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Related Concept Videos

Functions of Thyroid Hormones01:18

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Defining Gestational Thyroid Dysfunction Through Modified Nonpregnancy Reference Intervals: An Individual Participant

Joris A J Osinga1,2, Scott M Nelson3, John P Walsh4,5

  • 1Department of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands.

The Journal of Clinical Endocrinology and Metabolism
|July 31, 2024
PubMed
Summary
This summary is machine-generated.

Modified nonpregnancy reference intervals for thyroid-stimulating hormone (TSH) and free thyroxine (FT4) did not adequately approximate trimester-specific intervals for pregnant individuals. Further research is needed on the clinical significance of trimester-specific intervals.

Keywords:
pregnancyreference valuesthyroid function teststhyroid glandthyrotropinthyroxine

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Area of Science:

  • Endocrinology
  • Reproductive Medicine
  • Clinical Chemistry

Background:

  • Establishing local trimester-specific reference intervals for gestational thyroid-stimulating hormone (TSH) and free thyroxine (FT4) is challenging.
  • Alternative strategies are needed to accurately assess thyroid function during pregnancy.

Purpose of the Study:

  • To systematically evaluate the diagnostic performance of standardized modifications to nonpregnancy reference intervals for TSH and FT4.
  • To compare these modified intervals against established trimester-specific reference intervals.

Main Methods:

  • Prospective cohort data from the Consortium on Thyroid and Pregnancy were analyzed.
  • Thyroid reference intervals were modified using absolute, relative (5% increments), and fixed limit approaches.
  • Prevalence of (sub)clinical hypothyroidism, sensitivity, and positive predictive value (PPV) were compared across methods.

Main Results:

  • Optimal modifications for overt hypothyroidism: -5% TSH upper limit, +5% FT4 lower limit (Sensitivity: 0.70, PPV: 0.64).
  • Optimal modifications for subclinical hypothyroidism: -20% TSH upper limit, -15% FT4 lower limit (Sensitivity: 0.91, PPV: 0.71).
  • Absolute and fixed modifications showed similar outcomes, but wide confidence intervals limited generalizability.

Conclusions:

  • No tested modifications of nonpregnancy TSH and FT4 reference intervals adequately approximated trimester-specific intervals.
  • Future research should focus on the clinical relevance of trimester-specific intervals and risk-based decision limits.