Relevancia de screening universal de trastornos tiroideos en el embarazo

La enfermedad tiroidea representa un riesgo de morbilidad obstétrica durante la gestación; afecta el desarrollo fetal y los resultados en la vida postnatal. Sin embargo las distintas guías de manejo no recomiendan el tamizaje tiroideo. En este artículo se presenta una revisión de la literatura dispo...

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Autores:: Barceló Lara, Walter Antonio
Reales Nájera, Francisco Javier

Tipo de recurso:: Trabajo de grado de pregrado

Fecha de publicación:: 2016

Institución:: Universidad Libre

Repositorio:: RIU - Repositorio Institucional UniLibre

Idioma:: spa

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dc.title.spa.fl_str_mv	Relevancia de screening universal de trastornos tiroideos en el embarazo
title	Relevancia de screening universal de trastornos tiroideos en el embarazo
spellingShingle	Relevancia de screening universal de trastornos tiroideos en el embarazo Tiroides Embarazo Medicina Hypothyroidism Pregnancy Diagnosis Screening EMBARAZO HIPOTIROIDISMO EXAMENES MEDICOS Embarazo Tamizaje Hipotiroidismo Diagnóstico
title_short	Relevancia de screening universal de trastornos tiroideos en el embarazo
title_full	Relevancia de screening universal de trastornos tiroideos en el embarazo
title_fullStr	Relevancia de screening universal de trastornos tiroideos en el embarazo
title_full_unstemmed	Relevancia de screening universal de trastornos tiroideos en el embarazo
title_sort	Relevancia de screening universal de trastornos tiroideos en el embarazo
dc.creator.fl_str_mv	Barceló Lara, Walter Antonio Reales Nájera, Francisco Javier
dc.contributor.advisor.none.fl_str_mv	Mendoza Henriquez, Mario Julio Iglesias Acosta, Jesús
dc.contributor.author.none.fl_str_mv	Barceló Lara, Walter Antonio Reales Nájera, Francisco Javier
dc.subject.spa.fl_str_mv	Tiroides Embarazo Medicina
topic	Tiroides Embarazo Medicina Hypothyroidism Pregnancy Diagnosis Screening EMBARAZO HIPOTIROIDISMO EXAMENES MEDICOS Embarazo Tamizaje Hipotiroidismo Diagnóstico
dc.subject.subjectenglish.eng.fl_str_mv	Hypothyroidism Pregnancy Diagnosis Screening
dc.subject.lemb.spa.fl_str_mv	EMBARAZO HIPOTIROIDISMO EXAMENES MEDICOS
dc.subject.proposal.spa.fl_str_mv	Embarazo Tamizaje Hipotiroidismo Diagnóstico
description	La enfermedad tiroidea representa un riesgo de morbilidad obstétrica durante la gestación; afecta el desarrollo fetal y los resultados en la vida postnatal. Sin embargo las distintas guías de manejo no recomiendan el tamizaje tiroideo. En este artículo se presenta una revisión de la literatura disponible en los últimos 5 años con respecto a la patología tiroidea y su asociación con los resultados perinatales y obstétricos adversos. Los hallazgos muestran que el hipertiroidismo no representa actualmente un objeto de discusión en cuanto al diagnóstico y al manejo. Por otra parte, el hipotiroidismo afecta aproximadamente el 3-5% de los embarazos y el tipo subclínico corresponde al 80% de ellos, siendo hoy el elemento principal de la controversia, debido a la posibilidad de que existan un grupo de pacientes subclínicas que se comportarían como hipotiroideas clínicas y para las cuales se hace necesario ajustar los parámetros diagnósticos y de manejo.
publishDate	2016
dc.date.created.none.fl_str_mv	2016
dc.date.accessioned.none.fl_str_mv	2017-07-27T16:20:35Z
dc.date.available.none.fl_str_mv	2017-07-27T16:20:35Z
dc.type.local.spa.fl_str_mv	Tesis de Especialización
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dc.identifier.instname.spa.fl_str_mv	instname:Universidad Libre
dc.identifier.reponame.spa.fl_str_mv	reponame:Repositorio Institucional Universidad Libre
url	https://hdl.handle.net/10901/10262
identifier_str_mv	instname:Universidad Libre reponame:Repositorio Institucional Universidad Libre
dc.language.iso.none.fl_str_mv	spa
language	spa
dc.relation.references.SPA.fl_str_mv	Kliegman R, Stanton B, St Geme J y Schor N. Nelson Textbook of Pediatrics Twentieth Edition.Elsevier. 2016. Chapter 565. Chang D, Marqusee E. Estadosunidos de America. Serum TSH, T4, and Thyroid Antibodies in the United States Population (2005 to 2010): National Health and Nutrition Examination Survey, Boletin official (NHANES III) 2011.
