Document Detail

Impact of thyroxine-binding globulin on thyroid hormone economy during pregnancy.
MedLine Citation:
PMID:  14751039     Owner:  NLM     Status:  MEDLINE    
Pregnancy-associated changes in thyroid hormone economy are well-established and are of significant clinical relevance to women with established hypothyroidism because they usually result in increased thyroxine dose requirements by these women. Studies suggest that elevations in serum thyroxine-binding globulin (TBG) have the most influence on this increased need for thyroxine, although the exact contributions by TBG rises and by other mechanisms is as yet unclear. We report the case of a 42-year-old woman, with both established primary hypothyroidism and TBG deficiency, who we have now managed through two full-term pregnancies. The patient was noted to have a baseline TBG that was approximately 30% of the average baseline level reported for non-TBG-deficient individuals. Her TBG levels were induced by pregnancy, although the absolute increase of 1.0 mg/dL was only half the increase usually associated with pregnancy. Despite the patient's low baseline TBG level and her blunted pregnancy-associated TBG induction, her absolute and relative pregnancy-associated increases in thyroxine replacement dosage mirrored those found in non-TBG-deficient, hypothyroid women. Thus, our limited study suggests that an increase in TBG concentration is not the key determinant for the increase in thyroxine requirement in pregnancy.
Jeffrey M Zigman; Shmuel E Cohen; Jeffrey R Garber
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Thyroid : official journal of the American Thyroid Association     Volume:  13     ISSN:  1050-7256     ISO Abbreviation:  Thyroid     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2004-01-30     Completed Date:  2004-08-04     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  9104317     Medline TA:  Thyroid     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1169-75     Citation Subset:  IM    
Department of Medicine and Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
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MeSH Terms
Dose-Response Relationship, Drug
Hypothyroidism / drug therapy*,  metabolism*,  physiopathology
Pregnancy Complications / drug therapy*,  metabolism*,  physiopathology
Thyroid Function Tests
Thyroxine / administration & dosage*
Thyroxine-Binding Proteins / deficiency*,  metabolism
Grant Support
Reg. No./Substance:
0/Thyroxine-Binding Proteins; 7488-70-2/Thyroxine
Comment In:
Thyroid. 2004 Jun;14(6):479-80; author reply 480-1   [PMID:  15242581 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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