Chukwuma I. Onyeije, M.D.Chukwuma I. Onyeije, M.D.http://preeclampsiaonline.net

http://maternalfetalmedicineblog.comhttp://maternalfetalmedicineblog.com

The Link Between Preeclampsia Hypothyroidism:

New Evidence and Clinical Significance

PREECLAMPSIAPREECLAMPSIA

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Background

Preeclampsia is a pregnancy specific syndrome characterized by new onset hypertension and proteinuria in the second half of pregnacy

Preeclampsia causes substantial morbidity and mortality in mothers and infants.

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Background

Women with a history of pre-eclampsia have an increased risk of lipid disorders, hypertension, cardiovascular disease and renal disease.

The cause of preeclampsia is unknown

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Signs of Preeclampsia

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Background

3% to 5% of women experience preeclampsia

Preeclampsia is more common in African-American Women

What is What is Antiangiogenesis?Antiangiogenesis?

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Antiangiogenesis

Antiangiogenesis

(AN-tee-AN-jee-oh-JEN-eh-sis)

Prevention of the growth of new blood vessels.

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The Importance of Antiangiogenesis

The formation of new blood vessels is essential for a normal pregnancy

Studies in both humans and animals suggest that excess circulating antiangiogenic factors may be responsible for pre-eclampsia

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Examples of Antiangiogenic Factors

Soluble fms-like Tyrosine Kinase 1 (sFlt-1)

Soluble endoglin

*Laboratory rats exposed to sFlt-1 and Soluble endoglin develop severe

preeclampsia.

HYPOTHYROIDISMHYPOTHYROIDISM

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Hypothyroidism

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Hypothyroidism

Hypothyroidism is a decreased activity of the thyroid gland

Hypothyroidism can affect all body functions.

Slow metabolism due to hypothyroidism can cause mental and physical sluggishness.

The most severe form of hypothyroidism is myxedema, which is a medical emergency.

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TREATMENT OF HYPOTHYROIDISM

Small differences in dosage have significant clinical impact, both on safety and efficacy

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THE STUDY

Small differences in dosage have significant clinical impact, both on safety and efficacy

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Richard J. Levine, M.D., et al.

Pre-eclampsia, soluble fms-like tyrosine kinase 1, and the risk of reduced thyroid function: nested case-

control and population based study

BMJ 2009;339:b4336

Richard J Levine, Lars J Vatten,Gary L Horowitz, Cong Qian, Pal R

Romundstad, Kai F Yu, Anthony N Hollenberg, Alf I Hellevik, Bjorn O Asvold, S Ananth Karumanchi,

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Results

Women who develop preeclampsia are more likely to have slightly reduced thyroid function during the final weeks of their pregnancies.

Women who develop preeclampsia are also more likely to have low thyroid function more

than 20 years after giving birth.

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Conclusions

The level of hypothyroidism was strongly associated with levels of soluble fms-like tyrosine kinase 1 in

patients with preeclampsia

The researchers write that this suggests that the effect of preeclampsia on thyroid function may be

mediated by this protein.

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Clinical Significance

The findings of this study have important implications for the subsequent care of women

with pre-eclampsia.

Women who have had preeclampsia should be followed closely for the development of

cardiovascular and renal disease.

Women who have had preeclampsia should be monitored for reduced thyroid function and

clinically important hypothyroidism.

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Implications for Patients

Early treatment of hypothyroidism may substantially reduce the associated morbidity and improve quality

of life in women who have had preeclampsia

Treatment of hypothyroidism might prevent early cardiovascular disease in women with a history of

pre-eclampsia.

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Questions for Further Research

Does hypothyroidism contribute to cardiovascular disease in women with a history of pre-eclampsia?

Does subclinical hypothyroidism in women with pre-eclampsia have adverse effects on the long term

health of the children?

Does the risk of hypothyroidism in women with pre-eclampsia increase with time elapsed after

pregnancy?

Chukwuma I. Onyeije, M.D.Chukwuma I. Onyeije, M.D.http://preeclampsiaonline.net

http://maternalfetalmedicineblog.comhttp://maternalfetalmedicineblog.com

Thank You.Thank You.