Preeclampsia can reduce life expectancy, especially in cases of recurrent or early-onset/severe preeclampsia, and preterm delivery. Women who experience preeclampsia have an increased risk of developing chronic hypertension. Preeclampsia puts women at increased risk for heart disease as well as stroke and high blood pressure later in life [1]

Preeclampsia is a life-threatening disorder during pregnancy and postpartum periods. Preeclampsia can affect the activity of many organs.[2] It is very important because if this disorder is associated with changes in thyroid function, it can affect the results of maternal and feral tests. Accordingly, the aim of this meta-analysis study was to assess the abnormalities in thyroid function tests in preeclampsia.[3]

Hyperthyroidism, characterized by the thyroid gland producing too much hormone, affects approximately 0.2% to 1.3% of the global population.[4] Women are more likely to be affected than men, and the condition often manifests between the ages of 20 and 50.[5]

Hyperthyroidism, a condition where the thyroid gland produces too much thyroid hormone, is a prevalent health issue in India, affecting an estimated 10-12% of the population[6]. This figure includes both hypothyroidism (underactive thyroid) and hyperthyroidism. While iodine deficiency historically played a role, improved iodine intake has shifted the focus to other factors like genetics and autoimmune disorders.[7]

MATERIALS AND METHODOLOGY

A case control studywas carried out from October 2018- October 2019, in the Department of Obstetrics&Gynaecology in a medical college and hospital. The study protocol was approved by the institutional ethics committee and institutional study adopting random sampling system sampling procedure.

It was performed on 25 patients of preeclampsia (case group) and 25 normal pregnant women (control group) in between gestational age of 28-40 weeks of pregnancy, who were admitted in the department of Obstetrics and Gynaecology of IIMSAR Haldia,both groups were compared for thyroid profile. The Inclusion criteria was: Patients of pre-eclampsia in between gestational age of 28-40 weeks of pregnancy. The exclusion criteria for both the groups were: 1. History of any treatment that may affect thyroid profile. 2.History of metabolic syndrome before or during pregnancy. 3. History of hypertensive disorder. 4. History of renal dysfunction. 5. Previous history of thyroid dysfunction in pregnancy and the post- partum period. 6. Previous history of congenitally malformed baby

After the approval of institutional ethical review board, consent from the heads of the educational institutions and the Participants were selected and oral assent from all the selected participants were obtained. A predesigned and pre tested questionnaire was used to interview the students. The data was analysed using SPSS. Participants were categorized into two groups, Case and Control Group.

All eligible candidates were examined physically and clinically by our team. All the Clinical investigation diagnosis were made by Gynaecologist on the basis of inclusion and exclusion criteria. Written consent was taken from all participants No any outsider was allowed in the camp.

AIMS AND OBJECTIVES

To compare thyroid profile in pre- eclamptic patients and normal normotensive pregnant women in between gestational age of 28-40 weeks of pregnancy.

RESULT

Patients of preeclampsia (case group) and normal pregnant women (control group) included 25 participants each n1 stands for patients of preeclampsia (case group) and n2 stands for normal pregnant women (control group). The Table 1 states that mean age (± SD) in case group was 26.2 years with SD of 5.2, while mean age of participants  in control group was 27years with SD of 4.5. On statistical analysis, the p-value (p = 0.06) was not significant. The participants ofMean T3 in case group was 1.02 ng/ml with SD 0.1 and in control group was 1.11 ng/ml with SD 0.25. On statistical analysis, the p-value (p = 0.6) was not significant. The participants of Mean T4 value in case group was 7.2 ug/dl with SD 2.1and while in control group was 7.1 ug/dl with SD 1.7. On statistical analysis, the p-value (p = 0.02) was significant. The participants of Mean TSH in case group was 4.4 µIU/ml with SD 4.1 and in control group was 1.2 µIU/ml with SD 1.6.

Table 1: The Demographic profile of the women in case and control groups

On statistical analysis, the p-value (p = 0.001) was significant. Pregnancy specific and trimester specific reference levels recommended by American Thyroid Association, for TSH in third trimester of pregnancy is 0.38-4.04 µIU/ml. Table 2 revealed that out of 25 cases in our study 16 (64%) had TSH < 4.04 µIU/ml and 9 (36%) had TSH > 4.04 µIU/ml. Out of 25 controls in our study 7 (28%) had TSH < 4.04 µIU/ml and 18 (72%) had TSH > 4.04 µIU/ml. On statistical analysis (Chi square test) the p-value 0.0127 was significant.

Table 2: Distribution of TSH level in case and control group.

Table3:

The odds ratio related to the TSH levels >4.04µIU/ml in the patients of preeclampsia (case group) and normal pregnant women (control group) was 4. Thus, TSH was related to be a strong associating factor for the development of preeclampsia.

DISCUSSION

Hyperthyroidism, characterized by the thyroid gland producing too much hormone, affects approximately 0.2% to 1.3% of the global population. Women are more likely to be affected than men, and the condition often manifests between the ages of 20 and 50.

