Online ISSN: 2515-8260

Keywords : TSH


The profile of thyroid disorders in patients with type 2 diabetes mellitus patients above age of 40 years

Dr. Monika MP, Dr. Prajwal Kumar US

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 414-418

Type 2 DM hyperthyroidism is reported to be more common as compared to normal people. In many patients, uncontrolled hyperthyroidism may be the reason for poor glycemic control and recurrent diabetic ketoacidosis. In response to hyperthyroidism gut absorption of glucose is increased along with endogenous glucose production. Randomly selected 100 patients, both male and female with type 2 diabetes mellitus above age of 40 years including newly diagnosed diabetics attending hospital were included in this study. Among the study group of 100 patients 2 patients had high T4 value, 8 patients had high TSH values and 4 patients were low TSH values.

A STUDY OF THYROID FUNCTION TEST IN PATIENTS WITH DIABETES MELLITUS

DR.PARTH R. JANI,DR. PANKAJ. J. AKHOLKAR,DR. SAGAR S. GARCHAR, DR. N N. PANDYA

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 491-503

Introduction:  
Diabetes mellitus (DM) is a growing problem in our country and we have observed that many patients are associated with thyroid dysfunction later in their life. Hence, the prevalence of thyroid dysfunction in diabetes mellitus patients should be evaluated. 
Objectives:  
To evaluate spectrum of thyroid disorders in diabetic patients and To access  altered thyroid function in patients with diabetes mellitus regarding age, sex, duration of  diabetes, family history, regularity of treatment and BMI.  
Materials and Methods:  
In this cross sectional study, after taking permission from ethical committee, data of 280 DM patients who attended the OPD clinic of sir  takhtasinhji hospital, Bhavnagar over period of 9 month, and whose thyroid stimulating  hormone (TSH), free T3, free T4 level were investigated, were included. The inclusion criteria were known cases of DM. Exclusion criteria were patients with previous history of thyroid disorder and those on drugs affecting the thyroid profile, chronic renal failure and Diabetic nephropathy, acute illness, hepatic dysfunction, psychiatric illness, Pregnancy.  
 
Results:  
Out of 280 DM patients 158 were males and 122 were females, 195 (69.64%) were euthyroid, 37 (13.22%) had subclinical hypothyroidism, 23 (8.21%) had overt hypothyroidism, 14 (5%) had subclinical hyperthyroidism and 11 (3.9%) were overt hyperthyroidism cases.  Female sex (P < 0.0091) and patient with irregular treatment (P < 0.001) were at increased risk of having hypothyroidism.  
Conclusion:  
 
Prevalence of thyroid dysfunction was high in DM patients with female sex and patients with irregular treatment.  
Introduction:  
Diabetes mellitus (DM) is a growing problem in our country and we have observed that many patients are associated with thyroid dysfunction later in their life. Hence, the prevalence of thyroid dysfunction in diabetes mellitus patients should be evaluated. 
 
 
 
Objectives:  
To evaluate spectrum of thyroid disorders in diabetic patients and To access  altered thyroid function in patients with diabetes mellitus regarding age, sex, duration of  diabetes, family history, regularity of treatment and BMI.  
 
Materials and Methods:  
In this cross sectional study, after taking permission from ethical committee, data of 280 DM patients who attended the OPD clinic of sir  takhtasinhji hospital, Bhavnagar over period of 9 month, and whose thyroid stimulating  hormone (TSH), free T3, free T4 level were investigated, were included. The inclusion criteria were known cases of DM. Exclusion criteria were patients with previous history of thyroid disorder and those on drugs affecting the thyroid profile, chronic renal failure and Diabetic nephropathy, acute illness, hepatic dysfunction, psychiatric illness, Pregnancy.  
 
Results:  
Out of 280 DM patients 158 were males and 122 were females, 195 (69.64%) were euthyroid, 37 (13.22%) had subclinical hypothyroidism, 23 (8.21%) had overt hypothyroidism, 14 (5%) had subclinical hyperthyroidism and 11 (3.9%) were overt hyperthyroidism cases.  Female sex (P < 0.0091) and patient with irregular treatment (P < 0.001) were at increased risk of having hypothyroidism.  
 
