Trimester-specific reference interval for thyroid hormones during pregnancy at a Tertiary Care Hospital in Haryana, India

Rajput, Rajesh; Singh, Bir; Goel, Vasudha; Verma, Amit; Seth, Shashi; Nanda, Smiti

doi:10.4103/2230-8210.192903

Cited by 22 publications

(24 citation statements)

References 27 publications

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“…In addition, sample size, representativeness of the reference population and the manufacturer's immunoassay methodology also have an important impact on the reference interval [9,10].…”

Section: Introductionmentioning

confidence: 99%

Establishment of assay method- and trimester-specific reference intervals for thyroid hormones during pregnancy in Chengdu, China

Huang

Li-nong

et al. 2020

Preprint

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Background: The reference intervals of thyroid hormone will change at different stages of pregnancy because of physiological alterations. On the other hand, the reference intervals of hyroid hormone will also change in different detection systems due to manufacturer’s methodology as well as different race. The objective in this study was to establish the assay method- and trimester-specific reference intervals for thyroid stimulating hormone, free thyroxine, and free triiodothyronine for pregnant women in the Chengdu.Methods: A prospective, population-based cohort study involved 23701 reference samples of pregnant women during the three trimesters and 8646 non-pregnant women with pre-pregnancy clinical and laboratory tests. The 2.5th and 97.5th percentiles were calculated as the reference intervals for thyroid stimulating hormone, free thyroxine, and free triiodothyronine at each trimester of pregnant women according to ATA Guidelines.Results: The reference interval of thyroid stimulating hormone in the 2.5th and 97.5th percentiles has a significant increasing trend from first trimester, to second trimester, and to third trimester, which was 0.08-3.79 mIU/L for first trimester, and 0.12-3.95 mIU/L for second trimester, and 0.38-4.18 mIU/L for third trimester, respectively (P < 0.001). However, the reference intervals of free thyroxine and free triiodothyronine in the 2.5th and 97.5th percentiles have significant decreasing trends from first trimester, to second trimester, and to third trimester, which were 11.87-18.83 pmol/L and 3.77-5.50 pmol/L for first trimester, and 11.22-18.19 pmol/L and 3.60-5.41 pmol/L for second trimester, and 10.19-17.42 pmol/L and 3.37-4.79 pmol/L for third trimester, respectively (both P < 0.001).Conclusion: It is necessary to establish assay method- and trimester-specific reference intervals for thyroid stimulating hormone, free thyroxine, and free triiodothyronine because the reference intervals of these thyroid hormones are significantly different at different stages of pregnancy.

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“…In addition, sample size, representativeness of the reference population and the manufacturer's immunoassay methodology also have an important impact on the reference interval [9,10].…”

Section: Introductionmentioning

confidence: 99%

Establishment of assay method- and trimester-specific reference intervals for thyroid hormones during pregnancy in Chengdu, China

Huang

Li-nong

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Thus, in China it has been shown that prevalence of subclinical hypothyroidism using laboratory trimester specific ranges for TSH was 4% in pregnant women during the first trimester whereas this prevalence was 27.8% when a diagnostic criterion of TSH > 2.5 mU/L was used [21]. Moreover, many reported trimester-specific reference intervals for TSH were different from those recommended by 2011 ATA guidelines [22] [23]. It is therefore probable that, in our study, hypothyroidism frequency determined following 2011 ATA guidelines was overestimated.…”

