Establishment of Reference Interval for TSH in Pregnant Georgian Women
Keywords:
Pregnancy, Reference interval, Second trimester, TSH
Abstract
Introduction: Maternal thyroid dysfunction has been associated with variety of adverse maternal and fetal outcomes. Due to many physiological changes during pregnancy, interpretation of thyroid function tests needs trimester-specific reference intervals for a specific population. Aim of this study was to determine the second trimester-specific reference interval for thyroid-stimulating hormone (TSH) in healthy pregnant Georgian women.
Methods: 2876 pregnant women were admitted to Batumi Maternity House (BMH) from January 2009 to December 2011 for second trimester routine prenatal examination, including TSH screening. Standardized information regarding thyroidal, obstetric and general medical status of women was collected. The reference interval for TSH, based on 2.5th and 97.5th percentiles, was calculated from thyroid dysfunction risk free pregnant women.
Results: Derived reference interval for TSH in the second trimester of pregnancy was 0.21–4.1 mIU/L and it was significantly different from the reference intervals recommended by American Thyroid Association (ATA) and the reference interval provided by manufacturer for non-pregnant adults.
Conclusion: We calculated clinically relevant trimester-specific reference interval for TSH in order to facilitate detection and improve management of thyroid dysfunction in Georgian pregnant women.
Downloads
Download data is not yet available.
References
1. de Escobar GM, Obregȯn MJ, del Rey FE. Maternal thyroid hormones early in pregnancy and fetal brain development. Best Pract Res Clin Endocrinol Metab. 2004 Jun; 18(2): 225–48.
2. Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, et al. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol. 2005 Feb;105(2):239-45.
3. Allan WC, Haddow JE, Palomaki GE, Williams JR, Mitchell ML, Hermos RJ, et al. Maternal thyroid deficiency and pregnancy complications: implications for population screening. J Med Screen. 2000;7(3):127–130.
4. Haddow JE, Palomaki GE, Allan WC, Williams JR, Knight GJ, Gagnon J, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med.1999 Aug 19;341(8):549-55.
5. Lazarus JH. “Screening for thyroid dysfunction in pregnancy: is it worthwhile?” Journal of Thyroid Research, vol. 2011, Article ID 397012, 4 pages, 2011.
6. Glinoer D. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocr Rev 1997 Jun;18(3):404-33.
7. Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011 Oct; 21(10): 1081–1125.
8. Baloch Z, Carayon P, Conte-Devolx B, Demers LM, Feldt-Rasmussen U, Henry JF, et al. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid. 2003 Jan;13(1):3-126.
9. Gilbert RM, Hadlow NC, Walsh JP, et al. Assessment of thyroid function during pregnancy: first-trimester (weeks 9-13) reference intervals derived from Western Australian women. Med J Aust.2008 Sep 1;189(5):250-3.
10. Cotzias C, Wong SJ, Taylor E, et al. A study to establish gestation-specific reference intervals for thyroid function tests in normal singleton pregnancy. Eur J Obstet Gynecol Reprod Biol. 2008:137:61–6.
11. Springer D, Zima T, Limanova Z. Reference intervals in evaluation of maternal thyroid function during the first trimester of pregnancy. Eur J Endocrinol. 2009 May;160(5):791-7.
12. Aytan H, Aytan P, Demirtürk F, Çalişkan A, et al First-trimester thyroid hormone reference data in a Turkish pregnant women population living in middle blacksea region. Nobel Medicus Journal. 2014 Jan-Apr,10 (1) 1, 25-29.
13. Soldin OP, Soldin D, Sastoque M. Gestation-specific thyroxine and thyroid stimulating hormone levels in the Unitied States and worldwide. Ther Drug Monit, 2007 Oct; 29(5):553-9.
14. Stricker R, Echenard M, Eberhart R, Chevailler MC, Perez V, Quinn FA, et al. Evaluation of maternal thyroid function during pregnancy: the importance of using gestational age-specific reference intervals. Eur J Endocrinol. 2007 Oct;157(4):509-14.