Conclusion:  
Prevalence of thyroid dysfunction was high in DM patients with female sex and patients with irregular treatment.  
 

A HOSPITAL BASED PROSPECTIVE STUDY TO CORRELATE THE SEVERITY OF CHRONIC RENAL FAILURE AND ALTERATIONS OF THYROID INDICES AT TERTIARY CARE CENTRE

Sawan Agrawal, Regia Sultana, Suvajit Chakraborty, Rahul Deb Chakrabarty, Babul Akhtar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1666-1672

Background: The evaluation of thyroid function in systemic illness remains complex because the changes occur at all levels of the hypothalamic-pituitary-thyroid axis. So, it is prudent for the internist and treating physician to be aware of thyroid dysfunction so that early intervention can be instituted to improve the outcome. The aim of this study to correlate the severity of chronic renal failure and alteration of thyroid indices at tertiary care centre.
Materials& Methods: A hospital based prospective study done on 40 chronic renal failure patients admitted in medical ward at KPC Medical College, Jadavpur, Kolkata, West Bangal, India during one year period. Patients who fulfill the criteria for CRF and who are on conservative management were taken for the study. The correlation between the thyroid indices were analyzed and interpreted by the Karl Pearson’s coefficient(r). The interpretation of statistical procedures was performed by the statistical package SPSS (22.0 V). The value of P<0.05 was considered as significant.
Results: Among 40 patients, 10 patients were female, and 30patients were male. The mean age of the male and female patients was 52.76±11.65 and 50.45±7.32 years respectively. The prevalence of low T3 syndrome was 52.5% (21 cases) and the low T4 syndrome was 22.5 % (9 cases). The prevalence of TSH in hypothyroidism range was 5% (2cases). Among the males 46.66% of patients had low T3 syndrome. And among the females was 70%. The difference was not statistically significant P>0.05. The prevalence of low T4 among the males was 20% and among the females was 30%. The difference among the sexes was not statistically significant i.e. P>0.05. Theprevalence of TSH in clinical hypothyroidism range among males was 3.33% and among the females was 10%. The prevalence between the sexes was not statistically significant(P>0.05).
Conclusion: We concluded that serum level of total T3 and free T4 is directly proportional to creatinine clearance level. Alteration in the values of T3 and T4 occurs as a part of body adaptation mechanism to conserve energy.

A Study of Serum Electrolytes in Thyroid Patients Attending A Tertiary Care Hospital

Ratna Rajesh Gogulamudi, Laxmi Narayana Sripuram, Sreevani Namani

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 855-863

Background: The aim is to study the serum electrolyte levels in thyroid patients
attending a tertiary care hospital.
Materials and Methods: Thyroid hormones plays vital role in maintaining body's
metabolism, BMR, thermoregulation and hemodynamic status and present study was
prospective study done in the patients attending TRR Medical College & Hospital. The
study was conducted over duration of 2 years from December 2019 to June 2021. All the
patients in the age group of 18- 40 years were taken in the study. Total 100 patients
were included in the study (50 cases, 50 controls) to study the evaluation of serum
electrolytes on thyroid patients.
Results: In the present study, with respect to association of cases and controls with age,
no significant causation was seen. In this study thyroid patients have no association with
age, with not much mean difference in age of cases (32.11 years) and controls (30.02)
years. Thyroid cases were found to be more females (90%) as compared to males (10%),
but the association of sex with disease is not significant. This further concludes that
though females are commonly affected with thyroid disorders, but their association is
by chance and not significant. All serum electrolytes (Na+, K+, Cl-), TSH shows a
positive relationship it signifies that as TSH increases in patient the level of these
electrolytes also increases, but this relationship of TSH with all the electrolytes was not
significant (p>0.05).

