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What Should be the Thyroid Stimulating Hormone Cut-off Level in the First-Trimester Screening? A prospective Cohort Study and Mini Review of The Guidelines

Year 2023, Volume: 2 Issue: 2, 63 - 71, 19.06.2023
https://doi.org/10.57221/izmirtip.1277638

Abstract

Aim: Thyroid Stimulating Hormone (TSH) and Human Chorionic Gonadotropin (hCG) are glycoproteins that the alpha subunit common. As a consequence of this, hCG has intrinsic thyrotropic activity. Because of high levels of hCG, maternal serum thyrotropin level is seen to decrease in 80% of pregnancies. Novel investigation and several commission opinions recommend that the TSH cut-off value should be 2.5 mU/L in the first-trimester thyroid function screening.. We aimed to evaluate the contributions of the maternal serum TSH cut-off value of 2.5 mU/L to the development of maternal and fetal complications. Materials and Methods: We constructed the study with pregnancies in their first 12 weeks and planned to do only observation prospectively. We excluded pregnant women with systemic disease and any history of thyroid surgery or thyroid pathology. According to the TSH level, a case group(TSH level >2.5 mU/L) and a control group (TSH level<2.5 mU/L) were created through the pregnants with normal Thyroxine (T4) levels. The cohort group were divided into four subgroups according to whether they were anti-thyroid peroxidase (anti-TPO) positive or not. We observed the fetomaternal outcomes like pregnancy loss, hyperemesis gravidarum, hypertensive disorders, gestational diabetes, prelabour rupture of membranes, placental abruption, with routine prenatal visits until delivery; also delivery style, birth weight, shoulder dystocia, newborn intensive care needs, and postpartum hemorrhage were recorded. Results: The incidence of miscarriage in the subgroup with TSH >2.5 mU/L and anti-TPO (+) was significantly higher than in those with TSH <2.5 mU/L and anti-TPO (+) (p<0.05). All groups had no significant difference in other maternal or fetal/neonatal complications.
Conclusion: If only the population-based nomograms are created, we may advise maternal serum TSH level as <2.5 mU/L for first-trimester screening. Single or multiple pregnancy status, gestational age, and the presence of thyroid peroxidase antibodies should also be taken into account when creating these nomograms.

Thanks

This study was produced from the thesis of Dr. Halime Şen Selim.