dc.relation.references.eng.fl_str_mv	Vidjay H, Krassas G, Poppe K, y Glinoer D. Thyroid Function and Human Reproductive Health. EDRV. 2011, 31(5):702–755 Creasy R., Resnik R., Iams J., Lockwood C., Moore T. y Greene M., Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice, Seventh Edition. Saunders, an imprint of Elsevier Inc.2014; 24:1022-1037. Casey BM1, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, Cunningham FG. The Colorado Thyroid Disease Prevalence Study.Obstet Gynecol. 2011; 105 (2); 239-45. Estadosunidos de America. The American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum. 2011: Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum. Stagnaro-Greene A. Maternal thyroid disease and preterm delivery. J ClinEndocrinolMetab. 2010;94:21. Allan WC, Haddow JE, Palomaki GE, Williams JR, Mitchell ML, Hermos RJ, Faix JD & Klein RZ. Maternal thyroid deficiency and pregnancy complications: implications for population screening. Journal of Medical Screening 2010 7 127– 130. Vila L, et al. Detección de la disfunción tiroidea en la población gestante: está justificado el cribado universal. EndocrinolNutr. 2012;59:547-60. Elsevier España. Ravanbod M, Asadipooya K, KalantarhormoziM,Nabipour I. Treatment of Irondeficiency Anemia in Patients with Subclinical Hypothyroidism. AMJMED. 2013. Volume 126, numero 5. P. 420-424. Elsevier. Wang W, Teng W, Shan Z, Wang S, Li J, Zhu L, Zhou J. The prevalence of thyroid disorders during early pregnancy in China: the benefits of universal screening in the first trimester of pregnancy. Eur. J. Endocrinol. 2011. Volúmen 164, Número 2; Páginas 263-8. EuropeanSociety of Endocrinology. Vaidya B, Anthony S, Bilous M, et al: Detection of thyroid dysfunction in early pregnancy: universal screening or targeted high risk case finding. J ClinEndocrinolMetab 2010; 92: pp. 2011. Mundial. WHO/PAHO Regional Expert Group for Cardiovascular Disease.Improving Public Health in the Americas by Optimizing Sodium and Iodine Intakes Prevention through Population‐wide Dietary Salt Reduction Report from the Washington DC Meeting. 2011. Casey BM, Dashe JS, Wells CE, et al. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol. 2010. 105:239–245. McClain, M., Lambert-Messerlian, G., Haddow, J., Palomaki, G., Canick, J., Cleary-Goldman J., D. Malone F. first- and second-trimester TSH, free thyroxine, and thyroid antibody measurements in women with known hypothyroidism: a FASTER trial study. AJOG, 2012, Volúmen 199, Número 2, Pages 129.e1-129.e6, Mosby, Inc. De Groot L, Abalovich M, Alexander E. Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline. 2012. J ClinEndocrinolMetab. 2012, 97(8):2543–2565. Estadosunidos de America. Thyroid Disease in Pregnancy Number 148.The American College of Obstetricians and Gynecologists. 2015. Shields BM, Knight BA, Hill AV, HattersleyAT,Vaidya B. Five-year follow-up for women with subclinical hypothyroidism in pregnancy. J. Clin. Endocrinol. Metab. Publicado December 1, 2013.Volúmen 98, Número 12; Páginas E1941-5 Bartakova J, Potlukova E, Rogalewicz V, et al. Screening for autoimmune thyorid disorders after spontaneous abortion is cost-saving and it improves the subsequent pregnancy rate. BMC Pregnancy Childbirth. 2013;13:217. Fitzpatrick, D., Russell, M. Diagnosis and Management of Thyroid Disease in Pregnancy. ObstetGynecolClin N Am 37 (2010) 173–193. Elsevier Inc. Ghafoor F, Mansoor M, Malik T, et al. Role of thyroid peroxidase antibodies in the outcome of pregnancy. J Coll Physicians Surg Pak. 2010;16:468. Kester H, Simic N. The role of transient hypothyroxinemia of prematurity in development of visual abilities.SeminPerinatol. 2010;32:431. Abalovich M, Gutierrez S, Alcaraz G, et al. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid. 2012;12:63. Bath SC, Steer CD, Golding J, et al. Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Lancet. 