International Journal of Current Research and Review
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IJCRR - 8(23), December, 2016

Pages: 11-15

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A STUDY OF THYROID PROFILE AND SERUM ALBUMIN IN PREECLAMPSIA WOMEN

Author: Rahul R. Chaudhary, M.G. Muddeshwar

Category: Healthcare

Abstract:Aim: The study was carried out to estimate thyroid profile and serum albumin level in preeclamptic women as compare to normotensive women. In addition to this correlation between thyroid profile and albumin in preeclamptic women was also calculated.
Material and Methods: The study comprised of 60 cases of preeclamptic women who attended in Obstetrics and Gynaecology Department in Govt. Medical College, Nagpur from February 2013 to August 2014 and 60 normotensive healthy womens as controls. Serum total Tri-iodothyronine (T3), Tetraiodothyronine (T4), Thyroid Stimulating Hormone (TSH) and serum albumin were estimated.
Results: We observed that out of 60 preeclampsia patients 13 (21.66%) women having hypothyroidism, 18 (30%) women having sub-hypothyroidism and 29 (48.33%) women were of euthyroid. The mean serum TSH in preeclamptic cases (preeclampsia women) were increased significantly (p >0.001). On the other hand serumT3 levels and Serum T4 levels were decreased significantly in preeclamptic women when compared to controls (p >0.001). Serum albumin was decreased significantly in preeclamptic women when as compared to controls (p >0.001). We found that there was statistically significant positive correlation between serum T3 and T4 and serum albumin (r = 0.8735, p = 0.0001) and statistically significant negative correlation between serum TSH and serum albumin (r = - 0.6109 p = 0.0001).
Conclusion: From the results all these parameters play an important role in preeclampsia hence early detection of these parameters in preeclampsia may help to improve maternal and fetal outcome.

Keywords: T3 -Total triiodothyronine, T4- Tetraiodothyronine, TSH- Thyroid stimulating hormone

Full Text:

Introduction
Pregnancy is  a  physiological  state  associated  with many  alterations  in metabolic,  biochemical,  physiological,  haematological  and  immunological  processes. If these changes are exaggerated, they can lead to complications during pregnancy1.

Pregnancy induced hypertension presents with new onset hypertension and proteinuria after 20 weeks of gestation. Hypertensive disorders are the most common medical complications occurring during pregnancy. Pregnancy induced hypertension was reported with the incidence of about 10% of first pregnancy and 20% to 25% of previous pregnancy. The incidence of Pregnancy Induced Hypertension (PIH) varies among different hospitals, regions and countries.2

According to WHO's World Health Report 1998, Preeclampsia is defined as “the development of hypertension (>140/90 mm of Hg) after 20 weeks of pregnancy in a woman with proteinuria associated with or without edema having no previous history of hypertension"3

Recent finding related to  pathophysiology of preeclampsia suggest that  the endothelial cell  injury  and  altered  endothelial  cell  function  play  a  pivotal  role.4  It  has  been proposed5 that  the  poorly  perfused  placenta  is  the  origin  of  a  humoral  factor  that  affects  maternal  systemic  function,  directly  or  indirectly,  by  activating  endothelial cells, with the resultant vascular injury.5The characteristic pathologic lesion seen in the uteroplacental  bed  of  patients  with  preeclampsia  is  a  necrotizing  arteriopathy  consisting  of  fibrinoid  necrosis,  accumulation  of  foam  cells  or  lipid?laden macrophages  in  the  decidua,  fibroblast  proliferation and  a  perivascular  infiltrate. This lesion has been termed "acute atherosis.6

Normal pregnancy is associated with physiological and hormonal changes. However abnormal hormonal changes especially thyroid hormone dysfunctions has also shown the relationship between developments of preeclampsia. High levels of TSH, low level of T3 and T4 were shown to be associated with development of preeclampsia and its complication.

In recent glomerular injury also has been considered as characteristic feature of preeclamptic women.7  More precisely it comprises endothelial cell swelling, obliteration of endothelial fenestrate leading to loss of proteins via proteinuria. Keeping all these facts in mind the present work was undertaken to evaluate the relationship of these parameters with preeclampsia.8,9

Serum T3, T4, TSH was measured by enzyme immunoassay on STAT FAX 4300 CHROMATE ELISA Reader using ERBA Thyroid kits by Aspen Laboratories Pvt. Ltd.  The estimation of the serum albumin was done by BCG Dye binding method on fully automated XL300 analyse.

Material and methods
Hospital based cross sectional study was conducted in Department of Biochemistry with the help of Obstetrics and Gynaecology Department during period May 2013 to October 2014. The study was approved by institutional Ethics Committee for research work.

