The internal consistency and validity of the Vaccination Attitudes Examination Scale: A replication study

Background: Vaccinations are important preventative health behaviors. The recently developed Vaccination Attitudes Examination Scale (VAX) aims to measure the reasons behind refusal/hesitancy regarding vaccinations.  Purpose: The aim of this replication study is to conduct an independent test of the newly developed VAX scale in the U.K. We tested: (a) internal consistency (Cronbach’s alpha); (b) convergent validity by assessing its relationships with beliefs about medication, medical mistrust and perceived sensitivity to medicines; and (c) construct validity by testing how well the VAX scale discriminated between vaccinators and nonvaccinators.  Methods: A sample of 243 UK adults completed the VAX scale, the Beliefs about Medicines Questionnaire (BMQ), the Perceived Sensitivity to Medicines Scale (PSM) and the Medical Mistrust Index (MMI), in addition to demographics of age, gender, education levels and social deprivation. Participants were asked: (a) if they received an influenza vaccination in the past year; and (b) if they had a young child, had they vaccinated their young child against influenza in the past year.  Results: The VAX: (a) demonstrated high internal consistency (α=0.92); (b) was positively correlated with medical mistrust, beliefs about medicines and less strongly correlated with perceived sensitivity to medicines; and (c) successfully differentiated parental influenza vaccinators from non-vaccinators.  Conclusion: The VAX demonstrated good internal consistency, convergent and construct validity in an independent UK sample. It appears to be a useful measure to help us understand the health beliefs that promote or deter vaccination behavior

Thyroid hormones and antithyroid antibodies influence infertility treatment, reproductive outcome and indications for assisted reproduction

Cilj: Cilj istraživanja bio je utvrditi vrijednost rutinskog određivanja hormona štitnjače, autoprotutijela (antiperoksidazna – A-TPO, antitireoglobilinska A-Tg) u serumu te ultrazvučnog (UZ) pregleda štitnjače u procjeni ishoda liječenja neplodnih parova postupcima medicinski pomognute oplodnje. Ispitanice i metode: U istraživanje su uključene pacijentice (n = 222) s dijagnozom neplodnosti liječene u razdoblju od 2009. do 2015. godine postupcima medicinski pomognute oplodnje na Zavodu za humanu reprodukciju i Kliničkom zavodu za nuklearnu medicinu Kliničkog bolničkog centra u Rijeci. Pacijenticama je uzeta anamneza, učinjen je klinički i ultrazvučni pregled štitnjače, a određene su i koncentracije hormona i protutijela u serumu. Rezultati: Udio spontanih pobačaja bio je 29 % kod pacijentica s urednom funkcijom štitnjače, a 52 % kod pacijentica s autoimunom ili supkliničkom bolesti štitnjače. Zaključak: Povišene vrijednosti serumskih mikrosomalnih protutijela povezane su s češćim spontanim pobačajima nakon postupka medicinski pomognute oplodnje i u pacijentica koje imaju normalne serumske vrijednosti hormona štitnjače. Rutinsko određivanje hormona štitnjače i antitireoidnih antitijela u serumu te UZ pregled štitnjače može pomoći u utvrđivanju uzroka neplodnosti, probiru pacijentica s rizikom za spontani pobačaj te praćenju i liječenju neplodnosti.Aim: To estimate if the serum concentration of thyroid hormones, antithyroid antibodies and ultrasonographic examination of thyroid gland influence conception and reproductive outcome in infertile couples treated with methods of assisted reproduction Methods: Two hundred and twenty two (222) patients with infertility diagnosis have undergone a research during 2009 – 2015 in Department of human reproduction and Clinical department of nuclear medicine, University hospital Rijeka. The patients have undergone the anamnesis, clinical examination, ultrasound examination and we determined the levels of thyroid hormones and autoantibodies in serum. Results: The percent of patients with normal thyroid function who had spontaneous miscarriage was 29 %, whereas on patients with autoimune or subclinical thyroid gland disease was 52 %. Conclusion: Increased serum microsomal antibodies and increased incidence of miscarriage were observed also in infertile patients treated with methods of assisted reproduction with normal serum concentration of thyroid hormones. Routine determination of thyroid hormones, autoantibodies in serum and ultrasonographic examination of thyroid gland may be useful in infertility diagnosis, screening the patient with miscarriage risk, monitoring and treatment of infertility

