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Assessment of Thyroid Function During First-Trimester Pregnancy: What Is the Rational Upper Limit of Serum TSH During the First Trimester in Chinese Pregnant Women?
Abstract
CONTEXT: Guidelines of the American Thyroid Association (ATA) proposed that the upper limit of the TSH reference range should be 2.5 mIU/L in first trimester, but the reported ranges in China are significantly higher. OBJECTIVE: Our objective was to establish a rational reference range of serum TSH for diagnosis of subclinical hypothyroidism in the first trimester of pregnant women in China. DESIGN: We screened 4800 pregnant women in the first trimester and 2000 women who planned to become pregnant and evaluated 535 pregnant women in follow-up visits during the second and third trimester. RESULTS: Median concentrations of serum TSH decreased significantly from the seventh week of gestation. The median of TSH from 4 to 6 weeks was significantly higher than from 7 to 12 weeks (2.15 [0.56-5.31] mIU/L vs 1.47 [0.10-4.34] mIU/L, P<.001); however, there was no significant difference compared with nonpregnant women (2.07 [0.69-5.64] mIU/L; P=.784). The median of free T4 was not significantly altered in the first trimester. The prevalence of subclinical hypothyroidism in the 4800 pregnant women was 27.8% on the diagnostic criteria of TSH>2.5 mIU/L and 4.0% using the reference interval derived by our laboratory (0.14-4.87 mIU/L).Additionally, of 118 pregnant women who had serum TSH>2.5 mIU/L in the first trimester, only 30.0% and 20.3% of them at the 20th and 30th week of gestation had TSH>3.0 mIU/L. CONCLUSIONS: The reference range for nonpregnant women can be used for the assessment of pregnant women at 4 to 6 weeks of gestation. The upper limit of serum TSH in the first trimester was much higher than 2.5 mIU/L in Chinese pregnant women.
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“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 [439]
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Metadata
- Authors
- Li, C., Shan, Z., Mao, J., Wang, W., Xie, X., Zhou, W., Li, C., Xu, B., Bi, L., Meng, T., Du, J., Zhang, S., Gao, Z., Zhang, X., Yang, L., Fan, C., & Teng, W.
- Affiliations
- First Hospital of China Medical University (CN)
- Shenyang Women and Infants Hospital (CN)
- First Affiliated Hospital of Dalian Medical University (CN)
- Chinese People's Liberation Army (CN)
- Dalian Medical University (CN)
- Corresponding author
- Shan, Zhongyan
- Teng, Weiping
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2014-01
- Volume
- 99
- Issue
- 1
- Pages
- 73-79
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2117905484
- Cited by
- 249
- References
- 41
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 8 · 2023: 45 · 2022: 19 · 2021: 24 · 2020: 20 · 2019: 22 · 2018: 26 · 2017: 25 · 2016: 20 · 2015: 18 · 2014: 12
- FWCI
- 13.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- China Medical University
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Health Professions › Medical Laboratory Technology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- thyroid function in pregnancy, first trimester, serum TSH, reference values, subclinical hypothyroidism, free thyroxine, Chinese pregnant women
- MeSH terms
- Adolescent, Adult, China, Female, Humans, Hypothyroidism, Mass Screening, Middle Aged, Pregnancy, Pregnancy Complications, Pregnancy Trimester, First, Prenatal Diagnosis, Reference Values, Thyroid Function Tests, Thyrotropin, Young Adult
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