Defining Gestational Thyroid Dysfunction Through Modified Nonpregnancy Reference Intervals: An Individual Participant Meta-analysis.

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., Nelson SM; School of Medicine, Dentistry and Nursing, University of Glasgow, G12 8QQ Glasgow, UK., Walsh JP; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia.; Medical School, University of Western Australia, Crawley, WA 6009, Australia., Ashoor G; Harris Birthright Research Center for Fetal Medicine, King's College Hospital, SE5 9RS London, UK., Palomaki GE; Department of Pathology and Laboratory Medicine, Women & Infants Hospital and Alpert Medical School at Brown University, RI 02903 Providence, USA., 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., Bassols J; Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, 17007 Girona, Spain., Aminorroaya A; Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, 81745-33871 Isfahan, Iran., Broeren MAC; Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, 5504 DB Veldhoven, Netherlands., 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., Brown SJ; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia., Veltri F; Endocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium., 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., Männistö T; NordLab, Oulu and Translational Medicine Research Unit, University of Oulu, 90570 Oulu, Finland., Vafeiadi M; Department of Social Medicine, School of Medicine, University of Crete, 710 03 Heraklion, Crete, Greece., 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, Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, 230032 Anhui, China., Chatzi L; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA., Kianpour M; Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, 81745-33871 Isfahan, Iran., 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., 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, New York, NY 10032, USA., Poppe KG; Endocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium., Alexander E; Division of Endocrinology, Hypertension and Diabetes, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA., 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, 2100 Copenhagen, Denmark., Bliddal S; 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, 2100 Copenhagen, Denmark., Popova PV; Institute of Endocrinology, Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia., 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., Visser WE; 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., Peeters RP; 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., Vrijkotte TGM; Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, 1081 HV Amsterdam, the Netherlands., Pop VJM; Department of Medical and Clinical Psychology, Tilburg University, 5000 LE Tilburg, the Netherlands., 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 Oct 15; Vol. 109 (11), pp. e2151-e2158.
DOI:	10.1210/clinem/dgae528
Abstrakt:	Background: Establishing local trimester-specific reference intervals for gestational TSH and free T4 (FT4) is often not feasible, necessitating alternative strategies. We aimed to systematically quantify the diagnostic performance of standardized modifications of center-specific nonpregnancy reference intervals as compared to trimester-specific reference intervals. Methods: We included prospective cohorts participating in the Consortium on Thyroid and Pregnancy. After relevant exclusions, reference intervals were calculated per cohort in thyroperoxidase antibody-negative women. Modifications to the nonpregnancy reference intervals included an absolute modification (per .1 mU/L TSH or 1 pmol/L free T4), relative modification (in steps of 5%) and fixed limits (upper TSH limit between 3.0 and 4.5 mU/L and lower FT4 limit 5-15 pmol/L). We compared (sub)clinical hypothyroidism prevalence, sensitivity, and positive predictive value (PPV) of these methodologies with population-based trimester-specific reference intervals. Results: The final study population comprised 52 496 participants in 18 cohorts. Optimal modifications of standard reference intervals to diagnose gestational overt hypothyroidism were -5% for the upper limit of TSH and +5% for the lower limit of FT4 (sensitivity, .70, CI, 0.47-0.86; PPV, 0.64, CI, 0.54-0.74). For subclinical hypothyroidism, these were -20% for the upper limit of TSH and -15% for the lower limit of FT4 (sensitivity, 0.91; CI, 0.67-0.98; PPV, 0.71, CI, 0.58-0.80). Absolute and fixed modifications yielded similar results. CIs were wide, limiting generalizability. Conclusion: We could not identify modifications of nonpregnancy TSH and FT4 reference intervals that would enable centers to adequately approximate trimester-specific reference intervals. Future efforts should be turned toward studying the meaningfulness of trimester-specific reference intervals and risk-based decision limits. (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)
Databáze:	MEDLINE
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