Study of Serum Calcium, Magnesium and Phosphorous Levels in Hypothyroidism

Bonala Sharat Babu, Azmatulla Shaik, Md. Siddique Ahmed Khan, Naveed Altaf

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1286-1292

Background: Thyroid disorders are the most common endocrine abnormality in the
world secondary to diabetes mellitus. Thyroid hormones are essential for growth,
neuronal development, reproduction and regulation of energy metabolism. It influences
the metabolism of all substrates including minerals. Many studies have shown that
mineral metabolism is frequently disturbed in thyroid disorders.
Materials and Methods: The study was conducted on sixty newly confirmed
hypothyroid cases based on the thyroid profile and sixty euthyroid cases were recruited
as controls. Blood samples were collected from all the patients for the estimation of
serum T3, T4, FT3, FT4, TSH, calcium, phosphorus and magnesium by auto analyzer
method. Modified spectrophotometric micro-method was used to measure Serum
copper using Bathocuprine Disulphonate Disodium Salt (BCDS) and Guanidine
hydrochloride salt. The Statistical software namely SPSS 18.0, and R environment
ver.3.2.2 were used for the analysis of the data.
Results: It was found that the levels of serum sodium, potassium and calcium were
significantly decreased in cases than the controls. Serum magnesium and phosphorus
were significantly elevated in cases than controls.
Conclusion: Serum calcium, magnesium and phosphorous levels are significantly
altered in patients having hypothyroidism. Thyroid diseases have wide spread systemic
manifestations including their effects on bone and mineral metabolism. Also thyroid
hormone affects the glomerular filtration rate, renal blood flow, tubular reabsorption
and excretion of minerals which have direct effect on Calcium, Magnesium and
phosphorous level. Thus monitoring of these minerals in hypothyroid patient will be of
great benefit in improving clinical manifestation and can be treated appropriately.

Pulmonary Function Tests in Patients with Hypothyroidism: A Prospective Study

Bhausaheb Vasantrao Jagdale, Gouse Bin Mohammad Shaik, Vinay Kshirsagar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2413-2418

Background:Body  adiposity,  especially  ectopic  fat  accumulation,  has  a  range  of  metabolic  and cardiovascular effects. This study aimed to investigate whether thyroid function is associated with various regional fat quantities in euthyroid subjects.
Materials and Methods: This is a cross sectional study conducted on 90 patients divided into 2 groups (a) newly detected hypothyroids (b) normal control group. Cases were matched with controls in having similar environment exposure and age group. All patients had routine symptom and clinical assessment. Laboratory investigations such as complete blood picture, pulmonary function test, chest x ray and thyroid function test were done. Data was entered and analyzed.
Results: In this study author observed a significant decrease in FEV1 and FEV1/FVC ratio in hypothyroids. FVC between cases and controls did not show statistical significance, although the mean FVC was found to be lower in cases (1.44) as compared to controls (1.79). The various respiratory patterns seen in cases were as follows: obstructive pattern (32%), followed by mixed pattern and restrictive pattern (28%, 22% respectively). Furthermore, we observed that there was no significant correlation between TSH or fT4 with FVC, FEV1, and FEV1/FVC.
Conclusion: This study shows that hypothyroidism causes significant decrease in FEV1 and FEV1/FVC ratio, thereby suggesting obstructive patterns of lung involvement. Therefore, PFT can be used routinely as a screening test for all hypothyroid patients to detect early respiratory dysfunction and thereby optimize treatment especially in obese patients and patients with pre-existing lung disease as hypothyroidism adds to their respiratory dysfunction.

MATERNAL AND PERINATAL OUTCOME IN HYPOTHYROIDISM IN PREGNANCY AT TERTIARY CARE CENTER

Dr. Sonali Deshpande, Dr. Shrinivas Gadappa, Dr. Swati Badgire, Dr Anjali Punwatkar .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2562-2569

Aim & objective:Maternal and Perinatal Outcome in Hypothyroidism in preganacy at tertiary care center.
Materials & Methods:A prospective observational study conducted in the Department of Obstetrics & Gynaecology a tertiary care hospital in Aurangabad district of Maharashtra from September 2020  to September 2021. All patients who fulfilled the inclusion and exclusion criteria during the study period were included in the study.
Observation & Results: In the present studymajority of pregnant women 63 (38.4%) belonged to the age group of 21-25 years & majority 69(42.1%) of them were nulliparous. The risk factors identified in majority 20 (12.19%) of women was h/o pre-eclampsia and in 12 (7.31%) cases previous preterm delivery was observed as risk factor. Further it revealed that, there was statistically significant association between GA and raised TSH level (p<0.05). Maternal complications such as anaemia, severe pre-eclampsia and abruptio placenta were significantly correlated with high TSH level. It was observed that maternal and fetal outcome were significantly associated with level of TSH at the time of delivery.
Conclusion: The study concluded that timely diagnosis and management of thyroid dysfunction is the key to avoid obstetric complications. Supplementing thyroxin in patients with hypothyroidism can prevent maternal and fetal complication, so routine screening of thyroid dysfunction is recommended in pregnant women.
    