References

  • Referans1.Cooper DS, Biondi B. Subclinical thyroid disease. Lancet 2012; 379:1142.
  • Referans2.Ballabio M, Poshychinda M, Ekins RP. Pregnancy-induced changes in thyroid function: role of human chorionic gonadotropin as a putative regulator of maternal thyroid. J Clin Endocrinol Metab 1991;73:824.
  • Referans3.Yamazaki K, Sato K, Shizume K, Kanaji Y, Ito Y, Obara T et al. Potent thyrotropic activity of human chorionic gonadotropin variants in terms of 125I incorporation and de novo synthesized thyroid hormone release in human thyroid follicles. J Clin Endocrinol Metab 1995; 80:473.
  • Referans4.Portmann L, Hamada N, Heinrich G, DeGroot LJ. Anti-thyroid peroxidase antibody in patients with autoimmune thyroid disease: possible identity with anti-microsomal antibody. J Clin Endocrinol Metab. 1985;61:1001-3.
  • Referans5.Czarnocka B, Ruf J, Ferrand M, Carayon P, Lissitzky S. Purification of the human thyroid peroxidase and its identification as the microsomal antigen involved in autoimmune thyroid diseases. FEBS Lett. 1985;190:147-52.
  • Referans6.World Health Organization.Assessment of iodine deficiency disorders and monitoring their elimination. A guide for program managers. Geneva: WHO,2007:1-108.
  • Referans7.Laurberg P, Cerqueira C, Ovesen L, Rasmussen LB, Perrild H, Andersen S et al. Iodine intake as a determinant of thyroid disorders in populations. Best Pract Res Clin Endocrinol Metab. 2010;24:13-27.
  • Referans8.Stockigt JR. Free thyroid hormone measurement. A critical appraisal. Endocrinol Metab Clin North Am. 2001;30:265-89.
  • Referans9.Benvenga S, Cahnmann HJ, Robbins J. Characterization of thyroid hormone binding to apolipoprotein-E: localization of the binding site in the exon 3-coded domain. Endocrinology. 1993;133:1300-5.
  • Referans10.Dufour DR. Laboratory tests of thyroid function: uses and limitations. Endocrinol Metab Clin North Am. 2007;36:579-94.
  • 11.Caldwell G, Kellett HA, Gow SM, Beckett G J, Sweeting V M, Seth J et al. A new strategy for thyroid function testing. Lancet. 1985;1:1117-9.
  • Referans12.Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA. 2004;291:228-38.
  • Referans13.Walsh JP, Bremner AP, Feddema P, Leedman PJ, Brown SJ, O'Leary P. Thyrotropin and thyroid antibodies as predictors of hypothyroidism: a 13-year, longitudinal study of a community-based cohort using current immunoassay techniques. J Clin Endocrinol Metab. 2010;95:1095-104.
  • Referans14.Persani L, Borgato S, Romoli R, Asteria C, Pizzocaro A, Beck-Peccoz P.Changes in the degree of sialylation of carbohydrate chains modify the biological properties of circulating thyrotropin isoforms in various physiological and pathological states. J Clin Endocrinol Metab. 1998;83:2486-92.
  • Referans15.Persani L, Ferretti E, Borgato S, Faglia G, Beck-Peccoz P.Circulating thyrotropin bioactivity in sporadic central hypothyroidism. J Clin Endocrinol Metab. 2000;85:3631-5.
  • Referans16.Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinol Metab. 2010;95:1699-707.
  • Referans17.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; 21:1081.
  • Referans18.Lazarus JH., Thyroid disorders associated with pregnancy: etiology, diagnosis, and management.Treat Endocrinol. 2005;4:31-4.
  • Referans19.Monzani F, Del Guerra P, Caraccio N, Pruneti CA, Pucci E, Luisi M, et al., Subclinical hypothyroidism: neurobehavioral features and beneficial effect of L-thyroxine treatment. Clin Investig. 1993;71:367-71.
  • Referans20.Baker VL, Rone HM, Pasta DJ, Nelson HP, Gvakharia M, AdamsonGD. Correlation of thyroid-stimulating hormone (TSH) level with pregnancy outcome in women undergoing in vitro fertilization. Am J Obstet Gynecol. 2006;194:1668-74.
  • Referans21.Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Increased pregnancy loss rate in thyroid antibody negative women with TSH levels between 2.5 and 5.0 in the first trimester of pregnancy. J Clin Endocrinol Metab. 2010; 95:E44.
  • Referans22.Soldin OP., Thyroid Function Testing in Pregnancy and Thyroid Disease: Trimester-specific Reference Intervals.The Drug Monit. 2006; 28:8-11.
  • Referans23.Chen L, Hu R. Thyroid autoimmunity and miscarriage: a meta-analysis. Clin Endocrinol (Oxf) 2011;74:513.
  • Referans24.Thangaratinam S, Tan A, Knox E, Kilby MD, Franklyn J, Coomarasamy A. Association between thyroid autoantibodies and miscarriage and preterm birth: a meta-analysis of evidence. British Medical Journal. 2011; 342:d2616.
  • Referans25.Toulis KA, Goulis DG, Venetis CA, Kolibianakis EM, Negro R, Tarlatzis BC, et al. Risk of spontaneous miscarriage in euthyroid women with thyroid autoimmunity undergoing IVF: a meta-analysis. Eur J Endocrinol. 2010;162:643.
