First- and second-trimester thyroid hormone reference data in pregnant women: a FaSTER (First- and Second-Trimester Evaluation of Risk for aneuploidy) Research Consortium study
Open accessAbstract
Objective The purpose of this study was to calculate first and second trimester reference ranges and within-woman correlations for TSH, free T4, and thyroid antibodies.Study design TSH, free T4, and thyroid antibodies were measured in paired sera from 9562 women in the FaSTER trial of Down syndrome screening.Results The median first trimester TSH (1.05 mIU/L) is lower than the second (1.23 mIU/L); and 98th centile is higher (4.15 vs 3.77 mIU/L). Within-woman paired TSH correlations are moderately strong (r(2) = 0.64). Among women with first trimester TSH values above the 98th centile, second trimester values are over the 95th centile in 68%. Median first trimester free T4 values (1.10 ng/dL) are higher than second (1.01 ng/dL). Paired free T4 measurements correlate weakly (r(2) = 0.23). Among women with first trimester free T4 values below the 2nd centile, second trimester values are below the 5th centile in 32%. Antibody measurements correlate strongly between trimesters (thyroperoxidase r(2) = 0.79, thyroglobulin r(2) = 0.83).Conclusion TSH and free T4 measurements require gestation-specific reference ranges.
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Serum TSH levels may be below the nonpregnant reference range in the first half of a normal-term pregnancy, especially in gestational weeks 9-13.
“Serum TSH levels may be below the nonpregnant reference range in the first half of a normal-term pregnancy (435,436), and especially so in gestational weeks 9-13, during which a subset of pregnant women may develop a suppressed serum TSH (437-439).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [438]
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- Authors
- Lambert-Messerlian, G., McClain, M., Haddow, J. E., Palomaki, G. E., Canick, J. A., Cleary-Goldman, J., Malone, F. D., Porter, T. F., Nyberg, D. A., Bernstein, P., & D'Alton, M. E.
- Affiliations
- Brown University (US)
- Royal College of Surgeons in Ireland (IE)
- Intermountain Healthcare (US)
- Swedish Medical Center (US)
- Albert Einstein College of Medicine (US)
- Corresponding author
- Haddow, James E.
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2008-07
- Volume
- 199
- Issue
- 1
- Pages
- 62.e1-62.e6
- ISSN
- 0002-9378 (ISSN-L)
- PMC
- PMC2529146
- OpenAlex
- W2091803917
- Cited by
- 118
- References
- 18
- Citations by year
- 2024: 2 · 2023: 2 · 2022: 5 · 2021: 3 · 2020: 1 · 2019: 5 · 2018: 7 · 2017: 12 · 2016: 9 · 2015: 10 · 2014: 9 · 2013: 8 · 2012: 11
- FWCI
- 8.23
- Type
- journal article
- Language
- en
- Update notices
- erratum (2008-09-01)
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD038652, R01 HD 38652)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Screening and Diagnostics
- Keywords
- thyroid function in pregnancy, thyroid-stimulating hormone, free thyroxine, thyroid autoantibodies, thyroid peroxidase antibodies, thyroglobulin antibodies, reference values, first trimester, second trimester, Down syndrome screening
- MeSH terms
- Adult, Autoantibodies, Female, Gestational Age, Humans, Pregnancy, Pregnancy Trimester, First, Pregnancy Trimester, Second, Reference Values, Thyrotropin, Thyroxine
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