The Korean journal of internal medicine

  • 제33권3호
  • /
  • Pages.552-560
  • /
  • 2018
  • /
  • 1226-3303(pISSN)
  • /
  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

Reference intervals of thyroid hormones during pregnancy in Korea, an iodine-replete area

  • Kim, Hye Jeong (Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Cho, Yoon Young (Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Sun Wook (Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Tae Hyuk (Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jang, Hye Won (Department of Medical Education, Sungkyunkwan University School of Medicine) ;
  • Lee, Soo-Youn (Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Suk-Joo (Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Roh, Cheong-Rae (Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Jong-Hwa (Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Chung, Jae Hoon (Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Oh, Soo-young (Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 투고 : 2016.02.26
  • 심사 : 2016.07.19
  • 발행 : 2018.05.01
⟨ 이전 논문 다음 논문 ⟩

초록

Background/Aims: Maternal thyroid dysfunction has been associated with adverse pregnancy outcomes. The purpose of our study was to establish trimester-specific reference intervals for thyroid hormones in pregnant women in Korea, where iodine intake is more than adequate and to examine pregnancy and perinatal outcomes in their offspring. Methods: Among 459 healthy pregnant women who were screened, we enrolled 417 subjects who had negative results for thyroid autoantibodies. Serum thyroid stimulating hormone (TSH) and free thyroxine were measured using an immunoradiometric assay. Urine iodine concentration was measured using inductively coupled plasma-mass spectrometry in 275 women. Reference ranges of thyroid hormones were determined according to the guidelines of the National Academy of Clinical Biochemistry. Pregnancy and perinatal outcomes were compared according to maternal thyroid function. Results: The reference ranges of serum TSH were 0.03 to 4.24 mIU/L in the first trimester, 0.13 to 4.84 mIU/L in the second trimester, and 0.30 to 5.57 mIU/L in the third trimester. Pregnancy and perinatal outcomes did not vary in mothers with subtle changes in thyroid function. Conclusions: Trimester-specific thyroid hormone reference intervals in Korean pregnant women differ from those of other countries with different iodine nutrition status and ethnicity. The establishment of population-based, reliable trimester-specific reference intervals is critical for the interpretation of thyroid function in pregnant women to avoid unnecessary tests and treatments.

