Nancy D. Gaba

Marginal Iodine Status and High Rate of Subclinical Hypothyroidism in Washington DC Women Planning Conception

INTRODUCTION Subclinical hypothyroidism during pregnancy has been associated with adverse maternal and fetal outcomes. A subset of pregnant women in the United States have been shown to have mild iodine deficiency. No study has evaluated the thyroid and iodine status of women who are planning to become pregnant in the near future. METHODS Thyroid function tests, thyroid antibodies, and urine iodine levels were evaluated in women presenting for preconception screening and counseling. A thyrotropin (TSH) level above 3.0 mIU/L was considered abnormal. RESULTS One hundred and forty one women enrolled in the study. The median TSH level was 1.70 mIU/L (range 0.43-5.3 mIU/L). Sixteen women (11%) had a TSH above the upper limit of normal (>3.0 mIU/L). Eleven women (8%) were positive for TPO-Ab and 21 women (15%) for TgAb. Twenty-three women (16%) were positive for at least one thyroid antibody (TPOAb and/or TgAb). Median serum TSH concentrations were higher in women with detectable antithyroid antibodies than in women who were antibody negative (2.2 mIU/L vs. 1.7 mIU/L; p=0.005). The median urinary iodine concentration was 100.5 μg (range 19-843 μg/L). DISCUSSION The present cohort exhibited the lowest median urinary iodine concentration levels to date reported in the United States for women in their childbearing years. One out of every nine women (11%) had thyroid function tests consistent with subclinical hypothyroidism.

To err is human; To provide safe, quality, and cost-effective hysterectomy is divine!

Approximately 500,000 hysterectomies are performed each year in the United States despite the existence of numerous nondefinitive alternatives. Gaining an understanding of the relationship between quality, safety, and cost is critical to gynecologists performing this procedure. Analysis of quality measures includes important process measures such as time-out procedures, the Surgical Care Improvement Project, Peer Review, and Credentialing. Databases, such as the National Surgical Quality Improvement Program, are also available for review of quality. Safety is evaluated by analyzing outcomes including complications, route of procedure, and patient satisfaction. The cost of hysterectomy is impacted by continuous quality and safety improvements.