Lege Artis Medicinae

[Thyroid disorders during pregnancy]

HAJNÁCZKY Károly

DECEMBER 21, 2011

Lege Artis Medicinae - 2011;21(12)

[The hormones of the thyroid gland play a basic role in human reproduction and in the early development of the fetal brain, too. The frequency of hypo- and hyperthyroidism occuring in a pregnancy is between 1-2 per cent. Abnormal maternal thyroid function could result in harmful effects for both the mothers and their offsprings. An illness (gestational throphoblast disease) that is known to have an influence on the maternal thyroid function. Thyroid diseases occuring in pregnancy can result in diagnostical problems: the existing complaints and symptoms may be misdiagnosed as a consequence of pregnancy. Because of the changes in thyroid metabolism, which are typical to pregnancy, the analysis of the results of thyroid function may be difficult. Several diagnostical and therapeutical procedures (i. e. radioiodine techniques) are absolutely contraindicated during pregnancy. In the case of thyroid hormone replacement therapy one must take into consideration the continously changing maternal demand. Propylthiouracil is the choice of therapy regarding the treatment of the hyperthyreoidism during pregnancy. The incidence of thyroid cancer in pregnancy is 1 per 1000. Pregnancy itself does not appear to increase the risk of malignant tranformation or alter the course of thyroid cancer. The preferred period of the surgical intervention of the thyroid gland is the second trimester of the pregnancy. The introduction of a thyroid functional test (thyroid-stimulating hormone) as a screening method in the first trimester would be advisable in our country. Achieving this new procedure would reflect and expand a way of thinking in respect of prevention in our pregnancy care practice.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[Christmas in Medicine ]

KISS László

Lege Artis Medicinae

[Social Responsibilities of a Physician ]

SÓLYOM Antal, BÁLINT Géza

Lege Artis Medicinae

[A Tame Artist Among the ‘Wild”: The Life and Art of Rik Wouters]

NÉMETH István

Lege Artis Medicinae

[On the borderline]

KAPÓCS Gábor

Lege Artis Medicinae

[They are really saved]

FARSANG Csaba

All articles in the issue

Related contents

Hungarian Immunology

[Autoimmun thyroiditis presence in patient with Hodgkin’s disease in remission]

BÍRÓ Edit, BAKÓ Gyula, SZEGEDI Gyula, ILLÉS Árpád

[INTRODUCTION - It is known that the incidence of hypothyroidism is higher in long term survivor patients with Hodgkin's disease, and it is supposed to be the result of treatment, such as neck radiotherapy. The author believe that other etiologic factors may also play a role in the development of hypothyroidism. PATIENTS AND METHODS - Looking for the possible causes of hypothyroidism, the thyroid function of 151 patients treated for Hodgkin's disease since 1970 were examined. These patients with Hodgkin's disease in complete remission for at least one year and their data on thyroid autoantibody positivity [antithyroid peroxidase antibody (aTPO), antihuman thyroglobulin antibody (aHTG), TSH antireceptor antibody (TRAK)] were analysed. RESULTS - Among the patients with antibody positive 26 received ultrasound scanning and fine needle aspiration cytology of the thyroid, which confirmed autoimmun thyroiditis. There were no significant differences between the mean age, histologic subtypes and stage of the disease between the patients with antibody positive those with antibody negative. A significantly greater number of women in the group of antibody positive patients was found and thyroid dysfunction (two cases of hyper, and 13 cases of hyperthyroidism) was revealed in 53.6% of the patients. Though antibody positivity was more frequent in patients having been treated by neck irradiation, but no significant relationship was found between the form of Hodgkin’s disease treatment and the development of thyroiditis. Thus the authors cannot confirm the assumption according to which the autoantigens released from the thyroid gland damaged by neck irradiation for Hodgkin's disease would provoke the development of thyroiditis. Since - independently of the type of treatment received - the incidence of thyroiditis is higher in patients with Hodgkin's disease, it is probable that immune regulation disorders may also play a role in its development and thus hypothyroidism is the result of a multi-factor process. DISCUSSION - These results underline the importance of a regular control of thyroid hormones and thyroid autoantibodies in follow up Hodgkin’s disease patients. Levothyroxine administered as an isohormone treatment may inhibit the development of hypothyroidism in patients with thyroiditis may improve the quality of their life.]

Clinical Neuroscience

Electrophysiological investigation for autonomic dysfunction in patients with myasthenia gravis: A prospective study

NALBANTOGLU Mecbure, AKALIN Ali Mehmet, GUNDUZ Aysegul, KIZILTAN Meral

Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission. Autonomic dysfunction is not a commonly known association with MG. We conducted this study to evaluate autonomic functions in MG & subgroups and to investigate the effects of acetylcholinesterase inhibitors. This study comprised 30 autoimmune MG patients and 30 healthy volunteers. Autonomic tests including sympathetic skin response (SSR) and R-R interval variation analysis (RRIV) was carried out. The tests were performed two times for patients who were under acetylcholinesterase inhibitors during the current assessment. The RRIV rise during hyperventilation was better (p=0.006) and Valsalva ratio (p=0.039) was lower in control group. The SSR amplitudes were lower thereafter drug intake (p=0.030). As much as time went by after drug administration prolonged SSR latencies were obtained (p=0.043).Valsalva ratio was lower in the AchR antibody negative group (p=0.033). The findings showed that both ocular/generalized MG patients have a subclinical parasympathetic abnormality prominent in the AchR antibody negative group and pyridostigmine has a peripheral sympathetic cholinergic noncumulative effect.

Clinical Neuroscience

[The connection between the socioeconomic status and stroke in Budapest]

VASTAGH Ildikó, SZŐCS Ildikó, OBERFRANK Ferenc, AJTAY András, BERECZKI Dániel

[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

Hypertension and nephrology

[Association between cyclothymic affective temperament and hypertension]

NEMCSIK János, BATTA Dóra, KŐRÖSI Beáta, RIHMER Zoltán

[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]