Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Nomogram-based evaluation of thyroid function in appropriate-for-gestational-age neonates in intensive care unit

Journal of Perinatology volume 35, pages 204–207 (2015)Cite this article

Subjects

Abstract

Objective:

The objective of this study was to help neonatologists to interpret the thyroid hormone results accurately, and also to provide reference ranges and/or nomograms of FT4 (free thyroxine) and thyrotropin against gestational age at postnatal 1 week and 1 month in order to assess thyroid function in AGA (appropriate for gestational age) neonates in intensive care unit.

Study Design:

This is a retrospective study. We included a total number of 515 AGA neonates between 24 and 42 weeks of gestation. Routine results of serum FT4 and TSH that had been analyzed with an immunoassay were collected from existing laboratory data. Least square regression analyses were used to estimate both the mean and the s.d. curves as polynomial functions of gestational age.

Result:

Free T4 levels were correlated with gestational age both at postnatal 1 week (r=0.39, P<0.001) and 1 month (r=0.26, P<0.001). Serum TSH levels at postnatal 1 week and 1 month did not show any correlation with gestational age. Scatterplots of FT4 levels against gestational age at 1 week and 1 month, showing the predicted 2.5th, 50th and 97.5th percentiles and central 95% reference ranges for TSH were provided.

Conclusion:

Gestational age-specific nomograms for FT4 and reference ranges for TSH at postnatal 1 week and 1 month in AGA neonates have been developed. This can help neonatologists to interpret the thyroid hormone results accurately. Further studies providing reference ranges/nomograms for thyroid function in small-for-gestational-age neonates are needed.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Fisher DA . Hypothyroxinemia in premature infants: is thyroxine treatment necessary? Thyroid 1999; 9: 715–720.

    Article  CAS  Google Scholar 

  2. Virtanen A, Kairisto V, Uusipaikka E . Regression-based reference limits: determination of sufficient sample size. Clin Chem 1998; 44: 2353–2358.

    CAS  PubMed  Google Scholar 

  3. Royston P . Constructing time-specific reference ranges. Stat Med 1991; 10: 675–690.

    Article  CAS  Google Scholar 

  4. Franco B, Laura F, Sara N, Salvatore G . Thyroid function in small for gestational age newborns: a review. J. Clin Res Pediatr Endocrinol 2013; 5 (Suppl 1): 2–7.

    Google Scholar 

  5. Ovali F . Intrauterine growth curves for Turkish infants born between 25 and 42 weeks of gestation. J Trop Pediatr 2003; 49: 381–383.

    Article  Google Scholar 

  6. Surks MI, Sievert R . Drugs and thyroid function. N Engl J Med 1995; 333: 1688–1694.

    Article  CAS  Google Scholar 

  7. Royston P, Wright EM . How to construct 'normal ranges' for fetal variables. Ultrasound Obstet Gynecol 1998; 11: 30–38.

    Article  CAS  Google Scholar 

  8. Wright E, Royston P . Age-specific reference intervals (‘normal ranges’). Stata Tech Bull 1996; 6: 24–34.

    Google Scholar 

  9. Ekins R . Measurement of free hormones in blood. Endocr Rev 1990; 11: 5–46.

    Article  CAS  Google Scholar 

  10. Holm SS, Andreasen L, Hansen SH, Faber J, Staun-Olsen P . Influence of adsorption and deproteination on potential free thyroxine reference methods. Clin Chem 2002; 48: 108–114.

    CAS  PubMed  Google Scholar 

  11. Vogeser M, Weigand M, Fraunberger P, Fischer H, Cremer P . Evaluation of the ADVIA Centaur TSH-3 assay. Clin Chem Lab Med 2000; 38: 331–334.

    Article  CAS  Google Scholar 

  12. Waskiewicz D, Burkhardt A, Emancipator K . Performance characteristics of 6 third-generation assays for thyroid-stimulating hormone. Clin Chem 2005; 51: 1904–1905.

    Article  CAS  Google Scholar 

  13. Hemmati F, Pishva N . Evaluation of thyroid status of infants in the intensive care setting. Singapore Med J 2009; 50: 875–878.

