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Andersen SL, Christensen PA, Knøsgaard L, Andersen S, Handberg A, Hansen AB, Vestergaard P. Classification of Thyroid Dysfunction in Pregnant Women Differs by Analytical Method and Type of Thyroid Function Test. J Clin Endocrinol Metab 2020; 105:5896598. [PMID: 32835377 DOI: 10.1210/clinem/dgaa567] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/17/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Physiological alterations challenge the assessment of maternal thyroid function in pregnancy. It remains uncertain how the reference ranges vary by week of pregnancy, and how the classification of disease varies by analytical method and type of thyroid function test. DESIGN Serum samples from Danish pregnant women (n = 6282) were used for the measurement of thyrotropin (TSH), total and free thyroxine (T4), total and free 3,5,3'-triiodothyronine (T3), and T-uptake using "Method A" (Cobas 8000, Roche Diagnostics). TSH and free T4 were also measured using "Method B" (ADVIA Centaur XP, Siemens Healthineers). MAIN OUTCOME MEASURES Pregnancy week- and method-specific reference ranges were established among thyroid antibody-negative women (n = 4612). The reference ranges were used to classify maternal thyroid function, and results were compared by analytical method and type of thyroid function test. RESULTS The reference ranges for TSH showed a gradual decrease during pregnancy weeks 4 to 14, a gradual increase was observed for total T4, total T3, and T-uptake, whereas free T4 and free T3 showed less variation. When TSH and free T4 were used, Method A classified 935 (14.9%) with abnormal thyroid function, Method B a total of 903 (14.4%), and the methods agreed on 554 individuals. When TSH and total T4 were used, 947 (15.1%) were classified with abnormal thyroid function, and classifications by either total T4 or free T4 agreed on 584 individuals. CONCLUSIONS Even when pregnancy week- and method-specific reference ranges were established, the classification of maternal thyroid dysfunction varied considerably by analytical method and type of thyroid function test.
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Affiliation(s)
- Stine Linding Andersen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Biochemistry, Viborg Regional Hospital, Viborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Peter Astrup Christensen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Louise Knøsgaard
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Stig Andersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Geriatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Aase Handberg
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Annebirthe Bo Hansen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Vestergaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
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Pan Z, Cui T, Chen W, Gao S, Pearce EN, Wang W, Chen Y, Guo W, Tan L, Shen J, Zhang W. Serum iodine concentration in pregnant women and its association with urinary iodine concentration and thyroid function. Clin Endocrinol (Oxf) 2019; 90:711-718. [PMID: 30724372 DOI: 10.1111/cen.13945] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/17/2019] [Accepted: 02/02/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aims to evaluate the association of serum iodine concentration (SIC) with urinary iodine concentration (UIC) and thyroid function in pregnant women, as well as to provide the reference range of SIC of pregnant women in iodine-sufficiency area. METHODS Pregnant women were enrolled in the Department of Obstetrics, Tanggu Maternity Hospital, Tianjin from March 2016 to May 2017. Fasting venous blood and spot urine samples were collected. Serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), thyroglobulin (Tg), thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), UIC and SIC were measured. RESULTS One thousand and ninety-nine participants were included in this study. The median UIC was 156 μg/L. The median SIC was 108 μg/L, and the 95% reference interval for SIC was 65.6-164.7 μg/L. SIC was positively correlated with UIC (r = 0.12, P < 0.001), FT3 (r = 0.23, P < 0.001), and FT4 (r = 0.50, P < 0.001) and was inversely correlated with TSH (r = -0.14, P < 0.001). Pregnant women with a SIC < 79.9 μg/L had a higher risk of hypothyroxinemia compared to those with higher SIC (OR = 2.44, 95% CI: 1.31-4.75). Those having SIC > 138.5 μg/L were more likely to have thyrotoxicosis than those with lower SIC values (OR = 13.52, 95% CI: 4.21-43.36). CONCLUSIONS Serum iodine level is associated with UIC and thyroid function in pregnant women. Low SIC was associated with increased risk for iodine deficiency and hypothyroxinemia, while high SIC was related to excess and thyrotoxicosis.
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Affiliation(s)
- Ziyun Pan
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, China
| | - Tingkai Cui
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, China
| | - Wen Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, China
| | - Shu Gao
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, China
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts
| | - Wei Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, China
| | - Yanting Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, China
| | - Wenxing Guo
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, China
| | - Long Tan
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, China
| | - Jun Shen
- Department of Sanitary Chemistry, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wanqi Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, China
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Gozet T, Serdar M, Akın-Levi C, Ucal Y, Ozpinar A. Assessment of thyroid function during postpartum period with total thyroxine and total triiodothyronine levels measured by LC-MS/MS. J LIQ CHROMATOGR R T 2018. [DOI: 10.1080/10826076.2018.1511994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Tuba Gozet
- Faculty of Pharmacy, Department of Analytical Chemistry, Altinbas University, Istanbul, Turkey
| | - Muhittin Serdar
- School of Medicine, Department of Medical Biochemistry, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Cansu Akın-Levi
- School of Medicine, Department of Medical Biochemistry, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Yasemin Ucal
- School of Medicine, Department of Medical Biochemistry, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Aysel Ozpinar
- School of Medicine, Department of Medical Biochemistry, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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Labadzhyan A, Brent GA, Hershman JM, Leung AM. Thyrotoxicosis of Pregnancy. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2014; 1:140-144. [PMID: 25243108 PMCID: PMC4166486 DOI: 10.1016/j.jcte.2014.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Thyrotoxicosis presenting during pregnancy is a common clinical problem and can be challenging to differentiate between physiologic patterns of thyroid dysfunction during gestation and intrinsic hyperthyroidism. This review provides a summary of the differential diagnosis, clinical presentation, diagnostic options, potential adverse effects of maternal thyrotoxicosis to the fetus, and treatment recommendations for thyrotoxicosis arising in pregnancy.
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Affiliation(s)
- Artak Labadzhyan
- Division of Endocrinology, Cedars-Sinai Medical Center and VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Gregory A Brent
- Division of Endocrinology, David Geffen School of Medicine, University of California Los Angeles
| | - Jerome M Hershman
- Division of Endocrinology, David Geffen School of Medicine, University of California Los Angeles
| | - Angela M Leung
- Division of Endocrinology, David Geffen School of Medicine, University of California Los Angeles
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