Estudo dos hormônios tireoidianos em uma unidade de terapia intensiva obstétrica

Abstract

Physiological changes in thyroid function during pregnancy are important for maintaining homeostasis. It is estimated that hypothyroidism occurs in 4% of pregnancies (0.5% true hypothyroidism and 3.5% subclinical hypothyroidism) and hyperthyroidism occurs in 2.4% of pregnancies (0.6% true hyperthyroidism and 1 .8% subclinical hyperthyroidism). Because thyroid hormones have many effects on cardiovascular and renal physiology, thyroid dysfunction can have a significant impact on critically ill patients in the Intensive Care Unit (ICU). Our objective is to evaluate the degree of association between hormonal concentrations and clinical repercussions (age, weight, BMI, gestational age, complications and death) in critically ill pregnant women, according to the severity criteria of the APACHE II Prognostic and Mortality Score and compare the different reference methods of values of thyroid hormones (THs) in the diagnosis of thyroid dysfunctions, such as hypothyroidism, hyperthyroidism and sick euthyroid syndrome in pregnant women admitted to the ICU. Materials and methods: 1425 pregnant women admitted to the ICU, from January 2018 to December 2022, were evaluated and 160 pregnant women with thyroid hormones measured at admission were included. The study is retrospective, therefore, we used data from medical records of women with clinical diseases during the period of admission to the ICU, such as sepsis, diabetes mellitus, cardiovascular disorders, bleeding disorders, hydroeletrolytic disorders, obstetric infection, SARS CoV-2 infection, respiratory disorders, pregnant women with eclampsia and severe pre-eclampsia (PE). The women were divided into groups according to TSH and free T4 values, according to the values of the established laboratory test, and evaluated using the Hoffman mathematical method compared with the prognostic scores used in ICUs and their complications. Based on the results obtained, all the complications were significant in Q-square test. The hemodynamic instability, respiratory failure, uterine hemorrhage, fetal death and psychological disorders were significant in many Analysis. The conclusion was na evidente association between thyroid hormones and BMI, gestational age through Ultrasound and some complications observed in the obstetric ICU, as respiratory failure, hemodynamic instability uterine hemorrhage and fetal death, ix suggest that hormonal dosage can be used as a predictor of complications in obstetric therapy.