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DOI: 10.1055/a-0855-7128
Reference Intervals for Thyroid Hormones During the First Trimester of Gestation: A Report from an Area with a Sufficient Iodine Level
Funding The study was funded by the Endocrinology and Metabolism Research Center of Isfahan University of Medical Sciences in Isfahan, Iran; under the grant No. 394616. The authors declare that they have no competing financial interests.![](https://www.thieme-connect.de/media/hmr/201903/lookinside/thumbnails/2018-10-0334_10-1055-a-0855-7128-1.jpg)
Abstract
The physiological changes during pregnancy modulate the endocrine system. Therefore, both the American and the European thyroid associations recommend the use of local trimester-specific reference intervals. The purpose of this study was to establish the first trimester reference intervals for thyroid function tests in the central area of Iran. We examined 436 pregnant women in their first trimester of pregnancy, and 444 non-pregnant women in a cross sectional study. Serum levels of thyroid stimulating hormone (TSH), free thyroxin (FT4), free triiodothyronine (FT3), thyroid peroxidase antibody, urinary iodine concentration (UIC), and thyroid volume were measured for all subjects. The first trimester-specific reference intervals (2.5th–97.5th percentile) were determined for 185 pregnant women and 256 non-pregnant women with negative TPOAb, adequate iodine level (UIC≥150 μg/l in pregnant and UIC≥100 μg/l in non-pregnant women), and normal thyroid examination. We calculated multiples of the median (MoM) for TFTs to normalize the obtained data. The first trimester-specific reference intervals of serum TSH, FT4, and FT3 for pregnant women were 0.20–4.60 mIU/l, 9.0–18.02 pmol/l, and 3.40–5.64 pmol/l, respectively, while the corresponding figures for non-pregnant women were 0.59–5.60 mIU/l, 9.52–19.30 pmol/l, and 3.70–5.55 pmol/l, respectively. The first and 99th percentile MoM of TSH in pregnant women in their first-trimester was 0.026–4.61. The local normal reference ranges for the first trimester of pregnancy in central region of Iran were different from the ranges suggested by the ATA.
Key words
pregnancy - first trimester - gestation - thyroid function test - TPOAb - TSH - reference interval - multiples of the median (MoM)Publication History
Received: 09 October 2018
Accepted: 05 February 2019
Article published online:
12 March 2019
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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References
- 1 Moleti M, Trimarchi F, Vermiglio F. Thyroid Physiology in Pregnancy. Review Article. Endocr Pract 2014; 20: 589-596
- 2 Yoshimura M, Hershman JM. Thyrotropic action of human chorionic gonadotropin. Thyroid 1995; 5: 425-434
- 3 De Escobar GM, Obregón MJ, Del Rey FE. Role of thyroid hormone during early brain development. Eur J Endocrinol 2004; 151 (Suppl. 03) U25-U37
- 4 Fisher DA. Fetal thyroid function: Diagnosis and management of fetal thyroid disorders. Clin Obestet Gynecol 1997; 40: 16-31
- 5 Medici M, Korevaar TI, Visser WE. et al. Thyroid function in pregnancy: What is normal?. Clin Chem 2015; 61: 704-713
- 6 Lazarus JH, Bestwick JP, Channon S. et al. Antenatal thyroid screening and childhood cognitive function. N Engl J Med 2012; 366: 493-501
- 7 Lazarus JH. Thyroid function in pregnancy. Br Med Bull 2011; 97: 137-148
- 8 Delange F. Iodine deficiency as a cause of brain damage. Postgrad Med J 2001; 77: 217-220
- 9 Gilbert RM, Hadlow NC, Walsh JP. et al. Assessment of thyroid function during pregnancy: First-trimester (weeks 9–13) reference intervals derived from Western Australian women. Med J Aust 2008; 189: 250-253
- 10 Lin L, Zhang XL, Long Y. Analysis of thyroid peroxidase antibody in early pregnancy. Genet Mol Res 2014; 13: 5107-5114
- 11 Männistö T, Surcel HM, Ruokonen A. et al. Early pregnancy reference intervals of thyroid hormone concentrations in a thyroid antibody-negative pregnant population. Thyroid 2011; 21: 291-298
- 12 Berta E, Samson L, Lenkey A. et al. Evaluation of the thyroid function of healthy pregnant women by five different hormone assays Pharmazie. Pharmazie 2010; 65: 436-439
- 13 Wang QW, Yu B, Huang RP. et al. Assessment of thyroid function during pregnancy: The advantage of self-sequential longitudinal reference intervals. Arch Med Sci 2011; 4: 679-684
- 14 Khalid AS, Marchoki Z, Hayes K. et al. Establishing trimester-specific maternal thyroid function reference intervals. Ann Clin Biochem 2014; 51: 277-283
- 15 Alexander EK, Pearce EN, Brent GA. et al. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 2017; 27: 315-389
- 16 De Groot L, Abalovich M, Alexander EK. et al. Management of thyroid dysfunction during pregnancy and postpartum: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012; 97: 2543-2565
- 17 Lazarus J, Brown RS, Daumerie C. et al. 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J 2014; 3: 76-94
