TSH and FT4 Reference Interval Recommendations and Prevalence of Gestational Thyroid Dysfunction: Quantification of Current Diagnostic Approaches.

Autor:	Osinga JAJ; Department of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands.; Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands., Derakhshan A; Department of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands.; Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands., Feldt-Rasmussen U; Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.; Department of Clinical Medicine, Faculty of Health and clinical Sciences, Copenhagen University, 1172 Copenhagen, Denmark., Huang K; Department of Maternal, Child and Adolescent Health, Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, 230032 Anhui, China., Vrijkotte TGM; Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, 1081 HV Amsterdam, The Netherlands., Männistö T; Northern Finland Laboratory Center Nordlab and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90570 Oulu, Finland., Bassols J; Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, 17007 Girona, Spain., López-Bermejo A; Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, 17007 Girona, Spain.; Departament de Ciències Mèdiques, Universitat de Girona, 17003 Girona, Spain., Aminorroaya A; Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, 81745-33871 Isfahan, Iran., Vafeiadi M; Department of Social Medicine, School of Medicine, University of Crete, Heraklion, 710 03 Crete, Greece., Broeren MAC; Laboratory of Clinical Chemistry and Hematology, Máxima Medical Centre, 5504 DB Veldhoven, The Netherlands., Palomaki GE; Department of Pathology and Laboratory Medicine, Women & Infants Hospital and Alpert Medical School at Brown University, Providence, RI 02903, USA., Ashoor G; Harris Birthright Research Center for Fetal Medicine, King's College Hospital, SE5 9RS London, UK., Chen L; Department of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, 325035 Wenzhou, China., Lu X; Department of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, 325035 Wenzhou, China., Taylor PN; Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, CF10 3EU Cardiff, UK., Tao FB; Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 230032 Anhui, China.; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, 230032 Anhui, China., Brown SJ; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, 6009 Nedlands, Perth, Australia., Sitoris G; Endocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium., Chatzi L; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA., Vaidya B; Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, University of Exeter Medical School, EX1 2LU Exeter, UK., Popova PV; Institute of Endocrinology, Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia.; World-Class Research Center for Personalized Medicine, Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia., Vasukova EA; Institute of Endocrinology, Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia., Kianpour M; Departament de Ciències Mèdiques, Universitat de Girona, 17003 Girona, Spain., Suvanto E; Department of Obstetrics and Gynecology and Medical Research Center Oulu, University of Oulu, 90570 Oulu, Finland., Grineva EN; Institute of Endocrinology, Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia., Hattersley A; Molecular Medicine, University of Exeter Medical School, Royal Devon & Exeter Hospital, EX3 0AW Exeter, UK., Pop VJM; Department of Medical and Clinical Psychology, Tilburg University, 5000 LE Tilburg, The Netherlands., Nelson SM; School of Medicine, University of Glasgow, G12 8QQ Glasgow, UK., Walsh JP; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, 6009 Nedlands, Perth, Australia.; Medical School, University of Western Australia, Crawley, WA 6009, Australia., Nicolaides KH; Department of Women and Children's Health, Faculty of Life Sciences and Medicine King's College London, SE5 9RS London, UK., D'Alton ME; Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, NewYork, NY 10032, USA., Poppe KG; Endocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium., Chaker L; Department of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands.; Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands.; Department of Epidemiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands., Bliddal S; Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark., Korevaar TIM; Department of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands.; Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2024 Feb 20; Vol. 109 (3), pp. 868-878.
DOI:	10.1210/clinem/dgad564
Abstrakt:	Context: Guidelines recommend use of population- and trimester-specific thyroid-stimulating hormone (TSH) and free thyroxine (FT4) reference intervals (RIs) in pregnancy. Since these are often unavailable, clinicians frequently rely on alternative diagnostic strategies. We sought to quantify the diagnostic consequences of current recommendations. Methods: We included cohorts participating in the Consortium on Thyroid and Pregnancy. Different approaches were used to define RIs: a TSH fixed upper limit of 4.0 mU/L (fixed limit approach), a fixed subtraction from the upper limit for TSH of 0.5 mU/L (subtraction approach) and using nonpregnancy RIs. Outcome measures were sensitivity and false discovery rate (FDR) of women for whom levothyroxine treatment was indicated and those for whom treatment would be considered according to international guidelines. Results: The study population comprised 52 496 participants from 18 cohorts. Compared with the use of trimester-specific RIs, alternative approaches had a low sensitivity (0.63-0.82) and high FDR (0.11-0.35) to detect women with a treatment indication or consideration. Sensitivity and FDR to detect a treatment indication in the first trimester were similar between the fixed limit, subtraction, and nonpregnancy approach (0.77-0.11 vs 0.74-0.16 vs 0.60-0.11). The diagnostic performance to detect overt hypothyroidism, isolated hypothyroxinemia, and (sub)clinical hyperthyroidism mainly varied between FT4 RI approaches, while the diagnostic performance to detect subclinical hypothyroidism varied between the applied TSH RI approaches. Conclusion: Alternative approaches to define RIs for TSH and FT4 in pregnancy result in considerable overdiagnosis and underdiagnosis compared with population- and trimester-specific RIs. Additional strategies need to be explored to optimize identification of thyroid dysfunction during pregnancy. (© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society.)
Databáze:	MEDLINE
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