The study comprised of 60 cases of preeclamptic women who attended in Obstetrics and Gynaecology Department in Govt. Medical College, Nagpur from February 2013 to August 2014 and 60 normotensive healthy women as controls. These patients were all primigravidae aged between 18 to 30 years and in the third trimester of pregnancy

The diagnosis of Preeclampsia was done by the Department of Obstetrics and Gynaecology based on the definition given by American college of obstetrics and gynecology. Systolic blood pressure > 140 mm Hg or diastolic blood pressure >90 mm Hg; systolic blood pressure increase of > 30 mm Hg or diastolic blood pressure increase of 15 mm Hg over first trimester of pregnancy values (manifested on two occasion at least 6 hrs apart) and proteinuria ≥300 mg or greater in 24 hr urine collection or dipstick protein ≥ 1+ (on two occasion at least 6 hrs apart) is preeclampsia

The inclusion criteria for pre-eclamptic subjects include Age -18 to 30 years, primigravidae in the 3rd trimester of pregnancy, BP - 140/90 mm Hg in third trimester of pregnancy (ACOG criteria), Urine albumin ≥ | + dipstick or 300 mg per 24 hour urine. Normal pregnant women in third trimester of pregnancy were taken as controls.

The exclusion criteria for both the groups were Age < 18 years and > 30 years. (Multigravidae with more than one para, previous history of hypertension, diabetes mellitus, thyroid disorder, dyslipidemia, renal disease and convulsions, Family history of preeclampsia. After explaining all details, informed consent was taken from each subject for participation in this study. History of patient was recorded on preformed questionnaire which included detailed history about present pregnancy, family history of preeclampsia and exclusion criteria. 2 ml of fasting blood sample was collected in plane blub and serum is separated by centrifugation compare demographic, clinical and biochemical parameters between preeclampsia and control groups. Pearson’s correlation coefficient (r) was calculated to assess the correlation between serums TSH, T3 and T4 and serum albumin.

STATISTICAL ANALYSIS-
Unpaired t-test was performed to compare demographic, clinical and biochemical parameters between preeclampsia and control groups. Pearson’s correlation coefficient (r) was calculated to assess the correlation between serums TSH, T3 and T4 and serum albumin

Result
Characteristics in preeclampsia cases and normal pregnant controls

The mean age in the preeclampsia cases was 23.57 ± 2.99 years and that in controls was 22.90 ± 2.96 years. The mean gestational age of cases was 33.92 ± 2.42 weeks where as in controls 33.98 ± 2.48 weeks.(Table1) There was no significant difference in age and gestational age between cases and controls [p value > 0.05]. Study groups were well matched for age and gestational age.

In our study we found that out of 60 preeclampsia patients 13 (21.66%) women having hypothyroidism, 18 (30%) women having sub-hypothyroidism and 29 (48.33%) women were euthyroid. In normotensive pregnant controls all 60 women were euthyroid.

Comparison of serum thyroid profile
In the present study, in preeclamptic women the mean values of T3, T4 were found to be 1.10  ± 0.34 ng/mL and  6.54 ± 2.19  ug/dL respectively while in control group it was 1.47 ± 0.36 ng/mL and 8.46 ± 1.66 ug/dL. (Table 2) The results showed that mean T3 and T4 levels in preeclamptic women were significantly decreased as compared to control group with p value <0.0001. In preeclamptic women mean TSH level were found to be  4.49 ± 2.00 mlU/mL while in control group was found to be 2.95 ± 0.80 mlU/mL. The results showed that mean TSH levels in preeclamptic women were significantly increased as compared to control group with p value <0.0001.

The mean level of serum albumin in preeclampsia cases was 2.8 ± 0.49 mg/dL and in the normal pregnant women was 4.63 ± 0.37 mg/dL.(Table 2) There was low serum albumin in preeclampsia as compared to normal pregnant women and difference was statistically highly significant. (p=<0.001)

Serum T3 and T4 level correlated with serum albumin and r value was 0.8735 and 0.6299 respectively. This was statistically significant positive correlation. Serum TSH level correlated with serum albumin and r value was - 0.6109.This was statistically significant negative correlation. (p <0.001)

Discussion

Pregnancy is a physiological process. Pregnancy is associated with number of important physiological and hormonal changes.10Human chorionic gonadotrophin hormone secreted by the placenta stimulates thyroid gland during pregnancy due to its structural similarity with thyrotropin. Thyroid hormones have very important role in embryogenesis and fetal development.10,11  Normally pregnancy associated with mild hyperthyroidism on other hand preeclampsia associated with hypothyroidism.12,13 Normal pregnancy is state of hyperestrogenemia.14 During pregnancy increase in estrogens leads to increased thyroid binding globulin which is due to increase hepatic synthesis and increase the half life of thyroid binding globulin because of estrogen induced sialylation of protein.15 As a result of increase in thyroid binding globulin serum T3 and T4 level also increase. In addition there is increased production of type III deiodinase enzyme from placenta which may lead to increased production of the T3 and T4.15

Preeclampsia is a state of decreased estrogen, may be due to placental dysfunction. This decreased estrogen leads to decreased in synthesis of thyroid binding globulin.16,17 As thyroid binding globulin is decreased it might be the reason for lowering of  serum T3 and T4 levels in preeclampsia.