Primitive neuroectodermal tumor of the lung with pleural effusion - a case report

Uvod: Primitivni neuroektodermalni tumor pluća (PNET) spada u skupinu izrazito malignih tumora, koji se najvećim dijelom javljaju u djece i adolescenata. Ovaj tumor rano metastazira i ima nisku stopu preživljavanja. Prikaz slučaja: 29-godišnja žena tijekom mjesec dana imala je bolove u desnoj strani prsišta i progresivnu zaduhu. Višeslojna kompjutorizirana tomografija (MSCT) prsnoga koša pokazivala je opsežan desnostrani pleuralni izljev i veliku ekspanzivnu tvorbu u gornjem desnom plućnom režnju. Učinjena je torakocenteza, a u pleuralnom izljevu nađene su maligne stanice. Bronhoskopski je viđena vanjska kompresija na bronhe, bez malignih stanica u uzetim uzorcima bronha. U transtorakalnoj, CT-om vođenoj biopsiji tvorbe pluća, histološkom analizom utvrđene su male stanice, s hiperkromatskim jezgrama i atipičnim mitozama. Imunohistokemijski stanice su bile pozitivne na CD99, NSE i CD56 markere. Pozitron-emisijska tomografija kombinirana s kompjutoriziranom tomografijom (PET/CT) pokazivala je jako nakupljanje 18F-fluorodeoksiglukoze u gornjem desnom plućnom režnju i medijastinalnim limfnim čvorovima. Scintigrafijom somatostatinskih receptora (oktreoskan) nađeno je nakupljanje radiofarmaceutika u gornjem desnom plućnom režnju i medijastinumu, čime su utvrđeni somatostatinski receptori u tim dijelovima tijela. Bolesnica je liječena kemoterapijom (cisplatin i etopozid) i oktreotid acetatom, ali PET/CT je pokazivao progresiju tumora, te je provedena palijativna radioterapija. Tumor je brzo progredirao i bolesnica je preminula jedanaest mjeseci nakon utvrđivanja dijagnoze. Zaključak: PNET je agresivni i smrtonosni tumor, te ga treba uzeti u obzir u diferencijalnoj dijagnostici tumora prsnoga koša, bez obzira na dob bolesnika.Introduction: Primitive neuroectodermal tumor (PNET) is a group of rare, highly malignant neoplasms usually found in children and adolescents. The tumor tends to metastasize early, and consequently the survival rate is low. Case report: A 29-year-old female presented with pain in the right side of the thorax and progressive breathlessness of one-month duration. Multi-slice computed tomography (MSCT) of the chest revealed a large pleural effusion in the right hemithorax, and a large expansive formation in the right upper lobe. Thoracentesis was performed, and malignant cells were found in pleural effusion. Bronchoscopic examination revealed extrinsic compression on the bronchi, without malignant cells in the samples taken. Transthoracic MSCT guided biopsy of the mass histologically revealed small cells, with hyperchromatic nuclei and atypical mitosis. Immunohistochemically, the cells were positive for CD99, NSE and CD56. Positron emission tomography (PET) CT revealed intense accumulation of 18F-fluorodeoxyglucose in the right upper lobe and in the mediastinal lymph nodes. Octreoscan showed pathological accumulation of radiopharmaceuticals in the right upper lobe and mediastinum, indicating a lesion with the expression of somatostatin receptor. The patient received chemotherapy (cisplatin and etoposide), and octreotide acetate. PET/CT showed tumor progression. Palliative radiotherapy was administered. The disease progressed rapidly and the patient died subsequently eleven months after the diagnosis. Conclusion: PNET is an aggressive and lethal disease, therefore should be considered in the differential diagnosis of thoracic tumors regardless of the age of the patient

Primitive neuroectodermal tumor of the lung with pleural effusion - a case report

