Antepartum Care for Pregnant People with Overt Hypothyroidism, Subclinical Hypothyroidism, and Positive Thyroid Autoantibodies.

Maternal thyroid hormones are critical for the growth and development of a healthy fetus. During pregnancy, maternal thyroid hormone production is increased to meet the demands of fetal growth. The purpose of this review is to provide clinicians with current evidence about possible adverse maternal and fetal effects of hypothyroidism in pregnancy, including the role of hypothyroidism in recurrent pregnancy loss. In addition, clinical presentation, evidence-based screening guidelines, and evidence-based treatments are discussed.

Chest radiographic findings in pediatric patients with intraluminal pulmonary vein stenosis.

UNLABELLED: Early recognition of pulmonary vein stenosis (PVS) is crucial for optimizing clinical outcomes. Our goal was to characterize radiographic patterns specific to pediatric patients with PVS to facilitate early detection. PATIENTS AND METHODS: Pediatric patients with multivessel (≥2) intraluminal PVS were identified from a single-center registry. Initial chest radiographs were reviewed. Radiographic findings were summarized using frequencies and percentages for categorical data, and medians and ranges for continuous data. Interrater agreement was assessed using kappa statistics. RESULTS: Chest radiographs of 41 PVS patients were evaluated; median age at presentation 5.2 (0.5-102.6) months. Underlying congenital heart disease was present in 31 (76%), lung disease in four (10%), and neither in six (15%). Common heart diseases were hypoplastic left heart syndrome (five, 12%), totally anomalous pulmonary venous connection (nine, 22%), and heterotaxy (five, 12%). PVS was bilateral in 22 (54%), right-sided in six (14%), and left-sided in 13 (32%). All chest radiographs were abnormal. Increased interstitial opacity was present in all patients, reticular opacity in 35 (85%), and ground-glass opacity in 29 (71%). Consolidation (one, 2%), pleural effusions (four, 10%), and nodular opacities (0) were unusual. Distributional heterogeneity was common (17, 42%). Interrater agreement was generally high (kappa >0.84) except for lobe location. Findings were similar among patients with isolated PVS, PVS with congenital heart disease, and PVS with lung disease. CONCLUSION: Diagnosis of PVS should be considered in infants with increased interstitial opacity, reticular opacity, and ground-glass opacity on chest radiography, especially if findings are heterogeneous.