Interpretation of thyroid function tests during pregnancy
Abstract
Thyroid hormones are crucial for normal pregnancy and fetal development. Large physiological changes occur during pregnancy, posing challenges for the correct interpretation of thyroid function tests. TSH concentrations are the principal first test to rule out thyroid disease taking into account trimester-specific reference ranges. Free T4 (FT4) measurements by immuno-assays may be subject to interference by endogenous and exogenous factors. The relevance of measuring free T3 (FT3) during pregnancy is unclear. Thyroid autoimmunity is well-reflected by the presence of antibodies against TPO. TPO-antibody positivity is associated with an increased risk of adverse pregnancy outcomes.
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TH measurement is required to complement TSH measurement in pregnancy, intercurrent illness when TSH can be suppressed, and the initial treatment of hypo- or hyperthyroidism because the response of the pituitary-thyroid axis can be delayed after a change in thyroid status.
“TH measurement is also required to complement TSH measurement in a number of clinical situations (Table 2) such as pregnancy,60 intercurrent illness when TSH can be suppressed (the nonthyroidal illness syndrome61,62), and the initial treatment of hypo-63 or hyperthyroidism64 as the response of the pituitary-thyroid axis can be delayed after a change in thyroid status.57”
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References 35 · Cited by 44
- Authors
- Visser, W. E., & Peeters, R. P.
- Affiliations
- Erasmus MC (NL)
- Corresponding author
- Visser, W. Edward
- Venue
- Best Practice & Research Clinical Endocrinology & Metabolism
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 34
- Issue
- 4
- Pages
- 101431
- ISSN
- 1521-690X (ISSN-L)
- OpenAlex
- W3035944014
- Cited by
- 44
- References
- 35
- Citations by year
- 2026: 5 · 2025: 15 · 2024: 5 · 2023: 4 · 2022: 11 · 2021: 3 · 2019: 1
- FWCI
- 0.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Best Practice & Research Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Keywords
- thyroid function tests, pregnancy, thyroid hormones, thyroid-stimulating hormone, free thyroxine, free T3, thyroid autoimmunity, thyroid peroxidase antibodies, trimester-specific reference ranges, adverse pregnancy outcomes, fetal development
- MeSH terms
- Adult, Data Interpretation, Statistical, Female, Humans, Pregnancy, Pregnancy Complications, Prenatal Diagnosis, Reference Values, Thyroid Diseases, Thyroid Function Tests, Thyroid Hormones, Thyrotropin, Thyroxine, Triiodothyronine
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