Trimester-specific thyroid-stimulating hormone: An Indian perspective

Kalra, Sanjay; Agarwal, Sameer; Aggarwal, Rashmi; Ranabir, Salam

doi:10.4103/ijem.ijem_107_17

Cited by 8 publications

(8 citation statements)

References 19 publications

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“…Recent Indian report states that cutoff of 4.0 mIU/L as per revised ATA, 2017, may be too high for our patients, and they suggested to use an intermediate cutoff of 3.00 rather than 4.0 mIU/L [10].…”

Section: Indian Scenariomentioning

confidence: 86%

Thyroid-Stimulating Hormone Values in Pregnancy: Cutoff Controversy Continues?

Khadilkar

2019

J Obstet Gynecol India

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Thyroid disorders in pregnancy are important causes of adverse pregnancy outcome. So it is very pertinent that thyroid function is maintained in normal range during pregnancy. Serum thyroid-stimulating hormone (TSH) value is the best indicator for assessing and monitoring thyroid function. The increasing metabolic demands of pregnancy alter the thyroid physiology in early pregnancy; hence, it becomes necessary to define trimester-specific reference range. Several reports and guidelines have been published recommending varied TSH cutoffs in different studies. The most significant guidelines which created controversy about TSH cutoffs was that of American Thyroid Association (ATA) (Stagnaro-Green et al. in Thyroid 21:1081-1125 followed by Endocrine Society clinical practice guideline (De Groot et al. in J Clin Endocrinol 97:2543-2565, 2012. Both these gave stricter TSH cutoffs as .1 to 2.5 mIU/L in first trimester, .2 to 3.0 mIU/L in second trimester and .3 to 3 mIU/L in third trimester. Subsequently many reports, meta-analysis and systematic reviews were published which recommended higher cutoffs. With due consideration, ATA revised the guidelines in 2017, recommending the upper cutoff limit .5 mIU/L less than the preconception TSH value or as 4.0 mIU/L when local population-specific reference range is not available (Alexander et al. Thyroid 27(3):315-389, 2017). The controversy is not yet completely resolved specially regarding management of subclinical hypothyroidism. This editorial addresses this ongoing controversy.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Section: Indian Scenariomentioning

confidence: 86%

Thyroid-Stimulating Hormone Values in Pregnancy: Cutoff Controversy Continues?

Khadilkar

2019

J Obstet Gynecol India

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“…Optimal TSH cutoffs have been a topic of controversy since long and may have a bearing on prevalence estimates [ 97 ]. European Thyroid Association in 2014 recommended that, due to geographic variation in normal TSH and thyroid hormone levels, reference range should be defined for each antenatal hospital after assessment of local population data [ 98 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Hypothyroidism in Pregnant Women in India: A Meta-Analysis of Observational Studies

Yadav

Dabar

Goel

et al. 2021

Journal of Thyroid Research

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Introduction. This meta-analysis was conducted to estimate the prevalence of hypothyroidism among pregnant women in India. Methods. We searched PubMed, Web of Science, Scopus, Google Scholar, and Shodhganga (Indian thesis repository) for observational studies, providing prevalence of hypothyroidism among pregnant women in India. Systematic study selection and data extraction procedures were followed. Quality assessment of each study was done using JBI critical appraisal checklist. The random effects model was used for pooling the effect sizes. Publication bias was assessed using the funnel plot and rank correlation test. I2 statistics was used to measure heterogeneity across the studies. Heterogeneity in the pooled estimates was further explored with subgroup analyses and meta-regression analysis. Results. Sixty-one studies were found eligible and included in this review. The pooled estimate of the prevalence of hypothyroidism in pregnant women was 11.07% (95% CI: 8.79–13.84, I2 = 99%). Pooled prevalence estimates of subclinical and overt hypothyroidism are 9.51% (95% CI: 7.48–12.04, I2 = 98%) and 2.74% (95% CI: 2.08–3.58, I2 = 94%). Conclusion. We documented 11.07% pooled prevalence of hypothyroidism in pregnant women in India.

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“…1 The cut-off of 2.5 mIU/L in first trimester as recommended by ATA in 2011 was not accepted in many studies. 3,6,8,10,12,13 Looking at the Indian scenario, the current evidence is conflicting. Indian reports analysed by Kalra et al, stated that cut off of 4.0 mIU/L may be too high for Indian women and they suggested an intermediate cut off of 3.0 mIU/L for first trimester and 3.5 mIU/L for second and third trimester.…”

Section: Discussionmentioning

confidence: 99%

“…Indian reports analysed by Kalra et al, stated that cut off of 4.0 mIU/L may be too high for Indian women and they suggested an intermediate cut off of 3.0 mIU/L for first trimester and 3.5 mIU/L for second and third trimester. 12 In a study from China, the TSH value more than 4.8 mIU/L was taken for the diagnosis of hypothyroidism Negro et al 13 In a study from Spain by Lara et al, they concluded 4.7 mIU/L as the cut-off and they also found that the TSH levels in the first trimester of pregnancy are not useful to detect TPO Ab. 14…”

Section: Discussionmentioning

confidence: 99%

Thyroid disorders in the first trimester of pregnancy: a cross-sectional study

Shankarappa¹,

Parvathreddy²

2020

Int J Reprod Contracept Obstet Gynecol

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Background: Thyroid disorders in pregnancy are common and are associated with adverse maternal, fetal and neonatal effects. When the prevalence of thyroid disorders is high, then screening for thyroid disorders in early pregnancy can help improve the obstetrical outcome.Methods: Five hundred and fifty women in their first trimester of pregnancy were studied. They were investigated for estimation of free triiodo thyronine (FT3), free thyroxine (FT4) and thyroid stimulation hormone (TSH). The upper normal limit for TSH considered was 4.0 mIU/L.Results: Prevalence of thyroid disorders in the study was 12.6%. Hypothyroidism (12%) was more common than hyperthyroidism (0.6%). Subclinical hypothyroidism was present in 10%.Conclusions: Screening of thyroid disorders is to be considered for all pregnant women. As the prevalence of thyroid disorders is high, early recognition and treatment shall reduce maternal and fetal morbidity.

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Trimester-specific thyroid-stimulating hormone: An Indian perspective

Cited by 8 publications

References 19 publications

Thyroid-Stimulating Hormone Values in Pregnancy: Cutoff Controversy Continues?

Thyroid-Stimulating Hormone Values in Pregnancy: Cutoff Controversy Continues?

Prevalence of Hypothyroidism in Pregnant Women in India: A Meta-Analysis of Observational Studies

Thyroid disorders in the first trimester of pregnancy: a cross-sectional study

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