Iodine deficiency as a cause of hypothyroidosis in pregnant women: diagnostics and preventive measures
https://doi.org/10.21518/2079-701X-2022-16-5-70-77
Abstract
Pregnancy is a period of increased demands on all organs and systems of the mother’s body, including the thyroid gland (TG). The productivity of the thyroid gland increases by 30–50%. For continuous and sufficient synthesis of thyroid hormones (TG) requires optimal intake of dietary iodine. The need for a microelement increases significantly during pregnancy, due to increased activity of the thyroid gland. Iodine deficiency of mild or moderate degrees leads to insufficient synthesis of thyroid hormones, despite its compensatory increase. Hypothyroidism in women is one of the causes of infertility. Hypothyroidism in pregnant women significantly increases the risk of preterm birth. Iodine deficiency has a serious impact on the intrauterine development of the fetus, because iodine and thyroid hormones (TG) are actively involved in the development of the fetus, the formation of various organs and the development of the brain. In order to prevent the dangerous consequences of iodine deficiency in the Russian Federation, mass prevention is carried out in the form of the use of iodized salt. During the 1st trimester of pregnancy, each woman undergoes a laboratory test of the level of TSH, total T4 and total T3 as a screening in order to correct the hypofunction of the thyroid gland in time. In pregnant women, especially in the first trimester, iodine requirements increase by 50%, which requires not only the mandatory use of iodized salt, but also the appointment of pharmacological preparations of iodine with an accurate dosage. Preventive measures may not be enough, then replacement therapy with levothyroxine is used throughout the pregnancy.
About the Authors
M. S. Medvedeva
Vernadsky Crimean Federal University
Russian Federation
Russian Federation
Margarita S. Medvedeva, 5th Year Student of the Department of Obstetrics and Gynecology, Georgievskiy Medical Academy
47, Vernadskiy Ave., Simferopol, Republic of Crimea, 295007
A. S. Lyashenko
North-Western State Medical University named after I.I. Mechnikov
Russian Federation
Russian Federation
Anastasiya S. Lyashenko, 6th Year Student of the Department of Obstetrics and Gynecology
47, Piskarevsky Ave., St Petersburg, 195067
E. N. Lyashenko
Vernadsky Crimean Federal University
Russian Federation
Russian Federation
Elena N. Lyashenko, Cand. Sci. (Med.), Associate Professor of the Department of Obstetrics and Gynecology
4, Vernadskiy Ave., Simferopol, Republic of Crimea, 295007
References
1. Hormones and their effects. St Petersburg: Foliant; 2012. 136 p. (In Russ.)
2. Prilutskiy A.S., Glushuch S.Yu. Physiological changes in thyroid function during pregnancy. International Journal of Endocrinology. 2015;(5):140–146. (In Russ.) Available at: http://www.mif-ua.com/archive/article/41402.
3. Bates J.N., Kohn T.P., Pastuszak A.W. Effect of Thyroid Hormone Derangements on Sexual Function in Men and Women. Sex Med Rev. 2020;8(2):217–230. https://doi.org/10.1016/j.sxmr.2018.09.005.
4. McCabe M.P., Sharlip I.D., Atalla E., Balon R., Fisher A.D., Laumann E. et al. Definitions of Sexual Dysfunctions in Women and Men: A Consensus Statement From the Fourth International Consultation on Sexual Medicine 2015. J Sex Med. 2016;13(2):135–143. https://doi.org/10.1016/j.jsxm.2015.12.019.
5. Dedov I.I., Melnichenko G.A. (eds.). Endocrinology. National leadership. Short edition. Moscow: GEOTAR-Media; 2013. 752 p. (In Russ.) Available at: https://panacea21.files.wordpress.com/2017/08/dedov_i_i_melnichenko_g_a_red_endokrinologiya-2.pdf.
6. Berezhnoy V.V., Mamenko M.E. Child’s intelligence and iodine deficiency: mechanisms of negative influence and ways to prevent. International Journal of Endocrinology. 2014;(6):41–45. (In Russ.) Available at: http://www.mif-ua.com/archive/article/39246.
7. Gowachirapant S., Jaiswal N., Melse-Boonstra A., Galetti V., Stinca S., Mackenzie I. et al. Effect of iodine supplementation in pregnant women on child neurodevelopment: a randomised, double-blind, placebocontrolled trial. Lancet Diabetes Endocrinol. 2017;5(11):853–863. https://doi.org/10.1016/S2213-8587(17)30332-7.
8. Moog N.K., Entringer S., Heim C., Wadhwa P.D., Kathmann N., Buss C. Influence of maternal thyroid hormones during gestation on fetal brain development. Neuroscience. 2017;342:68–100. https://doi.org/10.1016/j.neuroscience.2015.09.070.
