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Dorizzi RM, Spiazzi G, Rolli N, Maltoni P, Mingolla L, Sgarzani C, Torello M, Tosi F, Bonin C, Moghetti P. Trimester-specific reference intervals for thyroid function parameters in pregnant Caucasian women using Roche platforms: a prospective study. J Endocrinol Invest 2023; 46:2459-2469. [PMID: 37095269 PMCID: PMC10632219 DOI: 10.1007/s40618-023-02098-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/13/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Standard thyroid function parameters reference intervals (RI) are unsuitable during pregnancy, potentially resulting in incongruous treatments that may cause adverse effects on pregnancy outcomes. We aimed at defining trimester-specific TSH, FT4 and FT3 RI, using samples longitudinally collected from healthy Caucasian women. MATERIALS AND METHODS Blood samples from 150 healthy Caucasian women, who had a physiological gestation and a healthy newborn at term, were collected in each trimester and at around six months post-partum. They showed mild iodine deficiency. After excluding women with overt TSH abnormalities (> 10 mU/L) and/or TPO antibodies, data from 139 pregnant women were analyzed by means of widely used Roche platforms, and TSH, FT4 and FT3 trimester-specific RI were calculated. Post-partum data were available for 55 subjects. RESULTS Serum TSH RI were 0.34-3.81 mU/L in the first trimester, and changed slightly to 0.68-4.07 U/L and 0.63-4.00 mU/L in the second and third trimester, respectively. Conversely, both FT4 and FT3 concentrations progressively decreased during pregnancy, the median values in the third trimester being 14.8% and 13.2% lower, respectively, than in the first trimester. Thyroid function parameters in the first trimester were similar to those measured after the end of pregnancy. CONCLUSIONS This study calculates trimester-specific RI for thyroid function parameters in pregnancy, and proposes the reference limits that should be adopted when using Roche platforms in Caucasian women.
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Affiliation(s)
- R M Dorizzi
- Clinical Pathology Unit, Hub Laboratory, AUSL Romagna, Cesena, Italy
| | - G Spiazzi
- Unit of Endocrinology, Diabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, p.le Stefani 1, 37126, Verona, Italy
| | - N Rolli
- Unit of Endocrinology, Diabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, p.le Stefani 1, 37126, Verona, Italy
| | - P Maltoni
- Clinical Pathology Unit, Hub Laboratory, AUSL Romagna, Cesena, Italy
| | - L Mingolla
- Unit of Endocrinology, Diabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, p.le Stefani 1, 37126, Verona, Italy
| | - C Sgarzani
- Clinical Pathology Unit, Hub Laboratory, AUSL Romagna, Cesena, Italy
| | - M Torello
- Clinical Pathology Unit, Hub Laboratory, AUSL Romagna, Cesena, Italy
| | - F Tosi
- Unit of Endocrinology, Diabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, p.le Stefani 1, 37126, Verona, Italy
| | - C Bonin
- Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - P Moghetti
- Unit of Endocrinology, Diabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, p.le Stefani 1, 37126, Verona, Italy.
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2
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D'Aurizio F, Kratzsch J, Gruson D, Petranović Ovčariček P, Giovanella L. Free thyroxine measurement in clinical practice: how to optimize indications, analytical procedures, and interpretation criteria while waiting for global standardization. Crit Rev Clin Lab Sci 2023; 60:101-140. [PMID: 36227760 DOI: 10.1080/10408363.2022.2121960] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Thyroid dysfunctions are among the most common endocrine disorders and accurate biochemical testing is needed to confirm or rule out a diagnosis. Notably, true hyperthyroidism and hypothyroidism in the setting of a normal thyroid-stimulating hormone level are highly unlikely, making the assessment of free thyroxine (FT4) inappropriate in most new cases. However, FT4 measurement is integral in both the diagnosis and management of relevant central dysfunctions (central hypothyroidism and central hyperthyroidism) as well as for monitoring therapy in hyperthyroid patients treated with anti-thyroid drugs or radioiodine. In such settings, accurate FT4 quantification is required. Global standardization will improve the comparability of the results across laboratories and allow the development of common clinical decision limits in evidence-based guidelines. The International Federation of Clinical Chemistry and Laboratory Medicine Committee for Standardization of Thyroid Function Tests has undertaken FT4 immunoassay method comparison and recalibration studies and developed a reference measurement procedure that is currently being validated. However, technical and implementation challenges, including the establishment of different clinical decision limits for distinct patient groups, still remain. Accordingly, different assays and reference values cannot be interchanged. Two-way communication between the laboratory and clinical specialists is pivotal to properly select a reliable FT4 assay, establish reference intervals, investigate discordant results, and monitor the analytical and clinical performance of the method over time.
