Thyroid-stimulating hormone in pregnancy: are we in need of a lower cutoff value?

2018 ◽  
Vol 35 (2) ◽  
pp. 241
Author(s):  
KhaledN Elfayoumy ◽  
MahmoudF Midan ◽  
WalaaM El-Bassiony ◽  
AhmadA Al-Metwally
Keyword(s):  
Thyroid Stimulating Hormone ◽  
Cutoff Value ◽  
Lower Cutoff ◽  
In Pregnancy ◽  
Stimulating Hormone

scholarly journals Management of thyroid disease in pregnancy – Room for improvement in the first trimester

2016 ◽  
Vol 9 (3) ◽  
pp. 126-129 ◽  
Author(s):  
Helen Robinson ◽  
Philip Robinson ◽  
Michael D’Emden ◽  
Kassam Mahomed
Keyword(s):  
General Practitioner ◽  
Thyroid Function ◽  
Thyroid Disease ◽  
Thyroid Dysfunction ◽  
First Trimester ◽  
Antenatal Clinic ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
In Pregnancy ◽  
Stimulating Hormone

Background First-trimester care of maternal thyroid dysfunction has previously been shown to be poor. This study evaluates early management of thyroid dysfunction in pregnancy in Australia. Methods Patients reviewed by the Obstetric Medicine team for thyroid dysfunction from 1 January 2012 to 30 June 2013 were included. Data were collected on gestation at referral from the patient’s general practitioner to the antenatal clinic, information provided in the referral letter, thyroid function tests and thyroid medications. Results Eighty-five women were included in the study. At the time of general practitioner referral to antenatal services, 19% of women with preexisting thyroid disease had no thyroid function tested. Forty-three percent had an abnormal thyroid-stimulating hormone defined as being outside the laboratory-specific pregnancy reference range if available, or outside the level of 0.1–2.5 mIu/L in the first trimester, 0.2–3.0 mIu/L in the second trimester and 0.3–3.0 mIu/L in the third trimester. Only 21% of women increased their thyroxine dose prior to their first antenatal clinic review. Conclusion This study highlights that a significant proportion of women with known thyroid disease either have untested thyroid function in the first trimester or a thyroid-stimulating hormone outside of levels recommended by guidelines.

Thyroid Disease I: Hyperthyroidism in Pregnancy

2020 ◽  
Author(s):  
Robert B. Martin ◽  
Brian Casey
Keyword(s):  
Hyperemesis Gravidarum ◽  
Beta Blockers ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Storm ◽  
Care Level ◽  
Hypermetabolic State ◽  
Life Threatening ◽  
Overt Hyperthyroidism ◽  
In Pregnancy ◽  
Stimulating Hormone

Thyroid physiologic adaptations in pregnancy may be confused with pathologic changes. Human chorionic gonadotropin rises early in pregnancy, stimulating thyrotropin secretion and suppressing thyroid stimulating hormone. These chemical changes are often seen in hyperemesis gravidarum and gestational transient thyrotoxicosis. Therefore, mild thyrotoxicosis may be difficult to differentiate from early pregnancy thyroxine stimulation.  However, overt hyperthyroidism usually includes classic symptoms seen outside of pregnancy in addition to suppressed TSH and T4 levels. Treatment includes thionamides propylthiouracil and methimazole.  Thyroid ablation is contraindicated in pregnancy. Often, in affected women, the fetus is euthyroid, but neonates can develop hyper or hypothyroidism with or without a goiter. Lastly, thyroid storm, though rare, is life threatening. Often presenting as a hypermetabolic state with cardiomyopathy and pulmonary hypertension, it generally results from decompensation from preeclampsia, anemia, sepsis, or surgery.  Treatment requires intensive care level management, with initiation of thionamides, iodine, and beta blockers.   This review contains 2 figures, 4 tables and 38 references. Keywords: Thyroid-releasing hormong, thyroid-stimulating hormone, thyromegaly, thyroid-stimulating immunoglobulins, thryotoxicosis, thionamides, thyroid storm

Thyroid stimulating hormone and free thyroxine in pregnancy: Expressing concentrations as multiples of the median (MoMs)

2014 ◽  
Vol 430 ◽  
pp. 33-37 ◽  
Author(s):  
Jonathan P. Bestwick ◽  
Rhys John ◽  
Aldo Maina ◽  
Varvara Guaraldo ◽  
Mohammed Joomun ◽  
...  
Keyword(s):  
Thyroid Stimulating Hormone ◽  
Free Thyroxine ◽  
In Pregnancy ◽  
Stimulating Hormone

Applicability of the Third-Generation, Thyroid-Stimulating Hormone Assay in Pregnancy

1998 ◽  
Vol 7 (2) ◽  
pp. 65-67
Author(s):  
Renee A. Bobrowski ◽  
Patricia Streicher ◽  
Jeffery S. Dzieczkowski ◽  
Mitchell P. Dombrowski ◽  
Bernard Gonik
Keyword(s):  
Thyroid Stimulating Hormone ◽  
Third Generation ◽  
The Third ◽  
In Pregnancy ◽  
Hormone Assay ◽  
Stimulating Hormone

scholarly journals Impact of Lower Screening TSH Cutoff Level on the Increasing Incidence of Congenital Hypothyroidism

2017 ◽  
Author(s):  
Violeta Anastasovska ◽  
Mirjana Kocova
Keyword(s):  
Congenital Hypothyroidism ◽  
Thyroid Stimulating Hormone ◽  
Retrospective Evaluation ◽  
Cutoff Value ◽  
Screening Programs ◽  
The Impact ◽  
Lower Cutoff ◽  
Cutoff Levels ◽  
Blood Spot

Lower cutoff levels in screening programs have led to an increase in the proportion of detected cases with transient hypothyroidism, leading to increase of the overall incidence of primary congenital hypothyroidism (CH) in several countries. We have performed retrospective evaluation on the data from 251,008 (96.72%) neonates screened for thyroid-stimulating hormone (TSH) level in dried blood spot specimens taken 48 hours after birth, between 2002 and 2015, using DELFIA method. A TSH value of 15 mIU/L was used as the cutoff point until 2010 and 10 mIU/L thereafter. Primary CH was detected in 127 newborns (1/1976) of which 81.1% had permanent and 18.9% had transient CH. The incidence of primary CH was increased from 1/2489 until to 2010 to 1/1585 thereafter (p=0.131). However, the incidence of permanent CH was slightly increased (p=0.922), while the transient CH incidence had 8-fold increasing after lowering the TSH cutoff level (p<0.001). In cases with permanent CH, we observed lower frequency for thyroid dysgenesis (82.7 vs. 66.7%) and higher frequency for normal in-situ thyroid gland (17.3 vs. 33.3%), for the period with reduced TSH cutoff value. Our findings support the impact of lower TSH cutoff on the increasing incidence of congenital hypothyroidism.

Applicability of the third-generation, thyroid-stimulating hormone assay in pregnancy

1998 ◽  
Vol 7 (2) ◽  
pp. 65-67 ◽  
Author(s):  
Renee A. Bobrowski ◽  
Patricia Streicher ◽  
Jeffery S. Dzieczkowski ◽  
Mitchell P. Dombrowski ◽  
Bernard Gonik
Keyword(s):  
Thyroid Stimulating Hormone ◽  
Third Generation ◽  
The Third ◽  
In Pregnancy ◽  
Hormone Assay ◽  
Stimulating Hormone
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