LOW SERUM FREE TRI-IODOTHYRONINE HORMONE AS A POSSIBLE PROGNOSTIC FACTOR IN ALCOHOL RELATED LIVER DISEASE

Dr Leelaraghavan G R, Dr Gnanendra D M,Dr sheshanv.s,Dr Kiran S,Dr Abhiman Shetty B,Dr R Madhumathi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5004-5009

Introduction: The levels of thyroid hormone & thyroid binding proteins are altered in patients of
chronic liver disease. Our aim was to assess the serum freeT3 and serum free T4 levels, in alcohol
related liver disease and to find the correlation between thyroid hormone levels and severity of
alcohol related liver disease.
Methods: A cross sectional study, with a sample size of 50, was done to assess the serum free T3
andserum free T4 levels of thyroid function andto correlate them with prognostic factors of alcohol
related liver disease, i.e.MELD-Na - which is derived by adding serum sodium to the original Model
for End-Stage Liver Disease (MELD) score and Maddrey’sDiscriminant Function (DF).Statistical
analysis was done with - Chi-Square test, p value <0.001 was considered as statistically significant.
Results: Of the 50 patients, low serum free T3 levels were found in 29 patients, among them15
patients had DF<32; 14 patients had DF>32(p value <0.001), and 14 patients had MELD-Na<24.50;
15 patients had MELD-Na >24.50(p value <0.006). Low serum freeT4 levels were found in 12
patients, among them 4 patients had DF<32;8 patients had DF >32 (p value <0.001), and 8 patients
had MELD <24.50; 4 patients had MELD >24.50(p value <0.825).
Conclusion: Significant decrease in the serum free T3 levels was found in patients of alcohol related
liver disease with Maddrey’sDiscriminant Function >32 and MELD-Na >24.50 (both prognostic
markers of more severe liver disease). Hence, low serum free T3 level can be used as a prognostic
indicator of severity of alcohol related liver disease.

ALTERATIONS IN LIPIDS LEVEL IN SUBCLINICAL HYPOTHYROIDISM

Dr Tariq Mohd Khan, Dr Shashi Paul, Dr Abhishek Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 11626-11632

Background: Although overt hypothyroidism is linked to lipid metabolic abnormalities, there are mixed results when it comes to the degree of lipid alterations in subclinical hypothyroidism (SCH).
Patients and Methods: In a cross-sectional investigation, the serum lipid parameters of 70 patients with subclinical hypothyroidism and 100 age and sex matched euthyroid controls were assessed.
Results: Patients with SCH had significantly higher mean serum total cholesterol (TC), triglycerides (TG), and very low-density cholesterol (VLDL) than controls (P<0.05). Patients with serum thyroid stimulating hormone (TSH) greater than 10 mU/L had higher mean TC, TG, and low-density cholesterol (LDL) concentrations than those with serum TSH equal to or less than 10 mU/L, although the difference was not statistically significant. The concentration of blood high-density cholesterol (HDL-C) and the amount of serum TSH had no correlation.
Conclusions: High TC, TG and VLDL were observed in our patients with SCH.