Uvod: Primitivni neuroektodermalni tumor pluća (PNET) spada u skupinu izrazito malignih tumora, koji se najvećim dijelom javljaju u djece i adolescenata. Ovaj tumor rano metastazira i ima nisku stopu preživljavanja. Prikaz slučaja: 29-godišnja žena tijekom mjesec dana imala je bolove u desnoj strani prsišta i progresivnu zaduhu. Višeslojna kompjutorizirana tomografija (MSCT) prsnoga koša pokazivala je opsežan desnostrani pleuralni izljev i veliku ekspanzivnu tvorbu u gornjem desnom plućnom režnju. Učinjena je torakocenteza, a u pleuralnom izljevu nađene su maligne stanice. Bronhoskopski je viđena vanjska kompresija na bronhe, bez malignih stanica u uzetim uzorcima bronha. U transtorakalnoj, CT-om vođenoj biopsiji tvorbe pluća, histološkom analizom utvrđene su male stanice, s hiperkromatskim jezgrama i atipičnim mitozama. Imunohistokemijski stanice su bile pozitivne na CD99, NSE i CD56 markere. Pozitron-emisijska tomografija kombinirana s kompjutoriziranom tomografijom (PET/CT) pokazivala je jako nakupljanje 18F-fluorodeoksiglukoze u gornjem desnom plućnom režnju i medijastinalnim limfnim čvorovima. Scintigrafijom somatostatinskih receptora (oktreoskan) nađeno je nakupljanje radiofarmaceutika u gornjem desnom plućnom režnju i medijastinumu, čime su utvrđeni somatostatinski receptori u tim dijelovima tijela. Bolesnica je liječena kemoterapijom (cisplatin i etopozid) i oktreotid acetatom, ali PET/CT je pokazivao progresiju tumora, te je provedena palijativna radioterapija. Tumor je brzo progredirao i bolesnica je preminula jedanaest mjeseci nakon utvrđivanja dijagnoze. Zaključak: PNET je agresivni i smrtonosni tumor, te ga treba uzeti u obzir u diferencijalnoj dijagnostici tumora prsnoga koša, bez obzira na dob bolesnika.Introduction: Primitive neuroectodermal tumor (PNET) is a group of rare, highly malignant neoplasms usually found in children and adolescents. The tumor tends to metastasize early, and consequently the survival rate is low. Case report: A 29-year-old female presented with pain in the right side of the thorax and progressive breathlessness of one-month duration. Multi-slice computed tomography (MSCT) of the chest revealed a large pleural effusion in the right hemithorax, and a large expansive formation in the right upper lobe. Thoracentesis was performed, and malignant cells were found in pleural effusion. Bronchoscopic examination revealed extrinsic compression on the bronchi, without malignant cells in the samples taken. Transthoracic MSCT guided biopsy of the mass histologically revealed small cells, with hyperchromatic nuclei and atypical mitosis. Immunohistochemically, the cells were positive for CD99, NSE and CD56. Positron emission tomography (PET) CT revealed intense accumulation of 18F-fluorodeoxyglucose in the right upper lobe and in the mediastinal lymph nodes. Octreoscan showed pathological accumulation of radiopharmaceuticals in the right upper lobe and mediastinum, indicating a lesion with the expression of somatostatin receptor. The patient received chemotherapy (cisplatin and etoposide), and octreotide acetate. PET/CT showed tumor progression. Palliative radiotherapy was administered. The disease progressed rapidly and the patient died subsequently eleven months after the diagnosis. Conclusion: PNET is an aggressive and lethal disease, therefore should be considered in the differential diagnosis of thoracic tumors regardless of the age of the patient

Primitive neuroectodermal tumor of the lung with pleural effusion - a case report