2013;382:331-337. Yassa L, Fawcett R, Marqusee E, Alexander EK. Thyroid Hormone Early Adjustment in Pregnancy (the THERAPY) trial. J ClinEndocrinolMetab. 2010;95:3234. Delange F. Optimal iodine nutrition during pregnancy, lactation and the neonatal period.Int J EndocrinolMetab. 2014;2:1. Delange F. Optimal iodine nutrition during pregnancy, lactation and the neonatal period.Int J EndocrinolMetab. 2014;2:1. Stagnaro-Green A, Abalovich M, Alexander E, et al. American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum. Yan J, Sripada S, Saravelos S, et al. Thyroid peroxidase antibody in women with unexplained recurrent miscarriage: prevalence, prognostic value, and response to empirical thyroxine therapy. FertilSteril. 2012. 98; 378-382. Negro R, Formoso G, Mangieri T, Pezzarossa A, et al.Levothyroxine Treatment in Euthyroid Pregnant Women with Autoimmune Thyroid Disease: Effects on Obstetrical Complications. JCEM. 2006, 91; 2587-2591. Lee Y, Ng H, Lau K, et al. Increased fetal abortion rate in autoinmune thyroid disease is related to circulating TPO autoantibodies in an autoinmune thyroiditis animal model. FertilSteril. 2009, 91- 2104-2109. Subclinical hypothyroidism in the infertile female population: a guideline. Practice Committee of the American Society for Reproductive Medicine. Fertility and sterility.2015; 104, N°3; 545-553 Korevaar TI, Medici M, de Rijke YB, et al. Ethnic differences in maternal thyroid parameters during pregnancy: The Generation R Study. J ClinEndocrinolMetab. 2013;98:3678-3686. Männistö T, Surcel HM, Ruokonen A, et al. Early pregnancy reference intervals of thyroid hormone concentrations in a thyroid antibody-negative pregnant population.Thyroid. 2011;21: 291-298. Negro R, Schwartz A, Gismondi R, et al. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J ClinEndocrinolMetab. 2010;95:1699. Lazarus JH, Bestwick JP, Channon S, et al. Antenatal thyroid screening and childhood cognitive function. N Eng J Med. 2012;366:493. Cleary-Goldman J, Fergal D, Lambert-Massrlian L, et al. Maternal thyroid hypofunction and pregnancy outcome. Obstet Gynecol. 2015;112:85-92. Pankkila F, Mannisto T, Surcel HM, et al. Maternal thyroid dysfunction during pregnancy and thyroid function of her child in adolescence. J ClinEndocrinolMetab. 2013;98:965-972. Stricker R, Echenard M, Eberhart R, et al. Evaluation of maternal thyroid function during pregnancy: the importance of using gestational age-specific reference intervals. Eur J Endocrinol. 2016;157:509. Stagnaro-Green A, Roman S, Cobin R, et al. Detection of At-Risk Pregnancy by Means of Highly Sensitive Assays for Thyroid Autoantibodies. JAMA. 1990; 1422-1425. Verma I, Sood R, Juneja S, et al. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Int J Appl Basic Med Res. 2012; 2(1): 17–19. Unuane D, Tournaye H, Velkeniers B, et al. Endocrine disorders & female infertility. BPRCEM; 2011; 25; 861-873. Mascarenhas J.V, Anoop H.S, Patil M, et al. provement in Fertility outcome follows initiation of thyroxine for women with subclinical Hypothyroidism. THETRP; 2011; 8; 3-6. Johnson M, Althouse A, Wakim N. et al. Hypothyroidism In Recipients Decreases Live Birth Rate In Donor-Recipient (Dr) In-Vitro Fertilization (Ivf) Cycles. FertilSteril. 2014. 102, e270. Bernardi L, Cohen R, Stephenson M. et al. Impact of subclinical hypothyroidism in women with recurrent early pregnancy loss. FertilSteril. 2013. 1326-1331. Wondisford F y Radovick S. Clinical Management of Thyroid disease.1era ed. 2009. Saunders. Chang D, Leung A, Braverman L, et al. Thyroid Testing during Pregnancy at an Academic Boston Area Medical Center.JCEM. 2011. 96.E1452–E1456. Vila Ll, Velasco I, Gonzalez S, et al. On the need for universal thyroid screening in pregnant women.EJE. 2014. R17-R30. Gyamfi C. Basic Science and Clinical Evidence Regarding Treatment of Subclinical Hypothyroidism During Pregnancy. ClinicalObGyn. 2011. 54. 488-492. Cooper D. y Biondi B. Subclinical thyroid disease. TheLancet.2012. 379. 1142- 1154.