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Affiliation(s)
- Federica D'Aurizio
- Department of Laboratory Medicine, University Hospital of Udine, Udine, Italy
| | - Jürgen Kratzsch
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, University of Leipzig, Leipzig, Germany
| | - Damien Gruson
- Department of Clinical Biochemistry, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Clinic for Nuclear Medicine and Thyroid Center, University and University Hospital of Zurich, Zurich, Switzerland
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3
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Jansen HI, van Herwaarden AE, Huijgen HJ, Painter RC, Hillebrand JJ, Boelen A, Heijboer AC. Pregnancy disrupts the accuracy of automated fT4 immunoassays. Eur Thyroid J 2022; 11:e220145. [PMID: 36219545 PMCID: PMC9641786 DOI: 10.1530/etj-22-0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/11/2022] [Indexed: 11/08/2022] Open
Abstract
Objective Thyroid hormone measurements are often performed in pregnant women, as hypo- and hyperthyroidism during pregnancy can severely affect the fetus. Serum free thyroxine (fT4) measurements are well known for their analytical challenges, due to low serum concentrations and the subtle equilibrium between free and bound T4 (to thyroid-binding globulin (TBG), transthyretin and albumin). Pregnant women have high TBG concentrations due to an increase in human chorionic gonadotropin (hCG) and estrogen and lower albumin concentrations which change the equilibrium and may affect the validity of fT4 measurements in their samples. As accurate serum fT4 measurements in pregnant women are important for the long-term health of the fetus, we aimed to evaluate the accuracy of several fT4 immunoassays in the serum of pregnant women. Methods FT4 was measured in healthy controls and pregnant women using a candidate-reference method (LC-MS/MS) and five commercially available automated immunoassays (Alinity (Abbott), Atellica (Siemens), Cobas (Roche), Lumipulse (Fujirebio) and UniCel DXI (Beckman Coulter)). Method comparisons (Bland Altman plots and Passing and Bablok analyses) were performed. Results Serum samples from both healthy controls (n = 30) and pregnant women (n = 30; mean gestational age, 24.8 weeks) were collected. The fT4 immunoassays deviated +7 to +29% more from the LC-MS/MS in serum samples of pregnant women than healthy controls (falsely high). Conclusions Our results indicate that immunoassays overestimate fT4 in pregnant women, which might lead to an overestimation of thyroid status. Physicians and laboratory specialists should be aware of this phenomenon to avoid drawing false conclusions about thyroid function in pregnant women.
