Evidence map›Paper›PMID 39083675›Full record

SynthesisThe Journal of clinical endocrinology and metabolism2024

Defining Gestational Thyroid Dysfunction Through Modified Nonpregnancy Reference Intervals: An Individual Participant Meta-analysis.

Joris A J Osinga, Scott M Nelson, John P Walsh, Ghalia Ashoor, Glenn E Palomaki, Abel López-Bermejo, Judit Bassols, Ashraf Aminorroaya, Maarten A C Broeren, Liangmiao Chen and 26 more

Abstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Journal of clinical endocrinology and metabolism, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

36 authors.

Joris A J OsingaDepartment of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands.ORCID 0000-0003-2527-5150
Scott M NelsonSchool of Medicine, Dentistry and Nursing, University of Glasgow, G12 8QQ Glasgow, UK.
John P WalshDepartment of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia.ORCID 0000-0002-1766-2612
Ghalia AshoorHarris Birthright Research Center for Fetal Medicine, King's College Hospital, SE5 9RS London, UK.
Glenn E PalomakiDepartment of Pathology and Laboratory Medicine, Women & Infants Hospital and Alpert Medical School at Brown University, RI 02903 Providence, USA.ORCID 0000-0001-6154-8449
Abel López-BermejoPediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, 17007 Girona, Spain.ORCID 0000-0002-5828-8911
Judit BassolsMaternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, 17007 Girona, Spain.
Ashraf AminorroayaIsfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, 81745-33871 Isfahan, Iran.
Maarten A C BroerenLaboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, 5504 DB Veldhoven, Netherlands.
Liangmiao ChenDepartment of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, 325035 Wenzhou, China.
Xuemian LuDepartment of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, 325035 Wenzhou, China.
Suzanne J BrownDepartment of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia.ORCID 0000-0002-8413-561X
Flora VeltriEndocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium.
Kun HuangDepartment of Maternal, Child and Adolescent Health, Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, 230032 Anhui, China.
Tuija MännistöNordLab, Oulu and Translational Medicine Research Unit, University of Oulu, 90570 Oulu, Finland.
Marina VafeiadiDepartment of Social Medicine, School of Medicine, University of Crete, 710 03 Heraklion, Crete, Greece.
Peter N TaylorThyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, CF10 3EU Cardiff, UK.
Fang-Biao TaoDepartment of Maternal, Child and Adolescent Health, Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, 230032 Anhui, China.
Lida ChatziDepartment of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA.
Maryam KianpourIsfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, 81745-33871 Isfahan, Iran.
Eila SuvantoDepartment of Obstetrics and Gynecology and Medical Research Center Oulu, University of Oulu, 90570 Oulu, Finland.
Elena N GrinevaInstitute of Endocrinology, Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia.
Kypros H NicolaidesDepartment of Women and Children's Health, Faculty of Life Sciences and Medicine King's College London, SE5 9RS London, UK.
Mary E D'AltonDepartment of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY 10032, USA.
Kris G PoppeEndocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium.
Erik AlexanderDivision of Endocrinology, Hypertension and Diabetes, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Ulla Feldt-RasmussenDepartment of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
Sofie BliddalDepartment of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.ORCID 0000-0002-2456-1019
Polina V PopovaInstitute of Endocrinology, Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia.
Layal ChakerDepartment of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands.
W Edward VisserDepartment of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands.
Robin P PeetersDepartment of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands.ORCID 0000-0001-7732-9371
Arash DerakhshanDepartment of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands.ORCID 0000-0001-7335-1918
Tanja G M VrijkotteDepartment of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, 1081 HV Amsterdam, the Netherlands.
Victor J M PopDepartment of Medical and Clinical Psychology, Tilburg University, 5000 LE Tilburg, the Netherlands.
Tim I M KorevaarDepartment of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands.

Funding

Netherlands Organization for Scientific Research 401.16.020Vidi grant 016.176.331
6 · The paper itself

Abstract

backgroundEstablishing local trimester-specific reference intervals for gestational TSH and free T4 (FT4) is often not feasible, necessitating alternative strategies. We aimed to systematically quantify the diagnostic performance of standardized modifications of center-specific nonpregnancy reference intervals as compared to trimester-specific reference intervals.

methodsWe included prospective cohorts participating in the Consortium on Thyroid and Pregnancy. After relevant exclusions, reference intervals were calculated per cohort in thyroperoxidase antibody-negative women. Modifications to the nonpregnancy reference intervals included an absolute modification (per .1 mU/L TSH or 1 pmol/L free T4), relative modification (in steps of 5%) and fixed limits (upper TSH limit between 3.0 and 4.5 mU/L and lower FT4 limit 5-15 pmol/L). We compared (sub)clinical hypothyroidism prevalence, sensitivity, and positive predictive value (PPV) of these methodologies with population-based trimester-specific reference intervals.

resultsThe final study population comprised 52 496 participants in 18 cohorts. Optimal modifications of standard reference intervals to diagnose gestational overt hypothyroidism were -5% for the upper limit of TSH and +5% for the lower limit of FT4 (sensitivity, .70, CI, 0.47-0.86; PPV, 0.64, CI, 0.54-0.74). For subclinical hypothyroidism, these were -20% for the upper limit of TSH and -15% for the lower limit of FT4 (sensitivity, 0.91; CI, 0.67-0.98; PPV, 0.71, CI, 0.58-0.80). Absolute and fixed modifications yielded similar results. CIs were wide, limiting generalizability.

conclusionWe 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.

Indexed as

HypothyroidismPregnancy ComplicationsThyroid Function TestsThyrotropinThyroxineFemaleHumansPregnancyPregnancy TrimestersProspective StudiesReference ValuesThyrotropinThyroxinepregnancyreference valuesthyroid function teststhyroid glandthyrotropinthyroxine

Identifiers

PMID39083675
PMCPMC11479686

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.