Subclinical thyroid dysfunction in the first trimester of pregnancy: ‘Disease’ versus physiological (pulsatile) variation in TSH concentrations

Lewandowski, Krzysztof C.; Horzelski, Wojciech; Kawalec, Joanna; Budzen, Karolina; Grzesiak, Mariusz; Lewiński, Andrzej

doi:10.1111/cen.14256

Cited by 5 publications

(9 citation statements)

References 27 publications

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“…assessed the variation in maternal TSH within one day using a series of five blood samples drawn in the morning with 30-min intervals from 110 healthy first-trimester pregnant women ( 9 ). In line with our findings, the study demonstrated a considerable variation in TSH across the samples with a variation of up to 40% between the highest and lowest individual TSH ( 9 ). They further illustrated that the variation influenced the classification of maternal thyroid function ( 9 ).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, we found considerable variation in the classification of thyroid function abnormalities in the NDRPC when different analytical methods and thyroid function tests were used, even when the reference ranges were method- and pregnancy week-specific ( 7 ). A recent study reported variation in the classification of maternal thyroid function when blood samples were repeated in short time intervals within the same day ( 9 ) and added to the knowledge on physiological variability in thyroid function tests ( 10 ). These findings led us to speculate if maternal thyroid function abnormalities would persist with repeated blood samples within some weeks in early pregnancy and if the persistency would be related to the severity of thyroid function abnormalities.…”

Section: Introductionmentioning

confidence: 99%

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Classification of maternal thyroid function in early pregnancy using repeated blood samples

Knøsgaard

Andersen

Hansen

et al. 2022

European Thyroid Journal

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Objective: The assessment of maternal thyroid function in early pregnancy is debated. It is well-established that pregnancy-specific reference ranges preferably should be used. We speculated if the use of repeated blood samples drawn in early pregnancy would influence the classification of maternal thyroid function. Design: Cohort study Methods: Pregnant women with repeated early pregnancy blood samples were identified in the North Denmark Region Pregnancy Cohort. Each sample was used for the measurement of TSH, free T4 (fT4), thyroid peroxidase antibodies (TPO-Ab), and thyroglobulin antibodies (Tg-Ab) (ADVIA Centaur XPT, Siemens Healthineers). Method- and pregnancy week-specific reference ranges were used for classification of maternal thyroid function. Results: Among 1,466 pregnancies included, 89 women had TSH above the upper reference limit in the first sample (median pregnancy week 8), and 44 (49.4%) of these similarly had high TSH in the second sample (median week 10). A total of 47 women had TSH below the lower reference limit in the first sample, and 19 (40.4 %) of these similarly had low TSH in the second sample. Regarding women classified with isolated changes in fT4 in the first sample, less than 20% were similarly classified as such in the second sample. The percentage agreement between the samples was dependent on the level of TSH in the first sample and the presence of TPO- and Tg-Ab. Conclusion: In a large cohort of pregnant women, the classification of maternal thyroid function varied considerably with the use of repeated blood samples. Results emphasize a focus on the severity of thyroid function abnormalities in pregnant women.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Classification of maternal thyroid function in early pregnancy using repeated blood samples

Knøsgaard

Andersen

Hansen

et al. 2022

European Thyroid Journal

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“…5 Some authors recommended treatment with thyroid hormone for women with TSH concentration of 4.1-10.0 mIU/L and not below this level while others recommend second testing before starting treatment. 23,24 Though this is first study conducted in pregnant woman of our population, there are certain limitations of this study. Firstly, it was hospital based and secondly the number was less, so it may not be representing the true population level.…”

Section: Discussionmentioning

confidence: 92%

Frequency of subclinical hypothyroidism and mean serum TSH level in first trimester of pregnancy.