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spelling	Mendoza Henriquez, Mario JulioIglesias Acosta, JesúsBarceló Lara, Walter AntonioReales Nájera, Francisco JavierBarranquilla2017-07-27T16:20:35Z2017-07-27T16:20:35Z2016https://hdl.handle.net/10901/10262instname:Universidad Librereponame:Repositorio Institucional Universidad LibreLa enfermedad tiroidea representa un riesgo de morbilidad obstétrica durante la gestación; afecta el desarrollo fetal y los resultados en la vida postnatal. Sin embargo las distintas guías de manejo no recomiendan el tamizaje tiroideo. En este artículo se presenta una revisión de la literatura disponible en los últimos 5 años con respecto a la patología tiroidea y su asociación con los resultados perinatales y obstétricos adversos. Los hallazgos muestran que el hipertiroidismo no representa actualmente un objeto de discusión en cuanto al diagnóstico y al manejo. Por otra parte, el hipotiroidismo afecta aproximadamente el 3-5% de los embarazos y el tipo subclínico corresponde al 80% de ellos, siendo hoy el elemento principal de la controversia, debido a la posibilidad de que existan un grupo de pacientes subclínicas que se comportarían como hipotiroideas clínicas y para las cuales se hace necesario ajustar los parámetros diagnósticos y de manejo.Thyroid disease represents a risk of obstetric morbidity to the course of pregnancies; affects fetal development and the results in the postnatal period. However actual guidelines do not approve universal screening. This article reviews the available information about thyroid disease and its relationship with adverse perinatal and obstetrics results. Actual findings show that hyprthyroidism does not represent a point of discussion about diagnosis and management. On the other hand, hypothyroidism affects 3-5% of pregnancies aproximally and the subclinical type represents 80% of them, being today the key element of controversy, due to the possibility that there is a group of subclinical patients that will act as clinical hypothyroidism and for whom it is necessary and adjustment to current guidelines and diagnostic criteria. KEY WORDS: Hypothyroidism, pregnancy, diagnosis, screening.PDFapplication/pdfspahttp://creativecommons.org/licenses/by-nc-nd/2.5/co/Atribución-NoComercial-SinDerivadas 2.5 Colombiainfo:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2TiroidesEmbarazoMedicinaHypothyroidismPregnancyDiagnosisScreeningEMBARAZOHIPOTIROIDISMOEXAMENES MEDICOSEmbarazoTamizajeHipotiroidismoDiagnósticoRelevancia de screening universal de trastornos tiroideos en el embarazoTesis de Especializacióninfo:eu-repo/semantics/acceptedVersionhttp://purl.org/coar/resource_type/c_7a1finfo:eu-repo/semantics/bachelorThesisKliegman R, Stanton B, St Geme J y Schor N. Nelson Textbook of Pediatrics Twentieth Edition.Elsevier. 2016. Chapter 565.Chang D, Marqusee E. Estadosunidos de America. Serum TSH, T4, and Thyroid Antibodies in the United States Population (2005 to 2010): National Health and Nutrition Examination Survey, Boletin official (NHANES III) 2011.Vidjay H, Krassas G, Poppe K, y Glinoer D. Thyroid Function and Human Reproductive Health. EDRV. 2011, 31(5):702–755Creasy R., Resnik R., Iams J., Lockwood C., Moore T. y Greene M., Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice, Seventh Edition. Saunders, an imprint of Elsevier Inc.2014; 24:1022-1037.Casey BM1, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, Cunningham FG. The Colorado Thyroid Disease Prevalence Study.Obstet Gynecol. 