본문 바로가기
KERD
논문KCI 등재

Evaluation of Pregnancy and Thyroid Function

박창은
대한임상검사과학회 (Korean Society for Clinical Laboratory Science)|2018.03|대한임상검사과학회지 (Korean Journal of Clinical Laboratory Science)|제50권 제1호|pp. 1-10|DOI 10.15324/kjcls.2018.50.1.1

2

조회

0

다운로드

1

인용

0

참고문헌

키워드

PregnancyTSHFree T4Reference ranges
주제분류기타자연과학

초록

During early pregnancy, before the development of a functioning thyroid gland, thyroid stimulating hormone (TSH) is a very sensitive marker of thyroid dysfunction during pregnancy. Normal values have been modified during gestation with a downward shift. The fetus is influenced by the TSH supplied by the mother. TSH and free thyroxine (FT4) concentrations vary during pregnancy and conventional units can vary between laboratories. A downward shift of the TSH reference range occurs during pregnancy, with a decrease in both the lower and upper limits of maternal TSH, relative to the typical non-pregnant TSH reference range. Each laboratory produces its own reference TSH and FT4 concentrations because there are many different assays that yield different results in pregnancy. Therefore, automated immunoassays used for serum FT4 analysis are still used widely, but the important considerations discussed above must be noted. The use of population-based, trimester-specific reference ranges remains the best way to handle this issue The slight downward shift in the upper reference range of TSH occurring in the latter first trimester (7∼12 weeks) of pregnancy, typically not observed prior to 7 weeks. Their use indicates high or low levels in a quantitative manner independent of the reference ranges. These data highlight the importance of calculating population-based pregnancy-specific thyroid parameter reference intervals. A precision medicine initiative in this area will require the collection and analysis of a large number of genetic, biological, psychosocial, and environmental variables in large cohorts of individuals. Large prospective randomized controlled trials will be needed to resolve these controversies.

Abstract

During early pregnancy, before the development of a functioning thyroid gland, thyroid stimulating hormone (TSH) is a very sensitive marker of thyroid dysfunction during pregnancy. Normal values have been modified during gestation with a downward shift. The fetus is influenced by the TSH supplied by the mother. TSH and free thyroxine (FT4) concentrations vary during pregnancy and conventional units can vary between laboratories. A downward shift of the TSH reference range occurs during pregnancy, with a decrease in both the lower and upper limits of maternal TSH, relative to the typical non-pregnant TSH reference range. Each laboratory produces its own reference TSH and FT4 concentrations because there are many different assays that yield different results in pregnancy. Therefore, automated immunoassays used for serum FT4 analysis are still used widely, but the important considerations discussed above must be noted. The use of population-based, trimester-specific reference ranges remains the best way to handle this issue The slight downward shift in the upper reference range of TSH occurring in the latter first trimester (7∼12 weeks) of pregnancy, typically not observed prior to 7 weeks. Their use indicates high or low levels in a quantitative manner independent of the reference ranges. These data highlight the importance of calculating population-based pregnancy-specific thyroid parameter reference intervals. A precision medicine initiative in this area will require the collection and analysis of a large number of genetic, biological, psychosocial, and environmental variables in large cohorts of individuals. Large prospective randomized controlled trials will be needed to resolve these controversies.

참고문헌 (60)

