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Rucsandra Dănciulescu Miulescu and Andrada Doina Mihai

Abstract

Hypothyroidism is a pathologic condition generated by the thyroid hormone deficiency. The American Thyroid Association advises for the screening of hypothyroidism beginning at 35 years and thereafter every 5 years in people at high risk for this condition: females older than 60 years, pregnant women, patients with other autoimmune disease or patients with a history of neck irradiation. In pregnant women, hypothyroidism can been associated with adverse effect for both mother and child. The „Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum“ recommends the treatment of maternal overt hypothyroidism: females with a thyrotropin (TSH) level higher than the trimester-specific reference interval and decreased free thyroxine (FT4), and females for which TSH level is higher than 10.0 mIU/L, irrespective of the FT4 value, with administration of oral levothyroxine. The goal of treatment of maternal overt hypothyroidism is to bring back the serum TSH values to the reference range specific for the pregnancy trimester. The Guidelines of the „European Thyroid Association for the Management of Subclinical Hypothyroidism in Pregnancy and in Children“ recommends treatment of pregnancy associated subclinical hypothyroidism with the following levothyroxine doses: „1.20 μg/kg/day for TSH≤4.2 mU/l, 1.42 μg/kg/day for TSH >4.2-10 and 2.33 μg/kg/day for overt hypothyroidism“. The „Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum“ and the „European Thyroid Association for the Management of Subclinical Hypothyroidism in Pregnancy and in Children“ do not recommend the treatment of isolated hypothyroxinemia in pregnancy.

Open access

Rucsandra Dănciulescu Miulescu, Denisa Margină, Anca Ungurianu, Roxana Irina Roșca, Alina Nicolau and Andrada Doina Mihai

Abstract

Background and Aims. Previous studies report the presence of cognitive impairment in patients with overt hypothyroidism. The thyroid hormones are essential for neurological and intellectual functions. Type 2 diabetes mellitus (T2DM) subjects are exposed to higher risk of cognitive function alteration compared to nondiabetic subjects. The aim of the present study was to analyze the cognitive function of T2DM subjects with overt hypothyroidism.

Materials and Methods. We performed an observational study between 2015-2017. A total of 12 patients (11 women and 1 men) with overt hypothyroidism and T2DM were recruited for this study. Their cognitive function was compared with that of subjects of a control group (16 patients - 12 women and 4 men with T2DM but without overt hypothyroidism). Cognitive function was evaluated using the Mini Mental State Examination (MMSE) test. Serum thyroid stimulating hormone (TSH) levels were measured by immunoradiometric assay, free thyroxine (FT4) by radioimmunoassay while fasting plasma glucose (FPG) levels were evaluated using automated devices.

Results. There were no significant differences between the two groups in respect of age and FPG. In the study group, mean TSH and FT4 levels were 11.76±4.43 mIU/L, resepectively 0.53±0.08 ng/dL while in the control group these were 2.60±0.40 mIU/L, respectively 1.12±0.19 ng/dL (p<0.001). Moderate cognitive impairment was present in 3 patients of the study group (25.00%) and in 2 subjects from the control group (12.50%). Mild cognitive impairment was present in 4 patients (33.33%) of the study group and in 2 subjects from the control group (12.50%).

Conclusion. This study showed that MMSE scores are significantly reduced in subjects with T2DM and hypothyroidism compared to subjects with T2DM without hypothyroidism (p<0.004). The study revealed a negative correlation between TSH and MMSE score in the study group.