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Thyroid Function Control among Pregnant Women Following a Therapeutic Thyroidectomy
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  • Gilad Horowitz,
  • Maya Ish-Shalom,
  • Anton Warshavsky,
  • Naftali Stern ,
  • Dan Fliss,
  • Doron Comaneshter,
  • Shlomo Vinker
Gilad Horowitz
Tel Aviv Sourasky Medical Center
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Maya Ish-Shalom
Tel Aviv Ichilov-Sourasky Medical Center
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Anton Warshavsky
Tel Aviv Ichilov-Sourasky Medical Center
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Naftali Stern
Tel Aviv Ichilov-Sourasky Medical Center
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Dan Fliss
Tel Aviv Sourasky Medical Center
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Doron Comaneshter
Clalit Health Services
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Shlomo Vinker
Tel Aviv University Sackler Faculty of Medicine
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Abstract

Background: The total number of thyroidectomies performed worldwide both for benign and malignant disease has increased dramatically during the past few decades. Gestational hypothyroidism has deleterious effects on the fetus. Objective: The aim of this study was to assess the extent of thyroid function control among pregnant women who had previously undergone a therapeutic thyroidectomy. Methods: This retrospective cohort study included all female patients insured in the largest health maintenance organization in Israel who were pregnant between May, 2001 and September, 2012 and had a medical history of thyroid surgery. The thyroid-stimulating hormone (TSH) levels throughout the pregnancy were compared to recommended trimestral values. A multivariate analysis was performed to determine risk factors for not attaining TSH recommended range. Results: A total of 477 females with a history of thyroid surgery had given 701 births during the study period. Forty-three percent (n= 203), had thyroidal malignancy. Nearly half of the women underwent total thyroidectomy (43.4% n=207). The women’s TSH values were within the recommended range in only 60% (n= 350) of the pregnancies during the first trimester (0.1-2.5 mIU/L), in 61% (n=335) during the second trimester (0.2–3 mIU/L), and in 70% (n=338) during the third trimester (0.3–3 mIU/L). In multivariate analysis, women that underwent a total thyroidectomy due to a benign thyroid disease, were at the highest risk for not attaining target TSH levels. Conclusions: This very large cohort of pregnant women with a past history of thyroid surgery demonstrated a significant percentage of pregnancies with TSH values above the recommended range. Women that underwent a total thyroidectomy due to benign thyroid disease were at the highest risk for gestational hypothyroidism.

Peer review status:ACCEPTED

16 Apr 2020Submitted to Clinical Otolaryngology
26 Apr 2020Submission Checks Completed
26 Apr 2020Assigned to Editor
28 May 2020Reviewer(s) Assigned
19 Jul 2020Review(s) Completed, Editorial Evaluation Pending
21 Jul 2020Editorial Decision: Revise Major
05 Aug 20201st Revision Received
06 Aug 2020Submission Checks Completed
06 Aug 2020Assigned to Editor
04 Sep 2020Reviewer(s) Assigned
15 Nov 2020Review(s) Completed, Editorial Evaluation Pending
15 Nov 2020Editorial Decision: Accept