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PIERRE BOURDOUX,
BERNARD LEJEUNE,
FRANÇOIS DELANGE,
MARC LEMONE,
JACQUES KINTHAERT,
CLAUDE ROBIJN,
JEAN-PAUL GRUN and
PHILIPPE DE NAYER
Department of Endocrinology, Saint-Pierre Hospital, Université Libre de Bruxelles Brussels, Belgium
Department of Nuclear Medicine, Saint-Pierre Hospital, Université Libre de Bruxelles Brussels, Belgium
Departments of Gynecology and Obstetrics, Saint-Pierre Hospital, Université Libre de Bruxelles Brussels, Belgium
Department of Pediatrics, Saint-Pierre Hospital, Université Libre de Bruxelles Brussels, Belgium
Department of Radiology, Saint-Pierre Hospital, Université Libre de Bruxelles Brussels, Belgium
The Department of Nuclear Medicine, Clinique Saint-Luc, Université Catholique de Louuain Woluwe, Belgium
Address requests for reprints to: Dr. Daniel Glinoer, Laboratory of Radioisotopes, Hôpital Saint-Pierre, 322 rue Haute, B-1000 Brussels, Belgium.
A prospective study was undertaken during pregnancy in 120 euthyroid women presenting with mild thyroid abnormalities (TA): 11 with a past history of thyroid disorder, 44 with goiter, 20 with nodules, and 45 with thyroid autoantibodies. The aims of the study were to assess whether the pattern of thyroid alterations during gestation was different in women with TA compared to that in healthy control pregnant subjects and to evaluate possible obstetrical and neonatal repercussions.
The overall prevalence of underlying subtle thyroid abnormalities in the cohort was 17%, probably as the result of the environmental moderately low iodine intake. Despite the intrinsic heterogeneity of the four groups of women with TA, the adaptation of the thyroid to the stress of pregnancy was different from that of the control subjects. Noteworthy were 1) the marked elevation of serum thyroglobulin in women with past history of thyroid disorder, goiter and thyroid nodules; 2) the increase in goiter size in a third of the goitrous women, associated with biochemical evidence of functional stimulation of the gland; 3) the indirect evidence of partial thyroidal autonomy in goitrous patients; and 4) the increase in the number and size of thyroid nodules during gestation. Taken together, the data indicated that pregnancy was associated with a greater thyroidal risk in patients with TA compared to healthy subjects.
In relation to thyroid autoimmunity, most patients remained euthyroid during gestation, but in a few cases, TSH was elevated at delivery, suggesting diminished thyroidal reserve. Also, 40% of newborns from mothers with thyroid autoimmunity had elevated thyroid peroxidase antibody titers at birth, and there was a highly significant correlation between maternal and neonatal thyroid peroxidase antibody titers. Finally, thyroid autoimmunity was clearly associated with an increased risk of spontaneous abortion (13.3 vs. 3.3%; P < 0.001)
Thyroid function in newborns from mothers with TA was normal and not different from that in controls; similarly, obstetrical features were similar in patients with TA and control subjects.
In conclusion, pregnancy is associated with a greater thyroidal risk in women with TA, thereby emphasizing a potential link between pregnancy and thyroid disorders. It is recommended that patients with known, even subtle, thyroid abnormalities be closely monitored during pregnancy, in particular those with a goiter, nodules, or thyroid autoimmunity, especially in areas with a moderately low iodine intake, where the prevalence of mild thyroid disturbances is high.
* This work was supported by Henning (Berlin), Triosol (Brussels), and the Fonds National Beige de la Recherche Scientifique (Contract 3.4531.91 to D.G.).
Present address: Department of Endocrinology, Hospital San Cecilio, University of Granada, Spain.
Received October 18, 1990.
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