Uvod: Primitivni neuroektodermalni tumor pluća (PNET) spada u skupinu izrazito malignih tumora, koji se najvećim dijelom javljaju u djece i adolescenata. Ovaj tumor rano metastazira i ima nisku stopu preživljavanja. Prikaz slučaja: 29-godišnja žena tijekom mjesec dana imala je bolove u desnoj strani prsišta i progresivnu zaduhu. Višeslojna kompjutorizirana tomografija (MSCT) prsnoga koša pokazivala je opsežan desnostrani pleuralni izljev i veliku ekspanzivnu tvorbu u gornjem desnom plućnom režnju. Učinjena je torakocenteza, a u pleuralnom izljevu nađene su maligne stanice. Bronhoskopski je viđena vanjska kompresija na bronhe, bez malignih stanica u uzetim uzorcima bronha. U transtorakalnoj, CT-om vođenoj biopsiji tvorbe pluća, histološkom analizom utvrđene su male stanice, s hiperkromatskim jezgrama i atipičnim mitozama. Imunohistokemijski stanice su bile pozitivne na CD99, NSE i CD56 markere. Pozitron-emisijska tomografija kombinirana s kompjutoriziranom tomografijom (PET/CT) pokazivala je jako nakupljanje 18F-fluorodeoksiglukoze u gornjem desnom plućnom režnju i medijastinalnim limfnim čvorovima. Scintigrafijom somatostatinskih receptora (oktreoskan) nađeno je nakupljanje radiofarmaceutika u gornjem desnom plućnom režnju i medijastinumu, čime su utvrđeni somatostatinski receptori u tim dijelovima tijela. Bolesnica je liječena kemoterapijom (cisplatin i etopozid) i oktreotid acetatom, ali PET/CT je pokazivao progresiju tumora, te je provedena palijativna radioterapija. Tumor je brzo progredirao i bolesnica je preminula jedanaest mjeseci nakon utvrđivanja dijagnoze. Zaključak: PNET je agresivni i smrtonosni tumor, te ga treba uzeti u obzir u diferencijalnoj dijagnostici tumora prsnoga koša, bez obzira na dob bolesnika.Introduction: Primitive neuroectodermal tumor (PNET) is a group of rare, highly malignant neoplasms usually found in children and adolescents. The tumor tends to metastasize early, and consequently the survival rate is low. Case report: A 29-year-old female presented with pain in the right side of the thorax and progressive breathlessness of one-month duration. Multi-slice computed tomography (MSCT) of the chest revealed a large pleural effusion in the right hemithorax, and a large expansive formation in the right upper lobe. Thoracentesis was performed, and malignant cells were found in pleural effusion. Bronchoscopic examination revealed extrinsic compression on the bronchi, without malignant cells in the samples taken. Transthoracic MSCT guided biopsy of the mass histologically revealed small cells, with hyperchromatic nuclei and atypical mitosis. Immunohistochemically, the cells were positive for CD99, NSE and CD56. Positron emission tomography (PET) CT revealed intense accumulation of 18F-fluorodeoxyglucose in the right upper lobe and in the mediastinal lymph nodes. Octreoscan showed pathological accumulation of radiopharmaceuticals in the right upper lobe and mediastinum, indicating a lesion with the expression of somatostatin receptor. The patient received chemotherapy (cisplatin and etoposide), and octreotide acetate. PET/CT showed tumor progression. Palliative radiotherapy was administered. The disease progressed rapidly and the patient died subsequently eleven months after the diagnosis. Conclusion: PNET is an aggressive and lethal disease, therefore should be considered in the differential diagnosis of thoracic tumors regardless of the age of the patient