    CAS  PubMed  Google Scholar 

  14. Adams LM, Emery JR, Clark SJ, Carlton EI, Nelson JC . Reference ranges for newer thyroid function tests in premature infants. J Pediatr 1995; 126: 122–127.

    Article  CAS  Google Scholar 

  15. Clark SJ, Deming DD, Emery JR, Adams LM, Carlton EI, Nelson JC . Reference ranges for thyroid function tests in premature infants beyond the first week of life. J Perinatol 2001; 21: 531–536.

    Article  CAS  Google Scholar 

  16. Carrascosa A, Ruiz-Cuevas P, Potau N, Almar J, Salcedo S, Clemente M et al. Thyroid function in seventy-five healthy preterm infants thirty to thirty-five weeks of gestational age: a prospective and longitudinal study during the first year of life. Thyroid 2004; 14: 435–442.

    Article  Google Scholar 

  17. Mutlu M, Karagüzel G, Alıyazicioğlu Y, Eyüpoğlu I, Okten A, Aslan Y . Reference intervals for thyrotropin and thyroid hormones and ultrasonographic thyroid volume during the neonatal period. J Matern Fetal Neonatal Med 2012; 25: 120–124.

    Article  CAS  Google Scholar 

  18. Sheikhbahaei S, Mahdaviani B, Abdollahi A, Nayeri F . Serum thyroid stimulating hormone, total and free T4 during the neonatal period: Establishing regional reference intervals. Indian J Endocrinol Metab 2014; 18: 39–43.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Kapelari K, Kirchlechner C, Högler W, Schweitzer K, Virgolini I, Moncayo R . Pediatric reference intervals for thyroid hormone levels from birth to adulthood: a retrospective study. BMC Endocr Disord 2008; 8: 15.

    Article  Google Scholar 

  20. Bijarnia S, Wilcken B, Wiley VC . Newborn screening for congenital hypothyroidism in very-low-birth-weight babies: the need for a second test. J Inherit Metab Dis 2011; 34: 827–833.

    Article  Google Scholar 

  21. Korzeniewski SJ, Kleyn M, Young WI, Chaiworapongsa T, Schwartz AG, Romero R . Screening for congenital hypothyroidism in newborns transferred to neonatal intensive care. Arch Dis Child Fetal Neonatal Ed 2013; 98: 310–315.

    Article  Google Scholar 

  22. Kurtoglu S, Akcakus M, Kocaoglu C, Gunes T, Budak N, Atabek ME et al. Iodine status remains critical in mother and infant in Central Anatolia (Kayseri) of Turkey. Eur J Nutr 2004; 43: 297–303.

    Article  CAS  Google Scholar 

  23. Zhu L, Zhang X, He X, Yang X, Wang Y, Wang C et al. Reference intervals for serum thyroid hormones in preterm hospitalized infants. J Pediatr Endocrinol Metab 2013; 26: 463–467.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank all mothers and neonates who took part in this study and also express their appreciation to Mrs. Nevra Aktas for her excellent technical assistance. A partial grant from Turkish Academy of Sciences was used for purchasing the analysis software used in the study.

Author information

Authors and Affiliations

  1. Zeynep Kamil Maternity and Children’s Training and Research Hospital, Neonatal Intensive Care Unit, Istanbul, Turkey

    E Y Imamoglu, G Karatekin & F Ovali

  2. Department of Pediatrics, School of Medicine, Koç University, Istanbul, Turkey

    T Gursoy

  3. Preventive Oncology Department, Hacettepe Medical Faculty, Ankara, Turkey

    M Hayran

Authors
  1. E Y Imamoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T Gursoy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Hayran
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G Karatekin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F Ovali
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E Y Imamoglu.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Imamoglu, E., Gursoy, T., Hayran, M. et al. Nomogram-based evaluation of thyroid function in appropriate-for-gestational-age neonates in intensive care unit. J Perinatol 35, 204–207 (2015). https://doi.org/10.1038/jp.2014.181

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2014.181

This article is cited by

Search

Advanced search

Quick links