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Affiliation(s)
- Heleen I Jansen
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Henk J Huijgen
- Department of Clinical Chemistry, Red Cross Hospital, Beverwijk, The Netherlands
| | - Rebecca C Painter
- Department of Obstetrics and Gynaecology, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Jacquelien J Hillebrand
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Anita Boelen
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Annemieke C Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
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Turkal R, Turan CA, Elbasan O, Aytan S, Çakmak B, Gözaydınoğlu B, Takır DC, Ünlü O, Bahramzada G, Tekin AF, Çevlik T, Büyükbayrak EE, Şirikçi Ö, Gözü H, Haklar G. Accurate interpretation of thyroid dysfunction during pregnancy: should we continue to use published guidelines instead of population-based gestation-specific reference intervals for the thyroid-stimulating hormone (TSH)? BMC Pregnancy Childbirth 2022; 22:271. [PMID: 35361138 PMCID: PMC8973886 DOI: 10.1186/s12884-022-04608-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Considering the changes in thyroid physiology associated with pregnancy and poor outcomes related to abnormal maternal thyroid function, international guidelines recommend using population-based trimester-specific reference intervals (RIs) for thyroid testing. If these RIs are not available in the laboratory, implementing recommended fixed cut-off values globally is still controversial. To address this issue, we aimed to establish appropriate RI of thyroid-stimulating hormone (TSH) in pregnant Turkish women for our laboratory and compare the prevalence of thyroid dysfunction based on the established and recommended criteria. Methods Of 2638 pregnant women, 1777 women followed in the obstetric outpatient were enrolled in the reference interval study after applying exclusion criteria related to medical and prenatal history. A retrospective study was conducted by collecting data from July 2016 to March 2019. Serum TSH was measured by UniCel DxI 800 Immunoassay System (Beckman Coulter Inc., Brea, CA, USA). The study design relied on two approaches in order to classify pregnant women: trimester-specific and subgroup-specific; the latter involved dividing each trimester into two subgroups: T1a, T1b, T2a, T2b, T3a, T3b. The lower and upper limits of the RIs were derived by the parametric method after normalizing the data distribution using the modified Box-Cox power transformation method. Results The lowest TSH value was detected at 8-12 weeks in early pregnancy, and the median value of TSH in the T1b subgroup was significantly lower than the T1a subgroup (P < 0.05). TSH levels showed a gradual trend of increase along with the pregnancy and increased significantly in the T2a, T2b, and T3b subgroups compared to the preceding subgroups (P < 0.05). Compared to the diagnostic criteria recommended by American Thyroid Association (ATA), the prevalence of thyroid dysfunction was significantly different from the established trimester- and subgroup-specific RIs throughout the pregnancy (P < 0.001). Conclusions We conclude that establishing gestation- and laboratory-specific RIs, especially for TSH, is essential for diagnosing thyroid disorders in pregnancy, and the recommended universal cut-off values, which may contribute to the risk of a misdiagnosis or a missed diagnosis, should be taken with caution in the clinical setting. However, regarding the fluctuation of thyroid function tests throughout pregnancy, trimester-specific RIs are insufficient, and implementing split phases is required.
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Affiliation(s)
- Rana Turkal
- Biochemistry Laboratory, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey.
| | - Cem Armağan Turan
- Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Onur Elbasan
- Subdepartment of Endocrinology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Serenay Aytan
- Medical Student, School of Medicine, Marmara University, Istanbul, Turkey
| | - Burcu Çakmak
- Medical Student, School of Medicine, Marmara University, Istanbul, Turkey
| | - Büşra Gözaydınoğlu
- Medical Student, School of Medicine, Marmara University, Istanbul, Turkey
| | - Duygu Ceyda Takır
- Medical Student, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ozan Ünlü
- Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey
| | - Günel Bahramzada
- Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ahmet Faruk Tekin
- Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey
| | - Tülay Çevlik
- Biochemistry Laboratory, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | - Esra Esim Büyükbayrak
- Department of Gynecology and Obstetrics, School of Medicine, Marmara University, Istanbul, Turkey
| | - Önder Şirikçi
- Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey
| | - Hülya Gözü
- Subdepartment of Endocrinology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Goncagül Haklar
- Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey
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5
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Bohn MK, Adeli K. Physiological and metabolic adaptations in pregnancy: importance of trimester-specific reference intervals to investigate maternal health and complications. Crit Rev Clin Lab Sci 2021; 59:76-92. [PMID: 34587857 DOI: 10.1080/10408363.2021.1978923] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Diagnosis, prognostication, and monitoring of maternal health throughout pregnancy relies on laboratory testing, including but not limited to key markers of thyroid, hepatic, cardiac, hematology, and renal function. Dynamic physiological processes during gestation significantly influence the maternal biochemistry that supports both the mother and fetus. Resultant changes in blood biochemistry alter the expected values of common laboratory tests. However, the importance of pregnancy-specific reference intervals for laboratory test result interpretation and appropriate monitoring of maternal health and complications is underappreciated. Most clinical laboratories continue to use non-pregnant adult reference intervals for laboratory test interpretation in pregnancy. The current review summarizes and critically evaluates the available literature regarding physiological and metabolic adaptations in pregnancy and their influence on common biomarkers of health and disease. The main laboratory parameters discussed include thyroid, hepatic, metabolic, renal, hematology, inflammatory, and cardiac markers. Considering the available data, further studies are urgently needed to establish trimester-specific reference intervals in healthy pregnant women on updated analytical platforms. Without such data, the standard of clinical laboratory service in pregnancy remains compromised and affects the quality of maternal-fetal healthcare.
