Specific Reference Range Research Articles

A-071 Macroprolactin Screening in Patients with Hyperprolactinemia: Comparison Between Different Criteria for Defining Macroprolactinemia

Abstract Background Prolactin (PRL) exists in different forms in human serum. The predominant form is monomeric PRL, the other forms include dimeric PRL and polymeric PRL, also known as macroprolactin, a biologically inactive form. Macroprolactin can be measured by almost all immunoassays for PRL. This may lead to misdiagnosis and mismanagement of patients. Polyethylene glycol (PEG) precipitation is the most widely used method for detecting macroprolactin, generally employing a cutoff of 40% to distinguish macroprolactinemia from true hyperprolactinemia. This approach lacks specificity, so the reported result may be misinterpreted in cases in which excess macroprolactin occurs simultaneously with supraphysiological concentrations of monomeric prolactin. Nowadays, it is recommended to report results as post-PEG PRL using method-specific post-PEG reference intervals, classifying as macroprolactinemia (false or pseudohyperprolactinemia) those individuals with post- PEG PRL within post-PEG reference intervals and true hyperprolactinemia above the upper limit of the post-PEG reference interval. The objective of this study was to evaluate the prevalence of macroprolactinemia in patients with hyperprolactinemia using two different criteria, a cutoff < 40% in PEG precipitation and a post- PEG PRL within post-PEG assay specific reference range. Methods We analyzed blood samples requesting serum macroprolactin from patients admitted to a private reference clinical laboratory in Rio de Janeiro, Brazil, from 01/01/2019 to 12/31/2023. Anonymized data on laboratory tests was available from a database of the local Laboratory Information System. All patients included had PRL levels above the reference range, males >15.2 ng/mL, females >23.3 ng/mL (ECLIA, Modular, Roche). Results 9423 patients, 80.1% women (W) were evaluated. Men (M) were statistically significantly older than women (p<0.001) (45.6; SD=15.0 vs. 38.9; SD=11.5). Prolactin median levels were significantly higher in women (p<0.001) than men (37.4ng/mL, IQR=26 vs. 23.8ng/mL, IQR=17.1). Macroprolactinemia detection was greater (p<0.001) by post-peg PRL concentration criteria (9.7% - 10.1%W vs. 8.4%M), than by < 40% PRL recovery criteria (5.5% - 5.7%W vs. 4.8%M). Dividing patients by prolactin levels (<50.0; 50.0 to <100.0; 100.0 to <150.0, >150.0 ng/mL, we found macroprolactinemia in 5.2% (5.2%W vs. 5.2%M), 7.7% (8.2%W vs. 2.4%M), 2.8% (2.8%W vs. 2.5%M) and 1.6% (1.3%W vs. 2.6%M) - <40% PRL recovery criteria; and 12.1% (12.8%W vs. 9.8%M), 4.4% (4.8%W vs. 0.6%M), 0.8% (0.8%W vs. 0%M), 0.0% (0%W vs. 0%M) - post-PEG PRL concentration criteria. By the last criteria, no patient with total PRL more than 150 ng/mL had macroprolactinemia. Conclusions The criterion for defining macroprolactinemia has a big impact on the study results and needs to be considered in data interpretation and comparison with other studies. PEG precipitation is an easy and fast screening method for macroprolactin. Its main purpose should be determining whether the bioactive monomeric prolactin concentration is increased which is why the post-PEG PRL with corresponding reference interval is the most suitable way of reporting results.

Trimester specific thyroid hormone reference range in mild iodine deficiency compared to normal iodine nutrition

Trimester specific thyroid hormone reference range in mild iodine deficiency compared to normal iodine nutrition

Development of Duffy Null–Specific Absolute Neutrophil Count Reference Ranges

This study establishes a Duffy null phenotype–specific absolute neutrophil count reference range to optimize care and improve health equity.

Evaluating a locally derived autoantibody specific reference range for the diagnosis of myositis

Background: Myositis associated (MAA), and myositis specific antibodies (MSA) are important for supporting the diagnosis of idiopathic inflammatory myopathies (IIM). Given the rarity of these autoantibodies, assay performance cannot easily be evaluated. The aim of this study was to retrospectively review the performance and determine a local reference range for the detection of myositis autoantibodies measured on the Euroimmun line immunoblot assay (LIA).