Perveen

Ali

Hasan

2021

TPMJ

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Objective: To find out the frequency of subclinical hypothyroidism (SCH) in our pregnant population during 1st Trimester and the mean TSH level in first trimester of pregnancy. Study Design: Cross Sectional Descriptive study. Setting: Dow University Hospital and Dr Ruth KM Pfau CHK. Period: June 2015 to May 2016. Material & Methods: All Pregnant women with <14 weeks gestation were screened for Serum TSH level. Data were recorded after informed consent and institutional ethical approval. Variables recorded were age, parity, gestational age and serum TSH level. Data were analyzed on SPSS version 16. Mean and SD were calculated for quantitative variables ie. Age, parity, gestational age, serum TSH level and serum free T4 level. Mean TSH level according to age group, parity and gestational age groups were determined by applying ANOVA test. Correlation of Serum TSH level with the maternal age, parity and gestational age groups were also assessed by Pearson Correlation test. Significant P-value was taken as <0.05. Results: The frequency of SCH found was 19.35% by taking cut off limit of <2.5 IU/L and 3.55% by taking cut off limit of <4.5 IU/L among total of 310 pregnant women. Mean TSH level was 1.84±1.36 IU/L. The mean maternal age was 27.22 ± 4.43 yrs. while median parity was 1. Mean gestational age of these patients were 9.41 ± 2.748 weeks and out of these 160 (51.61%) were between 4-9 weeks and 150(48.38%) between 10-14 weeks. Majority (74%) of these women belonged to lower middle socioeconomic class. Mean TSH level coorelation between different age groups, parity groups and gestational age groups were found to be insignificant. Conclusion: The prevalence of SCH is not so high and mean TSH level in our population was 1.84 IU/L. But to establish reference range for Pakistani population, further studies in population of different backgrounds and geographical distribution needs to be evaluated.

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“…The decision to start substitution treatment should take into account other biochemical and clinical data. It is worth mentioning that blood TSH concentrations are not constant, which has also been confirmed in women in the first trimester of pregnancy [91], so if there is any doubt about starting L-thyroxine treatment, the TSH measurement should simply be repeated.…”

Section: Hypothyroidismmentioning

confidence: 99%

“…Decyzja o rozpoczęciu leczenia substytucyjnego powinna uwzględniać inne dane biochemiczne i kliniczne. Warto wspomnieć, że stężenie TSH we krwi nie jest stałe, co potwierdzono również u kobiet w I trymestrze ciąży [91]. Z tego powodu w przypadku wątpliwości dotyczących rozpoczęcia leczenia L-tyroksyną należy po prostu powtórzyć badanie.…”

Section: Niedoczynność Tarczycyunclassified

Thyroid diseases in pregnancy: guidelines of the Polish Society of Endocrinology [Choroby tarczycy w ciąży: zalecenia postępowania Polskiego Towarzystwa Endokrynologicznego]

Hubalewska‐Dydejczyk

Trofimiuk–Müldner

Ruchała

et al. 2021

Endokrynologia Polska

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Appropriate care of pregnant women with coexisting thyroid dysfunction is still a subject of much controversy. In recent years, there has been a dynamic increase in the number of scientific reports on the diagnosis and treatment of thyroid diseases in women planning pregnancy, pregnant women, and women in the postpartum period. These mainly concern the management of hypothyroidism, autoimmune thyroid diseases, and fertility disorders. Therefore, the Polish Society of Endocrinology deemed it necessary to update the guidelines on principles of diagnostic and therapeutic management in this group of patients, previously published in 2011. The recommendations were prepared by Polish experts according to evidence based medicine principles, if such data were available.

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Subclinical thyroid dysfunction in the first trimester of pregnancy: ‘Disease’ versus physiological (pulsatile) variation in TSH concentrations

Cited by 5 publications

References 27 publications

Classification of maternal thyroid function in early pregnancy using repeated blood samples

Classification of maternal thyroid function in early pregnancy using repeated blood samples

Frequency of subclinical hypothyroidism and mean serum TSH level in first trimester of pregnancy.

Thyroid diseases in pregnancy: guidelines of the Polish Society of Endocrinology [Choroby tarczycy w ciąży: zalecenia postępowania Polskiego Towarzystwa Endokrynologicznego]

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