Update on a new controversy in endocrinology: isolated maternal hypothyroxinemia

Furnica, Raluca Maria; Lazarus, John H.; Gruson, Damien; Daumerie, Chantal

doi:10.1007/s40618-014-0203-5

Cited by 26 publications

(25 citation statements)

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“…One may speculate on how this turn towards a focus on smaller abnormalities in maternal thyroid function emerged? It is not part of the general concept of clinical hypothyroidism; however, an increasing number of review papers [49][50][51][52][53][54][55][56][57][58][59][60][61] (Table 2), observational studies [5,6,35], and RCTs [39,40] (Table 1) have focused on this entity in relation to pregnant women. RCTs, randomized controlled trials; hypo, hypothyroidism; IQ, intelligence quotient; L-T4, levothyroxine; TPO-Ab, thyroid peroxidase antibodies.…”

Section: The Turning Towards Smaller Abnormalitiesmentioning

confidence: 99%

“…Alterations of her offspring 2007 Román [54] Autism: transient in utero hypothyroxinemia related to maternal flavonoid ingestion during pregnancy and to other environmental antithyroid agents 2011 Negro [55] Hypothyroxinemia and pregnancy 2013 Henrichs [56] Maternal hypothyroxinemia and effects on cognitive functioning in childhood: how and why? 2015 Furnica [57] Update on new controversy in endocrinology: isolated maternal hypothyroxinemia 2015 Chan [58] Optimal management of hypothyroidism, hypothyroxinemia, and euthyroid TPO antibody positivity preconception and in pregnancy 2016 Lazarus [59] Hypothyroxinaemia and brain development 2016 Min [60] Maternal hypothyroxinemia-induced neurodevelopmental impairments in the progeny 2017 Dosiou [61] Isolated maternal hypothyroxinemia during pregnancy: knowns and unknowns DOI: 10.1159/000506228…”

Section: The Turning Towards Smaller Abnormalitiesmentioning

confidence: 99%

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Turning to Thyroid Disease in Pregnant Women

Andersen

2020

Eur Thyroid J

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• Overt thyroid disease should be diagnosed and treated in nonpregnant and pregnant patients. • Subclinical thyroid disease management is debatable in nonpregnant and pregnant patients. • Smaller aberrations in thyroid function have drawn much attention in pregnant women, specifically. • A main focus on maternal T4 in pregnancy emerged before TSH assays were available. • With the advancement of assays, the concept of "isolated hypothyroxinemia" emerged. • No effect of treating such smaller aberrations in maternal thyroid function appear from large RCTs. • A turn towards thyroid disease in pregnant women may be justified.

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Section: The Turning Towards Smaller Abnormalitiesmentioning

confidence: 99%

Section: The Turning Towards Smaller Abnormalitiesmentioning

confidence: 99%

Turning to Thyroid Disease in Pregnant Women

Andersen

2020

Eur Thyroid J

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“…Isolated maternal hypothyroxinemia (IMH) is defined as a low maternal free thyroxine (FT4) concentration in conjunction with a normal maternal thyroid-stimulating hormone (TSH) concentration. IMH during the early pregnancy is associated with the increased risk of placental abruption, gestational diabetes, macrosomia, and preterm delivery [ 2 , 4 , 5 ]. IMH in the second trimester of gestation may also result in adverse pregnancy outcomes.…”

Section: Introductionmentioning

confidence: 99%

The impact of isolated maternal hypothyroxinemia during the first and second trimester of gestation on pregnancy outcomes: an intervention and prospective cohort study in China

