CURRENT TOPICS IN HYPOTHYROIDISM WITH FOCUS ON DEVELOPMENT Edited by Eliška Potluková Current Topics in Hypothyroidism with Focus on Development http://dx.doi.org/10.5772/56084 Edited by Eliška Potluková Contributors Yardena Tenenbaum-Rakover, Ljiljana Saranac, Ashraf Soliman, Ferenc Péter, Ágota Muzsnai, Rózsa Gráf, Jandee Lee, Woong Youn Chung, Baha Zantour, Andrea Luigi Tranquilli, Piergiorgio Stortoni, Antonio Mancini, Eliska Potlukova, Jan Kratky, Jan Jiskra Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2013 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. 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Publishing Process Manager Ana Pantar Technical Editor InTech DTP team Cover InTech Design team First published February, 2013 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Current Topics in Hypothyroidism with Focus on Development, Edited by Eliška Potluková p. cm. ISBN 978-953-51-0970-9 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface VII Section 1 Hypothyroidism in Pregnancy 1 Chapter 1 Hypothyroidism, Fertility and Pregnancy 3 Piergiorgio Stortoni and Andrea L. Tranquilli Chapter 2 Hypothyroidism in Pregnancy 29 Baha Zantour, Wafa Alaya, Hela Marmouch and Wafa Chebbi Section 2 Hypothyroidism in Childhood 63 Chapter 3 Congenital Hypothyroidism 65 Ferenc Péter, Ágota Muzsnai and Rózsa Gráf Chapter 4 Congenital Hypothyroidism: Effects on Linear Growth, Catch- Up Growth, GH-IGF-I Axis and Bones 91 Ashraf T. Soliman, Vincenzo De Sanctis and El Said M.A. Bedair Chapter 5 Growth in Children with Thyroid Dysfunction 119 Ljiljana Saranac, Hristina Stamenkovic, Tatjana Stankovic, Zoran Radovanovic, Snezana Zivanovic and Zlatko Djuric Chapter 6 Approach to Subclinical Hypothyroidism in Children 135 Yardena Tenenbaum-Rakover Section 3 Challenging Laboratory Findings 163 Chapter 7 Subclinical Hypothyroidism; Natural History, Long-Term Clinical Effects and Treatment 165 Jandee Lee and Woong Youn Chung Chapter 8 Non-Thyroidal Illness: Physiopathology and Clinical Implications 183 Antonio Mancini, Sebastiano Raimondo, Chantal Di Segni, Mariasara Persano and Alfredo Pontecorvi Section 4 Imaging Techniques 203 Chapter 9 The Role of Ultrasound in the Differential Diagnosis of Hypothyroidism 205 Jan Kratky, Jan Jiskra and Eliska Potlukova ContentsVI Preface Dear Reader, As a physician, you are aware of the ongoing need to update your knowledge on the latest research in the field of medicine that you are practicing. In endocrinology, we may not en‐ counter such a large number of new medicaments as e.g. in cardiology. However, many in‐ teresting and mostly clinically oriented studies are ongoing also in our field. To be acquainted with them means to improve the care for our patients. The more we worked on the book you are now reading, the more I got to like the idea of it. This book gives an opportunity to authors literally from all over the world to present their medical expertise and express their opinion on selected interesting topics in hypothyroid‐ ism. Individual chapters of this book represent the most up-to-date reviews of literature combined with the clinical experience of the authors. Authors were asked to choose their own topic of interest concerning hypothyroidism. Inter‐ estingly, the majority chose to write on a theme connected with development: pregnancy, growth and hypothyroidism in childhood. Management of thyroid disorders in pregnancy seems to be a never-ending source of discussions and even disputes. Here we provide two comprehensive reviews on this controversial topic. Surprisingly for me as a non-paediatri‐ cian, the opinions on treatment of subclinical hypothyroidism in childhood may also differ quite substantially. If you want to learn how to differentiate the conditions when watchful waiting is enough from situations when immediate levothyroxine substitution is crucial, our book might help you. Moreover, if you are thinking of performing thyroid ultrasound by yourself, or you do it already and maybe are not so sure about it, our last Chapter might be a practical guide for you in the visualisation of a hypothyroid gland. Perhaps you will not agree with everything that is written in this book; and this was not our goal. Our book will help you form your own opinion. Our most important message is that whichever country we live in, we want to give the best treatment to our hypothyroid patients. Eliška Potluková, MD, PhD Third Department of Medicine, General University Hospital And the First Faculty of Medicine, Charles University in Prague Czech Republic Section 1 Hypothyroidism in Pregnancy [...]