{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T22:55:56Z","timestamp":1780700156514,"version":"3.54.1"},"reference-count":34,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,12,16]],"date-time":"2024-12-16T00:00:00Z","timestamp":1734307200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Different definitions of thyroid dysfunction during pregnancy may lead to under or overtreatment. The aims of this study were to (1) define population\u2010based pregnancy\u2010specific reference ranges for thyroid dysfunction during early pregnancy in Nepal and assess the impact of antibody positivity, (2) quantify the diagnostic impact of population\u2010based reference ranges compared with current practice and (3) assess the determinants of thyroid function and antibody positivity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 800 healthy pregnant women aged 20\u201340 years in the Bhaktapur municipality were included. Population\u2010based reference ranges for thyroid hormones levels were defined as 2.5th and 97.5th percentiles using competitive immunoluminometric assay design. Thyroid disease cases and those with recommended treatment indications were calculated using current non\u2010pregnancy new reference ranges. Multivariate regression analyses were performed to identify the determinants of thyroid hormones and antibody levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median gestational age was 11 weeks. The reference interval was 0.05\u20133.69\u2009\u00b5LU\/mL for thyroid stimulating hormone (TSH) and 8.89\u201315.28\u2009pg\/mL for free tetraiodothyronine (fT4) after excluding thyroid peroxidase antibody\u2010positive women. Compared with the current non\u2010pregnancy reference ranges, the new calculations increased the number of women who required treatment from 5 to 12 (0.9% increase). We identified 19 women (2.4%) who were positive for TSH receptor antibody (TRAb). We could not identify the determinants of TRAb positivity, and TRAb positivity was not associated with TSH or fT4 levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We found meaningful changes using population\u2010based pregnancy\u2010specific TSH and fT4 reference intervals and encourage further studies in other low\u2010 and middle\u2010income settings. Our findings suggest that population screening for TRAb is not clinically meaningful.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>Clinical Trial Registration: U1111\u20101183\u20104093.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.15175","type":"journal-article","created":{"date-parts":[[2024,12,16]],"date-time":"2024-12-16T10:40:49Z","timestamp":1734345649000},"page":"332-343","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Reference Ranges and Determinants of Thyroid Function and TSH Receptor Antibodies During Early Pregnancy in Nepal"],"prefix":"10.1111","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9308-3367","authenticated-orcid":false,"given":"Kjersti S.","family":"Bakken","sequence":"first","affiliation":[{"name":"Center for International Health University of Bergen Bergen Norway"},{"name":"Women's Clinic, Innlandet Hospital Trust Lillehammer Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apeksha","family":"Niraula","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, Institute of Medicine Tribhuvan University Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ram K.","family":"Chandyo","sequence":"additional","affiliation":[{"name":"Department of Community Medicine Kathmandu Medical College Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjeswori","family":"Ulak","sequence":"additional","affiliation":[{"name":"Center for International Health University of Bergen Bergen Norway"},{"name":"Department of Child Health, Institute of Medicine Tribhuvan University Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laxman","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Department of Child Health, Institute of Medicine Tribhuvan University Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay Kumar","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, Institute of Medicine Tribhuvan University Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tor A.","family":"Strand","sequence":"additional","affiliation":[{"name":"Center for International Health University of Bergen Bergen Norway"},{"name":"Department of Research Innlandet Hospital Trust Lillehammer Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7961-8791","authenticated-orcid":false,"given":"Tim I. M.","family":"Korevaar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Academic Center for Thyroid Diseases, Erasmus University Medical Center Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,12,16]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtemb.2012.03.004"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2016.0457"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199908193410801"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.19052"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13724"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.10931"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(19)30153-6"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2017.93"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.3126\/jnhrc.v15i2.18182"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.31729\/jnma.5529"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad564"},{"key":"e_1_2_9_13_1","volume-title":"Population","author":"Ministry of Health and Population, New ERA, UNICEF","year":"2016"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu8050255"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)00346-X"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/1478-7954-12-8"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgac425"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2018-00890"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/182472"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgac383"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/cei.12980"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2017.0413"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.3126\/nmcj.v21i3.26470"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.6065\/apem.2244186.093"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2007-0732"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-2960"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2015.0153"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.14793"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13044-019-0067-z"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.3803\/EnM.2014.29.3.240"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-10-1041"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-14-0047"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/MED.0b013e328355cd6c"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa567"},{"key":"e_1_2_9_35_1","doi-asserted-by":"crossref","unstructured":"L.Kn\u00f8sgaard S.Andersen A. 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