hormonal status in preeclampsia. Indian J Med Sci. 2005;59(2):57-63. DOI: https://doi.org/10.4103/0019-5359.13904

Hosen MB, Banna HA, Kabir Y, Howlader MZ. Association of maternal hypothyroidism with preeclampsia. BJST. 2014;1:1-7.

Basbug M, Aygen E, Tayyar M, Tutus A, Kaya E, ÖKTEM Ö. Correlation between maternal thyroid function tests and endothelin in preeclampsia-eclampsia. Obstet Gynecol. 1999;94(4):551-5. DOI: https://doi.org/10.1097/00006250-199910000-00012

Akter F, Kamrul-Hasan AB, Ahmed EU, Selim S, Aalpona FZ, Emran MS, et al. Thyroid Dysfunction and Autoimmunity in First Trimester of Pregnancy, Single Center Experience in Bangladesh. Mymensingh med J. 2018;27(3):603-9.

Khan MA, Hasanat MA, Alam MJ, Hossain MA, Saleh AA, Fariduddin M. Thyroid hormone profile in apparently healthy pregnant women attending in a tertiary care hospital of Bangladesh. Bangabandhu Sheikh Mujib Med Univ J. 2015;8(2):91-4. DOI: https://doi.org/10.3329/bsmmuj.v8i2.28928

Sheela SR, Dayanand CD, Sivaraj N. Evaluation of maternal thyroid hormone status and atherogenic potency in pre-eclampsia in Kolar District-A South West of India. Br J Med Med Res. 2015;10(4):1-8. DOI: https://doi.org/10.9734/BJMMR/2015/19452

Levine RJ, Vatten LJ, Horowitz GL, Qian C, Romundstad PR, Kai FY, et al. Risk factors for cardiovascular disease in women with subclinical hypothyroidism. Thyroid. 2002;12(5):421-5. DOI: https://doi.org/10.1089/105072502760043512

Kharb S, Sardana D, Nanda S. Correlation of thyroid functions with severity and outcome of pregnancy. Ann med health sci res. 2013;3(1):43-6. DOI: https://doi.org/10.4103/2141-9248.109478

Al-Naqeeb A. Correlation between Thyroid-related Hormones and Preeclampsia. Iraqi Nat J Nurs Spec. 2010;23(2). DOI: https://doi.org/10.58897/injns.v23i2.84

Buimer M, Van Wassenaer AG, Ganzevoort W, Wolf H, Bleker OP, Kok JH. Transient hypothyroxinemia in severe hypertensive disorders of pregnancy. Obstet Gynecol. 2005;106(5):973-9. DOI: https://doi.org/10.1097/01.AOG.0000180395.06136.b5

Khadem N, Ayatollahi H, Roodsari FV, Ayati S, Dalili E, Shahabian M, et al. Comparison of serum levels of Tri‐iodothyronine (T3), Thyroxine (T4), and Thyroid‐Stimulating Hormone (TSH) in preeclampsia and normal pregnancy. Iran J Reprod Med. 2012;10(1):47-52.