Gong

Liu

et al. 2018

J Endocrinol Invest

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Objectives To explore the effect of isolated maternal hypothyroxinemia (IMH) during the first and second trimester of gestation on pregnancy outcomes. To explore whether levothyroxine (L-T4) treatment of women who had IMH identified in the first trimester improves pregnancy outcomes. Methods Women in the early pregnancy in the iodine-sufficient area ( n = 3398) were recruited to this prospective cohort study (ChiCTR-TRC-12002326). Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid peroxidase antibody (TPOAb) were detected. Women with IMH before 12 weeks chose to receive L-T4 or remain untreated. The L-T4 dose was adjusted to attain a normal FT4 and TSH level. Pregnancy outcomes were evaluated during follow-up. Results IMH in the first trimester was not associated with increased risk of adverse pregnancy outcome compared with controls. The incidence of macrosomia ( p = 0.022) and gestational hypertension ( p = 0.018) was significantly higher in IMH identified in the second trimester of gestation compared with controls. IMH identified in the second trimester of gestation was a risk factor for macrosomia [adjusted odds ratio (aOR) 1.942, 95% CI 1.076–3.503, p = 0.027] and gestational hypertension (aOR 4.203, 95% CI 1.611–10.968, p < 0.01), when body mass index in the early pregnancy was < 25 kg/m 2 . Conclusions IMH in the first trimester did not increase the risk of adverse outcomes irrespective of whether women received L-T4 treatment. However, IMH identified in the second trimester was associated with increased risk of adverse pregnancy outcome. The results suggest that thyroid function follow-up during the second trimester is necessary, even if thyroid function is normal during the first trimester. Electronic supplementary material The online version of this article (10.1007/s40618-018-0960-7) contains supplementary material, which is available to authorized users.

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“…Early thyroid hormone replacement in the newborn can prevent or reduce fetal brain damage. Fetal brain damage can be severe in the presence of maternal hypothyroidism or may be medium/moderate or severe in the presence of maternal hypothyroxinemia (50,51,52) (fig 1).…”

Section: )mentioning

confidence: 99%

About odide: A Friendly and Necessary Ion

Mld¹,

Am²

2019

Preprint

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Iodide is an essential micronutrient present in very small quantities in the human body, with a fundamental action for the adequate synthesis of thyroid hormones, which are critical for cell differentiation, growth and metabolism. In the form of iodide, iodine is widely distributed in the environment, although in an irregular manner, occurring in abundant amounts in the oceans and in coastal areas and scarcely found on islands and mountains. The diet is the main source of iodine, whose intake varies according to the amount present in soil and water and according to eating habits. Governmental policies have been adopted to satisfy and guarantee the necessary daily supply of iodine, such as fortification of industrialized salt for domestic iodine consumption or addition to the bread commonly consumed in a given region, or the offer of iodized oil to the population, or even iodine supplementation through medications. Iodide deficiency is the main avoidable cause of brain damage to fetuses and children, as well as retardation of psychomotor development. Thyroid hormones are almost universally involved in the development and proliferation of fetal neural tissue. Permanent lesions of the cerebral cortex, hippocampus and cerebellum may occur, with loss of, or damage to the brainstem or spinal cord, affecting cortical areas that integrate highly specialized stimuli, which become poorly defined on an anatomical basis, including silent areas of the associative cortex. One of the more significant metabolic problems due to dietary iodine deficiency is the presence of goiter (increased volume of the thyroid gland). Thyroid carcinoma is the most frequent endocrine neoplasia affecting the human species and plasma iodine concentration is related to the development of specific subtypes of this neoplasia. An increased prevalence of follicular carcinoma, a more aggressive tumor, has been observed in areas of iodine deficiency, while the correction of this deficiency is associated with a higher prevalence of papilliferous carcinoma, a less aggressive form. CONCLUSION: An ideal plasma iodide concentration is necessary to insure the proper mental development of fetuses and young children and to minimize the aggressiveness of thyroid cancer from follicular cells in humans.

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Update on a new controversy in endocrinology: isolated maternal hypothyroxinemia

Cited by 26 publications

References 50 publications

Turning to Thyroid Disease in Pregnant Women

Turning to Thyroid Disease in Pregnant Women

The impact of isolated maternal hypothyroxinemia during the first and second trimester of gestation on pregnancy outcomes: an intervention and prospective cohort study in China

About odide: A Friendly and Necessary Ion

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