  • Referans26.Temur M, Cengiz H, Arici B., Yaşar L, Özdemir İA. Erken gebelikte tiroid fonksiyon bozukluğunun tespiti. Gazi Medical Journal. 2012; 23:6-9.
  • Referans27.Negro R, Formoso G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab. 2006;91:2587-91.
  • Referans28.Abramson J, Stagnaro-Green A., Thyroid antibodies and fetal loss: an evolving story.Thyroid. 2001;11:57-63.
  • Referans29.Akdemir N, Bilir C. Thyroid dysfunction in hyperemesis gravidarum: a study in Turkish pregnant women. J Turkish-German Gynecol Assoc. 2011;12: 140-3.
  • Referans30.Panesar NS, Chan KW, Li CY, Rogers MS. Status of anti-thyroid peroxidase during normal pregnancy and in patients with hyperemesis gravidarum. Thyroid. 2006;16:481-4.
  • Referans31.Fell DB, Dodds L, Joseph KS, Allen VM, Butler B. Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy. Obstet Gynecol. 2006; 107:277.
  • Referans32.Bostancı MS, Taşkesen F. Gebelikte tiroid fonksiyon bozuklukları ve sonuçlarının değerlendirilmesi. Klinik ve Deneysel Araştırmalar Dergisi. 2011; 2: 196-201.
  • Referans33.Leung AS, Millar LK, Koonings PP, Montoro M, Mestman JH. Perinatal outcome in hypothyroid pregnancies. Obstet Gynecol. 1993; 81:349.
  • Referans34.Cleary-Goldman J, Malone FD, Lambert-Messerlian G, Sullivan L, Canick J, Porter TF et al. Maternal thyroid hypofunction and pregnancy outcome. Obstet Gynecol. 2008; 112:85.
  • Referans35.Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ et al. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol. 2005;105:239-45.
  • Referans36.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; 21:1081.
  • Referans37.Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017; 27:315.
  • Referans38.Pearce EN, Oken E, Gillman MW, Lee SL, Magnani B, Platek D, et al., Association of first-trimester thyroid function test values with thyroperoxidase antibody status, smoking, and multivitamin use. Endocr Pract. 2008;14:33-9.
  • Referans39.Mandel SJ, Spencer CA, Hollowell JG. Are detection and treatment of thyroid insufficiency in pregnancy feasible?. Thyroid. 2005;15:44-53.
  • Referans40.Soldin OP, Tractenberg RE, Hollowell JG, Jonklaas J, Janicic N, Soldin SJ. Trimester-specific changes in maternal thyroid hormone, thyrotropin, and thyroglobulin concentrations during gestation: trends and associations across trimesters in iodine sufficiency. Thyroid. 2004;14:1084-90.
  • Referans41.Soldin OP, Hilakivi-Clarke L, Weiderpass E, Soldin SJ. Trimester-specific reference intervals for thyroxine and triiodothyronine in pregnancy in iodine-sufficient women using isotope dilution tandem mass spectrometry and immunoassays. Clin Chim Acta. 2004;349:181-9.
  • Referans42.Soldin OP, Tractenberg RE, Soldin SJ. Differences between measurements of T4 and T3 in pregnant and nonpregnant women using isotope dilution tandem mass spectrometry and immunoassays: are there clinical implications? Clin Chim Acta. 2004;347:61-9.
  • Referans43.Dashe JS, Casey BM, Wells CE, McIntire DD, Byrd EW, Leveno KJ et al. Thyroid-stimulating hormone in singleton and twin pregnancy: importance of gestational age-specific reference ranges. Obstet Gynecol. 2005;106:753-7.
  • Referans44.Spencer C, Lee R, Kazarosyan M, Bergoglio L, Braverman L, Mereshian P et al. Thyroid reference ranges in pregnancy: Studies on an iodine sufficient cohort. Thyroid. 2005;15(Supp 1):1-16.
  • Referans45.Walker JA, Illions EH, Huddleston JF, Smallridge RC. Racial comparisons of thyroid function and autoimmunity during pregnancy and the postpartum period. Obstet Gynecol. 2005;106:1365-71.
  • Referans46.Haddow JE, Knight GJ, Palomaki GE, McClain MR, Pulkkinen AJ. The reference range and within-person variability of thyroid stimulating hormone during the first and second trimesters of pregnancy. J Med Screen. 2004;11:170-4.
  • Referans47.Medici M, Korevaar TI, Visser WE, Visser TJ, Peeters RP. Thyroid function in pregnancy: what is normal? Clin Chem. 2015; 61:704.
  • Referans48.Korevaar TI, Schalekamp-Timmermans S, de Rijke YB, Visser WE, Visser W, de Muinck Keizer-Schrama SM et al. Hypothyroxinemia and TPO-antibody positivity are risk factors for premature delivery: the generation R study. J Clin Endocrinol Metab 2013; 98:4382.
  • Referans49.Li C, Shan Z, Mao J, Wang W, Xie X, Zhou W et al. 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? J Clin Endocrinol Metab. 2014;99:73.
  • Referans50.Akarsu E, Alagöl F, Altun B, Aral F, Ayvaz G, Boztepe, H et al. (2016). Türkiye Endokrinoloji ve Metabolizma Derneği. Tiroid hastalıkları tanı ve tedavi klavuzu. ISBN:978-625-401-061-3. Chromeextension://efaidnbmnnnibpcajpcglclefindmkaj/https://file.temd.org.tr/Uploads/publications/guides/documents/20200929134733-2020tbl_kilavuzf527c34496.pdf?a=1