  1. Jackson I, "The thyroid axis and depression", Thyroid, 8(10), pp.951~956 (1998)[DOI]
  2. Pop V, "Are autoimmune thyroid dysfunction and depression related?", J Clin Endocrinol Metab, 83(9), pp.3194~3197 (1998)
  3. Herrera E, "Disturbances in lipid metabolism in diabetic pregnancy-are these the cause of the problem?", Best Pract Res Clin Endocrinol Metab, 24(4), pp.515~525 (2010)[DOI]
  4. Laurberg P, "Dynamics and predictors of serum TSH and fT4 reference limits in early pregnancy: a study within the Danish National Birth Cohort", J Clin Endocrinol Metab, 101(6), pp.2484~2492 (2016)[DOI]
  5. Krassas GE, "Thyroid function and human reproductive health", Endocr Rev, 31(5), pp.702~705 (2010)[DOI]
  6. Lazarus JH, "Comprhensive Handbook of Iodine: Nutritional, Biochemical, Pathological and Therapeutic Aspects", pp.469~476 (2009), Academic
  7. Andersson M, "Prevention and control of iodine deficiency in pregnant and lactating women and in children less than 2- years-old: conclusions and recommendations of the Technical Consultation", Public Health Nutr, 10(12A), pp.1606~1611 (2007)
  8. Brent GA, "Maternal thyroid function: interpretation of thyroid function tests in pregnancy", Clin Obstet Gynecol, 40(1), pp.3~15 (1997)
  9. Shields B, "Cigarette smoking during pregnancy is associated with alterations in maternal and fetal thyroid function", J Clin Endocrinol Metab, 94(2), pp.570~574 (2009)[DOI]
  10. Garber JR, "Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association", Endocr Pract, 18(6), pp.988~1028 (2012)
  11. Tingi E, "Benign thyroid disease in pregnancy: A state of the art review", J Clin Transl Endocrinol, 23(6), pp.37~49 (2016)
  12. Velasco I, "Identifying and treating subclinical thyroid dysfunction in pregnancy: emerging controversies", Eur J Endocrinol, 178(1), pp.D1~D12 (2018)[DOI]
  13. Stagnaro-Green A, "Clinical guidelines: thyroid and pregnancy-time for universal screening?", Nat Rev Endocrinol, 13(4), pp.192~194 (2017)[DOI]
  14. Lee RH, "Free T4 immunoassays are flawed during pregnancy", Am J Obstet Gynecol, 200(3), pp.260.e1~260.e6 (2009)
  15. Weeke J, "A longitudinal study of serum TSH, and total and free iodothyronines during normal pregnancy", Acta Endocrinologica, 101(4), pp.531~537 (1982)
  16. Baloch Z, "Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease", Thyroid, 13(1), pp.3~126 (2003)
  17. Orito Y, "Thyroid function in early pregnancy in Japanese healthy women: relation to urinary iodine excretion, emesis, and fetal and child development", J Clin Endocrinol Metab, 94(5), pp.1683~1688 (2009)[DOI]
  18. Haddow JE, "The reference range and within-person variability of thyroid stimulating hormone during the first and second trimesters of pregnancy", J Med Screen, 11(4), pp.170~174 (2004)[DOI]
  19. Sapin R, "Free thyroxine measured with equilibrium dialysis and nine immunoassays decreases in late pregnancy", Clin Lab, 50(9-10), pp.581~584 (2004)
  20. Glinoer D, "The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology", Endocr Rev, 18(3), pp.404~433 (1997)[DOI]
  21. Persechini ML, "Decreased IGF-1 concentration during the first trimester of pregnancy in women with normal somatotroph function", Pituitary, 18(4), pp.461~464 (2015)
  22. Murillo-Llorente M, "Intra-individual variability in TSH levels of healthy women during the first half of pregnancy", Endocrinol Diabetes Nutr, 64(6), pp.288~294 (2017)[DOI]
  23. Chan SY, "The role of the placenta in thyroid hormone delivery to the fetus", Nat Clin Pract Endocrinol Metab, 5(1), pp.45~54 (2009)[DOI]
  24. Reh A, "What is a normal thyroid-stimulating hormone (TSH) level? Effects of stricter TSH thresholds on pregnancy outcomes after in vitro fertilization", Fertil Steril, 94(7), pp.2920~2922 (2010)
  25. Karmon AE, "Preconceptional thyroid-stimulating hormone levels and outcomes of intrauterine insemination among euthyroid infertile women", Fertil Steril, 103(1), pp.258~263 (2015)[DOI]
  26. Korevaar TI, "Thyroid autoimmunity impairs the thyroidal response to human chorionic gonadotropin: two populationbased prospective cohort studies", J Clin Endocrinol Metab, 102(1), pp.69~77 (2017)
  27. Thienpont LM, "Proposal of a candidate international conventional reference measurement procedure for free thyroxine in serum", Clin Chem Lab Med, 45(7), pp.934~936 (2007)
  28. d'Herbomez M, "Clinical evaluation of nine free thyroxine assays: persistent problems in particular populations", Clin Chem Lab Med, 41(7), pp.942~947 (2003)
  29. Wald NJ, "The triple test", Clin Chem, 60(1), pp.269~270 (2014)[DOI]
  30. Laurberg P, "Endocrinology in pregnancy: Pregnancy and the incidence, diagnosing and therapy of Graves' disease", Eur J Endocrinol, 175(5), pp.R219~R230 (2016)[DOI]
  31. Casey BM, "Subclinical hyperthyroidism and pregnancy outcomes", Obstet Gynecol, 107(2 Pt 1), pp.337~341 (2006)[DOI]