ANTITHYROID ANTIBODIES AS A RISK FACTOR IN INFERTILITY AND ASSISTED REPRODUCTION TREATMENT

Ciljevi: Cilj istraživanja je ispitati utjecaj medicinski pomognute oplodnje na vjerojatnost začeća i rađanje djece u bolesnica sa supkliničkim autoimunim tireoiditisom. Ispitanice i metode: U istraživanje su uključene pacijentice (n = 275) koje su se zbog neplodnosti liječile u tercijarnom bolničkom centru od 2009. do 2017. godine konzervativno ili MPO postupcima. U svih pacijentica je procijenjena funkcija štitnjače na osnovi hormonskog statusa, uz testiranje protutijela i ultrazvučni pregled. Reprodukcijski ishodi neplodnih pacijentica s autoimunim tireoiditisom su uspoređeni s pacijenticama s urednom funkcijom štitnjače. Metodom protočne citometrije analizirane su mononuklearne subpopulacije periferne krvi i folikularne tekućine bolesnica liječenih metodama medicinski pomognute oplodnje. Rezultati: U skupini pacijentica s autoimunim tireoiditisom liječenih MPO postupcima bilo je značajno manje onih koje nisu zanijele, međutim u istoj skupini, uočili smo značajno više spontanih pobačaja. Broj rođene djece u odnosu na broj začetih trudnoća nije se statistički značajno razlikovao. Postotak stanica urođene imunosti (NK) bio je statistički značajno niži u folikularnoj tekućini bolesnica s pozitivnim tireoidnim protutijelima u usporedbi s bolesnicama bez pozitivnih protutijela. Zaključak: Postupci medicinski pomognute oplodnje značajno pomažu u vjerojatnosti začeća u pacijentica sa supkliničkim autoimunim tireoiditisom, ali ne i u vjerojatnosti rađanja djeteta. Rizik za spontani pobačaj povećan je u istih pacijentica neovisno o tome da li su liječene konzervativno ili medicinski pomognutom oplodnjom.The aim: The objective of the study is to investigate whether in vitro fertilization (IVF) procedures in patients with autoimmune thyroid disorders increase the likelihood of conception and delivery. Patients and methods: The study included 275 patients who had been treated for infertility at the Clinical Hospital Center Rijeka between 2009 and 2017, either conservatively or with IVF. In all the participants thyroid function was assessed by measuring serum concentrations of thyroid-stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3), while thyroid autoimmunity was assessed by measuring thyroid peroxidase antibodies (TPOAt) and thyroglobulin antibodies (TgAt) in the serum samples, as well as by thyroid ultrasound examinations. The reproductive outcomes were compared between the infertile patients and the patients with normal hormone levels, negative thyroid antibody tests and normal ultrasound findings. The flow cytometry analysis was used to investigate the blood and follicular fluid mononuclear cells in patients treated with IVF. Results: In the group of patients with autoimmune thyroid disorders treated with IVF, significantly less women conceived and significantly more women experienced spontaneous abortions compared to the women with normal thyroid tests. The ratio of the number of births to the number of conceptions did not significantly differ between the two groups. There was a significantly lower proportion of natural killer cells in the follicular fluid of the patients with positive thyroid autoantibodies compared to patients with no thyroid autoantibodies. Conclusion: IVF procedures significantly increase probability of conception in patients with subclinical autoimmune thyroid disorder, but not probability of delivery. Despite euthyroid status as a result of levothyroxine replacement, the risk of spontaneous abortions was increased in patients with autoimmune thyroid disorders, regardless of the type of infertility treatment (conservative or IVF)

ANTITHYROID ANTIBODIES AS A RISK FACTOR IN INFERTILITY AND ASSISTED REPRODUCTION TREATMENT

Ciljevi: Cilj istraživanja je ispitati utjecaj medicinski pomognute oplodnje na vjerojatnost začeća i rađanje djece u bolesnica sa supkliničkim autoimunim tireoiditisom. Ispitanice i metode: U istraživanje su uključene pacijentice (n = 275) koje su se zbog neplodnosti liječile u tercijarnom bolničkom centru od 2009. do 2017. godine konzervativno ili MPO postupcima. U svih pacijentica je procijenjena funkcija štitnjače na osnovi hormonskog statusa, uz testiranje protutijela i ultrazvučni pregled. Reprodukcijski ishodi neplodnih pacijentica s autoimunim tireoiditisom su uspoređeni s pacijenticama s urednom funkcijom štitnjače. Metodom protočne citometrije analizirane su mononuklearne subpopulacije periferne krvi i folikularne tekućine bolesnica liječenih metodama medicinski pomognute oplodnje. Rezultati: U skupini pacijentica s autoimunim tireoiditisom liječenih MPO postupcima bilo je značajno manje onih koje nisu zanijele, međutim u istoj skupini, uočili smo značajno više spontanih pobačaja. Broj rođene djece u odnosu na broj začetih trudnoća nije se statistički značajno razlikovao. Postotak stanica urođene imunosti (NK) bio je statistički značajno niži u folikularnoj tekućini bolesnica s pozitivnim tireoidnim protutijelima u usporedbi s bolesnicama bez pozitivnih protutijela. Zaključak: Postupci medicinski pomognute oplodnje značajno pomažu u vjerojatnosti začeća u pacijentica sa supkliničkim autoimunim tireoiditisom, ali ne i u vjerojatnosti rađanja djeteta. Rizik za spontani pobačaj povećan je u istih pacijentica neovisno o tome da li su liječene konzervativno ili medicinski pomognutom oplodnjom.The aim: The objective of the study is to investigate whether in vitro fertilization (IVF) procedures in patients with autoimmune thyroid disorders increase the likelihood of conception and delivery. Patients and methods: The study included 275 patients who had been treated for infertility at the Clinical Hospital Center Rijeka between 2009 and 2017, either conservatively or with IVF. In all the participants thyroid function was assessed by measuring serum concentrations of thyroid-stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3), while thyroid autoimmunity was assessed by measuring thyroid peroxidase antibodies (TPOAt) and thyroglobulin antibodies (TgAt) in the serum samples, as well as by thyroid ultrasound examinations. The reproductive outcomes were compared between the infertile patients and the patients with normal hormone levels, negative thyroid antibody tests and normal ultrasound findings. The flow cytometry analysis was used to investigate the blood and follicular fluid mononuclear cells in patients treated with IVF. Results: In the group of patients with autoimmune thyroid disorders treated with IVF, significantly less women conceived and significantly more women experienced spontaneous abortions compared to the women with normal thyroid tests. The ratio of the number of births to the number of conceptions did not significantly differ between the two groups. There was a significantly lower proportion of natural killer cells in the follicular fluid of the patients with positive thyroid autoantibodies compared to patients with no thyroid autoantibodies. Conclusion: IVF procedures significantly increase probability of conception in patients with subclinical autoimmune thyroid disorder, but not probability of delivery. Despite euthyroid status as a result of levothyroxine replacement, the risk of spontaneous abortions was increased in patients with autoimmune thyroid disorders, regardless of the type of infertility treatment (conservative or IVF)

