Chukwuma I. Onyeije, M.D. Chukwuma I. Onyeije, M.D. http://preeclampsiaonline.ne t http:// http:// maternalfetalmedicineblog.co maternalfetalmedicineblog.co m m The Link Between Preeclampsia Hypothyroidism: New Evidence and Clinical Significance
Nov 06, 2014
Chukwuma I. Onyeije, M.D.Chukwuma I. Onyeije, M.D.http://preeclampsiaonline.net
http://maternalfetalmedicineblog.comhttp://maternalfetalmedicineblog.com
The Link Between Preeclampsia Hypothyroidism:
New Evidence and Clinical Significance
PREECLAMPSIAPREECLAMPSIA
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Background
Preeclampsia is a pregnancy specific syndrome characterized by new onset hypertension and proteinuria in the second half of pregnacy
Preeclampsia causes substantial morbidity and mortality in mothers and infants.
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Background
Women with a history of pre-eclampsia have an increased risk of lipid disorders, hypertension, cardiovascular disease and renal disease.
The cause of preeclampsia is unknown
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Signs of Preeclampsia
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Background
3% to 5% of women experience preeclampsia
Preeclampsia is more common in African-American Women
What is What is Antiangiogenesis?Antiangiogenesis?
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Antiangiogenesis
Antiangiogenesis
(AN-tee-AN-jee-oh-JEN-eh-sis)
Prevention of the growth of new blood vessels.
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The Importance of Antiangiogenesis
The formation of new blood vessels is essential for a normal pregnancy
Studies in both humans and animals suggest that excess circulating antiangiogenic factors may be responsible for pre-eclampsia
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Examples of Antiangiogenic Factors
Soluble fms-like Tyrosine Kinase 1 (sFlt-1)
Soluble endoglin
*Laboratory rats exposed to sFlt-1 and Soluble endoglin develop severe
preeclampsia.
HYPOTHYROIDISMHYPOTHYROIDISM
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Hypothyroidism
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Hypothyroidism
Hypothyroidism is a decreased activity of the thyroid gland
Hypothyroidism can affect all body functions.
Slow metabolism due to hypothyroidism can cause mental and physical sluggishness.
The most severe form of hypothyroidism is myxedema, which is a medical emergency.
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TREATMENT OF HYPOTHYROIDISM
Small differences in dosage have significant clinical impact, both on safety and efficacy
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THE STUDY
Small differences in dosage have significant clinical impact, both on safety and efficacy
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Richard J. Levine, M.D., et al.
Pre-eclampsia, soluble fms-like tyrosine kinase 1, and the risk of reduced thyroid function: nested case-
control and population based study
BMJ 2009;339:b4336
Richard J Levine, Lars J Vatten,Gary L Horowitz, Cong Qian, Pal R
Romundstad, Kai F Yu, Anthony N Hollenberg, Alf I Hellevik, Bjorn O Asvold, S Ananth Karumanchi,
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Results
Women who develop preeclampsia are more likely to have slightly reduced thyroid function during the final weeks of their pregnancies.
Women who develop preeclampsia are also more likely to have low thyroid function more
than 20 years after giving birth.
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Conclusions
The level of hypothyroidism was strongly associated with levels of soluble fms-like tyrosine kinase 1 in
patients with preeclampsia
The researchers write that this suggests that the effect of preeclampsia on thyroid function may be
mediated by this protein.
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Clinical Significance
The findings of this study have important implications for the subsequent care of women
with pre-eclampsia.
Women who have had preeclampsia should be followed closely for the development of
cardiovascular and renal disease.
Women who have had preeclampsia should be monitored for reduced thyroid function and
clinically important hypothyroidism.
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Implications for Patients
Early treatment of hypothyroidism may substantially reduce the associated morbidity and improve quality
of life in women who have had preeclampsia
Treatment of hypothyroidism might prevent early cardiovascular disease in women with a history of
pre-eclampsia.
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Questions for Further Research
Does hypothyroidism contribute to cardiovascular disease in women with a history of pre-eclampsia?
Does subclinical hypothyroidism in women with pre-eclampsia have adverse effects on the long term
health of the children?
Does the risk of hypothyroidism in women with pre-eclampsia increase with time elapsed after
pregnancy?
Chukwuma I. Onyeije, M.D.Chukwuma I. Onyeije, M.D.http://preeclampsiaonline.net
http://maternalfetalmedicineblog.comhttp://maternalfetalmedicineblog.com
Thank You.Thank You.