Gebelerde Birinci Trimester Taramasında Tiroid Uyarıcı Hormon Cut-off Düzeyi Ne Olmalıdır? Prospektif Kohort Çalışması ve Kılavuzların Mini İncelemesi

Year 2023, Volume: 2 Issue: 2, 63 - 71, 19.06.2023
https://doi.org/10.57221/izmirtip.1277638

Abstract

Amaç: Tiroid Uyarıcı Hormon (TSH) ve İnsan Koryonik Gonadotropin (hCG), alfa alt biriminin ortak olduğu glikoproteinlerdir. Bunun bir sonucu olarak hCG, içsel tirotropik aktiviteye sahiptir. Yüksek hCG seviyeleri nedeniyle hamile kadınların %80'inde tirotropin seviyesi düşer. Son çalışmalar ve bazı komite görüşleri, TSH için normalin birinci trimester üst sınırı olarak 2,5 U/ml'nin kullanılmasını önermektedir. Biz de maternal serum TSH düzeylerinin ve anti-tiroid antikor durumunun maternal/fetal olumsuz sonuçlar üzerindeki etkisini değerlendirmeyi ve ve birinci trimester cut-off düzeyi olarak 2,5 mU/L'nin gerekliliğini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Birinci trimesterdeki gebelerde prospektif gözlemsel kohort çalışması yapıldı. Bilinen diyabet, hipertansiyon, tiroid cerrahisi veya herhangi bir tiroid hastalığı öyküsü olan hastaları dışlandı. Tiroksin (T4) düzeyi normal olan kadınlar başlangıç TSH düzeylerine göre vaka grubu (TSH düzeyi >2,5 mU/L) ve kontrol grubu (TSH düzeyi <2,5 mU/L) olmak üzere iki gruba ayrıldı. Serum anti-tiroid antikor durumu değerlendirildi ve anti-tiroid peroksidaz (anti-TPO) pozitif olup olmamasına göre dört alt grup oluşturuldu. Gebelik kaybı, hiperemezis gravidarum, hipertansif bozukluklar, gestasyonel diyabet, doğum öncesi membran rüptürü, plasenta dekolmanı gibi fetomaternal sonuçları doğuma kadar rutin prenatal ziyaretlerle gözlemlendi; ayrıca doğum şekli, doğum ağırlığı, omuz distosisi, yenidoğan yoğun bakım ihtiyacı ve doğum sonu kanama olup olmadığı kaydedildi. Bulgular: TSH >2,5 mU/L ve anti-TPO (+) olan alt grupta spontan abortus insidansı, TSH<2,5 mU/L ve anti-TPO (+) olanlara göre anlamlı olarak yüksekti (p<0,05). Tüm gruplarda diğer maternal veya fetal/neonatal komplikasyonlarda anlamlı fark yoktu. Sonuç: Serum TSH düzeyini <2,5 mU/L olarak önermek için fetüs sayısı, gebelik haftası ve antitiroid antikor durumuna göre oluşturulmuş popülasyon tabanlı nomogramlar geliştirilmesi gerekmektedir.