9. Vanderpump M.P. Epidemiology of iodine deficiency. Minerva Med. 2017;108(2):116–123. https://doi.org/10.23736/S0026-4806.16.04918-1.
10. Torlinska B., Bath S.C., Janjua A., Boelaert K., Chan S.Y. Iodine Status during Pregnancy in a Region of Mild-to-Moderate Iodine Deficiency is not Associated with Adverse Obstetric Outcomes; Results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Nutrients. 2018;10(3):291. https://doi.org/10.3390/nu10030291.
11. Savelyeva G.M., Suchich G.T., Serov V.N., Radzinskiy V.E. Obstetrics: national leadership. Moscow: GEOTAR-Media; 2018. 1088 p. (In Russ.) Available at: http://ma.cfuv.ru/docs/савельева.pdf.
12. Springer D., Jiskra J., Limanova Z., Zima T., Potlukova E. Thyroid in pregnancy: From physiology to screening. Crit Rev Clin Lab Sci. 2017;54(2):102–116. https://doi.org/10.1080/10408363.2016.1269309.
13. Niwattisaiwong S., Burman K.D., Li-Ng M. Iodine deficiency: Clinical implications. Cleve Clin J Med. 2017;84(3):236–244. https://doi.org/10.3949/ ccjm.84a.15053.
14. Walkington L., Webster J., Hancock B.W., Everard J., Coleman R.E. Hyperthyroidism and human chorionic gonadotrophin production in gestational trophoblastic disease. Br J Cancer. 2011;104(11):1665–1669. https://doi.org/10.1038/bjc.2011.139.
15. Lazarus J. Thyroid Regulation and Dysfunction in the Pregnant Patient. In: Feingold K.R., Anawalt B., Boyce A. (eds.). Endotext. South Dartmouth (MA): MDText.com, Inc.; 2000. Available at: https://www.ncbi.nlm.nih.gov/books/ NBK279059/.
16. Akturk M., Oruc A.S., Danisman N., Erkek S., Buyukkagnici U., Unlu E., Tazebay U.H. Na+/I- symporter and type 3 iodothyronine deiodinase gene expression in amniotic membrane and placenta and its relationship to maternal thyroid hormones. Biol Trace Elem Res. 2013;154(3):338–344. https://doi.org/10.1007/s12011-013-9748-y.
17. Walkington L., Webster J., Hancock B.W., Everard J., Coleman R.E. Hyperthyroidism and human chorionic gonadotrophin production in gestational trophoblastic disease. Br J Cancer. 2011;104(11):1665–1669. https://doi.org/10.1038/bjc.2011.139.
18. Silva J.F., Ocarino N.M., Serakides R. Placental angiogenic and hormonal factors are affected by thyroid hormones in rats. Pathol Res Pract. 2015;211(3):226–234. https://doi.org/10.1016/j.prp.2014.11.003.
19. Loubière L.S., Vasilopoulou E., Bulmer J.N., Taylor P.M., Stieger B., Verrey F. et al. Expression of thyroid hormone transporters in the human placenta and changes associated with intrauterine growth restriction. Placenta. 2010;31(4):295–304. https://doi.org/10.1016/j.placenta.2010.01.013.
20. Sun Y.N., Liu Y.J., Zhang L., Ye Y., Lin L.X., Li Y.M. et al. Expression of organic anion transporting polypeptide 1c1 and monocarboxylate transporter 8 in the rat placental barrier and the compensatory response to thyroid dysfunction. PLoS ONE. 2014;9(4):e96047. https://doi.org/10.1371/journal.pone.0096047.
21. Mortimer R.H., Landers K.A., Balakrishnan B., Li H., Mitchell M.D., Patel J., Richard K. Secretion and transfer of the thyroid hormone binding protein transthyretin by human placenta. Placenta. 2012;33(4):252–256. https://doi.org/10.1016/j.placenta.2012.01.006.
22. Schroeder A.C., Privalsky M.L. Thyroid hormones, t3 and t4, in the brain. Front Endocrinol (Lausanne). 2014;5:40. https://doi.org/10.3389/fendo.2014.00040.
23. Bernal J., Guadaño-Ferraz A., Morte B. Thyroid hormone transporters – functions and clinical implications. Nat Rev Endocrinol. 2015;11(7):406–417. https://doi.org/10.1038/nrendo.2015.66.
24. Carosa E., Lenzi A., Jannini E.A. Thyroid hormone receptors and ligands, tissue distribution and sexual behavior. Mol Cell Endocrinol. 2018;467:49–59. https://doi.org/10.1016/j.mce.2017.11.006.
25. Pearce E.N., Caldwell K.L. Urinary iodine, thyroid function, and thyroglobulin as biomarkers of iodine status. Am J Clin Nutr. 2016;104(3 Suppl.):898S–901S. https://doi.org/10.3945/ajcn.115.110395.