2011; 105 (2); 239-45.Estadosunidos de America. The American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum. 2011: Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum.Stagnaro-Greene A. Maternal thyroid disease and preterm delivery. J ClinEndocrinolMetab. 2010;94:21.Allan WC, Haddow JE, Palomaki GE, Williams JR, Mitchell ML, Hermos RJ, Faix JD & Klein RZ. Maternal thyroid deficiency and pregnancy complications: implications for population screening. Journal of Medical Screening 2010 7 127– 130.Vila L, et al. Detección de la disfunción tiroidea en la población gestante: está justificado el cribado universal. EndocrinolNutr. 2012;59:547-60. Elsevier España.Ravanbod M, Asadipooya K, KalantarhormoziM,Nabipour I. Treatment of Irondeficiency Anemia in Patients with Subclinical Hypothyroidism. AMJMED. 2013. Volume 126, numero 5. P. 420-424. Elsevier.Wang W, Teng W, Shan Z, Wang S, Li J, Zhu L, Zhou J. The prevalence of thyroid disorders during early pregnancy in China: the benefits of universal screening in the first trimester of pregnancy. Eur. J. Endocrinol. 2011. Volúmen 164, Número 2; Páginas 263-8. EuropeanSociety of Endocrinology.Vaidya B, Anthony S, Bilous M, et al: Detection of thyroid dysfunction in early pregnancy: universal screening or targeted high risk case finding. J ClinEndocrinolMetab 2010; 92: pp. 2011.Mundial. WHO/PAHO Regional Expert Group for Cardiovascular Disease.Improving Public Health in the Americas by Optimizing Sodium and Iodine Intakes Prevention through Population‐wide Dietary Salt Reduction Report from the Washington DC Meeting. 2011.Casey BM, Dashe JS, Wells CE, et al. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol. 2010. 105:239–245.McClain, M., Lambert-Messerlian, G., Haddow, J., Palomaki, G., Canick, J., Cleary-Goldman J., D. Malone F. first- and second-trimester TSH, free thyroxine, and thyroid antibody measurements in women with known hypothyroidism: a FASTER trial study. AJOG, 2012, Volúmen 199, Número 2, Pages 129.e1-129.e6, Mosby, Inc.De Groot L, Abalovich M, Alexander E. Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline. 2012. J ClinEndocrinolMetab. 2012, 97(8):2543–2565.Estadosunidos de America. Thyroid Disease in Pregnancy Number 148.The American College of Obstetricians and Gynecologists. 2015.Shields BM, Knight BA, Hill AV, HattersleyAT,Vaidya B. Five-year follow-up for women with subclinical hypothyroidism in pregnancy. J. Clin. Endocrinol. Metab. Publicado December 1, 2013.Volúmen 98, Número 12; Páginas E1941-5Bartakova J, Potlukova E, Rogalewicz V, et al. Screening for autoimmune thyorid disorders after spontaneous abortion is cost-saving and it improves the subsequent pregnancy rate. BMC Pregnancy Childbirth. 2013;13:217.Fitzpatrick, D., Russell, M. Diagnosis and Management of Thyroid Disease in Pregnancy. ObstetGynecolClin N Am 37 (2010) 173–193. Elsevier Inc.Ghafoor F, Mansoor M, Malik T, et al. Role of thyroid peroxidase antibodies in the outcome of pregnancy. J Coll Physicians Surg Pak. 2010;16:468.Kester H, Simic N. The role of transient hypothyroxinemia of prematurity in development of visual abilities.SeminPerinatol. 2010;32:431.Abalovich M, Gutierrez S, Alcaraz G, et al. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid. 2012;12:63.Bath SC, Steer CD, Golding J, et al. Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Lancet. 2013;382:331-337.Yassa L, Fawcett R, Marqusee E, Alexander EK. Thyroid Hormone Early Adjustment in Pregnancy (the THERAPY) trial. J ClinEndocrinolMetab. 2010;95:3234.Delange F. Optimal iodine nutrition during pregnancy, lactation and the neonatal period.Int J EndocrinolMetab. 2014;2:1.Delange F. Optimal iodine nutrition during pregnancy, lactation and the neonatal period.Int J EndocrinolMetab. 