15. Marwaha RK, Chopra S, Gopalakrishnan S, et al. Establishment of reference range for thyroid hormones in normal pregnant Indian women. BJOG. 2008 Apr;115(5):602–6.
16. Bocos-Terraz JP, Izquierdo-Alvarez S, Bancalero-Flores JL, et al. Thyroid hormones according to gestational age in pregnant Spanish women. BMC Res Notes. 2009 Nov 26;2:237.
17. Yan Yu-qin, Dong Zuo-liang, Dong Ling, et al. Trimester –and method-specific reference intervals for thyroid tests in pregnant Chinese women: methodology, euthyroid definition and iodine status can influence the setting of reference intervals. Clinical Endocrinology. 2011 Feb,2, 262-69.
18. La’ulu SL, Roberts WL. Second-trimester reference intervals for thyroid tests: the role of ethnicity. Clin Chem. 2007;53(9):1658–64.
19. Abalovich M, Amino N, Barbour LA, Cobin RH, De Groot LJ, Glinoer D. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2007 Aug. 92(8 Suppl):S1-47.
20. de Escobar GM., Ares S, Berbel P, Obregón MJ, del Rey FE. The changing role of maternal thyroid hormone in fetal brain development. Semin Perinatol. 2008 Dec;32(6):380-6.
21. Cignini P, Cafà EV, Giorlandino C, Capriglione S, Spata A, Dugo N. Thyroid physiology and common diseases in pregnancy: review of literature. J Prenat Med. 2012 Oct;6(4):64-71.
22. Price A. Obel O. Cresswell J. Catch I. Rutter S. Barik S. Heller SR. Weetman AP. Comparison of thyroid function in pregnant and non-pregnant Asian and western Caucasian women. Clin Chim Acta. 2001 Jun;308(1-2): 91-8.
23. Walker JA, Illions EH, Huddleston JF, Smallridge RC. Racial comparisons of thyroid function and autoimmunity during pregnancy and the postpartum period. Obstet Gynecol. 2005 Dec; 106(6):1365-71.
24. Benhadi N, Wiersinga WM, Reitsma JB, Vrijkotte TG, van der Wal MF, Bonsel GJ. Ethnic differences in TSH but not in free T4 concentrations or TPO antibodies during pregnancy. Clin Endocrinol (Oxf).2007 Jun;66(6):765-70.
25. Suchdev PS, Jashi M, Sekhniashvili Z, Woodruff BA. Progress toward Eliminating Iodine Deficiency in the Republic of Georgia. Int J Endocrinol Metab 2009;3: 200-207.
2. Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, et al. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol. 2005 Feb;105(2):239-45.
3. Allan WC, Haddow JE, Palomaki GE, Williams JR, Mitchell ML, Hermos RJ, et al. Maternal thyroid deficiency and pregnancy complications: implications for population screening. J Med Screen. 2000;7(3):127–130.
4. Haddow JE, Palomaki GE, Allan WC, Williams JR, Knight GJ, Gagnon J, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med.1999 Aug 19;341(8):549-55.
5. Lazarus JH. “Screening for thyroid dysfunction in pregnancy: is it worthwhile?” Journal of Thyroid Research, vol. 2011, Article ID 397012, 4 pages, 2011.
6. Glinoer D. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocr Rev 1997 Jun;18(3):404-33.
7. Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011 Oct; 21(10): 1081–1125.
8. Baloch Z, Carayon P, Conte-Devolx B, Demers LM, Feldt-Rasmussen U, Henry JF, et al. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid. 2003 Jan;13(1):3-126.
9. Gilbert RM, Hadlow NC, Walsh JP, et al. Assessment of thyroid function during pregnancy: first-trimester (weeks 9-13) reference intervals derived from Western Australian women. Med J Aust.2008 Sep 1;189(5):250-3.
10. Cotzias C, Wong SJ, Taylor E, et al. A study to establish gestation-specific reference intervals for thyroid function tests in normal singleton pregnancy. Eur J Obstet Gynecol Reprod Biol. 2008:137:61–6.
