High prevalence of subclinical hypothyroidism in pregnant women in South India

Nabhi VR. Murty, Uma B, Rao JM, Sampurna K, Vasantha K, Vijayalakshmi G


Background: Thyroid dysfunction is one of the commonest endocrinopathies seen in pregnancy and affects both maternal and fetal outcomes. There is little data available on its prevalence in Indian pregnant women. This study was conducted at Bhaskar medical college and hospital situated in a rural/suburban area near Hyderabad, Telengana, India. The aim of the study was to find out the prevalence of thyroid disease among pregnant women.  

Methods: All consecutive pregnant women registered from January 2014 to December 2014 were included in the study. Morning samples of serum were tested for T3, T4 and TSH.  

Results: A total of 1340 women were included in the study. 260 pregnant women (19.41%) had TSH values more than 3.0 mIU/L, the cut-off value used for upper limit of normal in this study. Out of these, 216 had normal T4 value, hence labeled as subclinical hypothyroidism and 44 had low T4, hence termed overt hypothyroidism. Three pregnant women had overt hyperthyroidism and 11 had subclinical hyperthyroidism. Nine women had low T4 values-Isolated hypothyroidism.

Conclusions: Prevalence of thyroid disease in pregnancy was found to be higher in our patients, more so the sub clinical hypothyroidism.


Pregnancy, Thyroid dysfunction, Overt and subclinical hypothyroidism & hyperthyroidism, Isolated hypothyroidism

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Ballabio M, Poshyachindra M, Ekins RP. Pregnancy induced changes in thyroid function; role of human chorionic gonadotropin as a putative regulator of maternal thyroid. J Clin Endocrinol Metab. 1991;73:824-31.

Van Raaij JM, Vermaat-Miedema SH, Schonk CM, Peek ME, Hautvast JG. Energy requirements of pregnancy in the Netherlands. Lancet. 1987;2:953-5.

Negro R, Farmosos G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects of obstetrical complications. J Clin Endocrinol Metab. 2006;91:2587-91.

Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American thyroid association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011;21:1081-125.

LeBeau SO, Mandel SJ. Thyroid disorders during pregnancy. Endocrinol Metab Clin North Am. 2006;35:117-36.

Ghassabian A, Bongers- Schokking JJ, de Rijke YB, van Mil N, Jaddoe VW, de Muinck Keizer-Scharma SM, et al. Maternal thyroid autoimmunity during pregnancy and the risk of attention deficit / hyperactivity problems in children. The Generation R Study. Thyroid. 2012;22:178-86.

Sharma PP, Mukhopadhyay P, Mukhopadhyay A, Muraleedharan PD, Begum N. Hypothyroidism in pregnancy. J Obstet Gynecol India. 2007;57:331-4.

Nambiar V, Jagtap VS, Sarathi V, Lila AR, Kamalanathan S, Bandgar TR, et al. Prevalence and impact of thyroid disorders on maternal outcome in Asian-Indian pregnant women. J Thyroid Res. 2011;2011:4290-7.

Sahu MT, Das V, Mittal S, Agarwl A, Sahu M. Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and fetal outcome. Arch Gynecol Obstet. 2010;281:215-20.

Dhanwal DK, Sudha P, Agarwal AK, Dixit V, Banerjee AK. High prevalence of subclinical hypothyroidism during first trimester of pregnancy in North India. Indian J Endocrinol Metab. 2013;17:281-4.

Nangia AS, Aggarwal D, Bhatia P, Sharma M, Sarabhai V, Paul M. Prevalence of overt and subclinical thyroid dysfunction among pregnant women and its effect on maternal and fetal outcome. Indian J Obstet Gynecol. 2013;64(2):105-10.

Lee RH, Miller EA, Petrovc I, Braverman LE, Goodwin TM. Free T4 immunoassays are flawed during pregnancy. Am J Obstet Gynecol. 2009;200:261-6.

Mandel ST, Spencer CA, Hollowell JG. Are detection and treatment of thyroid insufficiency in pregnancy feasible? Thyroid. 2005;15:44-53.

Marcos Abalovich, Nobuyuki Amino, Linda A. Barbour, Rhoda H. Cobin, Leslie De Groot, , Daniel Glinoer, et al. Executive Summary for management of thyroid dysfunction during Pregnancy and Postpartum: Endocrine Society Clinical Practice Guideline. J Clin Endocrin Metabol. 2012;97:2543-65.

Baloch Z, Carayon P, Conte-Devolx B, Demers LM, Feldt-Rasmussen U, Henry JF, et al. Laboratory Medicine Practice Guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid. 2003;13:3-126.

Stagnaro-Green A. Thyroid antibodies and miscarriage: where are we a generation later? J Thyroid Res. 2011;2011:841-9.

Wang W, Teng W, Shan Z, Wang S, Li J, Zhu L, et al. The prevalence of thyroid disorders during early pregnancy in China: the benefits of Universal screening in the first trimester of pregnancy. Eur J Endocrinol. 2011;164:263-8.

Teng X, Shan Z, Chen Y, Lai Y, Yu J, Shan L, et al. More than adequate iodine intake may increase subclinical hypothyroidism and autoimmune thyroiditis: a cross-sectional study based on two Chinese communities with different iodine intake levels. Eur J Endocrinol. 2011;164:943-50.

Marwaha RK, Tandon N, Gupta N, Karak AK, Verma K, Kochupillai N. Residual goiter in the post iodization phase: iodine status, thiocyanate exposure and autoimmunity. Clin Endocrinol (Oxf). 2003;59:672-81.

Das S, Bhansali A, Dutta P, Aggarwal A, Bansal MP, Garg D, et al. Persistence of goiter in the postiodization phase. Micronutrient deficiency or thyroid autoimmunity? Indian J Med Res. 2011;133:103-9.

National Research Council. Fluoride in drinking water. In: NRC, eds. A Scientific Review of EPA’s Standards. Washington, DC: National Academies Press; 2006.

Gülhan Akbaba, Eren Akbaba, Dilek Berker, Serhat Işık Bercem, Ayçiçek Doğan, Ufuk Özuğuz, et al. Fetal-maternal outcomes of isolated hypothyroxinemia in pregnancy. Turk J Endocrinol Metab. 2014;18:106-10.