الفهرس 
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PhysiologyOnly 14 pages are availabe for public view
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Abstract
Pregnancy has pronounced effects on thyroid physiology, total concentrations of triiodothyronine and thyroxine increase during pregnancy because of elevated thyroxin-binding globulin concentration and human chorionic gonadotrophin (HCG), Thus, the serum TSH concentration is low in the first trimester and increases significantly in the second and third trimesters. Thus, the use of gestational-age–specific threshold values for thyroid hormones is essential for the accurate diagnosis of thyroid disorders such as SCH. In this work, a prospective observational study was carried out in Antenatal Care Unit and Emergency Unit at Obstetrics and Gynecology Department in Mansoura University Hospitals and 250 pregnant women were included in the study. A full precise history, including history [reproductive history (miscarriage, preterm delivery and infertility), personal history and family history of thyroid diseases (including first and second degree relatives)], General examination including body built, weight and neck swelling, Abdominal examination ,Discovery and exclusion of any evident cause of the present complications, Ultrasound scan, Laboratory investigations including thyroid gland hormones ( TSH, free T3 and free T4). We found that the prevalence of subclinical hypothyroidism was 4.8% and subclinical hyperthyroidism was 2%. Maternal thyroid dysfunction has been shown to be associated with a number of adverse maternal and fetal outcomes. As regard subclinical hypothyroidism, there were significant increase in maternal complications including severe preeclampsia and gestational diabetes. Higher incidence of gestational hypertension and placental abruption but not statistically significant. There was total increase in fetal complications with subclinical hypothyroidism including respiratory distress syndrome, low birth weight and intensive care entry. No significant increase in intracranial hemorrhage, major malformation, fetal death and neonatal death. On the other hand, subclinical hyperthyroidism has no effect on maternal and fetal outcomes in our study may be due to the small number of patients discovered to be subclinical hyperthyroid. Trimester-specific reference ranges for TSH and free T 4 should be established in each antenatal hospital setting. If TSH trimester-specific reference ranges are not available in that laboratory the following reference range upper limits are recommended: first trimester 2.5 mIU/L, second trimester 3.0mIU/L,third trimester 3.5 mIU/L. TSH should be measured at the beginning of pregnancy if screening is performed. If TSH is elevated, FT4should be determined . This will enable SCH or overt hypothyroidism to be diagnosed and decrease its complications.