CURRENT APPROACH TO PREGNANT WOMEN WITH THYROID ABNORMALITIES

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Abstract

The course of pregnancy, thyroid status, and hormonal background were studied in 96 women with autoimmune thyroiditis (AIT). It was established that pregnant women have a number of maternal and fetal complications (54.8%); AIT has an adverse effect on the course of pregnancy; a high risk of miscarriage and termination of pregnancy is observed; and the thyroid hormone level is reduced and the TSH level is increased in comparison with that in healthy pregnant women. To prevent gestational complications and prematurity in women with AIT, routine blood TSH testing from early gestation is recommended.

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42

Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

42-45

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

ABSTRACT

The course of pregnancy, thyroid status, and hormonal background were studied in 96 women with autoimmune
thyroiditis (AIT). It was established that pregnant women have a number of maternal and fetal complications (54.8%);
AIT has an adverse effect on the course of pregnancy; a high risk of miscarriage and termination of pregnancy is
observed; and the thyroid hormone level is reduced and the TSH level is increased in comparison with that in healthy
pregnant women. To prevent gestational complications and prematurity in women with AIT, routine blood TSH testing
from early gestation is recommended.

KEYWORDS

Pregnancy, thyroid pathology, autoimmune thyroiditis, thyroid status in pregnant women with AIT, complications in
pregnancy with AIT, prevention of thyroid pathology during pregnancy.

Research Article


CURRENT APPROACH TO PREGNANT WOMEN WITH THYROID
ABNORMALITIES

Submission Date:

February 28, 2022,

Accepted Date:

March 20, 2022,

Published Date:

March 31, 2022 |

Crossref doi:

https://doi.org/10.37547/TAJMSPR/Volume04Issue03-08


Zakirova N.I.

Professor, Department of Obstetrics and Gynecology №1 Samarkand State Medical Institute, Uzbekistan

Kamalova D.D.

Assistant of the Department of Obstetrics and Gynecology №1 Samarkand State Medical Institute,
Uzbekistan

Khasanova D.A.

Assistant of the Department of Obstetrics and Gynecology №1 Samarkand State Medical Institute,
Uzbekistan

Norhujaeva Ch.

5th year medical faculty of Samarkand State Medical Institute, Uzbekistan

Journal

Website:

https://theamericanjou
rnals.com/index.php/ta
jmspr

Copyright:

Original

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may be used under the
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background image

43

Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

42-45

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

INTRODUCTION

In recent decades, thyroid diseases occupy the leading
place in the structure of endocrine pathology, along
with type 2 diabetes mellitus, they are one of the most
pressing medical and social problems, which is due to
the growing prevalence of thyroid pathology among
the population of Uzbekistan, high frequency of
temporary and persistent disability. More than 665
million people in the world have endemic goiter or
other thyroid pathologies, and one and a half billion
people are at risk of developing iodine deficiency
diseases.

One common form of thyroiditis is autoimmune
thyroiditis (AIT), with a rate of 3-4% in the population
(2,6). AIT occurs predominantly in women, often
manifesting and progressing during pregnancy due to
increased physiological thyroid stimulation.

The literature suggests that pregnant women with
autoimmune thyroiditis have a number of maternal and
fetal

complications:

miscarriage,

threatened

miscarriage, premature termination, pre-eclampsia,
placental insufficiency, fetal hypoxia, etc. in children -
perinatal CNS damage, cardiopathy, morphofunctional
immaturity, intellectual disability, etc. [1,4,5,9], which
explains the increased interest in the management of
pregnant women with this pathology.

Thyroid diseases can cause not only reproductive
disorders in a woman and have an adverse effect on
the processes of embryogenesis, placentation and
gestation, worsen pregnancy and childbirth outcome,
negatively affect fetal growth and development, but
also have a significant impact on the female div in
general, impairing quality of life and performance [
1,3,7], which makes the problem urgent.