... levels, endocrine function and sex hormone-binding globulin (SHBG) levels in 121 healthy women The authors found that the levels of thyroxin-binding globulin (TBG), together with total cortisol and corticosteroid-binding globulin (CBG) levels, increased in both groups, with a significantly greater increase observed in the group with levonorgestrel/ ethinylestradiol Thyroid-stimulating hormone (TSH) and... women are responsible for a 1.5-fold increase in serum thy‐ roxin binding globulin (TBG) concentrations Therefore, there are higher levels of bound cir‐ culating total triiodothyronin (T3) and thyroxin (T4) In order to maintain free (or unbound) thyroid hormone levels, thyroid hormone gland production is enhanced [112] Some studies have demonstrated that total body T4 concentrations must increase 20%–50%... mation of iodine intake from various urinary iodine measurements in population studies Thyroid 2009;19:1281–6 [21] UNICEF, WHO and ICCIDD Assessment of the iodine deficiency disorders and monitoring their elimination 3rd ed Geneva: World Health Organization; 2007 [22] Gowachirapant S, Winichagoon P, Wyss L, Tong B, Baumgartner J, Melse-Boonstra A, et al Urinary iodine concentrations indicate iodine... of thyroid hormonal dysfunction during pregnancy J Clin Endocrinol Metab 2010; 95:1699–1707 25 26 Current Topics in Hypothyroidism with Focus on Development [128] Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A In creased pregnancy loss rate in thyroid antibody negative women with TSH levels be‐ tween 2.5 and 5.0 in the first trimester of pregnancy J Clin Endocrinol Metab 2010;... Effects of a monophasic combined oral contraceptive containing nome‐ gestrol acetate and 17 β estradiol in comparison to one containing levonorgestrel and ethinylestradiol on markers of endocrine function The European Journal of Contra‐ ception and Reproductive Health Care 2011; 16: 458–67 [145] Wiegratz I, Kutschera E, Lee JH, et al Effect of four oral contraceptives on thyroid hormones, adrenal and... hypothyroidism in the later stages of pregnancy in iodine-deficient women who were euthyroid in the first trimester In pregnancy, the production of thyroxin (T4) and triiodothyronin (T3) rapidly increases by 50% together with a subsequent 50% increase in the daily iodine requirement The fetal thy‐ roid begins to concentrate iodine to create triiodothyronin (T3) and thyroxin (T4) beginning at 10-12 weeks... thyroid hormone during ges‐ tation in women who are TAb+ Both OH and SCH may occur during the stress of pregnan‐ cy as a result of compromised thyroid function This situation usually occurs later in 13 14 Current Topics in Hypothyroidism with Focus on Development gestation because in the first part of pregnancy, the residual thyroid function can act as a buffer Because the risk of hypothyroidism in women... 18 Current Topics in Hypothyroidism with Focus on Development oxinemia during the first month of gestation: the importance of early iodine supplementation Thyroid 2009;19:511–9 [25] Velasco I, Carreira M, Santiago P, Muela JA, García-Fuentes E, Sánchez-Mu˜noz B, et al Effect of iodine prophylaxis during pregnancy on neurocognitive development of children during the first two years of life J Clin Endocrinol... estrogen-induced elevation of se‐ rum TBG concentration J Clin Endocrinol Metab 1987; 65(4):689–96 [105] Pittas AG, Lee SL Evaluation of thyroid function In: Hall JE, Niemann LK, editors Handbook of diagnostic endocrinology Totowa, New Jersey: Humana Press Inc 2003; p.112 [106] Glinoer D The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology Endocr... populations, lack of or limited randomization, and differences in the timing of the treatment) These are the limitations of the intervention trials with IVIG or LT4 in TAb+ women with recurrent abortions In consideration of these findings, the Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum [76] stress that there is insufficient . CURRENT TOPICS IN HYPOTHYROIDISM WITH FOCUS ON DEVELOPMENT Edited by Eliška Potluková Current Topics in Hypothyroidism with Focus on Development http://dx.doi.org/10.5772/56084 Edited. the limitations of the intervention trials with IVIG or LT4 in TAb+ women with recurrent abortions. In consideration of these findings, the Guidelines of the American Thyroid Association for the. can be obtained from orders@intechopen.com Current Topics in Hypothyroidism with Focus on Development, Edited by Eliška Potluková p. cm. ISBN 978-953-51-0970-9 free online editions of InTech Books