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עמוד בית
Sat, 20.07.24

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March 2018
Ronit Koren MD, Yifat Wiener MD, Karen Or MD, Carlos A. Benbassat MD and Shlomit Koren MD

Background: Previous surveys demonstrated variations in the clinical practices relating to the treatment and screening of maternal thyroid dysfunction.

Objectives: To study the current practices in the management of subclinical hypothyroidism (SCH) and thyroid nodules during pregnancy of obstetricians/gynecologists (OB/GYNs) and endocrinologists in Israel.

Methods: An electronic questionnaire was sent by email to all members of the Israeli Endocrine Society and the Israel Society of Obstetrics and Gynecology. Questionnaires included demographic data and clinical scenarios with questions regarding the screening and management of pregnant women with SCH, hypothyroxinemia, and a palpable thyroid nodule. The questionnaire for OB/GYNs was slightly modified.

Results: We received 90 responses from endocrinologists and 42 responses from OB/GYNs. Among endocrinologists, 39% would repeat a thyroid-stimulating hormone (TSH) test of 2.9 mU/L with normal free thyroxine and treat with thyroxine if the second result was above 2.5 mU/L. Among OB/GYNs, 73% would manage a woman with SCH at the beginning of her pregnancy by themselves and only 22% would start thyroxine after a first TSH result above 2.5 mU/L. Concerning screening, 57% endocrinologists and 71% OB/GYNs recommended screening for thyroid dysfunction in every woman at the beginning of her pregnancy. Among endocrinologists, 54% would order an ultrasound for a palpable thyroid nodule and perform a fine needle aspiration only for suspicious lesions.

Conclusions: The medical approach to thyroid disease in pregnant women remains a matter of controversy. Our results support the need for larger and prospective clinical studies.

 

April 2012
Y. Wiener, M. Frank, O. Neeman, Y. Kurzweil, J. Bar and R. Maymon

Background: The triple test serum markers for Down’s syndrome screening may be altered because of various conditions other than chromosomal trisomies.

Objectives: To assess the profile of mid-trimester triple test serum markers in a cohort of women treated with low molecular weight heparin (LMWH) for thrombophilia since the first trimester.

Methods: Women with inherited or acquired thrombophilia treated with LMWH prior to 12 weeks gestation were followed between October 2006 and September 2009 at our obstetric outpatient clinic. The second-trimester screening test for Down syndrome was calculated from the combination of triple serum markers and maternal age, and expressed as a multiple of the gestation specific normal median (MoM). Reference MoM values were calculated from the local population. Data on pregnancy outcome were obtained from patient records.

Results: The median human chorionic gonadotrophin (hCG) level of women with inherited thrombophilia was 0.87 MoM, compared to 0.99 MoM in controls (P = 0.038) and compared to 1.355 MoM in women with acquired thrombophilia (P = 0.034). In contrast, alpha-fetoprotein MoMs did not differ significantly between women with inherited and women with acquired thrombophilia (0.88 vs. 0.99 MoM, P = 0.403).

Conclusions: The triple test serum markers may be altered in thrombophilia patients treated with LMWH. Clinicians should consider offering these patients the first-trimester nuchal translucency test and other sonographic markers that are probably unaffected by the underlying maternal disease and/or treatment modality.

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