Defining Gestational Thyroid Dysfunction Through Modified Nonpregnancy Reference Intervals: An Individual Participant Meta-analysis
Authors' conclusion
We could not identify modifications of nonpregnancy TSH and FT4 reference intervals that would enable centers to adequately approximate trimester-specific reference intervals. Future efforts should be turned toward studying the meaningfulness of trimester-specific reference intervals and risk-based decision limits.
Study context
- Population
- Pregnant women in prospective cohorts of the Consortium on Thyroid and Pregnancy; reference intervals calculated in TPOAb-negative women
- Participants
- 52,496 women18 cohorts
- Comparison
- Modified center-specific nonpregnancy reference intervals vs population-based trimester-specific reference intervals
- Outcome
- Diagnostic performance (hypothyroidism prevalence, sensitivity, PPV) of modified nonpregnancy reference intervals vs trimester-specific reference intervals
Methodological detailsprospective cohorts, Consortium on Thyroid and Pregnancy
- Prospective cohorts
- Consortium on Thyroid and Pregnancy
Pooled result
As reported in the abstract
Diagnosis of gestational overt hypothyroidism with optimal modification (−5% upper TSH limit, +5% lower FT4 limit) vs trimester-specific reference intervals
Sensitivity (CI 0.47-0.86)
.70
PPV
0.64
CI 0.54–0.74
Further pooled results
Diagnosis of subclinical hypothyroidism with optimal modification (−20% upper TSH limit, −15% lower free T4 (FT4) limit) vs trimester-specific reference intervals
- Sensitivity
- 0.91 (CI 0.67-0.98)
- PPV
- 0.71 (CI 0.58-0.80)
Absolute and fixed modifications
- Absolute and fixed modifications yielded similar results
Original publication
Defining Gestational Thyroid Dysfunction Through Modified Nonpregnancy Reference Intervals: An Individual Participant Meta-analysis. J Clin Endocrinol Metab. Published 31 July 2024. doi:10.
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