Cad Aten Primaria 2017; 23 (1):14
STUDY GOALS.
1.- To get to know TSH levels during first trimester of pregnancy.
2.- To review the studies about iodine levels in pregnant women from our regional area.
3.- Screening method: selective/universal.
Study design.
– Origin of the data: IANUS electronic medical history from pregnant women at the Integrated Management Area Pontevedra-Salnés in the first three months of 2015.
– Type of study: Cross-sectional descriptive study.
– Type of sampling: Conglomerate sampling.
– Necessary sample size: 184 pregnant women. 275 stories were reviewed.
Results.
– Iodine consumption in Pontevedra is sufficient. Median urinary iodine concentration is 112.7 μg / l.
Study design.
– Origin of the data: IANUS electronic medical history from pregnant women at the Integrated Management Area Pontevedra-Salnés in the first three months of 2015.
– Type of study: Cross-sectional descriptive study.
– Type of sampling: Conglomerate sampling.
– Necessary sample size: 184 pregnant women. 275 stories were reviewed.
Results.
– Iodine consumption in Pontevedra is sufficient. Median urinary iodine concentration is 112.7 μg / l.
– Average age of pregnant women: 32.4 years old. Median: 33 years old.
– Days from the beginning of pregnancy to the performance of the blood test: mean: 85 days, median: 87 days.
– TSH levels in the first trimester: mean: 2.19 mU/L, percentile 2.5: 0.22, percentile 97.5: 5.63 mU/L.
– There is a decrease in the mean value of TSH in pregnancy (2.33 / 2.19). The decline is 6.1%.
– If the cut-off point for hypothyroidism is TSH> 2.5 mU / L, as suggested by the American Thyroid Association, 89 females (89/250) are diagnosed of hypothyroidism. The prevalence of hypothyroidism would be 36%.
– Universal screening for hypothyroidism during gestation is made (250/250).
Conclusions.
– Iodine supplements are not needed for pregnant women in our regional area.
– The reference values of TSH in pregnant women in our regional area are (0.22-5.61).
– Hipothyroidism screening practices recommended by the Ministry’s Pregnancy Monitoring Guide are not meeting the criteria.
Key words: Pregnancy, Thyroid, Thyrotropin, Iodine, Screening.
INTRODUCCION
La disfunción tirodea es una patología con alta prevalencia, sobre todo en el sexo femenino. Afecta al 2.5% de las mujeres y se incrementa con la edad.
Hay cuestiones con escasa evidencia científica en la valoración de la patología tiroidea de mujeres gestantes.
Dentro de estos puntos conflictivos se pueden plantear:
1.- ¿Precisan todas las mujeres embarazadas fármacos que aporten yodo?
2.- ¿Cuáles son los valores de referencia de las hormonas tiroideas en las gestantes de nuestra población?
3.- ¿Hay que realizar determinación universal de TSH a todas las gestantes?
1.- Las necesidades de yodo aumentan en el embarazo y en la lactancia
El yodo es indispensable para la biosíntesis de las hormonas tiroideas. La fuente de yodo del organismo depende exclusivamente de la ingesta.
La Organización Mundial de la Salud (OMS) recomienda 250 μg de yodo al día durante el embarazo y la lactancia.
La eliminación del yodo se efectúa fundamentalmente por el riñón y en menor cantidad por las heces. La excreción urinaria
