Lambert-Messerlian Geralyn, McClain Monica, Haddow James E, Palomaki Glenn E, Canick Jacob A, Cleary-Goldman Jane, Malone Fergal D, Porter T Flint, Nyberg David A, Bernstein Peter, D'Alton Mary E
Warren Alpert Medical School of Brown University, Providence, RI, USA.
Am J Obstet Gynecol. 2008 Jul;199(1):62.e1-6. doi: 10.1016/j.ajog.2007.12.003.
The purpose of this study was to calculate first and second trimester reference ranges and within-woman correlations for TSH, free T4, and thyroid antibodies.
TSH, free T4, and thyroid antibodies were measured in paired sera from 9562 women in the FaSTER trial of Down syndrome screening.
The median first trimester TSH (1.05 mIU/L) is lower than the second (1.23 mIU/L); and 98th centile is higher (4.15 vs 3.77 mIU/L). Within-woman paired TSH correlations are moderately strong (r(2) = 0.64). Among women with first trimester TSH values above the 98th centile, second trimester values are over the 95th centile in 68%. Median first trimester free T4 values (1.10 ng/dL) are higher than second (1.01 ng/dL). Paired free T4 measurements correlate weakly (r(2) = 0.23). Among women with first trimester free T4 values below the 2nd centile, second trimester values are below the 5th centile in 32%. Antibody measurements correlate strongly between trimesters (thyroperoxidase r(2) = 0.79, thyroglobulin r(2) = 0.83).
TSH and free T4 measurements require gestation-specific reference ranges.
本研究旨在计算孕早期和孕中期促甲状腺激素（TSH）、游离甲状腺素（free T4）及甲状腺抗体的参考范围和个体内相关性。
在唐氏综合征筛查的FaSTER试验中，对9562名女性的配对血清进行TSH、游离T4和甲状腺抗体检测。
孕早期TSH中位数（1.05 mIU/L）低于孕中期（1.23 mIU/L）；第98百分位数则较高（4.15对3.77 mIU/L）。个体内配对TSH相关性中等强度（r² = 0.64）。在孕早期TSH值高于第98百分位数的女性中，68%的孕中期值超过第95百分位数。孕早期游离T4中位数（1.10 ng/dL）高于孕中期（1.01 ng/dL）。配对游离T4测量相关性较弱（r² = 0.23）。在孕早期游离T4值低于第2百分位数的女性中，32%的孕中期值低于第5百分位数。孕期抗体测量相关性较强（甲状腺过氧化物酶r² = 0.79，甲状腺球蛋白r² = 0.83）。
TSH和游离T4测量需要特定孕周的参考范围。
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