Preeclampsia is pregnancy induced autotoxication multisystem disorder. In preeclampsia most affected organs are kidney, liver and brain. In liver and kidney peripheral conversion of the T4 to T3 occurs. Thus due to involvement of kidney and liver in preeclampsia no conversion of T4 to T3 occurs. This might be the main factor for decreased serum T3 concentration in preeclamptic patients.17,18 Preeclamptic women may have associated various condition like systemic illness, anorexia nervosa, starvation, protein energy malnutrition. This lead to reduced extra-thyroidal deiodination of T3 and T4. Change in thyroid profile in preeclampsia may be due to hypothalamic-pituitary dysfunction secondary to disease stress.18,19

The present finding of the our study resemble with studies of  Basbug M et al,20 Khaliq F et al21, Pasupathi P et al17, Sardana D et al22, Khadem N  et al18

The decrease TSH levels observed in our  study is in accordance with the studies of Dhananjaya BS et al23,Kumar Ashok et al19, Das S et al16, Larijani B et al.24

Endothelium injury play important role in the pathogenesis of preeclampsia25. During the preeclampsia there may be endothelial damage. This may lead to endotheliosis and loss of endothelial fenestrations and disruption of the glomerular filtration barrier. Ultimately endothelial damage may lead to proteinuria.7

Various studies26,27 explained that  decrease in the serum albumin during preeclampsia is due to proteinuria. Kidney eliminates waste product from the blood. This filtration occurs with help of the glomerular filtration barrier present in the Bowman’s capsule. Bowman’s capsule consists of three layers, first endothelial cell of the glomerular capillary, second a basement membrane, and third epithelial cell of bowman's capsules. The integrity of the glomerular filtration barrier avoids filtration of the protein. During the preeclampsia there is endothelial damage which may lead to endotheliosis and loss of endothelial fenestration and disruption of the glomerular filtration barrier which may lead to proteinuria.7

Serum T3 and T4 are mainly bound to thyroid binding globulin and also to some extent to pre-albumin and albumin.28 In preeclampsia there is loss of albumin in urine so hormones bound with to albumin are also lost in urine. This may lead low serum T3 and T4 levels. This suggests a strong relationship between loss of albumin with low serum T3 and T4 levels in preeclamptic women.13,22,29

As per our results the correlation between TSH and albumin appear to be is significantly negative. It might be due to fact that the pre-eclamptic patients are in a state of mild hypothyroidism. Lao TT et al30, Tolino A et al31 Farah Khaliq et al21 also found significant negative correlation between serum TSH and serum albumin.

Conclusion
Our results suggest that diseases of the thyroid gland itself might be a predisposing factor for the development of preeclampsia.

In addition to this serum albumin was decreased in preeclamptic women as compared to normal pregnant women. Hence at this juncture it can be suggested that serum albumin could be used as predictor of severity of preeclampsia.

A positive correlation in serum albumin was observed with T3 and T4 and negatively correlated with serum TSH level in preeclamptic women.

 As study was conducted on small group further study with large group is needed for confirmation of our finding.

Acknowledgement
We express our deep gratitude to all patients for their cooperation. We acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. I am thankful to Dr. Muddershwar Head Biochemistry of the department Govt. Medical College, Nagpur. Also we are thankful to Dr. Manisha Achawale for their guidance. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

Source of funding:  Nil

Conflict of interest: Nil

   

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5. Rodgers GM, Taylor RN, Roberts JM. Preeclampsia is associated with a serum factor cytotoxic to human endothelial cells. Am J Obstet Gynecol. Elsevier; 1988 Oct 10;159(4):908-14.

6. Goode GK, Miller JP, Heagerty AM. Hyperlipidaemia, hypertension, and coronary heart disease. Lancet. 1995 Feb;345(8946):362-4.

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9. Strevens H, Wide-Swensson D, Hansen A, Horn T, Ingemarsson I, Larsen S, et al. Glomerular endotheliosis in normal pregnancy and pre-eclampsia. An Int J Obstet Gynaecol. 2003 Sep;110(9):831-6.

10. Pasupathi P, Chandrasekar V, Kumar US. Thyroid Hormone Changes in Pregnant and Non-Pregnant Women: A Case-Control Study. Thyroid Sci. 2009;4(3):3-7.

11. Khandakar M, Ali AR, Kahtun M. Thyroid status of normal pregnant women in Dhaka City. Mymensingh Med J. 2002;11(1):1- 5.

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13. Kaya E, Sahin Y, Ozkceci Z, Pasaoglu H. Relation between birth weight and thyroid function in preeclampsia. Gynecol Obstet Invest. 1994;37(1):30-3.

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16. Das S, Char D, Sarkar S, Saha TK, Biswas S. Evaluation of Thyroid Hormone Changes in Non-Pregnant , Normotensive Pregnant and Pregnancy with Preeclampsia. J Dent Med Sci. 2013;11(6):16-8.

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A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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