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Publicación continuada como Endocrinología, Diabetes y Nutrición. SJR es una prestigiosa métrica basada en la idea de que todas las citaciones no son iguales. SJR usa un algoritmo similar al page rank de Google; es una medida cuantitativa y cualitativa al impacto de una publicación. El Bierzo area is characterized by low urinary iodine levels in the pregnant population. Guidelines recommend that local reference values are established for the diagnosis of thyroid dysfunction in pregnancy.
Our objectives were to establish reference values for thyroid-stimulating hormone TSHfree thyroxine FT4 and free triiodothyronine FT3 in women in the first trimester of pregnancy and to explore the factors influencing variability in these hormones. A retrospective study of women in the first trimester of pregnancy who were measured serum levels of TSH, FT4, and FT3; women with conditions with a potential influence on thyroid function were excluded. Thirty smoking pregnant women were also excluded from the study of reference values.
Factors examined in the variability study included age, body mass index BMIand smoking. A multifactorial analysis of covariance was performed. Reference values in first-trimester pregnant women were: TSH: 0. TSH levels depended on mother age and on interaction between age and smoking. FT3 levels depended on the mother's BMI and smoking, and there was also an interaction between both factors.
The reference values found may be used to assess thyroid dysfunction in pregnant women from El Bierzo. La zona de El Bierzo se caracteriza por una baja yoduria en la población gestante. Las guías recomiendan establecer valores de referencia locales para el diagnóstico de la disfunción tiroidea en el embarazo. Los objetivos fueron obtener valores de referencia de tirotropina TSHtiroxina libre T4L y triyodotironina libre T3L en gestantes de primer trimestre y estudiar los factores que intervienen en la variabilidad de estas hormonas.
Estudio retrospectivo de gestantes con determinaciones en suero de TSH, T4L y T3L en el primer trimestre; se excluyeron por condiciones con posible influencia sobre la función tiroidea. La TSH depende de la edad de la madre y de la interacción entre la edad y fumar. Los love express quotes in hindi de referencia obtenidos pueden utilizarse para valorar la disfunción tiroidea en mujeres gestantes de El Bierzo.
Pregnancy represents an exceptional challenge for the thyroid gland, and normal pregnancy involves complex changes in thyroid physiology, causing an increased risk of thyroid dysfunction. In pregnancy, they are mainly associated with abortion, 3—5 premature delivery, 4—6 postpartum anemia and bleeding, 7 and increased fetal loss odds ratio: Iodine is an essential element for the synthesis of thyroid hormones, and iodination levels in pregnant women are highly variable in Spain.
Reference thyroid hormone levels in pregnant women are different from those for the general population because of physiological changes in pregnancy, particularly in the first trimester. Since neurological fetal development occurs during that first trimester, any intervention should occur at the beginning of pregnancy why wont my ps4 connect to internet in time limit achieve a good neurological development.
A diagnosis of thyroid dysfunction should therefore be made during how to show increase or decrease between two numbers in excel first trimester of pregnancy. For this, thyroid-stimulating hormone TSH should primarily be measured, and when this is altered, free thyroxine FT4 and free triiodothyronine FT3 should also be measured. Several scientific societies, such as the American Thyroid Association ATA and the Endocrine Society, have recently published new guidelines for the diagnosis and management of thyroid dysfunction in pregnancy.
To diagnose thyroid dysfunction in pregnancy, all of these scientific bodies recommend verification that thyroid hormone levels are within the reference values for each trimester and area of the relevant laboratories. The purpose of this study was to establish reference values for TSH, FT4, and FT3 in women in the first trimester of pregnancy in our area that could be used for universal screening for thyroid dysfunction in the pregnant population.
A retrospective why is my internet not working properly was conducted on pregnant women consecutively attending Hospital del Bierzo from February to April for screening for chromosome diseases in the first trimester. The clinical histories of the pregnant women and the smart casual or casual smart of chromosome disease screening were consulted to collect population data at the time of sampling for thyroid hormone measurement.
Pregnant women with endocrine changes, with no thyroid hormone data available between 8 and 13 weeks of pregnancy, with no information available on population data or prior diseases, and with twin and Down syndrome pregnancies were excluded from the study. Endocrine causes included treatment with thyroxine or other drugs altering thyroid hormones, positive anti-thyroid antibodies, a prior diagnosis of hypothyroidism or hyperthyroidism, or nutritional problems, and a diagnosis of diabetes mellitus or gestational diabetes.
As smoking may alter thyroid hormone levels, 16 pregnant women who smoked at least three cigarettes daily were excluded from the calculation of reference values in the first trimester. TSH was measured using a double-antibody ultrasensitive assay with a range from 0. FT4 was measured using a competitive assay, with a range from 0.
