| Garantizando una India inteligente: Manejo del hipotiroidismo en el embarazo |
Ensuring an intelligent India: Managing hypothyroidism in pregnancy
Sahay R, Kalra S, Magon N.
Indian J Endocr Metab [serial online] 2011 [cited 2011 Jul 29];15:76-7.
Hypothyroidism is a disorder commonly encountered in pregnancy. While thyroid antibodies are present in up to 15% of women in the reproductive age group, overt hypothyroidism is noted in 0.3-0.5% of all pregnancies, and subclinical hypothyroidism in 2-3%. The pregnant woman presents a unique challenge, as well as an unparalleled opportunity, for the thyroidologist. Hypothyroidism may be difficult to diagnose in pregnancy, as most of the clinical features are nonspecific (asthenia, lethargy), or may be masked by obstetric symptoms (increase in weight, altered appetite). The various clinical scoring systems discussed in this issue are valid only for non-pregnant adults, and cannot be used in the antenatal outpatient department.
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Prevalencia de obstrucción de la vía aérea superior en pacientes con bocio multinodular eutiroideo aparentemente asintomático
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Prevalence of upper airway obstruction in patients with apparently asymptomatic euthyroid multi nodular goitre.
Menon SK, Jagtap VS, Sarathi V, Lila AR, Bandgar TR, Menon PS, Shah NS.
Indian J Endocr Metab 2011;15:127-31
Aims: To study the prevalence of upper airway obstruction (UAO) in "apparently asymptomatic" patients with euthyroid multinodular goitre (MNG) and find correlation between clinical features, UAO on pulmonary function test (PFT) and tracheal narrowing on computerised tomography (CT). Materials and Methods: Consecutive patients with apparently asymptomatic euthyroid MNG attending thyroid clinic in a tertiary centre underwent clinical examination to elicit features of UAO, PFT, and CT of neck and chest. Statistical Analysis Used: Statistical analysis was done with SPSS version 11.5 using paired t-test, Chi square test, and Fisher's exact test. P value of <0.05 was considered to be significant. Results: Fifty-six patients (52 females and four males) were studied. The prevalence of UAO (PFT) and significant tracheal narrowing (CT) was 14.3%. and 9.3%, respectively. Clinical features failed to predict UAO or significant tracheal narrowing. Tracheal narrowing (CT) did not correlate with UAO (PFT). Volume of goitre significantly correlated with degree of tracheal narrowing. Conclusions: Clinical features do not predict UAO on PFT or tracheal narrowing on CT in apparently asymptomatic patients with euthyroid MNG.
Keywords: Multi nodular goitre, pulmonary function test, upper airway obstruction
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| Detección de disfunción tiroidea en el embarazo: ¿Vale la pena? |
Screening for thyroid dysfunction in pregnancy: is it worthwhile?
Lazarus JH.
Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, University Hospital of Wales, Heath Park, Wales, Cardiff CF14 4XN, UK.
J Thyroid Res. 2011;2011:397012. Epub 2011 Jun 8.
Abstract
There is a high incidence of thyroid dysfunction during pregnancy resulting in adverse maternal (miscarriages, anaemia in pregnancy, preeclampsia, abruptio placenta and post-partum haemorrhage) and fetal effects (premature birth, low birth weight, increased neonatal respiratory distress) which may justify screening for thyroid function during early pregnancy with interventional levothyroxine therapy for thyroid hypofunction. There is a greater prevalence of subclinical hypothyroidism in women with delivery before 32 weeks and there is even an association between thyroid autoimmunity and adverse obstetric outcome, which is independent of thyroid function. Higher maternal TSH levels even within the normal reference range are associated with an increased risk of miscarriages, fetal and neonatal distress and preterm delivery. There are few prospective randomised trials to substantiate the benefit of screening and the recently reported CATS study did not show a benefit in child IQ at age 3 years. Nevertheless there seems to be a case for screening to prevent adverse obstetric outcomes. The clinical epidemiological evidence base does not justify universal screening at the present time. However, it is probable that more evidence will be produced which may alter this view in the future.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134289/pdf/JTR2011-397012.pdf
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