26. Tingi E., Syed A.A., Kyriacou A., Mastorakos G., Kyriacou A. Benign thyroid disease in pregnancy: A state of the art review. J Clin Transl Endocrinol. 2016;6:37–49. https://doi.org/10.1016/j.jcte.2016.11.001.
27. Velasco I., Bath S.C., Rayman M.P. Iodine as Essential Nutrient during the First 1000 Days of Life. Nutrients. 2018;10(3):290. https://doi.org/10.3390/nu10030290.
28. Dosiou C., Medici M. Management of endocrine disease: Isolated maternal hypothyroxinemia during pregnancy: knowns and unknowns. Eur J Endocrinol. 2017;176(1):R21–R38. https://doi.org/10.1530/EJE-16-0354.
29. Min H., Dong J., Wang Y., Wang Y., Teng W., Xi Q., Chen J. Maternal Hypothyroxinemia-Induced Neurodevelopmental Impairments in the Progeny. Mol Neurobiol. 2016;53(3):1613–1624. https://doi.org/10.1007/s12035-015-9101-x.
30. Alexander E.K., Pearce E.N., Brent G.A., Brown R.S., Chen H., Dosiou C. et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017;27(3):315–389. https://doi.org/10.1089/thy.2016.0457.
31. Kumru P., Erdogdu E., Arisoy R., Demirci O., Ozkoral A., Ardic C. et al. Effect of thyroid dysfunction and autoimmunity on pregnancy outcomes in low risk population. Arch Gynecol Obstet. 2015;291(5):1047–1054. https://doi.org/10.1007/s00404-014-3533-9.
32. Smetnik A.A., Sazonova A.I. Influence of the thyroid gland and its pathology on the reproductive function of women. Akusherstvo i Ginekologiya (Russian Federation). 2019;(3):46–52. (In Russ.) https://doi.org/10.18565/aig.2019.3.46-52.
33. Krassas G., Karras S.N., Pontikides N. Thyroid diseases during pregnancy: a number of important issues. Hormones (Athens). 2015;14(1):59–69. https://doi.org/10.1007/BF03401381.
34. Alferova V.I., Mustafina S.V., Rymar O.D. Iodine status of the population in Russia and the world: what do we have for 2019? Clinical and Experimental Thyroidology. 2019;15(2):73–82. (In Russ.) https://doi.org/10.14341/ket10353.
35. Melnichenko G.A., Troshina E.A., Platonova N.M., Panfilova E.A., Rybakova A.A., Abdulkhabirova F.M., Bostanova F.A. Iodine deficiency thyroid disease in the Russian Federation: the current state of the problem. Аnalytical review of publications and data of official state statistics (Rosstat). Consilium Medicum. 2019;21(4):14–20. (In Russ.) Available at: https://omnidoctor.ru/library/izdaniya-dlya-vrachey/consilium-medicum/cm2019/cm2019_4_endo/yododefitsitnye-zabolevaniya-shchitovidnoyzhelezy-v-rossiyskoy-federatsii-sovremennoe-sostoyanie-pr/.
36. Troshina E.A., Platonova N.M., Panfilova E.A. Dynamics of epidemiological indicators of thyroid pathology in the population of the Russian Federation: analytical report for the period 2009–2018. Problemy Endokrinologii. 2021;67(2):10–19. (In Russ.) https://doi.org/10.14341/probl12433.
37. Kutuzova L.A., Lebedeva A.M., Uzbekova L.D. Relevance of the problem of iodine deficiency in the Crimean region over the past decade. International Student Scientific Bulletin. 2018;(6). (In Russ.) Available at: https://eduherald.ru/ru/article/view?id=19302.
38. Zimmermann M.B., Gizak M., Abbott K., Andersson M., Lazarus J.H. Iodine deficiency in pregnant women in Europe. Lancet Diabetes Endocrinol. 2015;3(9):672–674. https://doi.org/10.1016/S2213-8587(15)00263-6.
39. Fenzi G.F., Giusti L.F., Aghini-Lombardi F., Bartalena L., Marcocci C., Santini F. et al. Neuropsychological assessment in schoolchildren from an area of moderate iodine deficiency. J Endocrinol Invest. 1990;13(5):427–431. https://doi.org/10.1007/BF03350696.
40. Romanenko T.G., Chayka O.I. Features of thyroid function in pregnant women against the background of iodine deficiency. International Journal of Endocrinology. 2014;(4):89–94. (In Russ.) Available at: http://www.mifua.com/archive/article/38944.
41. Pretell E.A., Pearce E.N., Moreno S.A., Dary O., Kupka R., Gizak M. et al. Elimination of iodine deficiency disorders from the Americas: a public health triumph. Lancet Diabetes Endocrinol. 2017;5(6):412–414. https://doi.org/10.1016/S2213-8587(17)30034-7.
