Gebelerde Birinci Trimester Tiroid Fonksiyon Testi Sonuçlarının Değerlendirilmesi

Ali Seven, Suna Kabil Kucur, Murat Polat, Beril Yüksel, Özben Işıklar, Nadi Keskin

Özet


 

Özet

Çalışmamızın amacı birinci trimesterde tiroid disfonksiyonu sıklığını iki farklı referans aralığına göre ayrı ayrı değerlendirip sonuçları karşılaştırmak ve ülkemizdeki gebelerde tiroid disfonksiyonu gerçek prevalansını belirlemektir. Tersiyer merkez olan hastanemizin kadın hastalıkları ve doğum poliklinikleri’ne başvuran hastalara ait ilk trimester TSH, sT4 ve sT3 değerleri retrospektif olarak tarandı ve kayıt altına alındı. Sonuç olarak 647 olgu çalışmaya dahil edildi. TSH referans aralıkları ayrı ayrı 0.1-2.5 mIU/L ve 0.34-5.6 mIU/L olacak şekilde hastaların tiroid disfonksiyonu sıklıkları değerlendirildi. TSH referans aralığı 0.1–2.5 mIU/L olarak alındığında hastaların 525’i (%81.14) ötiroidik,  16’sı (%2.47) hipertitoidik, 106’sı (%16.38) hipotiroidik olarak saptandı. TSH referans aralığı 0.34-5.6 mIU/L olarak alındığında ise hastaların 582’si (%89.95) ötiroidik, 50’si (%7.72) hipertiroidik, 15’i (%2.31) hipotiroidik olarak saptandı. İki farklı referans aralığı kullanımında prevalans ve dolayısıyla klinik yaklaşım açısından anlamlı fark olacağı gözlendi. TSH için önerilen güncel referans aralığı kullanıldığında bölgemizdeki gebelerde tiroid disfonksiyonu prevalansını literatüre göre belirgin olarak yüksek oranda saptadık. Bu durum; bölgesel iyot eksikliği ile açıklanabilir. Ancak kanaatimizce; önerilen referans aralığının, ülkemizde yapılacak ve perinatal sonuçlar ile gebelikteki TSH değerlerini karşılaştıran uzun dönem izlem çalışmalarıyla tekrar gözden geçirilmesi uygun olacaktır.

Anahtar Kelimeler: Birinci trimester, Gebelik, Tiroid disfonsiyonu, TSH

 

Abstract

The aim of this study is to examine the frequency of thyroid dysfunction in the first trimester based on two different reference ranges, and to compare the results. To determine the exact prevalence of thyroid dysfunction among pregnant women in Turkey. We retrospectively reviewed and recorded first trimester TSH, fT4 and fT3 levels of patients, who were presented to the gynecology and obstetrics outpatient clinics of our hospital, which is a tertiary healthcare center. Totally 647 patients were included in the study. The frequency of thyroid dysfunction was evaluated based on two different reference ranges for TSH levels as 0.1-2.5 mIU/L and 0.34-5.6 mIU/L. Based on a TSH reference range of 0.1–2.5 mIU/L, 525 (81.14%) patients were euthyroid, 16 (2.47%) had hyperthyroidism, and 106 (16.38%) had hypothyroidism. Based on a TSH reference range of 0.34-5.6 mIU/L, 582 (89.95%) patients were euthyroid, 50 (7.72%) had hyperthyroidism, and 15 (2.31%) had hypothyroidism. The two different reference ranges yielded significantly different prevalences of thyroid dysfunction and hence, would lead to a significant difference in terms of clinical approach to patients. When we used the current recommended reference range for TSH, we detected a remarkably higher prevalence of thyroid dysfunction among pregnant women in our region in comparison to the literature. This condition may be explained with endemic iodine deficiency. However, in our opinion, it would be best to revise the recommended reference range for TSH for our country via long-term follow-up studies that compare perinatal outcomes with pregnancy TSH levels.

Keywords: First trimester, Pregnancy, Thyroid dysfunction, TSH

 


Tam Metin:

PDF

Referanslar


Kaynaklar

Stagnaro-Green A, Abalovich M, Alexander E, 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.

Vanderpump MP, Tunbridge WM, French JM, et al. The incidence of thyroid disorders in the community: A twenty‑year follow-up of the Whickham Survey. Clin Endocrinol (Oxf) 1995;43:55-68.

De Groot L, Abalovich M, Alexander EK, et al. Management of thyroid dysfunction during pregnancy and postpartum: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012;97:2543-65.

Güzel E, Sivri Aydın D, Çilesiz Göksedef, BP, Boran AB. The incidence of thyroid dysfunction in pregnant women. Perinatal Journal 2015;23:96-100.

Nathan N, Sullivan SD. Thyroid disorders during pregnancy. Endocrinol Metab Clin North Am. 2014;43:573-97.

Rajput R, Goel V, Nanda S, Rajput M, Seth S. Prevalence of thyroid dysfunction among women during the first trimester of pregnancy at a tertiary care hospital in Haryana. Indian J Endocr Metab 2015;19:416-9.

Casey BM, Dashe JS, Wells CE, McIntire DD, Leveno KJ, Cunningham FG. Subclinical hyperthyroidism and pregnancy outcomes. Obstet Gynecol 2006;107:337‑41.

Giacobbe AM, Grasso R, Triolo O, Tonni G, Granese R. Thyroid diseases in pregnancy: a current and controversial topic on diagnosis and treatment over the past 20 years. Arch Gynecol Obstet. 2015;292:995-1002.

Ong GS, Hadlow NC, Brown SJ, Lim EM, Walsh JP. Does the thyroid-stimulating hormone measured concurrently with first trimester biochemical screening tests predict adverse pregnancy outcomes occurring after 20 weeks gestation? J Clin Endocrinol Metab. 2014;99:E2668-72.

Glinoer D. The importance of iodine nutrition during pregnancy. Public Health Nutr 2007;10:1542–46

Moleti M, Trimarchi F, Vermiglio F. Thyroid Physiology in Pregnancy. Endocr Pract. 2014; 21:1-26

Temur M, Cengiz H, Arıcı B, Yaflar L, Özdemir İA. Detection of Thyroid Dysfunction in Early Pregnancy. Gazi Medical Journal 2012;23:6–9.

Li C, Shan Z, Mao J, et al. Assessment of thyroid function during first-trimester pregnancy: what is the rational upper limit of serum TSH during the first trimester in Chinese pregnant women? J Clin Endocrinol Metab 2014;99:73–9.


Refback'ler

  • Şu halde refbacks yoktur.


Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.