196 research outputs found
Farmaci antitiroidei in gravidanza e malformazioni congenite:un aggiornamento
No full textUn problema legato all’impiego dei farmaci antitiroidei di sintesi (ATD) nel trattamento nell’ipertiroidismo nelle prima fasi della gravidanza è il rischio di effetti teratogeni. Il Metimazolo (MMI) e il Propiltiouracile (PTU) sono stati associati a malformazioni congenite distinte in differenti sottotipi. Questo articolo passa in rassegna gli studi osservazionali sull’associazione fra gli ATD e i difetti neonatali e discute le attuali evidenze relative ad altri possibili determinanti, compresa la funzione tiroidea materna per se
Iodine status in pregnant and breastfeeding women:a Danish regional investigation
No full textIodine is required for the synthesis of thyroid hormones, which are crucial regulators of early brain development. The source of iodine in the fetus and the breastfed infant is maternal iodine, and adequate iodine intake in pregnant and breastfeeding is of major concern. Severe iodine deficiency can cause irreversible brain damage, whereas the consequences of mild to moderate iodine deficiency are less clear. Denmark was previously iodine deficient with regional differences and a mandatory iodine fortification of salt was introduced in the year 2000. The PhD thesis investigated intake of iodine supplements and urinary iodine status in Danish pregnant and breastfeeding women after introduction of iodine fortification in a region of Denmark with previously moderate iodine deficiency. Additionally, thesis addressed mechanisms of iodiden transport to the fetus across the placenta and methodological challenges in the evaluation of urinary iodine status in prengnant and breastfeeding women.</p
Frequency and outcomes of maternal thyroid function abnormalities in early pregnancy
No full textThyroid function in pregnant women is of clinical importance considering the crucial role of thyroid hormones during fetal brain development, but the current level of evidence is insufficient to recommend for or against the routine testing of thyroid function in pregnant women. As part of this debate, it is important to evaluate the frequency of undiagnosed and untreated thyroid function abnormalities in pregnant women and to address challenges related to the biochemical assessment of maternal thyroid function in early pregnancy. A hypothesis of fetal programming by maternal thyroid disease has been proposed, but more evidence in humans is needed to extend the hypothesis and to evaluate child neurodevelopmental outcomes after in utero exposure to different abnormalities in maternal thyroid function. The nationwide registers in the Nordic countries provide unique opportunities within reproductive epidemiology to study the impact of various in utero exposures, and stored blood samples from pregnant women in nationwide birth cohorts provide a valuable source for the establishment of pregnancy specific reference ranges. This review addresses the frequency and outcomes of thyroid function abnormalities in pregnant women mainly focusing on observational studies that combine data from the Danish nationwide registers and biological specimens from the Danish National Birth Cohort. Dynamic changes in the reference range of maternal TSH and free T4 during the first trimester of pregnancy are described and discussed. A high frequency of unidentified maternal thyroid function abnormalities is illustrated, and outcomes of child neurodevelopment are evaluated according to subtypes and severity of maternal thyroid dysfunction.</p
Maternal thyroid disease in Pregnancy:Nationwide investigations on the occurrence and outcomes
Get PDFAn update on the safety of antithyroid drugs in pregnancy: the power of real-world data
No full textIntroduction: Antithyroid drugs (ATDs) constitute the treatment option for the management of pregnant women with hyperthyroidism of Graves’ disease. The risk of teratogenic side effects to the use of ATDs in pregnancy has challenged the clinical recommendation on the choice of drug and treatment strategy. Areas covered: Overview and methodological discussion of the evidence gathered within the last 50 years on the teratogenic risk of ATDs based on sources of real-world data (RWD) and different study designs. Expert opinion: The level of evidence has evolved within the last century and current state of the art points toward a teratogenic role of Methimazole and Carbimazole. On the other hand, evidence to substantiate the teratogenic role of PTU is less comprehensive and less clear. The findings challenge clinical guidance, and uncertainties prevail for recommendations on the choice of ATD and individual patient management in and around early pregnancy. Future research should focus on the combined use of different sources of RWD in large cohorts and across populations. Detailed assessment of exposure and outcome and considerations on other thyroidal and non-thyroidal related factors in the associations observed are important to inform and support the clinical guidance.</p
Iodine Status in Pregnant & Breastfeeding Women:A Danish Regional Investigation
Get PDFIodine is required for the synthesis of thyroid hormones, which are crucial regulator of early brain development. The source of iodine in the fetus and the breastfed infant is maternal iodine, and adequate iodine intake in pregnant and breastfeeding is of major concern. Severe iodine deficiency can cause irreversible brain damage, whereas the consequences of mild to moderate iodine deficiency are less clear. Denmark was previously iodine deficient with regional differences (mild iodine deficiency in East Denmark and moderate iodine deficiency in West Denmark), and also pregnant and breastfeeding women suffered from iodine deficiency. A mandatory iodine fortification of household salt and salt used for commercial production of bread was introduced in Denmark in the year 2000. The PhD thesis investigates intake of iodine supplements and urinary iodine status in Danish pregnant and breastfeeding women after the introduction of the mandatory iodine fortification of salt in a region of Denmark with previously moderate iodine deficiency. Additionally, the PhD thesis addresses mechanisms of iodide transport to the fetus across the placenta and methodological challenges in the evaluation of urinary iodine status in pregnant and breastfeeding women
Turning to Thyroid Disease in Pregnant Women
No full textThyroid disease in pregnant women needs attention from a clinical and scientific standpoint due to the potential severe adverse consequences. It is well-established that overt thyroid disease in pregnant women should be treated to prevent maternal and fetal complications, but routine testing for overt thyroid function test abnormalities has not been implemented. In contrast, the scientific focus has shifted towards smaller aberrations in maternal thyroid function including subclinical thyroid disease and isolated deviations in maternal thyroxine. In this focused review, we touch upon the assessment of maternal thyroid function in pregnancy and how the historical advancements in thyroid function tests parallel with the thyroid function test abnormalities described. Furthermore, we discuss how the scientific focus has evolved and how the field could turn in view of the existing discrepancies between results of observational studies and randomized controlled trials.</p
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