11. Springer D, Zima T, Limanova Z. Reference intervals in evaluation of maternal thyroid function during the first trimester of pregnancy. Eur J Endocrinol. 2009 May;160(5):791-7.
12. Aytan H, Aytan P, Demirtürk F, Çalişkan A, et al First-trimester thyroid hormone reference data in a Turkish pregnant women population living in middle blacksea region. Nobel Medicus Journal. 2014 Jan-Apr,10 (1) 1, 25-29.
13. Soldin OP, Soldin D, Sastoque M. Gestation-specific thyroxine and thyroid stimulating hormone levels in the Unitied States and worldwide. Ther Drug Monit, 2007 Oct; 29(5):553-9.
14. Stricker R, Echenard M, Eberhart R, Chevailler MC, Perez V, Quinn FA, et al. Evaluation of maternal thyroid function during pregnancy: the importance of using gestational age-specific reference intervals. Eur J Endocrinol. 2007 Oct;157(4):509-14.
15. Marwaha RK, Chopra S, Gopalakrishnan S, et al. Establishment of reference range for thyroid hormones in normal pregnant Indian women. BJOG. 2008 Apr;115(5):602–6.
16. Bocos-Terraz JP, Izquierdo-Alvarez S, Bancalero-Flores JL, et al. Thyroid hormones according to gestational age in pregnant Spanish women. BMC Res Notes. 2009 Nov 26;2:237.
17. Yan Yu-qin, Dong Zuo-liang, Dong Ling, et al. Trimester –and method-specific reference intervals for thyroid tests in pregnant Chinese women: methodology, euthyroid definition and iodine status can influence the setting of reference intervals. Clinical Endocrinology. 2011 Feb,2, 262-69.
18. La’ulu SL, Roberts WL. Second-trimester reference intervals for thyroid tests: the role of ethnicity. Clin Chem. 2007;53(9):1658–64.
19. Abalovich M, Amino N, Barbour LA, Cobin RH, De Groot LJ, Glinoer D. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2007 Aug. 92(8 Suppl):S1-47.
20. de Escobar GM., Ares S, Berbel P, Obregón MJ, del Rey FE. The changing role of maternal thyroid hormone in fetal brain development. Semin Perinatol. 2008 Dec;32(6):380-6.
21. Cignini P, Cafà EV, Giorlandino C, Capriglione S, Spata A, Dugo N. Thyroid physiology and common diseases in pregnancy: review of literature. J Prenat Med. 2012 Oct;6(4):64-71.
22. Price A. Obel O. Cresswell J. Catch I. Rutter S. Barik S. Heller SR. Weetman AP. Comparison of thyroid function in pregnant and non-pregnant Asian and western Caucasian women. Clin Chim Acta. 2001 Jun;308(1-2): 91-8.
23. Walker JA, Illions EH, Huddleston JF, Smallridge RC. Racial comparisons of thyroid function and autoimmunity during pregnancy and the postpartum period. Obstet Gynecol. 2005 Dec; 106(6):1365-71.
24. Benhadi N, Wiersinga WM, Reitsma JB, Vrijkotte TG, van der Wal MF, Bonsel GJ. Ethnic differences in TSH but not in free T4 concentrations or TPO antibodies during pregnancy. Clin Endocrinol (Oxf).2007 Jun;66(6):765-70.
25. Suchdev PS, Jashi M, Sekhniashvili Z, Woodruff BA. Progress toward Eliminating Iodine Deficiency in the Republic of Georgia. Int J Endocrinol Metab 2009;3: 200-207.
CITATION
DOI: 10.17511/ijmrr.2015.i7.143
Published: 2015-08-31
How to Cite
1.
Peshkova T, Giorgadze E, Uchava L, Kamashidze K. Establishment of Reference Interval for TSH in Pregnant Georgian Women. Int J Med Res Rev [Internet]. 2015Aug.31 [cited 2024Jul.3];3(7):748-53. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/314
Section
Original Article
OAI - Open Archives Initiative