References

  • Referans1.Cooper DS, Biondi B. Subclinical thyroid disease. Lancet 2012; 379:1142.
  • Referans2.Ballabio M, Poshychinda M, Ekins RP. Pregnancy-induced changes in thyroid function: role of human chorionic gonadotropin as a putative regulator of maternal thyroid. J Clin Endocrinol Metab 1991;73:824.
  • Referans3.Yamazaki K, Sato K, Shizume K, Kanaji Y, Ito Y, Obara T et al. Potent thyrotropic activity of human chorionic gonadotropin variants in terms of 125I incorporation and de novo synthesized thyroid hormone release in human thyroid follicles. J Clin Endocrinol Metab 1995; 80:473.
  • Referans4.Portmann L, Hamada N, Heinrich G, DeGroot LJ. Anti-thyroid peroxidase antibody in patients with autoimmune thyroid disease: possible identity with anti-microsomal antibody. J Clin Endocrinol Metab. 1985;61:1001-3.
  • Referans5.Czarnocka B, Ruf J, Ferrand M, Carayon P, Lissitzky S. Purification of the human thyroid peroxidase and its identification as the microsomal antigen involved in autoimmune thyroid diseases. FEBS Lett. 1985;190:147-52.
  • Referans6.World Health Organization.Assessment of iodine deficiency disorders and monitoring their elimination. A guide for program managers. Geneva: WHO,2007:1-108.
  • Referans7.Laurberg P, Cerqueira C, Ovesen L, Rasmussen LB, Perrild H, Andersen S et al. Iodine intake as a determinant of thyroid disorders in populations. Best Pract Res Clin Endocrinol Metab. 2010;24:13-27.
  • Referans8.Stockigt JR. Free thyroid hormone measurement. A critical appraisal. Endocrinol Metab Clin North Am. 2001;30:265-89.
  • Referans9.Benvenga S, Cahnmann HJ, Robbins J. Characterization of thyroid hormone binding to apolipoprotein-E: localization of the binding site in the exon 3-coded domain. Endocrinology. 1993;133:1300-5.
  • Referans10.Dufour DR. Laboratory tests of thyroid function: uses and limitations. Endocrinol Metab Clin North Am. 2007;36:579-94.
  • 11.Caldwell G, Kellett HA, Gow SM, Beckett G J, Sweeting V M, Seth J et al. A new strategy for thyroid function testing. Lancet. 1985;1:1117-9.
  • Referans12.Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA. 2004;291:228-38.
  • Referans13.Walsh JP, Bremner AP, Feddema P, Leedman PJ, Brown SJ, O'Leary P. Thyrotropin and thyroid antibodies as predictors of hypothyroidism: a 13-year, longitudinal study of a community-based cohort using current immunoassay techniques. J Clin Endocrinol Metab. 2010;95:1095-104.
  • Referans14.Persani L, Borgato S, Romoli R, Asteria C, Pizzocaro A, Beck-Peccoz P.Changes in the degree of sialylation of carbohydrate chains modify the biological properties of circulating thyrotropin isoforms in various physiological and pathological states. J Clin Endocrinol Metab. 1998;83:2486-92.
  • Referans15.Persani L, Ferretti E, Borgato S, Faglia G, Beck-Peccoz P.Circulating thyrotropin bioactivity in sporadic central hypothyroidism. J Clin Endocrinol Metab. 2000;85:3631-5.
  • Referans16.Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinol Metab. 2010;95:1699-707.
  • Referans17.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; 21:1081.
  • Referans18.Lazarus JH., Thyroid disorders associated with pregnancy: etiology, diagnosis, and management.Treat Endocrinol. 2005;4:31-4.
  • Referans19.Monzani F, Del Guerra P, Caraccio N, Pruneti CA, Pucci E, Luisi M, et al., Subclinical hypothyroidism: neurobehavioral features and beneficial effect of L-thyroxine treatment. Clin Investig. 1993;71:367-71.
  • Referans20.Baker VL, Rone HM, Pasta DJ, Nelson HP, Gvakharia M, AdamsonGD. Correlation of thyroid-stimulating hormone (TSH) level with pregnancy outcome in women undergoing in vitro fertilization. Am J Obstet Gynecol. 2006;194:1668-74.
  • Referans21.Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Increased pregnancy loss rate in thyroid antibody negative women with TSH levels between 2.5 and 5.0 in the first trimester of pregnancy. J Clin Endocrinol Metab. 2010; 95:E44.
  • Referans22.Soldin OP., Thyroid Function Testing in Pregnancy and Thyroid Disease: Trimester-specific Reference Intervals.The Drug Monit. 2006; 28:8-11.
  • Referans23.Chen L, Hu R. Thyroid autoimmunity and miscarriage: a meta-analysis. Clin Endocrinol (Oxf) 2011;74:513.
  • Referans24.Thangaratinam S, Tan A, Knox E, Kilby MD, Franklyn J, Coomarasamy A. Association between thyroid autoantibodies and miscarriage and preterm birth: a meta-analysis of evidence. British Medical Journal. 2011; 342:d2616.
  • Referans25.Toulis KA, Goulis DG, Venetis CA, Kolibianakis EM, Negro R, Tarlatzis BC, et al. Risk of spontaneous miscarriage in euthyroid women with thyroid autoimmunity undergoing IVF: a meta-analysis. Eur J Endocrinol. 2010;162:643.
