DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20210744

Prevalence of thyroid disorders among pregnant women at a tertiary care hospital in Rajasthan

Shalini Singh, Pragya Shree, Vaibhav Kanti, Kalpana Kumari, Rajeev Suchdeva

Abstract


Background: Hormonal changes and metabolic demands during pregnancy result in profound alterations in the biochemical parameters of thyroid function. Screening for thyroid disorders and initiation of its management at the earliest stage during first trimester is essential as maternal thyroid failure during the first half of pregnancy has been associated with several pregnancy complications and intellectual impairment in offspring. Aim was to evaluate the prevalence of thyroid dysfunction during the first and second trimester of pregnancy among women of Rajasthan state in India.

Methods: The study comprised a cohort of 313 consecutive pregnant women in the first and second trimester that attended the OPD and were admitted as pregnant women in Obstetrics and Gynecology Department of the NIMS Medical College and Hospital, Jaipur, Rajasthan. Thyroid stimulating hormone (TSH) levels and free T4 (fT4) were estimated. The subjects were grouped into six groups based on the value of serum TSH and fT4.

Results: Out of 313 antenatal women enrolled in the study, 213 (68%) attended antenatal clinic in first trimester of pregnancy and 100 (32%) women in their second trimester. The prevalence of thyroid dysfunction was 15.97% (overt hypothyroidism 1.28%, subclinical hypothyroidism 4.79%, isolated hypothyroxinemia 4.47%, overt hyperthyroidism 1.92%, and subclinical hyperthyroidism 3.51%). The women with overt hypo- or hyperthyroidism and subclinical hypothyroidism were older than euthyroid women. Maternal weight was high in pregnant women with overt hypothyroidism (58.22±6.18 kg) and subclinical hypothyroidism (52.04±2.94 kg). Gravid status was high in pregnant women with overt hypothyroidism, subclinical hypothyroidism and isolated hypothyroxinemia, but low in hyperthyroid group. History of miscarriage was high in pregnant women with subclinical hypothyroidism.

Conclusions: With this study, it was concluded that there is high prevalence of thyroid dysfunction in pregnancy predominantly in rural population of Rajasthan. Majority among these being subclinical hypothyroidism and hypothyroxinemia.


Keywords


Hyperthyroidism, Hypothyroidism, Pregnant women, Thyroid dysfunction, Thyroid stimulating hormone

Full Text:

PDF

References


Burrow GN. Thyroid function and hyperfunction during gestation. Endocr Rev. 1993;14(2):194-202.

Mandel SJ. Hypothyroidism and chronic autoimmune thyroiditis in the pregnant state: maternal aspects. Best Pract Res Clin Endocrinol Metab. 2004;18:213-24.

Amino N, Izumi Y, Hidaka Y, Takeoka K, Nakata Y, Tatsumi KI, et al. No increase of blocking type anti-thyrotropin receptor antibodies during pregnancy in patients with Graves’ disease. J Clin Endocrinol Metab. 2003;88(12):5871-4.

Amino N, Tada H, Hidaka Y, Izumi Y. Postpartum autoimmune thyroid syndrome. Endocr J. 2000;47(6):645-55.

Ando T, Imaizumi M, Graves PN, Unger P, Davies TF. Intrathyroidal fetal microchimerism in Graves’ disease. J Clin Endocrinol Metab. 2002;87(7):3315-20.

Anselmo J, Cao D, Karrison T. Fetal loss associated with excess thyroid hormone exposure. JAMA. 2004;292:691.

Arafah BM. Increased need for thyroxine in women with hypothyroidism during estrogen therapy. N Engl J Med. 2001;344:1743.

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(10):1081-125.

Casey BM, Leveno KJ. Thyroid disease in pregnancy. Obstet Gynecol. 2006;108:1283-92.

Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev. 2008;29:76-13 .

Casey BM, Dashe JS, Wells CE, Subclinical hyperthyroidism and pregnancy outcomes. Obstet Gynecol. 2006;107:337-41.

Gärtner R. Thyroid diseases in pregnancy. Curr Opin Obstet Gynecol. 2009;21(6):501-7.

Horacek J, Spitalnikova S, Dlabalova B, Malirova E, Vizda J, Svilias I, et al. Universal screening detects two-times more thyroid disorders in early pregnancy than targeted high-risk case finding. Eur J Endocrinol. 2010;163(4):645-50.

Mukhopadhyay A, Pati S, Mukherjee S, Das N, Mukhopadhyay P, Saumandal B. Autoimmune thyroid disorders and pregnancy outcome: a prospective observational study. Thyroid Res Pract. 2007;4(1):50-2.

Stagnaro-Green A. Overt hyperthyroidism and hypothyroidism during pregnancy. Clin Obstet Gynecol. 2011;54(3):478-87.

Sahu MT, Das V, Mittal S, Agarwal 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(2):215-20.

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):429097.

Bandela V, Havilah P, Hindumathi M, Prasad DK. Antenatal thyroid dysfunction in Rayalaseema region: a preliminary cross sectional study based on circulating serum thyrotropin levels. Int J Appl Biol Pharm Technol. 2013;4:74‑8.

Gayathri R, Lavanya S, Raghavan K. Subclinical hypothyroidism and autoimmune thyroiditis in pregnancy- a study in south Indian subjects. J Assoc Phys India. 2009;57:691‑3.

Abalovich M, Gutierrez S, Alcaraz G, Maccallini G, Garcia A, Levalle O. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid. 2002;12(1):63-8.

Abalovich M, Amino N, Barbour LA, Cobin RH, De Groot LJ, Glinoer D, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline 2007. J Clin Endocrinol Metab. 2007;92(8 Suppl):S1-47.