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Affiliation(s)
- Mary Kathryn Bohn
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Khosrow Adeli
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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6
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Iron status of full-term infants in early infancy is not associated with maternal ferritin levels nor infant feeding practice. Br J Nutr 2021; 127:1198-1203. [PMID: 34103112 DOI: 10.1017/s0007114521001975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Iron deficiency (ID) in early life is associated with morbidities. Most fetal iron required for infant growth is acquired in the third trimester from maternal iron store. However, how prenatal iron level affects ferritin level in early infancy remains controversial. This study aimed to examine the associations between maternal ferritin levels and cord blood serum ferritin (CBSF) and to compare the ferritin levels between different feeding practices in early infancy. Healthy Chinese mothers with uncomplicated pregnancy and their infants were followed up at 3 months post-delivery for questionnaire completion and infant blood collection. Infants who were predominantly breastfed and those who were predominantly formula fed were included in this analysis. Serum ferritin levels were measured in maternal blood samples collected upon delivery, cord blood and infant blood samples at 3 months of age. Ninety-seven mother-baby dyads were included. Maternal ID is common (56 %) while the CBSF levels were significantly higher than maternal ferritin levels. Only three infants (3 %) had ID at 3 months of age. There were no significant correlations between maternal ferritin levels with CBSF (r 0·168, P = 0·108) nor with infant ferritin levels at 3 months of age (r 0·023, P = 0·828). Infant ferritin levels at 3 months were significantly and independently associated with CBSF (P = 0·007) and birth weight (P < 0·001) after adjusting for maternal age, parity, maternal education, infant sex and feeding practice. In conclusion, maternal ID was common upon delivery. However, maternal ferritin levels were not significantly associated with CBSF concentrations nor infant ferritin concentrations at 3 months of age.
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7
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Hernández JM, Soldevila B, Velasco I, Moreno-Flores F, Ferrer L, Pérez-Montes de Oca A, Santillán C, Muñoz C, Ballesta S, Canal C, Puig-Domingo M, Granada ML. Reference Intervals of Thyroid Function Tests Assessed by Immunoassay and Mass Spectrometry in Healthy Pregnant Women Living in Catalonia. J Clin Med 2021; 10:jcm10112444. [PMID: 34072898 PMCID: PMC8198941 DOI: 10.3390/jcm10112444] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Recent guidelines recommend establishing a local reference interval (RI) for thyroid function. We aimed to establish trimester-specific RIs for thyrotropin (TSH) and free thyroxine (FT4) in a cohort of healthy pregnant women in Catalonia (Spain). METHODS A prospective observational study was conducted with 332 healthy pregnant women, from the first trimester (1T) to delivery. TSH was measured using an Architect® immunoassay (Abbott) and FT4 by two immunoassays, Architect® (Abbott) and Cobas® (Roche), in the three trimesters. FT4 was also measured by liquid chromatography mass spectrometry (LC/MS/MS) in the 1T. RESULTS TSH (µUI/mL) increased throughout pregnancy (1T: 0.03-3.78; 2T: 0.51-3.53; 3T: 0.50-4.32; p < 0.0001) and FT4 (pmol/L) progressively decreased (Architect® 1T: 10.42-15.96; 2T: 8.37-12.74; 3T: 8.24-12.49; p < 0.0001; and Cobas®: 1T: 11.46-19.05; 2T: 9.65-14.67; 3T: 8.88-14.54; p < 0.0067). The FT4 RI during 1T determined LC/MS/MS was 8.75-18.27. Despite the 1T FT4 results measured by LC/MS/MS and with the two immunoassays being significantly correlated, the results obtained by the three methods were found to be non-interchangeable. CONCLUSIONS We established trimester-specific RIs for TSH and for FT4 with immunoassays in our population. We also validated the 1T FT4 using LC/MS/MS to confirm the results of FT4 lower than the 2.5th percentile or higher than the 97.5th percentile.