ANTITHYROID ANTIBODIES AS A RISK FACTOR IN INFERTILITY AND ASSISTED REPRODUCTION TREATMENT

Ciljevi: Cilj istraživanja je ispitati utjecaj medicinski pomognute oplodnje na vjerojatnost začeća i rađanje djece u bolesnica sa supkliničkim autoimunim tireoiditisom. Ispitanice i metode: U istraživanje su uključene pacijentice (n = 275) koje su se zbog neplodnosti liječile u tercijarnom bolničkom centru od 2009. do 2017. godine konzervativno ili MPO postupcima. U svih pacijentica je procijenjena funkcija štitnjače na osnovi hormonskog statusa, uz testiranje protutijela i ultrazvučni pregled. Reprodukcijski ishodi neplodnih pacijentica s autoimunim tireoiditisom su uspoređeni s pacijenticama s urednom funkcijom štitnjače. Metodom protočne citometrije analizirane su mononuklearne subpopulacije periferne krvi i folikularne tekućine bolesnica liječenih metodama medicinski pomognute oplodnje. Rezultati: U skupini pacijentica s autoimunim tireoiditisom liječenih MPO postupcima bilo je značajno manje onih koje nisu zanijele, međutim u istoj skupini, uočili smo značajno više spontanih pobačaja. Broj rođene djece u odnosu na broj začetih trudnoća nije se statistički značajno razlikovao. Postotak stanica urođene imunosti (NK) bio je statistički značajno niži u folikularnoj tekućini bolesnica s pozitivnim tireoidnim protutijelima u usporedbi s bolesnicama bez pozitivnih protutijela. Zaključak: Postupci medicinski pomognute oplodnje značajno pomažu u vjerojatnosti začeća u pacijentica sa supkliničkim autoimunim tireoiditisom, ali ne i u vjerojatnosti rađanja djeteta. Rizik za spontani pobačaj povećan je u istih pacijentica neovisno o tome da li su liječene konzervativno ili medicinski pomognutom oplodnjom.The aim: The objective of the study is to investigate whether in vitro fertilization (IVF) procedures in patients with autoimmune thyroid disorders increase the likelihood of conception and delivery. Patients and methods: The study included 275 patients who had been treated for infertility at the Clinical Hospital Center Rijeka between 2009 and 2017, either conservatively or with IVF. In all the participants thyroid function was assessed by measuring serum concentrations of thyroid-stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3), while thyroid autoimmunity was assessed by measuring thyroid peroxidase antibodies (TPOAt) and thyroglobulin antibodies (TgAt) in the serum samples, as well as by thyroid ultrasound examinations. The reproductive outcomes were compared between the infertile patients and the patients with normal hormone levels, negative thyroid antibody tests and normal ultrasound findings. The flow cytometry analysis was used to investigate the blood and follicular fluid mononuclear cells in patients treated with IVF. Results: In the group of patients with autoimmune thyroid disorders treated with IVF, significantly less women conceived and significantly more women experienced spontaneous abortions compared to the women with normal thyroid tests. The ratio of the number of births to the number of conceptions did not significantly differ between the two groups. There was a significantly lower proportion of natural killer cells in the follicular fluid of the patients with positive thyroid autoantibodies compared to patients with no thyroid autoantibodies. Conclusion: IVF procedures significantly increase probability of conception in patients with subclinical autoimmune thyroid disorder, but not probability of delivery. Despite euthyroid status as a result of levothyroxine replacement, the risk of spontaneous abortions was increased in patients with autoimmune thyroid disorders, regardless of the type of infertility treatment (conservative or IVF)

