Valores de referencia para la tirotropina y hormonas tiroideas en embarazadas cubanas
Keywords:
pregnancy, thyrotropin, hormones, thyroid, reference values.Abstract
Introduction: Thyroid function parameters in pregnant women are modified during pregnancy and are specific for each population.
Objective: To establish reference values for thyrotropin and thyroid hormones in a population of Cuban pregnant women.
Methods: Cross-sectional study, in the Plaza de la Revolución municipality, of 362 pregnant women without personal or family history of thyroid disease, with negative anti-thyroid antibodies and absence of lesions in the thyroid ultrasound. Maternal age, gestational age, race, smoking, number of pregnancies, use of iodine supplements, body mass index, thyrotropin, total (TT4) and free (FT4) thyroxine, total (TT3) and free (FT3) triiodothyronine were analyzed. Reference intervals were established for each parameter using the 2.5 and 97.5 percentiles as lower and upper limits, respectively.
Results: The reference values in the first, second and third trimesters were for thyrotropin 0.1-3.3 mIUI/L, 0.6-3.4 mIU/L and 0.3-3.9 mIU/L; for TT4 90.1-204.1 nmol/L, 92.2-189.2 nmol/L and 79.8-170.4 nmol/L; for FT4 7.3-16.7 pmol/L, 6.3-17.3 pmol and 5.6-12.7 pmol/L; for TT3 1.8-3.9 nmol/L, 1.8-3.9 nmol/L and 1.7-4.0 nmol/L and for FT3 1.0-7.4 pmol/L, 0.7-6.3 pmol/L and 0.7-5.4 pmol/L, respectively.
Conclusions: Reference values for thyrotropin and thyroid hormones were determined for the first time in a population of Cuban pregnant women. These values differ from those established by the manufacturer of the diagnostic kits and from those recommended by previous international guidelines.
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References
1. Hershman JM. Physiological and pathological aspects of the effect of human chorionic gonadotropin on the thyroid. Best Pract Res Clin Endocrinol Metab. 2004;18(2):249-65. DOI: https://doi.org/10.1016/j.beem.2004.03.010
2. Springer D, Jiskra J, Limanova Z, Zima T, Potlukova E. Thyroid in pregnancy: from physiology to screening. Crit Rev Clin Lab Sci. 2017;54(2):102-16. DOI: https://doi.org/10.1080/10408363.2016.1269309
3. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017;27(3):315-89. DOI: https://doi.org/10.1089/thy.2016.0457
4. Taylor PN, Albrecht D, Scholz A, Gutierrez G, Lazarus J, Dayan C, et al. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol. 2018;14(5):301-16. DOI: https://doi.org/10.1038/nrendo.2018.18
5. Korevaar T, Medici M, Visser TJ, Peeters RP. Thyroid disease in pregnancy: new insights in diagnosis and clinical management. Nat Rev Endocrinol. 2017;13(10):610-22. DOI: https://doi.org/10.1038/nrendo.2017.93
6. Kostecka-Matyja M, Fedorowicz A, Bar-Andziak E, Bednarczuk T, Buziak-Bereza M, Dumnicka P, et al. Reference values for TSH and free thyroid hormones in healthy pregnant women in Poland: a prospective, multicenter study. Eur Thyroid J. 2017;6(2):82-8. DOI: https://doi.org/10.1159/000453061
7. Bulur O, Atakb Z, Ertugrula DT, Beyana E, Gunakanb E, Karakayaa S, et al. Trimester-specific reference intervals of thyroid function tests in Turkish pregnants. Gynecol Endocrin. 2020;36(5):413-6. DOI: https://doi.org/10.1080/09513590.2019.1666817
8. Gao X, Li Y, Li J, Liu A, Sun W, Teng W, et al. Gestational TSH and FT4 Reference Intervals in Chinese Women: A systematic review and meta-analysis. Front Endocrinol. 2018;9:432. DOI: https://doi.org/10.3389/fendo.2018.00432
9. Khalir AB, Salih BT, Chinengo O, Bardies MRD, Turner A, Abdel LO. Trimester specific reference ranges for serum TSH and Free T4 among United Arab Emirates pregnant women. Pract Lab Med. 2018;12:e00098. DOI: https://doi.org/10.1016/j.plabm.2018.e00098
10. Kim HJ, Cho YY, Kim SW, Kim TH, Jang HW, Lee SY, et al. Reference intervals of thyroid hormones during pregnancy in Korea, an iodine-replete area. Korean J Intern Med. 2018;33(3):552-60. DOI: https://doi.org/10.3904/kjim.2016.051