키워드

과제정보

연구 과제 주관 기관 : Samsung Medical Center

참고문헌

  1. Allan WC, Haddow JE, Palomaki GE, et al. Maternal thyroid deficiency and pregnancy complications: implications for population screening. J Med Screen 2000;7:127-130. https://doi.org/10.1136/jms.7.3.127
  2. Sheehan PM, Nankervis A, Araujo Junior E, Da Silva Costa F. Maternal thyroid disease and preterm birth: systematic review and meta-analysis. J Clin Endocrinol Metab 2015;100:4325-4331. https://doi.org/10.1210/jc.2015-3074
  3. Casey BM, Dashe JS, Wells CE, et al. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol 2005;105:239-245. https://doi.org/10.1097/01.AOG.0000152345.99421.22
  4. Cleary-Goldman J, Malone FD, Lambert-Messerlian G, et al. Maternal thyroid hypofunction and pregnancy outcome. Obstet Gynecol 2008;112:85-92. https://doi.org/10.1097/AOG.0b013e3181788dd7
  5. 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;95:1699-1707. https://doi.org/10.1210/jc.2009-2009
  6. Lazarus JH, Bestwick JP, Channon S, et al. Antenatal thyroid screening and childhood cognitive function. N Engl J Med 2012;366:493-501. https://doi.org/10.1056/NEJMoa1106104
  7. Korevaar TI, Muetzel R, Medici M, et al. Association of maternal thyroid function during early pregnancy with offspring IQ and brain morphology in childhood: a population-based prospective cohort study. Lancet Diabetes Endocrinol 2016;4:35-43. https://doi.org/10.1016/S2213-8587(15)00327-7
  8. Medici M, Korevaar TI, Visser WE, Visser TJ, Peeters RP. Thyroid function in pregnancy: what is normal? Clin Chem 2015;61:704-713. https://doi.org/10.1373/clinchem.2014.236646
  9. Baloch Z, Carayon P, Conte-Devolx B, et al. Laboratory medicine practiceguidelines: laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 2003;13:3-126. https://doi.org/10.1089/105072503321086962
  10. Stagnaro-Green A, Abalovich M, Alexander E, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 2011;21:1081-1125. https://doi.org/10.1089/thy.2011.0087
  11. International Council for Control of Iodine Deficiency Disorders; UNICEF; World Health Organization. Assessment of Iodine Deficiency Disorders and Monitoring Their Elimination: A Guide for Programme Managers. 3rd ed. Geneva: World Health Organization, 2007.
  12. Cho YY, Kim HJ, Oh SY, et al. Iodine status in healthy pregnant women in Korea: a first report. Eur J Nutr 2016;55:469-475. https://doi.org/10.1007/s00394-015-0864-7
  13. Moon HW, Chung HJ, Park CM, Hur M, Yun YM. Establishment of trimester-specific reference intervals for thyroid hormones in Korean pregnant women. Ann Lab Med 2015;35:198-204. https://doi.org/10.3343/alm.2015.35.2.198
  14. American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy. Hypertension in pregnancy: report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013;122:1122-1131. https://doi.org/10.1097/01.AOG.0000437382.03963.88
  15. Koster EL, McIntire DD, Leveno KJ. Recurrence of mild malformations and dysplasias. Obstet Gynecol 2003;102:363-366.
  16. Lee JH, Ji OJ, Song MJ, et al. Determination of urinary iodine concentration by inductively coupled plasma-mass spectrometry in thyroid cancer patients on low-iodine diet. Korean J Lab Med 2010;30:351-356. https://doi.org/10.3343/kjlm.2010.30.4.351
  17. Stricker R, Echenard M, Eberhart R, et al. Evaluation of maternal thyroid function during pregnancy: the importance of using gestational age-specific reference intervals. Eur J Endocrinol 2007;157:509-514. https://doi.org/10.1530/EJE-07-0249
  18. Sang Z, Wei W, Zhao N, et al. Thyroid dysfunction during late gestation is associated with excessive iodine intake in pregnant women. J Clin Endocrinol Metab 2012;97:E1363-E1369. https://doi.org/10.1210/jc.2011-3438
  19. Soldin OP, Soldin D, Sastoque M. Gestation-specific thyroxine and thyroid stimulating hormone levels in the United States and worldwide. Ther Drug Monit 2007;29:553-559. https://doi.org/10.1097/FTD.0b013e31815709ac
  20. Bocos-Terraz JP, Izquierdo-Alvarez S, Bancalero-Flores JL, et al. Thyroid hormones according to gestational age in pregnant Spanish women. BMC Res Notes 2009;2:237. https://doi.org/10.1186/1756-0500-2-237
  21. Marwaha RK, Chopra S, Gopalakrishnan S, et al. Establishment of reference range for thyroid hormones in normal pregnant Indian women. BJOG 2008;115:602-606. https://doi.org/10.1111/j.1471-0528.2008.01673.x
  22. Li C, Shan Z, Mao J, 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;99:73-79. https://doi.org/10.1210/jc.2013-1674
  23. Fuse Y, Ohashi T, Yamaguchi S, Yamaguchi M, Shishiba Y, Irie M. Iodine status of pregnant and postpartum Japanese women: effect of iodine intake on maternal and neonatal thyroid function in an iodine-sufficient area. J Clin Endocrinol Metab 2011;96:3846-3854. https://doi.org/10.1210/jc.2011-2180
  24. Lee JY, Park JS, Jun JK, Shin SH, Ko YJ, Park SM. The associations between bridal pregnancy and obstetric outcomes among live births in Korea: population-based study. PLoS One 2014;9:e103178. https://doi.org/10.1371/journal.pone.0103178
  25. Yang JH, Kim YJ, Chung JH, et al. A multi-center study for birth defect monitoring systems in Korea. J Korean Med Sci 2004;19:509-513. https://doi.org/10.3346/jkms.2004.19.4.509

피인용 문헌

  1. Wider reference ranges of serum thyroid stimulating hormone in pregnant Korean women: is it time to stop overtreatment? vol.33, pp.3, 2018, https://doi.org/10.3904/kjim.2018.131
  2. Letter: Thyroid-Stimulating Hormone Reference Ranges in the First Trimester of Pregnancy in an Iodine-Sufficient Country ( Endocrinol Metab 2018;33:466-72, Carmen Castillo et al.) vol.34, pp.1, 2018, https://doi.org/10.3803/enm.2019.34.1.93
  3. Recent Issues Related to Thyroid Disease in Pregnancy vol.13, pp.2, 2018, https://doi.org/10.11106/ijt.2020.13.2.85
  4. Pattern analysis for prognosis of differentiated thyroid cancer according to preoperative serum thyrotropin levels vol.11, pp.1, 2021, https://doi.org/10.1038/s41598-021-01898-9