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Limitations of new thyroid function tests in pregnancy.

S M Gow, H A Kellett, J Seth

    Clinica Chimica Acta; International Journal of Clinical Chemistry
    |November 15, 1985
    PubMed
    Summary
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    New thyroid function tests, including immunoradiometric assays (IRMA) for TSH and radioimmunoassay (RIA) kits for free thyroid hormones (fT4, fT3), require careful interpretation during pregnancy due to altered reference ranges.

    Area of Science:

    • Endocrinology
    • Reproductive Medicine
    • Clinical Chemistry

    Background:

    • Immunoradiometric assays (IRMA) for TSH and radioimmunoassay (RIA) kits for free thyroid hormones (fT4, fT3) are increasingly utilized in routine thyroid diagnostics.
    • Pregnancy significantly alters thyroid hormone levels, necessitating evaluation of standard diagnostic assays in this population.

    Purpose of the Study:

    • To assess the performance and interpretation of sensitive IRMA for TSH and RIA kits for fT4 and fT3 in euthyroid pregnant women.
    • To compare results from RIA kits with direct equilibrium dialysis for free thyroxine (fT4) measurements.

    Main Methods:

    • Analysis of TSH, fT4, and fT3 levels using IRMA and RIA kits in 93 euthyroid pregnant women.
    • Comparison of fT4 measurements obtained via RIA kits versus direct equilibrium dialysis.

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  • Assessment of potential confounding factors, including serum non-esterified fatty acid (NEFA) and albumin levels.

    • Main Results:

    • Mean fT4 and fT3 values decreased significantly with advancing gestation when measured by RIA kits, with some values falling below non-pregnant reference ranges.
    • Direct equilibrium dialysis showed a smaller decrease in fT4 levels during pregnancy, with all values remaining within the reference range.
    • TSH levels measured by IRMA were generally lower than those measured by RIA, with three cases falling below the IRMA detection limit, potentially indicating false hyperthyroidism.

    Conclusions:

    • Standard RIA kits for free thyroid hormones may yield results that fall outside established reference ranges during pregnancy.
    • TSH measurements by IRMA may also be affected, with a potential for false-positive hyperthyroid interpretations.
    • Interpretation of these novel thyroid function tests in pregnancy requires special consideration and awareness of physiological changes.