FT3 was measured using a competitive assay, with a range from 0. Data were collected in Excel versionand CBStat version 5. Multivariate linear regression tests were done to obtain an approximation of significant variables, followed by a comprehensive study of multifactorial covariance ANCOVA for TSH, FT4, and FT3, in order to ascertain the main factors and interactions accounting for thyroid hormone variability.
TSH, FT4, or FT3 were introduced in the models as covariates if they were significant, in order to better differentiate the variability of the factors. Homogeneity and model lack-of-fit tests were performed, and residuals charts were analyzed to see whether the covariance models were correct. A value of p 0. A total of women aged 16—43 years in the first trimester of pregnancy were studied.
Of these, were excluded from the study of reference values, and from the variability study. The reasons for exclusion are given in Table 1. The prevalence of anti-thyroid antibodies in pregnant women was 5. Table 2 shows the characteristics of the study population, which were not significantly different between the pregnant women included and excluded. Description of reasons for study exclusion. Table 3 shows the reference values obtained in the first trimester of pregnancy for TSH, FT4, and FT3, with their corresponding confidence intervals.
A significant age-related decrease in TSH was seen p 0. Table 3 also shows TSH reference values for pregnant women aged p 0. Reference values in women in the first trimester of pregnancy weeks 8—13 in El Bierzo. Thirty women who smoked three or more cigarettes daily were excluded. TSH profile plots. Covariate FT4 assessed at 1. TSH: thyroid-stimulating hormone; FT4: free thyroxine.
Significance: age p 0. Smoking also increased FT3 levels in pregnant women p 0. This interaction is better seen in the profile plot Fig. FT3 profile plots. Significance: BMI p 0. The issue of the various recommendations made by scientific bodies and the lack of reference values for TSH, FT4, and FT3 in El Bierzo, an area where a high proportion of pregnant women have iodine deficiency, led us to calculate more precisely the reference values for those hormones in the first trimester of pregnancy.
Although this was a retrospective study, maximum precautions were taken in our exclusion criteria. Any pregnant woman in whom there was the least doubt as to whether a treatment or disease would influence thyroid function was excluded from the study. This explains the high proportion of women excluded However, as shown in Table 2pregnant women included in and excluded from the study did not differ in the population data, and a homogeneous population could be assumed.
To calculate reference what makes good communication in a relationship, distributions were normalized to obtain reference values with confidence intervals as adjusted as possible, which made the number of individuals less relevant. The upper TSH reference value Since TSH and FT4 and FT3 levels did not differ between weeks 8 and 13 of pregnancy, a differentiation of reference values by week is not required, and they are grouped as reference values for the first trimester.
Some reports provide reference values by weeks of pregnancy, 27,28 while others do not, 29,30 but even García de Guadiana Romualdo et al. A direct comparison of reference values found how to show increase or decrease between two numbers in excel this and other studies, even with the how to show increase or decrease between two numbers in excel procedures, is very difficult for several reasons. Many retrospective population studies use positive anti-thyroid antibodies as the only criterion, but as suggested by Spencer et al.
Other studies used populations that were not comparable to ours both with regard to race 25 and because the nutritional iodine status of the population had not been studied. As in some studies, smoking alone did not result in different TSH levels, 16 although differences were found in other studies. Age-related increases 31 what is logistic regression and how does it work decreases how to show increase or decrease between two numbers in excel in TSH levels have however been seen in the general population.
Specifically, Völzke et al. This is a new finding which should be investigated in other studies so as to confirm it with a greater number of cases. If this finding is confirmed, TSH reference values in the first trimester of pregnancy for thyroid dysfunction screening will have to be stratified according to the age and smoking status of the women.
Other studies also reached the same conclusion with regard to smoking. As regards FT3 levels, other studies suggested that they increase with BMI 35,36 and also with smoking, 16 but independently. This interaction may be due to increased peripheral metabolism induced by smoking 16 and increased by the how to play it cool when dating someone body surface area.
TSH levels in the first trimester of pregnancy are influenced by the age of the mother and by the interaction between age and smoking. FT3 levels in the first trimester of pregnancy depend on BMI and the smoking status of the mother, and an interaction between both factors also exists. The authors state that they have no conflicts of interest. Valores de referencia y estudio de la variabilidad de hormonas tiroideas en gestantes de El Bierzo.
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DOI: Reference values and variability study of thyroid hormones in pregnant women from El Bierzo. Descargar PDF. Manuel Lombardo Grifol?? Autor para correspondencia. Este artículo ha recibido. Información del artículo. Table 1.