Case: 36 years old woman is admitted to the ICU for severe depression and suicidal ideation since she had three consecutive losses of pregnancy. All lab work appears relatively stable except for mild thyroid-stimulating hormone (TSH) elevation of 5.2 mIU/L.
Discussion: Interestingly, thyroid health is highly related to pregnancy health. Even in mild and clinically asymptomatic hypothyroidism, the incidence of spontaneous miscarriage is high.
Also, in euthyroid females with thyroid peroxidase (TPO) antibodie,s the risk can be doubled to tripled.
Fortunately, with thyroid treatment, the risk can be minimized.
#ob-gyn
#endo
#psychiatry
References:
1. Negro R, Schwartz A, Gismondi R, et al. Increased pregnancy loss rate in thyroid antibody negative women with TSH levels between 2.5 and 5.0 in the first trimester of pregnancy. J Clin Endocrinol Metab 2010; 95:E44.
2. Chen L, Hu R. Thyroid autoimmunity and miscarriage: a meta-analysis. Clin Endocrinol (Oxf) 2011; 74:513.
3. Thangaratinam S, Tan A, Knox E, et al. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. BMJ 2011; 342:d2616.
4. Bliddal S, Feldt-Rasmussen U, Rasmussen ÅK, et al. Thyroid Peroxidase Antibodies and Prospective Live Birth Rate: A Cohort Study of Women with Recurrent Pregnancy Loss. Thyroid 2019; 29:1465.
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