{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T22:05:12Z","timestamp":1791929112517,"version":"4.3.4"},"reference-count":42,"publisher":"The Endocrine Society","issue":"11","license":[{"start":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T00:00:00Z","timestamp":1722384000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003246","name":"Netherlands Organization for Scientific Research","doi-asserted-by":"publisher","award":["401.16.020"],"award-info":[{"award-number":["401.16.020"]}],"id":[{"id":"10.13039\/501100003246","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Vidi grant","award":["016.176.331"],"award-info":[{"award-number":["016.176.331"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Establishing 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We 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\u2005pmol\/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\u2005pmol\/L). We compared (sub)clinical hypothyroidism prevalence, sensitivity, and positive predictive value (PPV) of these methodologies with population-based trimester-specific reference intervals.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The final study population comprised 52 496 participants in 18 cohorts. Optimal modifications of standard reference intervals to diagnose gestational overt hypothyroidism were \u22125% 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 \u221220% for the upper limit of TSH and \u221215% 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgae528","type":"journal-article","created":{"date-parts":[[2024,7,30]],"date-time":"2024-07-30T19:30:40Z","timestamp":1722367840000},"page":"e2151-e2158","source":"Crossref","is-referenced-by-count":6,"title":["Defining Gestational Thyroid Dysfunction Through Modified Nonpregnancy Reference Intervals: An Individual Participant Meta-analysis"],"prefix":"10.1210","volume":"109","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2527-5150","authenticated-orcid":false,"given":"Joris A J","family":"Osinga","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Erasmus University Medical Center , 3000 CA Rotterdam ,","place":["the Netherlands"]},{"name":"Academic Center for Thyroid Diseases, Erasmus University Medical Center , 3000 CA Rotterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott M","family":"Nelson","sequence":"additional","affiliation":[{"name":"School of Medicine, Dentistry and Nursing, University of Glasgow , G12 8QQ Glasgow ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1766-2612","authenticated-orcid":false,"given":"John P","family":"Walsh","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital , Nedlands, WA 6009 ,","place":["Australia"]},{"name":"Medical School, University of Western Australia , Crawley, WA 6009 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghalia","family":"Ashoor","sequence":"additional","affiliation":[{"name":"Harris Birthright Research Center for Fetal Medicine, King's College Hospital , SE5 9RS London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6154-8449","authenticated-orcid":false,"given":"Glenn E","family":"Palomaki","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Women & Infants Hospital and Alpert Medical School at Brown University , RI 02903 Providence ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5828-8911","authenticated-orcid":false,"given":"Abel","family":"L\u00f3pez-Bermejo","sequence":"additional","affiliation":[{"name":"Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital , 17007 Girona ,","place":["Spain"]},{"name":"Departament de Ci\u00e8ncies M\u00e8diques, Universitat de Girona , 17003 Girona 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