  • Referans26.Temur M, Cengiz H, Arici B., Yaşar L, Özdemir İA. Erken gebelikte tiroid fonksiyon bozukluğunun tespiti. Gazi Medical Journal. 2012; 23:6-9.
  • Referans27.Negro R, Formoso G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab. 2006;91:2587-91.
  • Referans28.Abramson J, Stagnaro-Green A., Thyroid antibodies and fetal loss: an evolving story.Thyroid. 2001;11:57-63.
  • Referans29.Akdemir N, Bilir C. Thyroid dysfunction in hyperemesis gravidarum: a study in Turkish pregnant women. J Turkish-German Gynecol Assoc. 2011;12: 140-3.
  • Referans30.Panesar NS, Chan KW, Li CY, Rogers MS. Status of anti-thyroid peroxidase during normal pregnancy and in patients with hyperemesis gravidarum. Thyroid. 2006;16:481-4.
  • Referans31.Fell DB, Dodds L, Joseph KS, Allen VM, Butler B. Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy. Obstet Gynecol. 2006; 107:277.
  • Referans32.Bostancı MS, Taşkesen F. Gebelikte tiroid fonksiyon bozuklukları ve sonuçlarının değerlendirilmesi. Klinik ve Deneysel Araştırmalar Dergisi. 2011; 2: 196-201.
  • Referans33.Leung AS, Millar LK, Koonings PP, Montoro M, Mestman JH. Perinatal outcome in hypothyroid pregnancies. Obstet Gynecol. 1993; 81:349.
  • Referans34.Cleary-Goldman J, Malone FD, Lambert-Messerlian G, Sullivan L, Canick J, Porter TF et al. Maternal thyroid hypofunction and pregnancy outcome. Obstet Gynecol. 2008; 112:85.
  • Referans35.Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ et al. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol. 2005;105:239-45.
  • Referans36.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; 21:1081.
  • Referans37.Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017; 27:315.
  • Referans38.Pearce EN, Oken E, Gillman MW, Lee SL, Magnani B, Platek D, et al., Association of first-trimester thyroid function test values with thyroperoxidase antibody status, smoking, and multivitamin use. Endocr Pract. 2008;14:33-9.
  • Referans39.Mandel SJ, Spencer CA, Hollowell JG. Are detection and treatment of thyroid insufficiency in pregnancy feasible?. Thyroid. 2005;15:44-53.
  • Referans40.Soldin OP, Tractenberg RE, Hollowell JG, Jonklaas J, Janicic N, Soldin SJ. Trimester-specific changes in maternal thyroid hormone, thyrotropin, and thyroglobulin concentrations during gestation: trends and associations across trimesters in iodine sufficiency. Thyroid. 2004;14:1084-90.
  • Referans41.Soldin OP, Hilakivi-Clarke L, Weiderpass E, Soldin SJ. Trimester-specific reference intervals for thyroxine and triiodothyronine in pregnancy in iodine-sufficient women using isotope dilution tandem mass spectrometry and immunoassays. Clin Chim Acta. 2004;349:181-9.
  • Referans42.Soldin OP, Tractenberg RE, Soldin SJ. Differences between measurements of T4 and T3 in pregnant and nonpregnant women using isotope dilution tandem mass spectrometry and immunoassays: are there clinical implications? Clin Chim Acta. 2004;347:61-9.
  • Referans43.Dashe JS, Casey BM, Wells CE, McIntire DD, Byrd EW, Leveno KJ et al. Thyroid-stimulating hormone in singleton and twin pregnancy: importance of gestational age-specific reference ranges. Obstet Gynecol. 2005;106:753-7.
  • Referans44.Spencer C, Lee R, Kazarosyan M, Bergoglio L, Braverman L, Mereshian P et al. Thyroid reference ranges in pregnancy: Studies on an iodine sufficient cohort. Thyroid. 2005;15(Supp 1):1-16.
  • Referans45.Walker JA, Illions EH, Huddleston JF, Smallridge RC. Racial comparisons of thyroid function and autoimmunity during pregnancy and the postpartum period. Obstet Gynecol. 2005;106:1365-71.
  • Referans46.Haddow JE, Knight GJ, Palomaki GE, McClain MR, Pulkkinen AJ. The reference range and within-person variability of thyroid stimulating hormone during the first and second trimesters of pregnancy. J Med Screen. 2004;11:170-4.
  • Referans47.Medici M, Korevaar TI, Visser WE, Visser TJ, Peeters RP. Thyroid function in pregnancy: what is normal? Clin Chem. 2015; 61:704.
  • Referans48.Korevaar TI, Schalekamp-Timmermans S, de Rijke YB, Visser WE, Visser W, de Muinck Keizer-Schrama SM et al. Hypothyroxinemia and TPO-antibody positivity are risk factors for premature delivery: the generation R study. J Clin Endocrinol Metab 2013; 98:4382.
  • Referans49.Li C, Shan Z, Mao J, Wang W, Xie X, Zhou W et al. 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? J Clin Endocrinol Metab. 2014;99:73.
  • Referans50.Akarsu E, Alagöl F, Altun B, Aral F, Ayvaz G, Boztepe, H et al. (2016). Türkiye Endokrinoloji ve Metabolizma Derneği. Tiroid hastalıkları tanı ve tedavi klavuzu. ISBN:978-625-401-061-3. Chromeextension://efaidnbmnnnibpcajpcglclefindmkaj/https://file.temd.org.tr/Uploads/publications/guides/documents/20200929134733-2020tbl_kilavuzf527c34496.pdf?a=1
There are 50 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Articles
Authors