OBSTETRIC & PERINATAL OUTCOMES OF PREGNANCIES WITH HYPOTHYROIDISM

Pooja Gupta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1347-1352

Background: Hypothyroidism is widely prevalent in pregnant women, since hypothyroidism is easily treated, timely detection and treatment of the disorder could reduce the burden of adverse fetal and maternal outcomes, which are very commonly encountered. Present study was aimed to study obstetric & neonatal outcomes in pregnancies with hypothyroidism.
Material and Methods: Present study was single-center, prospective, observational study, conducted in pregnant women with more than 28 weeks pregnancy, diagnosed as hypothyroid (TSH > 3.0 mIU/L after 12 weeks of gestation), delivered at our hospital.
Results: Out of 58 patients, majority patients were of 26-30 years age group (39.66 %), 62.07 % were nulliparous, delivered at term (> 37 weeks) (68.97 %), had Spontaneous Onset of labour (67.24 %) & vaginal route was most common Mode of delivery (70.69 %). Common maternal complications observed were haemoglobin < 9 gm% (32.76 %), preterm delivery (31.03 %), hypertensive disorders of pregnancy (22.41 %), oligohydramnios (15.52 %), PPROM (10.34 %), gestational diabetes mellites (6.90 %) & post-partum hemorrhage (6.90 %). No maternal mortality was noted. Birth weight was 2.5-4 kg in majority neonates (58.62 %), while APGAR ≤ 7 at 1 min (12.07 %) & APGAR ≤ 7 at 5 min (5.17 %) noted in few cases. Other characteristics such as meconium aspiration (15.52 %), Required neonatal resuscitation (18.97 %), Neonatal jaundice (22.41 %), Admission to NICU (37.93 %) & neonatal death (1.72 %) were noted.
Conclusion: Hypothyroidism during pregnancy had an impact on maternal as well as perinatal outcome. Routine screening of thyroid dysfunction is recommended to prevent adverse fetal and maternal outcome. Supplementation of thyroid hormone had obvious benefits of treatment to reduce potential adverse outcomes associated with maternal thyroid disorders.

Correlation Analysis of Anaemia with TSH Level and Anti-TPO Expression in Anti-TPO Positive Hypothyroid Patients

Bhawna Sandhir, Sumeet Chadha, Gagan Sandhir, Rajesh Kashyap, Suraj Bisht, Neeraj Joshi, Jagdeep Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 176-181

Introduction: Elevated anti-thyroid peroxidase (Anti-TPO) antibodies and thyroid
stimulating hormone (TSH) levels in hypothyroidism have been linked to the alter the
vitamin B12 metabolic pathway thereby imparting the anemia. Thyroid peroxidase is
an important enzyme responsible during organification of iodide for synthesis of
thyroid hormone. Antibodies to TPO are formed as a part of autoimmune response of
body causing autoimmune thyroiditis in patients. Antibodies to thyroid peroxidase
(TPO) are clinically useful markers of thyroid autoimmunity
Objectives: Present study aims to correlate the thyroid stimulating hormone and antithyroid
peroxidase expression in Anti-TPO positive patients with the anemia.
Methods:60 patients who were anti-TPO positive and hypothyroid were recruited in
present study.TSH level, anti-TPO antibodies level and haemogram was analysed
among all patients.
Results: There was a positive correlation between the haemoglobin and TSH level (r=
0.09580). There was a negative correlation between the Haemoglobin and Anti-TPO
expression (r= -0.2086).
Conclusion: Present study revealed a correlation of anemia with TSH level and Anti-
TPO expression which have the diagnostic value. Anti-TPO positive hypothyroid
patients have risk of developing anaemia.

Congenital hypothyroidism screening in neonates in an iodine deficient endemic region: A prospective study at a tertiary care centre in north India