42. Markhus M.W., Dahl L., Moe V., Abel M.H., Brantsæter A.L., Øyen J. et al. Maternal Iodine Status is Associated with Offspring Language Skills in Infancy and Toddlerhood. Nutrients. 2018;10(9):1270. https://doi.org/10.3390/nu10091270.
43. De Benua B., Shvets O.V. Eliminating iodine deficiency is one of the key health problems. International Journal of Endocrinology. 2011;(6). (In Russ.) Available at: http://www.mif-ua.com/archive/article/22529.
44. Toloza F.J.K., Motahari H., Maraka S. Consequences of Severe Iodine Deficiency in Pregnancy: Evidence in Humans. Front Endocrinol (Lausanne). 2020;11:409. https://doi.org/10.3389/fendo.2020.00409.
45. Zimmermann M.B., Andersson M. Update on iodine status worldwide. Curr Opin Endocrinol Diabetes Obes. 2012;19(5):382–387. https://doi.org/10.1097/MED.0b013e328357271a.
46. Dedov I.I., Melnichenko G.A. (eds.). Iodine deficiency diseases in the Russian Federation: decision-¬making time. Moscow: Konti-Print; 2012. 32 p. (In Russ.)
47. Bougma K., Aboud F.E., Harding K.B., Marquis G.S. Iodine and mental development of children 5 years old and under: a systematic review and meta-analysis. Nutrients. 2013;5(4):1384–1416. https://doi.org/10.3390/nu5041384.
48. Scheplyagina L.A., Kurmacheva N.A. Prevention of iodine deficiency in pregnant women: iodine monopreparations or iodine-containing vitamin-mineral complexes? Russian Bulletin of Obstetrician--Gynecologist. 2014;(6):86–89. (In Russ.) Available at: https://www.mediasphera.ru/issues/rossijskij-vestnik-akushera-ginekologa/2014/6/downloads/ru/031726-61222014617.
49. Troshina E.A. Current aspects of prevention and treatment of iodine deficiency disorders. Focus on risk groups. Meditsinskiy Sovet. 2016;(3):82–85. (In Russ.) https://doi.org/10.21518/2079-701X-2016-3-82-85.
50. Bouhouch R.R., Bouhouch S., Cherkaoui M., Aboussad A., Stinca S., Haldimann M. et al. Direct iodine supplementation of infants versus supplementation of their breastfeeding mothers: a double-blind, randomised, placebo-controlled trial. Lancet Diabetes Endocrinol. 2014;2(3):197–209. https://doi.org/10.1016/S2213-8587(13)70155-4.
51. Maraka S., Singh Ospina N.M., O’Keeffe D.T., Rodriguez-Gutierrez R., Espinosa De Ycaza A.E., Wi C.I. et al. Effects of Levothyroxine Therapy on Pregnancy Outcomes in Women with Subclinical Hypothyroidism. Thyroid. 2016;26(7):980–986. https://doi.org/10.1089/thy.2016.0014.
52. Panfilova E.A., Isaeva M.P., Troshina E.A. Hypothyroidism: a lecture for primary care physicians. Meditsinskiy Sovet. 2020;(11):124–130. (In Russ.) https://doi.org/10.21518/2079-701X-2020-11-124-130.
53. Taylor P.N., Okosieme O.E., Dayan C.M., Lazarus J.H. Therapy of endocrine disease: Impact of iodine supplementation in mild-to-moderate iodine deficiency: systematic review and meta-analysis. Eur J Endocrinol. 2013;170(1):R1–R15. https://doi.org/10.1530/EJE-13-0651.
54. Shabalina E.A., Morgunova T.B., Orlova S.V., Fadeev V.V. Selenium and thyroid gland. Clinical and Experimental Thyroidology. 2011;7(2):7–18. (In Russ.) https://doi.org/10.14341/ket2011727-18.
55. Gromova O.A., Torshin I.Yu., Kosheleva N.G. Molecular synergistic iodine: new approaches to effective prevention and therapy of iodine deficiency diseases in pregnant women. Russian Journal of Woman and Child Health. 2011;(1):51. (In Russ.) Available at: https://www.rmj.ru/articles/ginekologiya/Molekulyarnye_sinergisty_yoda_novye_podhody_k_effektivnoy_profilaktike_i_terapii_yod-deficitnyh_zabolevaniy_u_beremennyh/.
Review
For citations:
Medvedeva MS, Lyashenko AS, Lyashenko EN. Iodine deficiency as a cause of hypothyroidosis in pregnant women: diagnostics and preventive measures. Meditsinskiy sovet = Medical Council. 2022;(5):70-77. (In Russ.) https://doi.org/10.21518/2079-701X-2022-16-5-70-77
Views:
439
Email this article 