Hyperthyroidism, a condition where the thyroid gland produces too much thyroid hormone, is a prevalent health issue in India, affecting an estimated 10-12% of the population. This figure includes both hypothyroidism (underactive thyroid) and hyperthyroidism. While iodine deficiency historically played a role, improved iodine intake has shifted the focus to other factors like genetics and autoimmune disorders.

In the developing countries, preeclampsia and eclampsia are an important Causative factors of maternal and perinatal morbidity and mortality.[9] Very mild hyperthyroxinemia is usually associated with pregnancy but high incidence of hypothyroidism found in preeclamptic women that might related to the severity of preeclampsia[10]. Various studies have sought to determine the relation between deranged thyroid function and preeclampsia. Present study was done on 25 patients of preeclampsia and 25 normal normotensive pregnant women in between gestational age of 28-40 weeks of pregnancy at IIMSAR Haldia. The purpose of study was to compare thyroid profile in pre- eclamptic patients and normal normotensive pregnant women in between gestational age of 28-40 weeks of pregnancy.[11]

In the present study mean T3 was not statistically significant between pre- eclamptic patients and normal pregnant women, but statistically significant difference was observed in mean T4 between pre- eclamptic patients and normal pregnant women. It was found that serum TSH level was significantly higher in pre- eclamptic patients’ group as compared to normal pregnant women[12]. On statistical analysis, the p-value (p = 0.001) was significant. These findings were in accordance with Kumar et al, 9 L Harshvardhan et al, 10 Dhananjaya B.S. et al, 11 Larijani et al. 12 On the other hand Khadem et al, [13]Qublan et al. 14 observed insignificant TSH values. It was found that there was high prevalence of hypothyroidism 9 in patients of preeclampsia as compared to 18 in normal pregnant women group. These findings supported that patients of preeclampsia had higher incidence of hypothyroidism compared to normal pregnant women (Kumar et al. 40% v/s 12.2%), 9 (Harshvardhan L et al. 46% v/s 14%). [10]

In this study proportion of patients of preeclampsia with TSH> 4.04 µIU/ml was found to be significantly higher than that in the normal pregnant women group (p=0.012 ).The severity of preeclampsia was correlated with decrease in thyroid hormones with simultaneous increase in TSH titters.[3 ]The mechanism of it in these preeclamptic women is not well understood. Mild alteration in the thyroid hormones might occur due to non-thyroidal illness acting as a stress factor as well as due to decreased plasma albumin concentrations in these patients. In patients of preeclampsia in between gestational age of 28-40 weeks of pregnancy, serum total T3 and TT4 levels were decreased significantly and TSH levels was increased significantly. [3,4] Severity of preeclampsia correlated with modest decreases in thyroid hormones along with increased TSH level in maternal serum and high levels of endothelin. 3 Thyroid hormone may affect hypertensive disorders onset in pregnant women. Increased level of thyroid hormone can cause endothelial cell dysfunction, which has an important role in the pathophysiology of hypertensive disorders during pregnancy.[15]

Preeclampsia is a life-threatening disorder during pregnancy and postpartum periods. Preeclampsia can affect the activity of many organs. It is very important because if this disorder is associated with changes in thyroid function, it can affect the results of maternal and fetal tests. Accordingly, the aim of this meta-analysis study was to assess the abnormalities in thyroid function tests in preeclampsia.

Association, for TSH in third trimester of pregnancy is 0.38-4.04 µIU/ml. Table 2 revealed that out of 25 cases in our study 16 (64%) had TSH < 4.04 µIU/ml and 9 (36%) had TSH > 4.04 µIU/ml. Out of 25 controls in our study 7 (28%) had TSH < 4.04 µIU/ml and 18 (72%) had TSH > 4.04 µIU/ml. On statistical analysis (Chi square test) the p-value 0.0127 was significant. The odds ratio related to the TSH levels >4.04µIU/ml in the patients of preeclampsia (case group) and normal pregnant women (control group) was 4. Thus, TSH was related to be a strong associating factor for the development of preeclampsia

In this Present study it was found that pathogenesis of preeclampsia is related to primary hypo-functioning of the thyroid. In this study 36% of preeclamptic women had hypothyroidism with abnormally high serum TSH. If the titers of TSH were above 4.04 µIU/ml, then there was 5.5 times higher risk of the development of preeclampsia. This high-risk potential marker of preeclampsia needs further investigation because of the small number of subjects in this study. A multi-centric study of many research article may answer the relationship and mechanism of thyroid dysfunction in patients of preeclampsia. Identification of thyroid .In two large cohorts of Danish pregnant women, maternal hypothyroidism was consistently associated with a higher risk of preeclampsia. Biochemical assessment of maternal thyroid function revealed that the severity of hypothyroidism was important

Financial Support

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Conflict Of Interest

The authors report no conflicts of interest.

Submission Declaration

This submission has not been published anywhere previously and that it is not simultaneously being considered for any other

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