Subclinical Autoimmune Thyroid Dysfunction in Infertile Euthyroid Patients: The Risk of Spontaneous Abortion

OBJECTIVE: To investigate whether in vitro fertilization (IVF) procedures in patients with autoimmune thyroid disorder increase the likelihood of conception and delivery. STUDY DESIGN: The study included 125 patients (N=241 with male factor cases included) who were treated for infertility at the tertiary center between 2009 and 2015, either conservatively or by IVF. In all the participants, thyroid function was assessed by measuring serum concentrations of thyroid- stimulating hormone, free thyroxine, and free triiodothyronine, whereas thyroid autoimmunity was assessed by measuring thyroid peroxidase antibodies and thyroglobulin antibodies (TgAb) in the serum samples, and by thyroid ultrasound examinations. The reproductive outcomes were compared between the infertile patients with autoimmune thyroid disorder and patients with normal hormone levels, negative thyroid antibody tests, and normal ultrasound findings. RESULTS: In the group of patients with autoimmune thyroid disorder who were treated by IVF, significantly more women conceived. Also, significantly more women in this group had spontaneous abortions as compared to the women with euthyroid (p=0.039). The number of births per woman did not differ significantly between the groups. The percentage of births (birth per patient) was similar and without significant statistical difference. Similar results were observed in patients with autoimmune thyroid disorders and combined infertility (female- male). CONCLUSION: IVF procedures significantly increase the likelihood of conception in patients with subclinical autoimmune thyroid disorder, but not the likelihood of delivery. Despite the euthyroid status as a result of levothyroxine replacement, the risk of spontaneous abortion was increased in patients with autoimmune thyroid disorder, regardless of the type of infertility treatment (conservative or IVF)

Subclinical Autoimmune Thyroid Dysfunction in Infertile Euthyroid Patients: The Risk of Spontaneous Abortion

OBJECTIVE: To investigate whether in vitro fertilization (IVF) procedures in patients with autoimmune thyroid disorder increase the likelihood of conception and delivery. STUDY DESIGN: The study included 125 patients (N=241 with male factor cases included) who were treated for infertility at the tertiary center between 2009 and 2015, either conservatively or by IVF. In all the participants, thyroid function was assessed by measuring serum concentrations of thyroid- stimulating hormone, free thyroxine, and free triiodothyronine, whereas thyroid autoimmunity was assessed by measuring thyroid peroxidase antibodies and thyroglobulin antibodies (TgAb) in the serum samples, and by thyroid ultrasound examinations. The reproductive outcomes were compared between the infertile patients with autoimmune thyroid disorder and patients with normal hormone levels, negative thyroid antibody tests, and normal ultrasound findings. RESULTS: In the group of patients with autoimmune thyroid disorder who were treated by IVF, significantly more women conceived. Also, significantly more women in this group had spontaneous abortions as compared to the women with euthyroid (p=0.039). The number of births per woman did not differ significantly between the groups. The percentage of births (birth per patient) was similar and without significant statistical difference. Similar results were observed in patients with autoimmune thyroid disorders and combined infertility (female- male). CONCLUSION: IVF procedures significantly increase the likelihood of conception in patients with subclinical autoimmune thyroid disorder, but not the likelihood of delivery. Despite the euthyroid status as a result of levothyroxine replacement, the risk of spontaneous abortion was increased in patients with autoimmune thyroid disorder, regardless of the type of infertility treatment (conservative or IVF)