Halime Şen Selim 0000-0002-9545-6873

Sefa Kelekcı 0000-0002-9952-3068

Publication Date June 19, 2023
Submission Date April 5, 2023
Published in Issue Year 2023 Volume: 2 Issue: 2

Cite

APA Şen Selim, H., & Kelekcı, S. (2023). What Should be the Thyroid Stimulating Hormone Cut-off Level in the First-Trimester Screening? A prospective Cohort Study and Mini Review of The Guidelines. İzmir Tıp Fakültesi Dergisi, 2(2), 63-71. https://doi.org/10.57221/izmirtip.1277638
AMA Şen Selim H, Kelekcı S. What Should be the Thyroid Stimulating Hormone Cut-off Level in the First-Trimester Screening? A prospective Cohort Study and Mini Review of The Guidelines. İzmir Tıp Fak. Derg. June 2023;2(2):63-71. doi:10.57221/izmirtip.1277638
Chicago Şen Selim, Halime, and Sefa Kelekcı. “What Should Be the Thyroid Stimulating Hormone Cut-off Level in the First-Trimester Screening? A Prospective Cohort Study and Mini Review of The Guidelines”. İzmir Tıp Fakültesi Dergisi 2, no. 2 (June 2023): 63-71. https://doi.org/10.57221/izmirtip.1277638.
EndNote Şen Selim H, Kelekcı S (June 1, 2023) What Should be the Thyroid Stimulating Hormone Cut-off Level in the First-Trimester Screening? A prospective Cohort Study and Mini Review of The Guidelines. İzmir Tıp Fakültesi Dergisi 2 2 63–71.
IEEE H. Şen Selim and S. Kelekcı, “What Should be the Thyroid Stimulating Hormone Cut-off Level in the First-Trimester Screening? A prospective Cohort Study and Mini Review of The Guidelines”, İzmir Tıp Fak. Derg., vol. 2, no. 2, pp. 63–71, 2023, doi: 10.57221/izmirtip.1277638.
ISNAD Şen Selim, Halime - Kelekcı, Sefa. “What Should Be the Thyroid Stimulating Hormone Cut-off Level in the First-Trimester Screening? A Prospective Cohort Study and Mini Review of The Guidelines”. İzmir Tıp Fakültesi Dergisi 2/2 (June 2023), 63-71. https://doi.org/10.57221/izmirtip.1277638.
JAMA Şen Selim H, Kelekcı S. What Should be the Thyroid Stimulating Hormone Cut-off Level in the First-Trimester Screening? A prospective Cohort Study and Mini Review of The Guidelines. İzmir Tıp Fak. Derg. 2023;2:63–71.
MLA Şen Selim, Halime and Sefa Kelekcı. “What Should Be the Thyroid Stimulating Hormone Cut-off Level in the First-Trimester Screening? A Prospective Cohort Study and Mini Review of The Guidelines”. İzmir Tıp Fakültesi Dergisi, vol. 2, no. 2, 2023, pp. 63-71, doi:10.57221/izmirtip.1277638.
Vancouver Şen Selim H, Kelekcı S. What Should be the Thyroid Stimulating Hormone Cut-off Level in the First-Trimester Screening? A prospective Cohort Study and Mini Review of The Guidelines. İzmir Tıp Fak. Derg. 2023;2(2):63-71.