INTRODUCTIONSubclinical hypothyroidism (SCH) in pregnancy is defined by a serum thyroid-stimulating hormone (TSH) concentration higher than the upper limit of the pregnancy related reference range associated with a normal serum thyroxine [T 4; either total (TT 4) or free (FT 4 )] concentration.The prevalence of hypothyroidism during pregnancy is estimated to be 0.3-0.5% for overt hypothyroidism (OH) and 2-3% for subclinical hypothyroidism (SCH).1 There are few reports of prevalence of hypothyroidism during pregnancy from India with prevalence rates ranging from 4.8% to 14.3%. [2][3][4] It is now well established that not only overt but subclinical thyroid dysfunction can also have adverse effects on fetal and maternal outcome. Current data indicate an increase in pregnancy loss, gestational diabetes, gestational hypertension, pre-eclampsia and preterm delivery in women with SCH in pregnancy. The association between SCH in pregnancy and impaired neuropsychological development of the offspring is inconsistent.Many of these adverse effects could be prevented or ameliorated by early detection and appropriate treatment. ABSTRACT Background:It is now well established that not only overt but subclinical thyroid dysfunction can also have adverse effects on fetal and maternal outcomes. In recent years several studies show a much larger prevalence of SCH and marked variation between different ethnic groups. The aim of this study was to find out the prevalence of subclinical hypothyroidism during first trimester in a teaching hospital in North India. Methods: A prospective observational study was conducted in all the consecutive first trimester pregnant women attending Santosh Medical College, Hospital, Ghaziabad from June 2014 to April 2015 after institutional ethics approval and consent from the study subjects. Morning samples of serum were tested for TSH. If serum TSH value was more than 2.5mIU/L then Free T4 and TPO Antibody level were estimated. Results: Serum TSH level was normal in 66.2 % women, 32.5 % women had subclinical hypothyroidism and 1.3 % women had overt hypothyroidism using a first trimester normal reference range of 0.1 to 2.5 mU/l suggested by American Thyroid Association or by the American Endocrine Society. Using 5 mIU/L as upper limit of TSH suggested by some Indian studies serum TSH level was normal in 90.6 % women, 8.1 % women had subclinical hypothyroidism and 1.3 % women had overt hypothyroidism. Conclusion:The prevalence of SCH is very high in our study population. We feel that the use of thyroid function reference values based on studies using different populations and different backgrounds can introduce bias in the evaluation of a local population.

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An extremely malnourished, anemic, 30-year-old woman (para 1, gravida 2) presented in early labor. The patient's previous pregnancy had been unsupervised and she had delivered at home, after which she sustained multiple fractures caused by minor trauma, persistent body ache, and limitation of movement. The disability progressed from movement only on all fours to a bedridden state.The patient conceived her second pregnancy during the time she was breastfeeding her first child. Fear of hospitals, compounded by illiteracy and poverty, prevented the patient from seeking timely treatment. On examination, the patient was in pain with fresh and old malunited fractures in all four limbs. The intermittently contracting uterus was term size and the singleton fetus was in longitudinal lie. A reduced subpubic angle made vaginal examination difficult. A female neonate weighing 1.8 kg was delivered by lower segment cesarean. The neonate was clinically normal with no evidence of hypocalcemia.Investigations carried out on the patient revealed hypocalcemia (serum calcium 8 mg/dL), and raised alkaline phosphatase (serum alkaline phosphatase 966 IU/L; normal range up to 300 IU/L). Estimation of fractionated levels could not be done because of non-availability in our centre and prohibitive costs in other laboratories. Serum parathyroid hormone level was 831 pg/mL (normal range 10-69 pg/mL). X-rays showed severe demineralization of all bones, spiral fracture of the mid-third of the right femur, a displaced fracture of the right humerus (Fig. 1), and Looser's zones in the right clavicle.