RESUMEN
Pregnant women are prone to iodine deficiency due to the increased need for iodine during gestation. Progress has recently occurred in establishing serum thyroglobulin (Tg) as an iodine status biomarker, but there is no accepted reference range for iodine sufficiency during pregnancy. An observational study was conducted in 164 pregnant women. At week 16 of gestation urinary iodine concentration (UIC), serum Tg, and thyroid functions were measured, and information on the type of iodine supplementation and smoking were recorded. The parameters of those who started iodine supplementation (≥150 µg/day) at least 4 weeks before pregnancy (n = 27), who started at the detection of pregnancy (n = 51), and who had no iodine supplementation (n = 74) were compared. Sufficient iodine supply was found in the studied population based on median UIC (162 µg/L). Iodine supplementation ≥150 µg/day resulted in higher median UIC regardless of its duration (nonusers: 130 µg/L vs. prepregnancy iodine starters: 240 µg/L, and pregnancy iodine starters: 205 µg/L, p < .001, and p = .023, respectively). Median Tg value of pregnancy starters was identical to that of nonusers (14.5 vs. 14.6 µg/L), whereas prepregnancy starters had lower median Tg (9.1 µg/L, p = .018). Serum Tg concentration at week 16 of pregnancy showed negative relationship (p = .010) with duration of iodine supplementation and positive relationship (p = .008) with smoking, a known interfering factor of iodine metabolism, by multiple regression analysis. Serum Tg at week 16 of pregnancy may be a promising biomarker of preconceptual and first trimester maternal iodine status, the critical early phase of foetal brain development.
Asunto(s)
Enfermedades Carenciales/prevención & control , Yodo/uso terapéutico , Fenómenos Fisiologicos Nutricionales Maternos , Estado Nutricional , Atención Preconceptiva , Complicaciones del Embarazo/prevención & control , Tiroglobulina/sangre , Adulto , Biomarcadores/sangre , Biomarcadores/orina , Enfermedades Carenciales/sangre , Enfermedades Carenciales/etiología , Enfermedades Carenciales/orina , Dieta Saludable , Suplementos Dietéticos , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Hungría , Yodo/deficiencia , Yodo/orina , Cooperación del Paciente , Embarazo , Complicaciones del Embarazo/sangre , Complicaciones del Embarazo/etiología , Complicaciones del Embarazo/orina , Primer Trimestre del Embarazo , Segundo Trimestre del Embarazo , Valores de Referencia , Autoinforme , Fumar/efectos adversos , Cloruro de Sodio Dietético/uso terapéuticoRESUMEN
Graves' orbitopathy is the most common extrathyroidal manifestation of Graves' disease. Up to now, curative treatment modalities for the most severe sight-threatening cases have not been developed. Here the authors summarize the treatment protocol of Graves' orbitopathy and review novel therapeutic options. They review the literature on this topic and present their own clinical experience. The authors point out that anti-CD20 antibody could positively influence the clinical course of Graves' orbitopathy. Selenium is efficient in mild cases. Further prospective investigations are warranted.