Organ transplant recipients (OTRs) have a high incidence of cutaneous squamous cell carcinoma (cSCC), and immunosuppression has been reported to be an important risk factor for metastasis. The aim of this study was to identify the metastasis risk over a 10-year period for 593 patients with cSCC, of whom 134 were OTR and 459 were immunocompetent. Metastasis incidence rate was 1,046 (95% confidence interval (95% CI) 524-2,096) per 100,000 person years in OTR and 656 (95% CI; 388-1,107) in immunocompetent patients, yielding an incidence rate ratio of 1.6 (95% CI 0.67-3.81). In OTRs head/neck location, older age at transplantation and older age at diagnosis of first cSCC were associated with metastatic risk, and 7 out of 8 metastasized tumours were smaller than 2 cm. In immunocompetent patients tumour size and tumour depth were associated with metastasis. In conclusion, we were not able to demonstrate an increased incidence rate of metastasis in OTRs compared with immunocompetent patients. However, OTRs and immunocompetent patients differed with regard to risk factors for metastasis.

Context Interpretation of thyroid function tests during pregnancy is limited by the generalizability of reference intervals between cohorts due to inconsistent methodology. Objective 1) To provide an overview of published reference intervals for TSH and FT4 in pregnancy, 2) to assess the consequences of common methodological between-study differences by combining raw data from different cohorts. Methods 1) Ovid MEDLINE, EMBASE and Web of Science were searched until the 12th of December 2021. Studies were assessed in duplicate. 2) The individual participant data (IPD) meta-analysis was performed in participating cohorts in the Consortium on Thyroid and Pregnancy. Results 1) Large between-study methodological differences were identified, 11 of 102 included studies were in accordance with current guidelines. 2) 22 cohorts involving 63,198 participants, were included in the meta-analysis. Not excluding TPOAb-positive participants led to a rise of the upper limits of TSH in all cohorts, especially in the first (mean: +17.4%[range +1.6 to +30.3%]) and second trimester (mean: +9.8% [range +0.6 to +32.3%]). The use of the 95th percentile led to considerable changes in upper limits, varying from -10.8% to -21.8% for TSH and -1.2% to -13.2% for FT4. All other additional exclusion criteria changed reference interval cut-offs by a maximum of 3.5%. Applying these findings to the 102 studies included in the systematic review, 48 studies could be used in a clinical setting. Conclusions We provide an overview of clinically relevant reference intervals for TSH and FT4 in pregnancy. The results of the meta-analysis indicate that future studies can adopt a simplified study setup without additional exclusion criteria.

Postpartum depression (PPD) has a major impact on maternal and offspring wellbeing, with multiple possible risk factors: studies on the association of thyroid peroxidase antibody (TPOAb) positivity and thyroid function with PPD provide heterogeneous results. Objective: To study the association of thyroid function and TPOAb positivity with PPD. Design: We assessed the association of TPOAb and thyroid function with PPD in a population-based prospective cohort study and performed a systematic literature review and meta-analysis. Methods: We measured TSH, FT4, and TPOAb between 9-17 weeks gestation. Postpartum depression was assessed with Edinburgh Postpartum Depression Scale at 2 months postpartum and Brief Symptom Inventory at 2, 6, and 36 months postpartum. Additionally, we performed a systematic literature review and meta-analysis assessing this association. Results: In the present study, there was no association of thyroid function with PPD (TSH OR:0.83, 95%CI 0.58-1.19, p=0.32; fT4 OR:0.99, 95%CI 0.95-1.05, p=0.86), or TPOAb positivity with PPD (OR:0.79, 95%CI 0.47-1.33, p=0.37). An impaired thyroidal response to hCG, a surrogate marker for TPOAb positivity, was associated with a lower risk of PPD (P for interaction TSH=0.04, FT4=0.06). Our systematic review and meta-analysis included three articles which were combined with the present study. There was no statistically significant association of TPOAb positivity with PPD (OR:1.93, 95%CI 0.91-4.10, p= 0.08) but results were heterogeneous (I2=79%). Conclusions: There was no significant association of TPOAb positivity, TSH or FT4 with PPD. Our systematic review and meta-analysis revealed high heterogeneity of the current literature. Although TPOAb-positive women should be monitored for postpartum thyroiditis, our findings do not support routinely screening for PPD.