Prateek Agarwal,Inderpreet Sohi, Rajeev Vinayak, Harpreet Kaur Walia

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 418-423

Introduction: Congenital Hypothyroidism is one of the most common causes of preventable mental
retardation with an estimated incidence of 1:2500-2800 live births in India. The need for neonatal
screening for CH is essential as the majority of signs and symptoms are not exhibited in the neonatal
period.
Aim: To use TSH values as a marker for screening for Congenital Hypothyroidism in neonates in an
iodine deficient endemic region and to find normative values of Serum TSH for the study group.
Material and Methods: A prospective observational study was conducted over a period of 18 months.
A total of 500 newborns who fulfilled inclusion criteria were enrolled. Umbilical Cord Blood samples
(2ml from placental side) were taken for TSH values for all Term neonates with birth weight ≥ 2.5 Kgs
whereas Serum TSH values at 48-72 hours of life were taken for Preterm (<37 completed weeks) and
Low birth weight neonates. All babies who had a cord blood TSH value of >20 mIU/L were sampled
again for TSH and T4 and if repeat TSH was >20 mIU/L and/or T4 < 10 mIU/L they were subjected for
further examination and treatment if required.
Results: The mean cord blood TSH was 7.26 mIU/L in our study, with 7.28 mIU/L in term neonates and
6.94 mIU/L in preterm neonates. Nine babies had TSH values >20mIU/L in the initial screen but all were
<20 mIU/L on repeat sampling. Hence none of the 500 neonates who were screened for CH in our study
were detected to have congenital hypothyroidism. TSH values corresponding to the 5th, 10th, 25th, 50th,
75th and 95th percentile were 3.08, 4.71, 5.39, 13.18, 21.65 and 39.22 respectively. The babies born to
mothers with hypothyroidism, had higher TSH values compared to those without risk factors.
Conclusion: In our study, none of the 500 newborns screened had congenital hypothyroidism. We
observed that neonates born to mother with hypothyroidism had higher cord blood TSH which was
statistically significant. According to our normogram, the 50th centile corresponded to 13.18 mIU/mL
which is <20 mIU/mL while neonates above 75th centile had TSH values above 20 mIU/ml.

ASSOCIATION BETWEEN SERUM ZINC-ALPHA-2-GLYCOPROTEIN WITH THYROID HORMONE IN NEWLY DIAGNOSED HYPERTHYROIDISM

Ahmed Nofal Ali, Ihab Mohamed Salem, Atef Gouda Hussein, Mohamed Gaber Hamed

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 4669-4678

Background: Thyroid dysfunction may contribute to lipids metabolic disorders. Zinc-alpha-2-glycoprotein (ZAG) function comes from its specific lipolytic action.  This study aimed to find the association of serum ZAG levels with thyroxin and lipid profile in patients with hyperthyroidism before and after carbimazole treatment. Patients and methods: This study was conducted as a case-cohort study done on 23 patients suffering from typical symptoms of hyperthyroidism. In addition, 23 apparently healthy individuals were chosen as a control group. All patients were selected from Internal medicine department, Zagazig University Hospitals. Results: The present study showed fasting plasma glucose levels and SBP were significantly higher among case group. The difference in lipid profile in case group before and after treatment with carbimazole.There was significant higher levels in total cholesterol and TG Levels after treatment. The difference in lipid profile in case group before and after treatment with carbimazole. There was significant reduction in HDL Levels after treatment. While LDLwas significant higher after the treatment. Significant reduction in ZAG levels after treatment with carbimazole in case group. Conclusion: ZAG has a novel role in lipid metabolism as it has specific lipolytic action so it has a potential role in body weight regulation, protect against fatty liver by ameliorating hepatic steatosis, insulin resistance and inflammation.

Subclinical Hypothyroidism in Pregnancy: A Review

Dr. Ritimukta Panda; Dr. Kavya Sudha; Dr. K.Jaya Sri; Dr. Rachita Sarangi; Dr. Bhagirathi Kar; Dr. Gangadhar Sahoo

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 6, Pages 1443-1446

Pregnancy-reference levels of Subclinic hypothyroidism (SCH), along with normal level of serum thyroxine, are called high thyroid stimulation hormone level (TSH).
Autoimmune Thyroiditis is also common in patients of subclinical hypothyroidism. Subclinical Hypothyroidism in pregnancy is the cause of some adverse obstetric consequences. Changes in the metabolism of thyroid hormones during pregnancy needs to be kept in mind, while diagnosing thyroid abnormalities. There is a jump in the obstetric and neonatal results, like preterm delivery, miscarriage, fetal growth restriction, preeclampsia, gestational diabetes mellitus, low birth weight, abruptio placentae and poor Apgar scores at birth. Treatment with Cevothyroxine therapy may help reduce some of these adverse effects, however there is restricted evidence to provision it. The behavior of subclinical hypothyroidism should target maternal TSH concentrations of less than 2.5mIU/L. However there is a lack of recommendation for the official starting dose of levothyroxine. So, individualised low doses of levothyroxine can be started and thereafter titred to the maintain the TSH in the target level