Section: Discussionmentioning

confidence: 99%

Thyroid Function in Pregnant Women from a West-African Population

Awede¹,

Hounnou²,

Tshabu-Aguemon³

et al. 2018

OJMIP

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Thyroid dysfunction is frequent in pregnant women and is often associated with an increased risk of adverse maternal and fetal outcome. In the present work, thyroid function of pregnant women from Benin republic was studied. Two hundred forty (240) pregnant women, without thyroid disease history, have been included in the study. A blood sample was drawn for measurement of TSH, free T3 and free T4 serum levels. From the first to the third trimester, plasma levels of free T3 and free T4 decreased when plasma levels of TSH increased. Using recommendations of the 2011 American Thyroid Association (ATA) guidelines, thyroid dysfunction was observed in 24.17% of subjects. Hypothyroidism was present in 22.50% of subjects with 19.17% of subclinical hypothyroidism, 0.83% of overt hypothyroidism and 2.50% of hypothyroxinemia and hyperthyroidism was observed in 1.67% of subjects. An increase from 15.52% to 28.07% was observed in the frequency of hypothyroidism from the first to the third trimester of pregnancy. When an upper cut-off value of 4 mU/L was used for TSH, as recommended in the 2017 ATA guidelines, prevalence of thyroid disorders was 14.58% with 12.91% of hypothyroidism but no hypothyroidism was observed in women in the first trimester of pregnancy. A rise in hypothyroidism frequency was observed when pregnant women age increased. Hypothyroidism was very common in pregnant women in Benin. To allow accurate assessment of thyroid status in pregnant women in Benin, pregnancy specific range for plasma level of TSH and thyroid hormones should be established.

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“…One was excluded in view of poor quality. Sevens studies are published manuscripts[ 13 14 15 16 20 21 22 ] while one study was poster at an endocrine conference (Choudhary et al .) [ Table 1 ].…”

Section: R Esultsmentioning

confidence: 99%

“…TSH was measured by different assay methods which include electrochemiluminescence,[ 13 15 20 ] enzyme-linked immunosorbent assay,[ 14 ] enzyme immunoassay,[ 21 ] and chemiluminescence immunoassays. [ 16 22 ]…”

Section: R Esultsmentioning

confidence: 99%

A systematic review on normative values of trimester-specific thyroid function tests in Indian women

Kannan

Mahadevan

Sigamani

2018

Indian J Endocr Metab

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Background: Small cross-sectional studies are published on the trimester-specific normal ranges of thyrotropin and thyroxine levels in Indian women from various parts of the country. Objective: We sought to review the published literature on thyroid function tests in normal pregnant Indian women to see if the pooled data from various studies can define normative data and hypothyroidism in pregnancy. Methods: We retrieved 56 studies from online databases with detailed search using multiple search terms. Unanimously eight studies were finalized. Results: Data of 2703 pregnant women (age 16–45 years; 966 were in the first trimester, 1072 in their second trimester, and 1037 women in their third trimester) were analyzed. All eight studies included singleton pregnancies from the northern and eastern part of India with seven studies being cross-sectional in nature. The exclusion criteria in all studies included those with historical/clinical evidence of thyroid dysfunction, those with family history of thyroid dysfunction, infertility and those with history of recurrent miscarriages (usually >3). Ultrasound evidence of thyroid disease, urinary iodine assessment, and thyroid antibodies were included as additional exclusion criteria in two, three, and four studies, respectively. None of the studies included the outcome of pregnancy as part of follow-up. As part of the pooled data analysis, the 5 th –95 th centile values of normal TSH extended from 0.09 to 6.65 IU/mL in the first trimester, 0.39–6.61 IU/mL in the second trimester, and 0.70–5.18 IU/mL in the third trimester. The FT4 levels (5 th –95 th centile values) extended from 8.24 to 25.74 pmol/L in the first trimester, 6.82–26.0 pmol/L, and 5.18–25.61 pmol/L in the third trimester. Conclusions: With due limitations imposed by the quality of the available studies, the current review suggests that upper normal limit of TSH values can extend up to 5–6 IU/mL in pregnancy.

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Trimester-specific reference interval for thyroid hormones during pregnancy at a Tertiary Care Hospital in Haryana, India

Cited by 22 publications

References 27 publications

Establishment of assay method- and trimester-specific reference intervals for thyroid hormones during pregnancy in Chengdu, China

Establishment of assay method- and trimester-specific reference intervals for thyroid hormones during pregnancy in Chengdu, China

Thyroid Function in Pregnant Women from a West-African Population

A systematic review on normative values of trimester-specific thyroid function tests in Indian women

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