2014;2:1.Stagnaro-Green A, Abalovich M, Alexander E, et al. American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum.Yan J, Sripada S, Saravelos S, et al. Thyroid peroxidase antibody in women with unexplained recurrent miscarriage: prevalence, prognostic value, and response to empirical thyroxine therapy. FertilSteril. 2012. 98; 378-382.Negro R, Formoso G, Mangieri T, Pezzarossa A, et al.Levothyroxine Treatment in Euthyroid Pregnant Women with Autoimmune Thyroid Disease: Effects on Obstetrical Complications. JCEM. 2006, 91; 2587-2591.Lee Y, Ng H, Lau K, et al. Increased fetal abortion rate in autoinmune thyroid disease is related to circulating TPO autoantibodies in an autoinmune thyroiditis animal model. FertilSteril. 2009, 91- 2104-2109.Subclinical hypothyroidism in the infertile female population: a guideline. Practice Committee of the American Society for Reproductive Medicine. Fertility and sterility.2015; 104, N°3; 545-553Korevaar TI, Medici M, de Rijke YB, et al. Ethnic differences in maternal thyroid parameters during pregnancy: The Generation R Study. J ClinEndocrinolMetab. 2013;98:3678-3686.Männistö T, Surcel HM, Ruokonen A, et al. Early pregnancy reference intervals of thyroid hormone concentrations in a thyroid antibody-negative pregnant population.Thyroid. 2011;21: 291-298.Negro R, Schwartz A, Gismondi R, et al. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J ClinEndocrinolMetab. 2010;95:1699.Lazarus JH, Bestwick JP, Channon S, et al. Antenatal thyroid screening and childhood cognitive function. N Eng J Med. 2012;366:493.Cleary-Goldman J, Fergal D, Lambert-Massrlian L, et al. Maternal thyroid hypofunction and pregnancy outcome. Obstet Gynecol. 2015;112:85-92.Pankkila F, Mannisto T, Surcel HM, et al. Maternal thyroid dysfunction during pregnancy and thyroid function of her child in adolescence. J ClinEndocrinolMetab. 2013;98:965-972.Stricker R, Echenard M, Eberhart R, et al. Evaluation of maternal thyroid function during pregnancy: the importance of using gestational age-specific reference intervals. Eur J Endocrinol. 2016;157:509.Stagnaro-Green A, Roman S, Cobin R, et al. Detection of At-Risk Pregnancy by Means of Highly Sensitive Assays for Thyroid Autoantibodies. JAMA. 1990; 1422-1425.Verma I, Sood R, Juneja S, et al. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Int J Appl Basic Med Res. 2012; 2(1): 17–19.Unuane D, Tournaye H, Velkeniers B, et al. Endocrine disorders & female infertility. BPRCEM; 2011; 25; 861-873.Mascarenhas J.V, Anoop H.S, Patil M, et al. provement in Fertility outcome follows initiation of thyroxine for women with subclinical Hypothyroidism. THETRP; 2011; 8; 3-6.Johnson M, Althouse A, Wakim N. et al. Hypothyroidism In Recipients Decreases Live Birth Rate In Donor-Recipient (Dr) In-Vitro Fertilization (Ivf) Cycles. FertilSteril. 2014. 102, e270.Bernardi L, Cohen R, Stephenson M. et al. Impact of subclinical hypothyroidism in women with recurrent early pregnancy loss. FertilSteril. 2013. 1326-1331.Wondisford F y Radovick S. Clinical Management of Thyroid disease.1era ed. 2009. Saunders.Chang D, Leung A, Braverman L, et al. Thyroid Testing during Pregnancy at an Academic Boston Area Medical Center.JCEM. 2011. 96.E1452–E1456.Vila Ll, Velasco I, Gonzalez S, et al. On the need for universal thyroid screening in pregnant women.EJE. 2014. R17-R30.Gyamfi C. Basic Science and Clinical Evidence Regarding Treatment of Subclinical Hypothyroidism During Pregnancy. ClinicalObGyn. 2011. 54. 488-492.Cooper D. y Biondi B. Subclinical thyroid disease. 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