- 18 Parvin CA, Gray DL, Kessler G. Influence of assay method differences on multiple of the median distributions: Maternal serum alpha-fetoprotein as an example. Clin Chem 1991; 37: 637-642
- 19 Cunninghan FG, Leveno KJ, Bloom SL. et al. Williams obstetrics 23rd ed. . New York: McGraw Hill Medical; 2010
- 20 Khazan M, Yaghmaei P, Behdadfar L. et al. Microwave digestion for urine iodine determination. Iran J Endocrinol Metab 2010; 12: 65-70
- 21 NAOES Morias, ASA Assis, Corcino CM. et al. Recent recommendations from ATA guidelines to define the upper reference range for serum TSH in the first trimester match reference ranges for pregnant women in Rio de Janeiro. Arch Endocrinol Metab 2018; 62: 386-391
- 22 Stricker R, Echenard M, Eberhart R. et al. Evaluation of maternal thyroid function during pregnancy: The importance of using gestational age-specific reference intervals. Eur J Endocrinol 2007; 157: 509-514
- 23 Sekhri T, Juhi JA, Wilfred R. et al. Trimester specific reference intervals for thyroid function tests in normal Indian pregnant women. Indian J Endocrinol Metab 2016; 20: 101-107
- 24 Dhatt GS, Jayasundaram R, Wareth LA. et al. Thyrotrophin and free thyroxine trimester-specific reference intervals in a mixed ethnic pregnant population in the United Arab Emirates Clinica Chimi Acta. 2006; 370: 147-151
- 25 Korevaar TI, Medici M, de Rijke YB. et al. Ethnic differences in maternal thyroid parameters during pregnancy: The generation r study. J Clin Endocrinol Metab 2013; 98: 3678-3686
- 26 O’Brien JE, Dvorin E, Drugan A. et al. Race-ethnicity-specific variation in multiple-marker biochemical screening: Alpha-fetoprotein, hCG, and estriol. Obstet Gynecol 1997; 89: 355-358
- 27 McNeil AR, Stanford PE. Reporting thyroid function tests in pregnancy. Review article. Clin Biochem Rev 2015; 36: 109-126
- 28 Karakosta P, ChatziL Bagkeris E. et al. First- and second-trimester reference intervals for thyroid hormones during pregnancy in “rhea”mother-child cohort, crete, greece. J Thyroid Res 2011; 490783
- 29 Mehran L, Amouzegar A, Delshad H et al. Trimester-specific reference ranges for thyroid hormones in iranian pregnant women. J Thyroid Res 2013 Article ID 651517
- 30 Azizi F, Mehran L, Amouzegar A. et al. Establishment of the trimester-specific reference range for free thyroxine index. Thyroid 2013; 23: 354-359
- 31 Pearce EN, Oken E, Gillman MW. et al. Association of first-trisemester thyroid function test values with thyroperoxidase antibody status, smoking, and multivitamin use. Endocr Pract 2008; 14: 33-39
- 32 Lepoutre T, Debiéve DF, Gruson D. et al. Reduction of miscarriages through universal screening and treatment of thyroid autoimmune diseases. Gynecol Obstet Invest 2012; 74: 265-273
- 33 Pekonen F, Alfthan H, Stenman UH. et al. Human chorionic gonadotropin (hCG) and thyroid function in early human pregnancy: circadian variation and evidence for intrinsic thyrotropic activity of hCG. J Clin Endocrinol Metab 1988; 66: 853-856
- 34 Marwaha RK, Chopra S, Gopalakrishnan S. et al. Establishment of reference range for thyroid hormones in normal pregnant Indian women. BJOG 2008; 115: 602-606
- 35 Li C, Shan Z, Mao J. et al. Assessment of thyroid function during first-trimester pregnancy: what is the rational upper limit of serum TSH during the first trimester in Chinese pregnant women?. J Clin Endocrinol Metab 2014; 99: 73-79
- 36 Moon H-W, Chung H-J, Park C-M. et al. Establishment of Trimester-Specific Reference Intervals for Thyroid Hormones in Korean Pregnant Women. Ann Lab Med 2015; 35: 198-204
- 37 Yan YQ, Dong ZL, Dong L. et al. Trimester- and method-specific reference intervals for thyroid tests in pregnant Chinese women: Methodology, euthyroid definition and iodine status can influence the setting of reference intervals. Clin Endocrinol 2011; 74: 262-269
- 38 Xing J, Yuan E, Li J. et al. Trimester-and assay-specific thyroid reference intervals for pregnant women in China. Int J Endocrinol 2016; 3754213
- 39 Bestwick JP, John R, Maina A. et al. Thyroid stimulating hormone and free thyroxine in pregnancy: expressing concentrations as multiples of the median (MoMs). Clin Chim Acta 2014; 430: 33-37
- 40 Medici M, de Rijke YB, Peeters RP. et al. Maternal Early preganacy and newborn thyroid hormone parameters:The Generation R study. J Clin Endocrinol Metab 2012; 97: 646-652
- 41 Dashe JS, Casey BM, CB Wells CE. et al. Thyroid-stimulating hormone in singletonand twin pregnancy: importance of gestational age-specific reference ranges. Obstet Gynecol 2005; 106: 753-757
- 42 Bishop JC, Dunstan F, Nix BJ. et al. All MoMs are not equal: Some statistical properties associated with reporting results in the form of multiples of the median. Am J Human Genet 1993; 52: 425
- 43 Baloch Z, Carayon P, Conte-Devolx B. et al. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 2003; 13: 3
- 44 Hollowell JG, Staehling NW, Flanders WD et al. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002: 87: 489–499