Purpose of the study:

To investigate the course and

outcome of pregnancy and the thyroid status of
women with AIT

RESEARCH

In 2019-2022 we examined 96 pregnant women with
autoimmune thyroiditis (AIT) with gestational age up
to 34 weeks of gestation. The thyroid gland (Thyroid)
was investigated and hormonal background (thyroid
hormone, free thyroxine and thyroid peroxidase
antibodies were determined) was examined. An
ultrasound of the thyroid gland was also performed. All
pregnant

women

were

examined

by

an

endocrinologist and, when indicated, by other
specialists. Pregnant women with AIT (60 women) and
those with normal gestation (36 pregnant women)
without thyroid pathology were divided into 2 groups.

RESULTS

The patients complained of lower abdominal and
lumbar pain (28.5%), palpitations (11.4%), irritability
(9.1%), tremors (in rare cases), etc. The number of
primiparous women was 18 (18.7%), first-time and
repeated women were 78 (81.2%). The mean age of
primiparous women was 19.4+3.8 years, repeated
women 27.6+- 8.7 years, with a history of obstetrics and
gynecology in 47%, and anemia in 62% of pregnant
women.

Among pregnancy complications, maternal vomiting
occurred with almost equal frequency in both
compared groups. This complication was mild in most
cases. A moderate severity was diagnosed in 8.1 ± 4.4%
of the women in the first group; 6.5 ± 4.6% in the
second; none of the cases were of a severe form.
Threatened miscarriage occurred in 34.3% of cases,
miscarriages in early and late gestation occurred in


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44

Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

42-45

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

10.8%, and an uncompleted pregnancy occurred in 3.1%
of women with AIT. Hypertensive disorders in
pregnancy occurred in 9.4% of cases, including
preeclampsia in 7.3%; no eclampsia was observed.
Ultrasound findings in pregnant women with AIT were
characterized by an enlarged thyroid gland, reduced
echogenicity, and a mean of 13.9 cm3. Ultrasound
findings in the uterus were small in 6.2% and abundant
in 7.6% of women, suggesting placental insufficiency.
The incidence of placental insufficiency was
comparable in the AIT and healthy pregnant women
and was 19.0±4.3% and 16.1±6.6%, respectively. The
diagnosis of placental insufficiency was based on
ultrasound placenta- and fetometry, Doppler study of
blood flow in the arteries of the mother-placenta-fetal
functional system and fetal cardiotocographic
examination.

Echographic signs of placental insufficiency included
symptoms of premature placental maturation
(appearance of grade II placental maturity before 32
weeks, grade III - before 36 weeks of pregnancy),
decreased or increased placental thickness, placental
structural changes: dilation of intervorsinian spaces,
the presence of calcinates and cysts.

One important indicator of placental insufficiency is
the state of uterine-placental-foetal blood flow, which
is assessed by Doppler study. Blood flow in the right
and left uterine arteries, umbilical arteries, aorta and
fetal middle cerebral artery was analysed in the
patients who participated in our study. Vascular
resistance

indices:

systolic-diastolic

ratio

and

resistance index were assessed. According to Doppler
data, approximately 12% of AIT patients had blood flow
abnormalities, with a higher incidence of this
complication in patients with initial hypothyroidism.
The severity of the distress was mild in all cases,

together with intrauterine fetal retardation in 11.9% of
cases.

Intrauterine infection of the fetus was observed in 12%
of patients with autoimmune thyroiditis, which was
almost 2 times higher than in the control group. It
should be noted that our data are consistent with the
literature, according to which at least 10% of neonates
are intrauterine infected [2,3,6,7]. The diagnosis of
intrauterine infection was made based on a
combination of clinical and anamnestic findings
(inflammatory diseases of the urogenital tract, threat
of miscarriage, presence of extragenital foci of
infection, especially with an exacerbation of the
infectious process during pregnancy, acute respiratory
viral infections suffered during pregnancy, etc.),
ultrasound markers of intrauterine infection, and
laboratory methods to identify infectious agents. Thus,
it should be noted that a total of 54.8% of women had
pregnancy complications.