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Affiliation(s)
- José María Hernández
- Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, s/n Camí de les Escoles, 08916 Badalona, Spain;
| | - Berta Soldevila
- Endocrinology & Nutrition Department, Hospital Universitari Germans Trias i Pujol, s/n Carretera del Canyet, 08916 Badalona, Spain; (B.S.); (L.F.); (A.P.-M.d.O.); (S.B.)
- Endocrine, Thyroid & Obesity Research Group, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, s/n Camí de les Escoles, 08916 Badalona, Spain; (I.V.); (C.M.); (M.L.G.)
| | - Inés Velasco
- Endocrine, Thyroid & Obesity Research Group, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, s/n Camí de les Escoles, 08916 Badalona, Spain; (I.V.); (C.M.); (M.L.G.)
- Gynecology & Obstetrics Department, Hospital Universitari Germans Trias i Pujol, s/n Carretera del Canyet, 08916 Badalona, Spain
- Pediatrics, Gynecology & Obstetrics Department, Autonomous University of Barcelona, Campus UAB, Plaça Cívica, 08193 Bellaterra, Spain
| | - Fernando Moreno-Flores
- Clinical Biochemistry Department, Hospital Universitari Germans Trias i Pujol, s/n Carretera del Canyet, 08916 Badalona, Spain;
| | - Laura Ferrer
- Endocrinology & Nutrition Department, Hospital Universitari Germans Trias i Pujol, s/n Carretera del Canyet, 08916 Badalona, Spain; (B.S.); (L.F.); (A.P.-M.d.O.); (S.B.)
- Endocrine, Thyroid & Obesity Research Group, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, s/n Camí de les Escoles, 08916 Badalona, Spain; (I.V.); (C.M.); (M.L.G.)
| | - Alejandra Pérez-Montes de Oca
- Endocrinology & Nutrition Department, Hospital Universitari Germans Trias i Pujol, s/n Carretera del Canyet, 08916 Badalona, Spain; (B.S.); (L.F.); (A.P.-M.d.O.); (S.B.)
- Endocrine, Thyroid & Obesity Research Group, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, s/n Camí de les Escoles, 08916 Badalona, Spain; (I.V.); (C.M.); (M.L.G.)
| | - Cecilia Santillán
- Endocrinology Department, Doctor Arturo Oñativia Hospital, 30 E.Paz Chain, Salta A4400AWQ, Argentina;
| | - Carla Muñoz
- Endocrine, Thyroid & Obesity Research Group, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, s/n Camí de les Escoles, 08916 Badalona, Spain; (I.V.); (C.M.); (M.L.G.)
| | - Sílvia Ballesta
- Endocrinology & Nutrition Department, Hospital Universitari Germans Trias i Pujol, s/n Carretera del Canyet, 08916 Badalona, Spain; (B.S.); (L.F.); (A.P.-M.d.O.); (S.B.)
