Urinary iodine level assessment during third trimester in a sample of Egyptian pregnant women and its relation to thyroid function

Background: Inadequate intakes of iodine during pregnancy may cause thyroid dysfunctions that adversely affect pregnancy outcomes. Aim of the work was to evaluate the urinary iodine level as a marker of iodine status in a sample of Egyptian pregnant women during 3rd trimester and assess its relation to thyroid functions.Methods: This cross-sectional study was conducted on 100 pregnant females at their 3rd trimester aged (18-35) years. They were divided according to their urinary iodine concentration into 3 groups; Group (I): Pregnant females with deficient iodine (<150 μg/l), Group (II): Pregnant females with adequate iodine (150-249) μg/l, Group (III): pregnant females including who have above requirements (250-499 μg/l), and excessive (≥500 μg/l). TSH, free t4, free t3, Anti-Thyroglobulin (TgAb) and anti-thyroid perioxidase (TPOAb), medium urinary Iodine concentration (UIC) by ELISA and neck U/S were performed to all participants.Results: 18% of the pregnant women in our study had iodine deficiency during 3rd trimester (UIC<150 ug/l) whereas 55% of pregnant women had excess iodine level, and adequate iodine level was observed in 27%.  Serum TSH was significantly higher in group I with deficient iodine level (p value<0.01). All pregnant women included at group I were suffering from subclinical hypothyroidism. Serum TSH and thyroid volume were inversely correlated with urinary iodine among pregnant females at 3rd trimester (p value<0.01).Conclusions: Serum TSH and thyroid volume were inversely correlated with urinary iodine level among pregnant females at 3rd trimester

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients