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Doctoral Thesis
DOI
https://doi.org/10.11606/T.17.2022.tde-03022023-123758
Document
Author
Full name
Janet Isabel Cherres Pacheco
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2022
Supervisor
Committee
Cavalli, Ricardo de Carvalho (President)
Korkes, Henri Augusto
Moisés, Elaine Christine Dantas
Peracoli, Jose Carlos
Title in Spanish
Investigar la prevalencia de hipotiroidismo subclínico en pacientes preeclámpticas y normotensas
Keywords in Spanish
Disfunciones de la tiroides
Gestantes hipertensas
Hipotiroidismo subclínico
Mujeres gestantes
Preeclampsia
Abstract in Spanish
Introducción: El hipotiroidismo subclínico es la situación clínica que se presenta con elevación de la hormona estimulante de la tiroides por encima del límite superior de la normalidad en presencia de concentraciones séricas normales de tiroxina libre, han sugerido que la hormona tiroidea tiene un efecto en el sistema cardiovascular a través de la contracción cardíaca, la resistencia vascular sistémica lo que causa disfunción celular endotelial, caracterizado por una producción de óxido nítrico disminuida con vasodilatación deteriorada, por lo que su relación con la preeclampsia sería importante. La preeclampsia es un trastorno multiorgánico, caracterizado por hipertensión y proteinuria, que puede estar presente o ausente, en donde se consideran para su diagnóstico el conteo plaquetario, enzimas hepáticas, creatinina, edema pulmonar, síntomas neurológicos. La etiología de la preeclampsia sigue siendo multifactorial. Objetivo:Investigar la prevalencia del hipotiroidismo subclínico en pacientes portadoras de preeclámpsia y normotensas. Métodos: Es un estudio transversal ,observacional, con casos y controles en mujeres atendidas durante la labor de parto en el Hospital Enrique Garcés de Quito- Ecuador, en las que se realizó ,los análisis en suero de la hormona estimulante de la tiroides y la fracción libre de tiroxina ,Se consideraron controles a las pacientes con diagnóstico de normotensas y casos a las pacientes con preeclampsia a su vez divididas en dos subgrupos con y sin signos de gravedad con o sin hipotiroidismo subclínico. Resultados: Se analizaron 639 mujeres, con un mayor porcentaje la región sierra de 98,9%,edad promedio de 26,07 años el 50,39% son solteras y de raza mestiza 91,86%,nivel de educación secundario con un porcentaje 66,51 y sin empleo 78,09%.se encontró normotensas 509 mujeres con hipotiroidismo subclínico 137 y mujeres preeclámpticas 130 con signos de gravedad 59 y sin signos de gravedad 71, de las mujeres con preeclampsia 34 con hipotiroidismo subclínico 16 son gestantes preeclámpticas con signos de gravedad y 18 son gestantes preeclámpticas sin signos de gravedad, la prevalencia de hipotiroidismo subclínico fue 26.76%, el hipotiroidismo subclínico en normotensas y preeclámpticas no hubo significancia con una p 0,861 y en preeclámpticas con y sin signos de gravedad con una p0,81,95 , la TSH menor a 3 mUl/l o mayor igual a 3mUl/l en normotensas y preeclámpticas su valor p0,306 y en pacientes preeclámpticas con y sin signos de severidad la p0,8346.la vía de terminación del embarazo fue la cesárea en mayor porcentaje 52,27%, Conclusiones: Nuestro estudio no tuvieron significancia estadistica entre la relacion de hipotiroidismo subclínico y la preeclampsia pero es importante continuar realizando mas estudios que puedan llegar a esclarecer esta correlación y poder hacer un tamizaje oportuno a todas las gestantes.
Title in English
Investigate the prevalence of subclinical hypothyroidism in patients with preeclampsia and normotensives
Keywords in English
Hypertensive pregnant women
Preeclampsia
Pregnant women
Subclinical hypothyroidism
Thyroid dysfunction
Abstract in English
Introduction: Subclinical hypothyroidism is the clinical situation that presents with elevation of thyroid-stimulating hormone above the upper limit of normal in the presence of normal serum concentrations of free thyroxine, have suggested that thyroid hormone has an effect on the cardiovascular system through cardiac contraction, systemic vascular resistance which causes endothelial cell dysfunction, characterized by decreased nitric oxide production with impaired vasodilation, so its relationship with preeclampsia would be important. Preeclampsia is a multiorgan disorder, characterized by hypertension and proteinuria, which may be present or absent, where platelet count, liver enzymes, creatinine, pulmonary edema, neurological symptoms are considered for diagnosis. The etiology of preeclampsia remains multifactorial. Objective: Investigate the prevalence of subclinical hypothyroidism in normotensive patients with preeclampsia. Methods: It is a cross-sectional, observational study, with cases and controls in women attended during labor at the Enrique Garcés Hospital in Quito-Ecuador, in which serum analyzes of thyroid-stimulating hormone and thyroxine free fraction, Controls were considered to be patients diagnosed as normotensive and cases to patients with preeclampsia, in turn divided into two subgroups with and without signs of severity with or without subclinical hypothyroidism. Results: 639 women were analyzed, with a higher percentage in the Sierra region of 98.9%, average age of 26.07 years, 50.39% are single and of mixed race 91.86%, secondary education level with a percentage 66.51 and 78.09% unemployed. 509 women with subclinical hypothyroidism 137 and preeclamptic women 130 with signs of severity 59 and without signs of severity 71 were found to be normotensive, of the women with preeclampsia 34 with subclinical hypothyroidism 16 are preeclamptic pregnant women with signs of severity and 18 are preeclamptic pregnant women without signs of severity, the prevalence of subclinical hypothyroidism was 26.76%, subclinical hypothyroidism in normotensive and preeclamptic women was not significant with p 0.861 and in preeclamptic women with and without signs of severity with p 0.81 .95, TSH less than 3 mUl/l or greater than 3mUl/l in normotensive and preeclamptic patients its value p0.306 and in preeclamptic patients with and without signs of severity p0.8346. The route of termination of pregnancy 52.27% was the cesarean section in the highest percentage. Conclusions: Our study did not have statistical significance between the relationship of subclinical hypothyroidism and preeclampsia, but it is important to continue carrying out more studies that can clarify this correlation and be able to make a timely screening of all patients. the pregnant women.
 
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Publishing Date
2023-02-07
 
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