Resumen 

ANTECEDENTES: el hipotiroidismo subclínico es la elevación de la hormona estimulante de la tiroides ante una fracción libre de L tiroxina (T4) normal. Su prevalencia se estima en 2 a 5% en mujeres embarazadas y ha adquirido un interés especial luego de varios estudios observacionales que asocian la concomitancia de mayor tasa de complicaciones perinatales: enfermedad hipertensiva del embarazo, predominantemente preeclampsia severa. 

Objetivo: demostrar la mayor prevalencia de hipotiroidismo subclínico en pacientes con enfermedad hipertensiva del embarazo versus un grupo normotenso; y si el hipotiroidismo subclínico predispone a mayor severidad de la enfermedad hipertensiva. 

Material y método: estudio prospectivo, longitudinal, descriptivo, de casos y controles de mujeres atendidas durante el parto en el Hospital Universitario de Saltillo, entre junio de 2012 y enero de 2015, consistente en la medición en suero de hormona estimulante de la tiroides y fracción libre de T4. Se consideraron casos las pacientes con diagnóstico de enfermedad hipertensiva del embarazo, a su vez divididas en dos subgrupos identificados como pacientes con y sin hipotiroidismo subclínico. Y se denominó controles a las pacientes sin disfunción tiroidea previa conocida, a su vez divididas en dos subgrupos identificados como: pacientes con y sin hipotiroidismo subclínico

RESULTADOS: se analizaron 978 expedientes de los que solo 274 cumplieron con los criterios de inclusión. La incidencia de hipotiroidismo subclínico (42.3%) fue significativamente mayor en pacientes hipertensas que en normotensas (22.8%), con p=0.007. No se encontró asociación entre la hipofunción tiroidea subclínica y la mayor severidad de la enfermedad hipertensiva u otras complicaciones perinatales, pero sí mayor estancia hospitalaria. 

CONCLUSIONES: el cribado temprano de la función tiroidea permite detectar a las pacientes con alguna disfunción, en particular hipotiroidismo subclínico, que las predisponga a mayor riesgo de enfermedad hipertensiva del embarazo, e iniciar las medidas de prevención, vigilancia y tratamiento oportunos. 

PALABRAS CLAVE: hipotiroidismo subclínico, disfunción tiroidea, enfermedad hipertensiva inducida por el embarazo, preeclampsia.

Abstract

BACKGROUND: Subclinical hypothyroidism is defined as elevated thyroid stimulating hormone in the presence of normal T4 free fraction, its prevalence is estimated at between 2-5% in the pregnant population and took a special interest after several observational studies where he associated to a higher rate of perinatal complications, including the development of hypertensive disease induced by pregnancy, predominantly severe preeclampsia.

OBJECTIVE: Demonstrating the highest prevalence of subclinical hypothyroidism in those patients with pregnancy-induced group compared to normotensive and hypertensive disease if their carry it predisposes to the severity of the disease.

MATERIAL AND METHODS: A prospective, longitudinal, descriptive, case-control studies of women attended during childbirth at the University Hospital of Saltillo, between June 2012 and January 2015, consisting of measuring serum thyroid stimulating hormone and fraction study free T4. Cases were considered patients diagnosed with hypertensive disease of pregnancy, further divided into two subgroups identified as patients with and without subclinical hypothyroidism. And was called to controls patients without known thyroid dysfunction, further divided into two subgroups identified as: patients with and without subclinical hypothyroidism.

RESULTS: 78 records of only 274 met the inclusion criteria were analyzed. The incidence of subclinical hypothyroidism (42.3%) was significantly higher in hypertensive patients than in normotensive (22.8%), with p = 0.007. No association between subclinical underactive thyroid and increased severity of hypertensive disease or other perinatal complications, longer hospital stay but found.

CONCLUSIONS: Early screening of thyroid function will identify those women carrying some dysfunction, particularly subclinical hypothyroidism, as subjects of increased risk for developing hypertensive disease of pregnancy and establish a prevention, vigilance and timely handling.

KEY WORDS: Subclinical hypothyroidism; Thyroid dysfunction; Hypertensive disease; Induced pregnancy; Preeclampsia