A STUDY OF SERUM TSH AND CORTISOL LEVELS IN PREECLAMPSIA. Dr.Tarique aziz

Dr.Tarique aziz 1 and Dr.G.G Kaushik 2 . 1. Senior Demonstrator, Department of Biochemistry, J.L.N Medical College, Ajmer. 2. Senior Professor & Head, Department of Biochemistry, J.L.N Medical College, Ajmer. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 10 February 2019 Final Accepted: 12 March 2019 Published: April 2019 Aim: The study was carried out to estimate TSH and Cortisol level in preeclamptic women as compare to normotensive women. Material and Methods: The present study has been conducted on 100 preeclamptic primigravidae in their trimester of pregnancy attending O.P.D of janana hospital, J.L.N Medical college Ajmer. 50 healthy primigravidae of similar age group were included in the study, as the control group. Results: In this study we observed that out of 100 patients of preeclampsia in which 82 patients were of mild preeclampsia and 18 patients were of severe preeclampsia. There was significant decrease in level of cortisol in patients of mild and severe preeclampsia. Decrease in level of cortisol was more in severe preeclamptics as compared to mild preeclamptic patients. There was significant increase in level of TSH in mild preeclampsia whereas more increase in severe preeclampsia. Conclusion: In this present study of 100 patients we concluded that from the results all these parameters play an important role in preeclampsia hence the measurement of TSH and cortisol activity may be used in early diagnosis and management of patients of preeclampsia. This can also be useful in assessing the severity of preeclampsia.


ISSN: 2320-5407
Int. J. Adv. Res. 7(4), 565-568 566 Preeclampsia stands out among the hypertensive disorder for its impact on maternal and neonatal health. It is one of the leading causes of maternal and perinatal mortality and morbidity Pregnancy is usually associated with mild hypothyroidism. Woman complicated with preeclampsia have high incidence of hypothyroidism that might correlates with the severity of preeclampsia. During pregnancy, there is an increased thyroid demand and increased iodine uptake and synthesis of thyroid hormones. Even though there is a state of hypothyroxinemia in normal pregnancy, it is more pronounced in preeclampsia.
Cortisol is a steroid hormone in the glucocorticoid class of hormones. It is produced in human by zona fasciculate of the adrenal cortex within the adrenal gland. Considerable evidence suggests that serum cortisol may play some important role in the normal pregnancy had a significant higher cortisol level then that of PIH patients. The lower maternal cortisol level of PIH patients became more significant with the severity of clinical symptoms of PIH. Further studies are required to know the cause of high level of TSH and lower CORTISOL level, observed in pregnant woman with preeclampsia, which may help in management of pregnant woman at risk of pre eclamptic toxemia. The mean value (±SD) of cortisol in normal pregnancy was 67.1±14.7 ng/ml. In preeclampsia mean cortisol was 50.07±9.3 ng/ml. Therefore mean level of cortisol was lower in the preeclamptic subjects than in normotensive group.

Methodology:-
Mean value (±SD) of cortisol in normal pregnant women was 67.1±14.7 ng/ml. In mild preeclampsia mean was 42.08±7.26 ng/ml. In severe preeclampsia mean was 33.80±7.2 ng/ml. Thus there was highly significant difference between normal pregnant and severe preeclamptic subjects.
Pregnancy induces physiologic changes which coupled with emotional stress and challenges, contribute to changes in hormonal and biochemical status of pregnant women, especially, electrolytes imbalance and depletion of macronutrients. The associated increase in serum cortisol is a possible indicator of emotional stress and physiological challenges in pregnancy. The concurrent increase in progesterone and prolactin are compensating mechanism in response to these challenges, particularly an increase in cortisol concentration. While homeostatic mechanism corrected the electrolytes imbalance, most of the biochemical and hormonal changes which are more pronounced at the first and second trimester extends to last weeks of pregnancy. This study shows that cortisol may be playing a central role in the biochemical changes that were earlier reported in pregnancy and those that are peculiar to this study.
Mean value (±SD) of TSH in normal pregnant was 3.05±1.06 mlU/L. Mean value (±SD) of TSH in pre eclamptic women was 4.70±2.55 mlU/L. Therefore mean level of TSH was higher in the preeclamptic subjects than in normotensive groups.
Mean value (±SD) of TSH in normal pregnancy was 3.05±1.06 mlU/L. Mean value (±SD) of mild preeclamptic was 5.95±0.60 mlU/L. In severe preeclamptic mean value (±SD) was 8.95±1.42 mlU/L. There was significantly higher level of TSH in both mild and severe preeclamptic subjects than in control subjects.
Increase in serum binding forms of thyroid hormone may be due to the marked increase in the circulating level of the major T 4 binding protein, thyroid-binding globulin. This globulin is induced by high estrogen levels in pregnancy, the stimulatory effect of serum hcG of placental origin, increased metabolic demand and mental stress may play increase overall thyroid activity and elevate thyroid hormone levels.
Conclusion:-1. The present study was conducted on 100 patients of pre eclampsia in which 82 patients were of mild preeclampsia and 18 patients were of severe preeclampsia. The results were compared with 50 normotensive age matched subjects. 2. There was significant decrease in level of cortisol in patients of mild and severe preeclampsia. Decrease in level of cortisol was more in severe preeclamptics as compared to mild preeclamptic patients. 3. There was significant increase in level of TSH in mild and severe preeclampsia. 4. There was more increase in level of TSH in severe preeclamptic patients as compared to mild preeclamptic patients. 5. The study shows that in preeclampsia the activity of TSH is elevated whereas cortisol level is decreased. 6. Because of its reliability, easy accessibility and affordability, it's hereby suggested that measurement of TSH and cortisol activity may be used in early diagnosis and management of patients of preeclampsia. 7. This can also be useful in assessing the severity of preeclampsia.