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Thyroid dysfunction in pregnancy: definition of TSH cut-off should precede the decision of screening in low-risk pregnant women

DGYE-2010-0044.R1[488774]

ROSARIO, PEDRO

Objective: To evaluate the frequency of elevated TSH in pregnant women of low risk for thyroid dysfunction. Subjects and Methods: TSH was measured in 838 pregnant women during the first trimester of gestation (from 6 to 14 weeks, median 9 weeks) and who were considered to be of low risk for thyroid dysfunction because they did not meet any of the following criteria: more

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A 46,XX SRY – negative man with infertility, and co-existing with chronic autoimmune thyroiditis

Erdogan – DGYE-2009-0174 [ID 463731] 3 pag

46,XX male (de la Chapelle syndrome) is a rare syndrome with a frequency of 1 in 20 000–25 000 males. 46, XX males exist in different clinical categories with ambiguous genitalia or partially to fully mature male genitalia, in combination with complete or incomplete masculinization. We herein report a case of SRY-negative XX male with complete masculinization but infertility, and co-existing with autoimmune thyroiditis. The patient had fully mature male genitalia with descended but small testes and no signs of undervirilization. Peripheral blood culture for chromosome studies revealed 46 chromosomes with XX constitution. Repeat polymerase chain reaction (PCR) analysis, using Y-specific sequence tagged sites analysing about 40 metaphases of genomic DNA, confirmed the absence of the Y chromosome, including any detectable SRY gene. We herein report a case of a man 46, XX male SRY- with normal male phenotype and infertility. This case is the first reported case, co-existing with chronic autoimmune thyroiditis.

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Postpartum thyroiditis and hypothalamo-hypophysial insufficiency in the same woman with successive pregnancies: a case report.

Ertek, Sibel, Erdogan, Gurbuz

Abstract: Objective: Although the incidence of postpartum autoimmune disorders of endocrine glands are not rare, the presence of two different entities in the same patient with two different pregnancies is uncommon. Methods: We present a 35 years’ old woman whose story starts with her first pregnancy when she was 29 years’ old, she had the diagnosis of postpartum thyroiditis with hypothyroidism. We followed-up the patient when she had her second pregnancy. Results: When she was being followed up with levothyroxine replacement, five years later she had her second delivery after which she had complaints of polydipsia, polyuria, weight loss and had the diagnosis of central diabetes insipitus and she has started desmopressin treatment and 17 months later the delivery she again applied with amenorrhea, continuation of lactation later she noticed oligomenorrhea, and her gonadotropin levels were found to be low as well as her TSH levels, although the L-thyroxine treatment dose was not changed. Dynamic tests of hypophysis revealed hypophyseal insufficiency and repeated hypophyseal MRI was in concordance with lymphocytic hypophysitis which explains the pattern of endocrinological abnormalities after the second delivery. Conclusion: This case signals role of autoimmune mechanisms underlying the endocrinopathies seen after successive pregnancies of the same patient.

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Is a upper limit of 2.5 mUI/L for TSH appropriate for the first trimester of pregnancy among young ATPO negative women?

Castro, Luiz; Coeli, Claudia; Netto, Lino; Buescu, Alexandru; Vaisman, Mario

Abstract: Objectives The general purpose of study is to asses the distribution between the various hormonal indices in young pregnant women with negative thyroid peroxidase antibodies and iodine sufficiency and classify them accordingly while comparing them to literature proposed reference values for the first trimester. Methods: A sectional study was carried out, including 127 pregnant women enrolled at the prenatal out patient clinic at the Nova Iguaçu General Hospital in the period comprised between 2000 and June 2007.They were submitted to TSH, free T4, total T4, TBG and thyroid peroxidase antibody determinations. Results: A median equal to 38.7 mcg/mL was observed for TBG , TSH values varied between 0.02 mcUI/mL and 5.84 mcUI/mL, with a median of 1.25 mcUI/mL. For total T4 and free T4, median values were, respectively 10.3 mcg/dL and 1.20 ng/dL. Thirteen patients out of 115 displayed a TSH serum level above 2.5 mUI/ml.. Conclusions Patients with subclinical hypothyroidism classified by this new cutoff(serum TSH concentration between 2,5 mUI/L and the upper limit of the reference range), chiefly ATPO negative young women, display no need for treatment as there is no evidence that this condition is associated with maternal and fetal complications.

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• December, 2009 •

Progesterone, Thyroid Hormone and Relaxin in the Regulation of the Invasive Potential of Extravillous Trophoblasts in Early Placental Development

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Takeshi Maruo, M.D., Ph.D. ,
Director, Kobe Children’s Hospital and Feto-Maternal Medical Center & Professor Emeritus, Kobe University, Kobe, Japan

Placental tissues contain a heterogeneous population of cells, including villous cytotrophoblasts, syncytiotrophoblasts and extravillous trophoblasts(EVTs). EVTs are mainly uninuclear cells comprising all the trophoblastic elements located outside the villi. EVT has two distinct phenotypes, proliferative and invasive. The activity of the invasive EVTs is dependent on its apoptotic capacity and less on its proliferative potential. Apoptosis is an important determinant in regulating placental growth. Actually, apoptosis is more evident in the invasive EVTs than its proliferative counterpart and the extent of apoptosis is associated with augmented Fas and Fas ligand expression and reduced Bcl-2 protein expression (1). more

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