A Cross-Sectional Growth Reference and Chart of Stretched Penile Length for Egyptian Prepubertal Boys Aged 5-9 Years: A Single Center Study

Penile length is very important for evaluation of the normal external genitalia and detection of genital anomalies such as macro- and micro-penis. Establishing a normal population, age specific reference range for penile length helps in both accurate evaluation of penile size and early detection of any penile abnormalities

Therapeutic drug monitoring of perampanel in children diagnosed with epilepsy: Focus on influencing factors on the plasma concentration-to-dose ratio.

This study aimed to investigate the efficacy and tolerability of perampanel (PER) therapy and to optimize a specific plasma reference range for PER in children. Another major aim was to evaluate the potential determinators of PER concentration. Concentrations obtained from 80 children were analyzed for routine therapeutic drug monitoring (TDM) between 2021 and 2022. We retrospectively reviewed the clinical data of these patients and assessed the efficacy at 3 months after treatment initiation. Trough concentration-to-dose ratio (C0 /Dose ratio) of PER was compared among patients on various potential influencing factors. A 3-month PER therapy produced a ≥50% reduction in seizure frequency in 58.8% of patients. Twelve patients reported at least one adverse effect (AE), mainly dizziness. The monitoring data showed that the median C0 was 325.5ng/mL. Under maintenance dosages, approximately 75% of the C0 values were 180.0-610.0ng/mL. The C0 /Dose ratio in patients aged 1 to <4 was significantly lower by twofold than in those aged 4 to ≤12 years (P= 0.001). Enzyme-inducing ASMs (EIASMs) decreased the C0 /Dose ratio of PER by 25.9% (P= 0.165). In addition, seizure frequency reduction in responders was achieved at a median PER C0 value of 357 ng/mL, which was similar to the value of 314 ng/mL found in nonresponders (P= 0.288). No significant difference was found in PER C0 values between patients with and without AEs (P= 0.082). In this study, PER treatment showed acceptable efficacy and tolerance in Chinese children with epilepsy. Contributing factors like age to variable C0 /Dose ratios were identified, and complex PER-ASMs interactions were observed. Notably, the reference range, that is, 180.0-610.0ng/mL, for routine PER monitoring may be more applicable for them. Routine TDM should be considered a positive attempt to manage the effectiveness and safety of PER.

Intrahepatic cholestasis of pregnancy: Green-top Guideline No. 43 June 2022.

Intrahepatic cholestasis of pregnancy: Green-top Guideline No. 43 June 2022.

Biochemical assessment of adequate levothyroxine replacement in primary hypothyroidism differs with different TSH assays: potential clinical implications

AimThyroid stimulating hormone (TSH) assays provided by Abbott Laboratories and Roche Diagnostics are used by approximately 75% of laboratories in the UK. We assessed the potential impact of Abbott and...

Gender-Dependent Reference Range of Serum Calcitonin Levels in Healthy Korean Adults.

BackgroundSerum calcitonin measurement contains various clinical and methodological aspects. Its reference level is wide and unclear despite sensitive calcitonin kits are available. This study aimed to identify the specific reference range in the healthy Korean adults.MethodsSubjects were ≥20 years with available calcitonin (measured by a two-site immunoradiometric assay) data by a routine health checkup. Three groups were defined as all eligible subjects (group 1, n=10,566); subjects without self or family history of thyroid disease (group 2, n=5,152); and subjects without chronic kidney disease, autoimmune thyroid disease, medication of proton pump inhibitor/H2 blocker/steroid, or other malignancies (group 3, n=4,638).ResultsThis study included 6,341 male and 4,225 female subjects. Males had higher mean calcitonin than females (2.3 pg/mL vs. 1.9 pg/mL, P<0.001) in group 1. This gender difference remained similar in groups 2 and 3. Calcitonin according to age or body mass index was not significant in both genders. Higher calcitonin in smoking than nonsmoking men was observed but not in women. Sixty-nine subjects had calcitonin higher than the upper reference limit (10 pg/mL) and 64 of them had factors associated with hypercalcitoninemia besides medullary thyroid cancer. Our study suggests the reference intervals for men who were non, ex-, current smokers, and women (irrespective of smoking status) as <5.7, <7.1, <7.9, and <3.6 pg/mL, respectively.ConclusionSpecific calcitonin reference range should be provided considering for sex and smoking status. Taking account for several factors known to induce hypercalcitoninemia can help interpret the gray zone of moderately elevated calcitonin.