- Endocrine, Thyroid & Obesity Research Group, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, s/n Camí de les Escoles, 08916 Badalona, Spain; (I.V.); (C.M.); (M.L.G.)
| | - Cristina Canal
- Gynecology & Obstetrics Department, ASSIR La Riera, Hospital Universitari Germans Trias i Pujol, 1 Riera Matamoros, 08911 Badalona, Spain;
| | - Manel Puig-Domingo
- Endocrinology & Nutrition Department, Hospital Universitari Germans Trias i Pujol, s/n Carretera del Canyet, 08916 Badalona, Spain; (B.S.); (L.F.); (A.P.-M.d.O.); (S.B.)
- Endocrine, Thyroid & Obesity Research Group, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, s/n Camí de les Escoles, 08916 Badalona, Spain; (I.V.); (C.M.); (M.L.G.)
- Correspondence: ; Tel.: +34-934-978-860
| | - María Luisa Granada
- Endocrine, Thyroid & Obesity Research Group, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, s/n Camí de les Escoles, 08916 Badalona, Spain; (I.V.); (C.M.); (M.L.G.)
- Clinical Biochemistry Department, Hospital Universitari Germans Trias i Pujol, s/n Carretera del Canyet, 08916 Badalona, Spain;
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8
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Ma C, Li X, Liu L, Cheng X, Xue F, Wu J, Xia L, Yin Y, Wang D, Zou Y, Qiu L, Liu J. Establishment of Early Pregnancy Related Thyroid Hormone Models and Reference Intervals for Pregnant Women in China Based on Real World Data. Horm Metab Res 2021; 53:272-279. [PMID: 33853119 DOI: 10.1055/a-1402-0290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Thyroid hormone reference intervals are crucial for diagnosing and monitoring thyroid dysfunction during early pregnancy, and the dynamic change trend of thyroid hormones during pregnancy can assist clinicians to assess the thyroid function of pregnant women. This study aims to establish early pregnancy related thyroid hormones models and reference intervals for pregnant women. We established two derived databases: derived database* and derived database#. Reference individuals in database* were used to establish gestational age-specific reference intervals for thyroid hormones and early pregnancy related thyroid hormones models for pregnant women. Individuals in database# were apparently healthy non-pregnant women. The thyroid hormones levels of individuals in database# were compared with that of individuals in database* using nonparametric methods and the comparative confidence interval method. The differences in thyroid stimulating hormone and free thyroxine between early pregnant and non-pregnant women were statistically significant (p<0.0001). The reference intervals of thyroid stimulating hormone, free thyroxine and free triiodothyronine for early pregnant women were 0.052-3.393 μIU/ml, 1.01-1.54 ng/dl, and 2.51-3.66 pg/ml, respectively. Results concerning thyroid stimulating hormone and free thyroxine reference intervals of early pregnancy are comparable with those from other studies using the same detection platform. Early pregnancy related thyroid hormones models showed various change patterns with gestational age for thyroid hormones. Early pregnancy related thyroid hormones models and reference intervals for pregnant women were established, so as to provide accurate and reliable reference basis for the diagnosing and monitoring of maternal thyroid disfunction in early pregnancy.
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Affiliation(s)
- Chaochao Ma
- Department of Clinical Laboratory, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
| | - Xiaoqi Li
- Department of Clinical Laboratory, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
| | - Lixin Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
| | - Xinqi Cheng
- Department of Clinical Laboratory, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
| | - Fang Xue
- Department of Epidemiology and Biostatistics, School of Basic Medicine Peking Union Medical College, Beijing, P. R. China
| | - Jie Wu
- Department of Clinical Laboratory, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
| | - Liangyu Xia
- Department of Clinical Laboratory, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
| | - Yicong Yin
- Department of Clinical Laboratory, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
| | - Danchen Wang
- Department of Clinical Laboratory, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
| | - Yutong Zou
- Department of Clinical Laboratory, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
| | - Ling Qiu
- Department of Clinical Laboratory, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
| | - Juntao Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, P. R. China
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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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