SUBCLINICAL HYPOTHYROIDISM IN EARLY GESTATION: PREGNANCY OUTCOME IN TREATED AND UNTREATED WOMEN

Anamul Haq, Sheeba Wani and Shazieya Akhtar Government Lalla Ded Hospital, an Associated Hospital of Govt. Medical College, Srinagar. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 16 February 2020 Final Accepted: 18 March 2020 Published: April 2020


887
There are many studies which have reported adverse effects of SCH on pregnancy and neonatal outcome,these associations include pregnancy loss,preterm delivery,gestational diabetes,gestational hypertension,preeclampsia,placental abruption,premature rupture of membranes,intrauterine growth restriction,low birth weight,small for gestational age,low APGAR score and neonatal death [5][6][7][8][9][10] similarly other studies however have not found any adverse outcomes associated with SCH [11][12][13]  Currently there is no evidence that identification and treatment of SCHduring pregnancy improve these outcomes.No consensus has been reached about the need for universal thyroid screening and the treatment of subclinical hypothyroidism in pregnancy.

Methodology:-
This prospective randomized study was conducted in Department of Obstetrics and Gynaecology, Government Medical College Srinagar.A total of 200 pregnant women having TSH value between 2.5-6 mIU/L were taken. Half of patients received treatment as (Group A) and another half were left untreated as controls (Group B). The selected group received 25-50 mcg thyroxine daily. They were followed till delivery and the outcome compared in both groups.

888
Results:-  In the obstetric score, primigravidas were highest in number from both the groups.There was a significant difference 2 =4.26, p=<0.05).In our study multi gravida were also comparable.

Series 1 = Cases; Series 2 = Controls
Antenatal Complications: Gestational Diabetes was found in 12 cases from group A and 14 controls from group B. Gestational hypertension was found in 7 cases from group A and 5 controls from group B.SGA /IUGR was found in 4 cases from both groups.Preterm deliveries were found in 6 cases from group A and 8 controls from group B. From above results we observed almost equal results in both groups. In the mode of delivery 62 women from treated group and 70 women in the control group delivered vaginally at te 2 = 0.49,p>0.05).In the treated group 20 cases delivered by primary LSCS whereas among controls 8 women delivered by primary LSCS,there was significant difference in both groups 2 =5.82,p<0.05).The number of repeat caesarean section and preterm vaginal delivery were comparable in the two groups. Regarding the gestational age at delivery,5 cases from group A and 4 controls from group B delivered less than 34 weeks whereas 4 cases from group A and 6 controls from group B delivered between 34 to 37 weeks.Majority of women delivered after 37 weeks and the numbers were 91 from group A and 90 from group B. Majority of newborns in both groups had birth weight in the range of >2.5 to <3.5 kg.The mean birth weight in the treated group was 2.75kg and in the control group was 2.84 kg and there was no significant difference (p value=>0.05).

Discussion:-
TSH levels are generally lower throughout the pregnancy especially during the 1 st trimester when HCG levels peak.Subclinical hypothyroidism is found to have a high risk for placental abruption,preterm labour,gestational hypertension,diabetes and neurodevelopmental delay in the baby.Multiple studies done earlier emphasized the treatment for SCH in early pregnancy. In the present study pregnant women with SCH and TSH level <6mu/l were selected and were divided into two groups .Group A received thyroxine and group B were given placebo.They were However observations made by Casey BM and associates 14 were different,they found significant increase in placental abruption,preterm labour and neonatal respiratory distress among patients who were not treated.The mean age of both the groups and the gestational age at delivery was comparable among both the groups in our study.In the obstetric score, significant number of women with previous abortion werefrom group A.Among the mode of delivery in the present study,statistically significant difference was found in the primary caesarean rate.There was no significant difference in the average birth weight of newborns in both the groups.Casey BM 14 and associates found that although SCH has been associated with severe obstetric complications there has been no direct evidence that levothyroxine therapy reduces these risks.Similar observation was made in present study.

Conclusion:-
In pregnant women with SCH (TSH> 2.5-6 mu/l and normal T4 level) treatment with thyroxine does not have any association in reducing the incidence of complications.Experts in 2011 opine that even if subclinical hypothyroidism is diagnosed insufficient evidence exists either for or against a recommendation for treatment with a low dose of thyroxine. So universal screening of all pregnant women for SCH is not recommended.