11. Ruiz D, Piedra M, Lavín BA, Baamonde C, García MT, de Castro R, et al. Impacto del empleo de umbrales específicos de referencia en el diagnóstico de las alteraciones funcionales tiroideas en la mujer gestante. Rev Arg Endocrin Metab. 2017;54(1):21-8. DOI: https://doi.org/10.1016/j.raem.2016.12.003
12. Yang X, Meng Y, Zhang Y, Zhang C, Guo F, Yang S, et al. Thyroid function reference ranges during pregnancy in a large Chinese population and comparison with current guidelines. Chin Med J. 2019;132(5):505-11. DOI: https://doi.org/10.1097/cm9.0000000000000051
13. 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(10):1081-125. DOI: https://doi.org/10.1089/thy.2011.0087
14. De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J Clin Endocrin Metab. 2012;97(8):2543-65. DOI: https://doi.org/10.1210/jc.2011-2803
15. Khadilkar S. Thyroid‑stimulating hormone values in pregnancy: cutoff controversy Continues? J Obstet Gynecol India. 2019;69(5):389-94. DOI: https://doi.org/10.1007/s13224-019-01272-w
16. Lazarus J, Brown RC, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. 2014 European Thyroid Association Guidelines for the management of subclinical hypothyroidism in pregnancy and in Children. Eur Thyroid J. 2014;3(2):76-94. DOI: https://doi.org/10.1159/000362597
17. Brenta G, Vaisman M, Sgarbi JA, Bergoglio LM, Carvalho de Andrada N, Pineda P, et al. Guías de práctica clínica para el tratamiento del hipotiroidismo. Arq Bras Endocrinol Metab. 2013 [acceso 13/04/2019];57(4). Disponible en: https://www.lats.org/wp-content/uploads/Statement_and_Guidelines/Hypothyroidism_management_(spanish).pdf
18. Terry B. Naturaleza, severidad y situación actual de los desórdenes por deficiencia de yodo. Rev Cub Hig Epidem. 2008 [acceso 13/04/2019];46(2). Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1561-30032008000200008
19. Baloch Z, Carayon P, Conte-Devolx B, Demers LM, Feldt-Rasmussen U, Henry JF, et al. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid. 2004;13(1):3-126. DOI: https://doi.org/10.1089/105072503321086962
20. Brent GA, Weetman AP. Hypothyroidism and thyroiditis. En: Melmed S, Polonsky KS, Reed Larsen P, Kronenberg HM, editors. Williams Textbook of Endocrinology. Philadelphia: Elsevier; 2016. p. 416-48.
21. Laurberg P, Linding S, Hindersson P, Nohr EA, Olsen J. Dynamics and predictors of serum TSH and fT4 reference limits in early pregnancy: a study within the Danish National Birth Cohort. J Clin Endocrin Metab. 2016;101(6):2484-92. DOI: https://doi.org/10.1210/jc.2016-1387
22. De Oliveira NA, Almeida de Assis AS, Martins C, Ayres D, Martins T, Donner C, et al. Recent recommendations from ATA guidelines to define the upper reference range for serum TSH in the first trimester match reference ranges for pregnant women in Rio de Janeiro. Arch Endocrinol Metab. 2018;62(4):386-91. DOI: https://doi.org/10.20945/2359-3997000000064
23. Sekhri T, Juhi JA, Wilfred R, Kanwar RS, Sethi J, Bhadra K, et al. Trimester specific reference intervals for thyroid function tests in normal Indian pregnant women. Indian J Endocrin Metab. 2016;20(1):101-7. DOI: https://doi.org/10.4103/2230-8210.172239
24. Korevaar TI, Chaker L, Medici M, de Rijke YB, Jaddoe VW, Steegers EA, et al. Maternal total T4 during the first half of pregnancy: physiologic aspects and the risk of adverse outcomes in comparison with free T4. Clin Endocrinol (Oxf). 2016;85(5):757-63. DOI: https://doi.org/10.1111/cen.13106
25. Dosiou C, Medici M. Management of endocrine disease: isolated maternal hypothyroxinemia during pregnancy: knowns and unknowns. Eur J Endocrinol. 2017;176(1):R21-R38. DOI: https://doi.org/10.1530/EJE-16-0354
26. La’ulu SL, Roberts WL. Second-trimester reference intervals for thyroid tests: the role of ethnicity. Clin Chem. 2007;53(9):1658-64. DOI: https://doi.org/10.1373/CLINCHEM.2007.089680
27. Fabbro D, Onetto A, Smithuis F, Hernández S, Papaleo N, Cárcano ME, et al. Distribución de los valores de hormonas del eje tiroideo en una población de embarazadas. RAEM. 2013;50:63.
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