Our studies have shown that the TSH level in AIT
patients averaged 2.5 to 3.1 mU/l, which was higher
than that in the control group. The thyroxine level was
14.0 mmol/l, its increase in the main group was
compensatory for iodine deficiency. At the same time,
there was a decrease in free thyroxine and an increase
in peroxidase antibodies (TPO)-18.9, which appears to
be associated with destructive changes in the thyroid
gland and a decrease in its function, which is an
indicator of autoimmune damage to it. Particular
attention should be paid to the fact that pregnant
women have slightly different thyroid norms than non-
pregnant women. The TTH level in non-pregnant
women ranges from 0.4 to 4.0 mU/l, and in the first
trimester of pregnancy the TTH level should be in the
range: 0.1-2.5 mU/l is normal; 2.5-4.0 mU/l is a marker of
subclinical hypothyroidism; over 4 mU/l is a high


background image

45

Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

42-45

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

probability of manifest hypothyroidism and can be a
threat for abortion.

We noted that pregnant women with threatened
abortion (in the first trimester) had a significant change
in their thyroid status toward hypothyroidism;
however, normal TTH values were detected in 42% of
the women. In 25% of patients at risk of miscarriage,
there was a 25% increase in TSH levels, which was
almost 10 times higher than normal. The TSH level
associated with subclinical hypothyroidism was
detected in 33% of the examined women.

CONCLUSIONS

1.

In iodine deficient region, which is our region, AIT
is the most common endocrine pathology.

2.

AIT has an adverse effect on pregnancy, with a high
risk of miscarriage and termination of pregnancy.

3.

Pregnant women with AIT have lower thyroid
hormone levels and increased TSH levels compared
with those of healthy pregnant women.

4.

To prevent gestational complications and
prematurity in women with AIT, routine blood TSH
testing from early gestation is recommended.

REFERENCES

1.

Aylamazyan, E.K. Obstetrics: National Guide / Ed. by
E.K. Aylamazyan, V.I. Kulakov, V.E. Radzinsky et al -
Moscow.- 2009.- 1218 p.

2.

Zakirova N.I., Zakirova F.I., "Reproductive Health of
Women of Samarkand Province"/ / Problems of
Biology and Medicine,2021, ¹1.1(126), p. 5-7

3.

Kolendo, S.A. Obstetrical and perinatal outcomes in
pregnant women with hypothyroidism of various
etiology // Author's abstract of dissertation .... D. in
medical sciences. -Moscow. -2012. - 26 с.

4.

Ulbasheva, A.S. Influence of ante- and postnatal
iodine prophylaxis on the development of young

children // Author's dissertation .... D. in medical
sciences: 14.01.08.- Stavropol.- 2013.- 18 p.

5.

Fadeev, V.V. Thyroid pathology and pregnancy /
V.Fadeev, S.Perminova, T.Nazarenko // Vrach.-
2008.- No.5.- P. 11-16.

6.

Khojaeva, Z.S. Thyroid diseases in women of
reproductive age. Guidance for physicians/ Z.S.
Khojaeva, S.G. Perminova, E.I. Degtyareva et al./ Ed.
by G.T. Sukhikh. - Moscow: GOETAR-Media, 2013. с.

7.

Breathnach, F.M. Subclinical hypothyroidism as a
risk factor for placental abruption: evidence from a
low-risk primigravid population / F.M. Breathnach,
J.Donnelly, S.M.Cooley 11 Aust. NZJ Obstet.
Gynaecol. - 2013.- Dec.- 53(6).-P.553-560.

8.

Lazarus, J.H. Antenatal thyroid screening and
childhood cognitive function. / J.H. Lazarus, J.P.
Bestwick, S.Channon, et al. // The New England
Journal of Medicine. - 2012. - 366.- P.493-501.

9.

Lazarus, J. European thyroid association guidelines
for the management of subclinical hypothyroidism
in pregnancy and in children / J.Lazarus, R.Brown,
C.Daumerie et al. //Eur. Thyroid J. - 2014.- Jun.-3(2).-
P.76-94.

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