ETA2023 Poster Presentations Pregnancy (9 abstracts)
TSH elevation before or after a pregnancy according to unidentified maternal thyroid function and thyroid autoantibody status in the early pregnancy: A study of 13,664 danish pregnant women
Stine Linding Andersen 1 , Maja Hjelm Lundgaard 2 , Nanna Maria Uldall Torp 3 , Simon Lykkeboe 2 , Allan Carlé 4 , Jesper Karmisholt 4 , Inge Bülow Pedersen 4 , Peter Vestergaard 4 & Stig Andersen 5
1Aalborg University Hospital, Department of Clinical Medicine, Aalborg University, Department of Clinical Biochemistry, Aalborg, Denmark; 2Department of Clinical Biochemistry, Aalborg University Hospital, Denmark; 3Department of Clinical Biochemistry, Aalborg University Hospital, Department of Clinical Medicine, Aalborg University, Denmark; 4Department of Endocrinology, Aalborg University Hospital, Department of Clinical Medicine, Aalborg University, Denmark; 5Department of Geriatrics, Aalborg University Hospital, Department of Clinical Medicine, Aalborg University, Denmark
Objectives: One of the risk-based screening criteria for thyroid disease in pregnancy is previous abnormal thyroid function or thyroid autoantibody-positivity. We speculated on the frequency and results of thyroid function testing in women of fertile age as part of routine care before and after a pregnancy.
Methods: The North Denmark Region Pregnancy Cohort includes retrospective assessment of thyroid function and thyroid autoantibodies (ADVIA Centaur XPT, Siemens Healthineers) in stored biobank samples from early pregnant women, 2011-2015. For this study, all thyroid-stimulating hormone (TSH) analyses drawn as part of routine care, 2006-2022, were identified for each woman in the cohort. Elevated TSH before or after the pregnancy was defined by the non-pregnant upper reference limit (above 4.5 mIU/l) and the frequency was evaluated according to thyroid function and autoantibody status (thyroid peroxidase (TPO) and thyroglobulin (Tg) antibodies (Ab) using cohort- and method-specific cut-offs) in the early pregnancy biobank sample.
| Assessment in the early pregnancy biobank sample | All women | TSH assessed before the pregnancy | TSH before elevated | TSH assessed after the pregnancy | TSH after elevated |
| Maternal TSH (mIU/l) | n | n | n (%) | n | n (%) |
| < 0.1 | 370 | 188 | < 3 (NA) | 285 | 9 (3.2) |
| 0.1-2.5 | 12,080 | 6,398 | 151 (2.4) | 9,048 | 318 (3.5) |
| 2.6-3.5 | 772 | 392 | 69 (17.6) | 576 | 115 (20.0) |
| 3.6-6.0 | 357 | 191 | 56 (29.3) | 276 | 136 (49.3) |
| > 6.0 | 85 | 38 | 16 (42.1) | 65 | 50 (76.9) |
| Maternal TPO-/Tg-Ab | n | n | n (%) | n | n (%) |
| Positive | 2,120 | 1,092 | 125 (11.4) | 1,633 | 398 (24.4) |
| Negative | 11,544 | 6,104 | 168 (2.8) | 8,617 | 230 (2.7) |
Results: Altogether 13,664 singleton pregnant women without clinically detected and treated thyroid disease were included and retrospective assessment of TSH, TPO-Ab, and Tg-Ab in the early pregnancy biobank sample revealed that 812 (5.9%) had unidentified TSH outside the range of 0.1-3.5 mIU/l, and 15.5% were antibody-positive (Table). Considering then all TSH results from routine care, altogether 7,207 women (52.7%) had had TSH assessed before the pregnancy under study (median 2.5 years before; median 3 times), and 10,250 (75.0%) after the pregnancy (5.1 years after; 6 times). The frequency of elevated TSH before or after the pregnancy was increased with increasing maternal TSH in the early pregnancy biobank sample and among thyroid autoantibody-positive women (Table).
Conclusions: Routine assessment of thyroid function in Danish women of fertile age is commonly performed. A substantial number of women with unidentified elevated TSH in early pregnancy previously had or later encountered an elevated TSH.
Volume 92
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Endocrine Abstracts
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