  32. Thienpont LM, "Report of the IFCC working group for standardization of thyroid function tests; part 1: thyroid-stimulating hormone", Clin Chem, 56(6), pp.902~911 (2010)[DOI]
  33. Thienpont LM, "Report of the IFCC working group for standardization of thyroid function tests; part 2: free thyroxine and free triiodothyronine", Clin Chem, 56(6), pp.912~920 (2010)[DOI]
  34. Thienpont LM, "Report of the IFCC working group for standardization of thyroid function tests; part 3: total thyroxine and total triiodothyronine", Clin Chem, 56(6), pp.921~929 (2010)[DOI]
  35. Pop VJ, "Maternal thyroid parameters, body mass index and subsequent weight gain during pregnancy in healthy euthyroid women", Clin Endocrinol (Oxf), 79(4), pp.577~583 (2013)
  36. De Groot L, "Management of thyroid dysfunction during pregnancy and postpartum: an endocrine society clinical practice guideline", J Clin Endocrinol Metab, 97(8), pp.2543~2565 (2012)[DOI]
  37. 문희원, "Establishment of Trimester-Specific Reference Intervals for Thyroid Hormones in Korean Pregnant Women", Annals of Laboratory Medicine, 35(2), pp.198~204 (2015), 대한진단검사의학회
  38. Bestwick JP, "Thyroid stimulating hormone and free thyroxine in pregnancy: expressing concentrations as multiples of the median (MoMs)", Clin Chim Acta, 430, pp.33~37 (2014)[DOI]
  39. Ashoor G, "Maternal thyroid function at 11-13 weeks of gestation", Fetal Diagn Ther, 27(3), pp.156~163 (2010)[DOI]
  40. Moreno-Reyes R, "High prevalence of thyroid disorders in pregnant women in a mildly iodine-deficient country: a population based study", J Clin Endocrinol Metab, 98(9), pp.3694~3701 (2013)[DOI]
  41. Ashoor G, "Maternal thyroid function at 11 to 13 weeks of gestation and subsequent fetal death", Thyroid, 20(9), pp.989~993 (2010)[DOI]
  42. Benhadi N, "Ethnic differences in TSH but not in free T4 concentrations or TPO antibodies during pregnancy", Clin Endocrinol (Oxf), 66(6), pp.765~770 (2007)[DOI]
  43. La'ulu SL, "Second-trimester reference intervals for thyroid tests: the role of ethnicity", Clin Chem., 53(9), pp.1658~1664 (2007)[DOI]
  44. Kachuei M, "Prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome", Arch Gynecol Obstet, 285(3), pp.853~856 (2012)[DOI]
  45. Monteleone P, "Female infertility related to thyroid autoimmunity: the ovarian follicle hypothesis", Am J Reprod Immunol, 66(2), pp.108~114 (2011)[DOI]
  46. Alexander EK, "2017 Guidelines of the American thyroid association for the diagnosis and management of thyroid disease during pregnancy and the postpartum", Thyroid, 27(3), pp.315~389 (2017)[DOI]
  47. Medici M, "Thyroid function in pregnancy: what is normal?", Clin Chem, 61(5), pp.704~713 (2015)
  48. Pappa T, "Prenatal diagnosis of resistance to thyroid hormone and its clinical implications", J Clin Endocrinol Metab, 102(10), pp.3775~3782 (2017)[DOI]
  49. Roelfsema F, "Thyrotropin secretion patterns in health and disease", Endocr Rev, 34(5), pp.619~657 (2013)[DOI]
  50. Roti E, "Circadian thyrotropin variations are preserved in normal pregnant women", Eur J Endocrinol, 133(1), pp.71~74 (1995)
  51. Robinson H, "Management of thyroid disease in pregnancy-Room for improvement in the first trimester", Obstet Med, 9(3), pp.126~129 (2016)[DOI]
  52. Tingi E, "Benign thyroid disease in pregnancy: A state of the art review", J Clin Transl Endocrinol, 6, pp.37~49 (2016)
  53. Budenhofer BK, "Thyroid (dys-)function in normal and disturbed pregnancy", Arch Gynecol Obstet, 287(1), pp.1~7 (2013)[DOI]
  54. Bassols J, "Lower free thyroxin associates with a less favorable metabolic phenotype in healthy pregnant women", J Clin Endocrinol Metab, 96(12), pp.3717~3723 (2011)[DOI]
  55. Faupel-Badger JM, "Plasma volume expansion in pregnancy: implications for biomarkers in population studies", Cancer Epidemiol Biomarkers Prev, 16(9), pp.1720~1723 (2007)[DOI]
  56. Lazarus J, "European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children", Eur Thyroid J, 3(2), pp.76~94 (2014)[DOI]
  57. McNeil AR, "Reporting thyroid function tests in pregnancy", Clin Biochem Rev, 36(4), pp.109~126 (2015)
  58. Yalamanchi S, "Thyroid disorders in pregnancy", Curr Opin Obstet Gynecol, 27(6), pp.406~415 (2015)[DOI]
  59. Krassas G, "Thyroid diseases during pregnancy: a number of important issues", Hormones (Athens), 14(1), pp.59~69 (2015)
  60. Abalovich M, "Overt and subclinical hypothyroidism complicating pregnancy", Thyroid, 12(1), pp.63~68 (2002)

이 간행물의 다른 논문 (8건)

장내 세균총과 위장관 질환이기종, 김성훈, 황순재pp. 11-19Performance Evaluation of In Vitro Diagnostic Reagents for Mycobacterium tuberculosis and Non-tuberculous Mycobacteria by FDA Approval장연희, 최연임, 김 연, 하선목, 이혜영, 김정호, 박선영pp. 20-28한국의 임상검체로부터 분리된 해외유입 두 형태 진균에 대한 연구구본경, 유성률, 이장호, 문철pp. 29-36편백나무 잎 추출물의 성분분석과 면역효능에 관한 연구김선건, 지원대, 백영두, 이승욱, 도국배, 김극준, 김정희pp. 37-43한국 성인의 인슐린저항성 및 대사증후군 위험 예측인자로서체형지수와 허리둘레/신장 비율의 효용성신경아pp. 44-53
원문 보기