Thyroid Disorders in Pregnancy: Role of Routine Antenatal Thyroid Screening

Background &amp; objective:Thyroid disorders are among the common endocrine problems during pregnancy with well-known adverse effects on both mother and fetus. Many of these adverse effects could be prevented or ameliorated by early detection and appropriate treatment of conditions, provided routine antenatal thyroid screening is done. Considering this view, the present study was aimed to find the prevalence of thyroid disorders and their spectrum in pregnancy in order to justify the necessity of routine antenatal thyroid screening.&#x0D; Methods: This cross-sectional study was conducted in the Department of Obstetrics &amp; Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka over a period 1 year from July 2012 to June 2013 on pregnant women to screen for the thyroid disorders in pregnancy. Based on predefined eligibility criteria, a total of 246 pregnant women up to 36 weeks of gestation were consecutively included in the study. A short history with brief physical examination was done followed by collection of blood samples. Thyroid function was assessed by measuring serum levels of thyroid stimulating hormone (TSH). Serum free thyroxin (FT4) level was estimated in 71 cases, where TSH value was deranged. Trimester specific reference range of serum TSH was used to define hypothyroid, euthyroid and hyperthyroid cases. The suspected risk factors were then compared between abnormal and euthyroid groups to find their association with thyroid disorders.&#x0D; Result: The results of the study showed that the overall prevalence of abnormal thyroid function status was 30.9% (hypothyroidism 29.7% and hyperthyroidism 1.2%) based on normal range of serum TSH in different trimesters of pregnancy. Pregnant women with thyroid disorders were generally older than their euthyroid counterparts (p = 0.039). Hypothyroid state was fairly common with advancing gestation (21.3%, 30.3% and 34% in the 1st, 2nd, and 3rd, trimesters respectively). Pregnant women with personal or family history of thyroid disease in the past exhibited a higher prevalence of abnormal thyroid function than those who did not have such history (p = 0.041 and p = 0.044 respectively). Past menstrual irregularity, past history of subfertility or abortion were significantly associated with thyroid disorders (p = 0.042, p = 0.004 and p &lt; 0.001 respectively). Presence of goitre (21.1%) in current pregnancy also showed significant association with thyroid dysfunction (p = 0.001). The risk of developing abnormal thyroid function was observed to be 3.6(95% CI = 1.9 – 6.4) times higher in those who had at least one risk factor than those who did not have any risk factors (p &lt; 0.001). However, a sizable portion (27.6%) of pregnant women without any risk factors developed abnormal thyroid function.&#x0D; Conclusion: The study concluded that one in every three women may have thyroid disorder during pregnancy, primarily hypothyroidism. Adopting risk factor-based screening for thyroid disorders in pregnancy, there is every chance that a substantial number of cases with thyroid dysfunction may be missed. Therefore, routine antenatal thyroid screening is recommended.&#x0D; Ibrahim Card Med J 2020; 10 (1&amp;2): 74-83

A prospective study of placental growth factor in twin pregnancy and development of a dichorionic twin pregnancy specific reference range.

To develop a dichorionic twin pregnancy specific reference range for placental growth factor (PlGF), and to compare gestation-specific placental growth factor levels in twin pregnancies later complicated by pre-eclampsia, hypertensive disorder of pregnancy or fetal growth restriction with control pregnancies. Prospective observational study. Single large tertiary maternity unit in Ireland. Women with a twin pregnancy. Consenting pregnant women, across a variety of gestations, had a single blood sample taken at one time-point only during their pregnancy. The plasma was initially biobanked and PlGF was measured later in batches using the point of care Triage® PlGF test. Development of pre-eclampsia, hypertensive disorder of pregnancy or fetal growth restriction. Placental growth factor levels in uncomplicated dichorionic twin pregnancies were significantly lower in the women who later developed pre-eclampsia than in the controls at all gestational intervals. In those that later developed any hypertensive disorder of pregnancy, median PlGF was lower only in those recruited before 24weeks of gestation, whereas in infants with a customised birthweight below the third centile, PlGF was lower only in those sampled after 24weeks of gestation. Placental growth factor levels in twin pregnancy differ significantly between those women with a pregnancy that will later be complicated by pre-eclampsia and those that will not. This difference is present many weeks before clinical signs or symptoms of disease are present. Using cross-sectional values from uncomplicated twin pregnancies, we have developed a dichorionic twin pregnancy specific reference range for PlGF. Placental growth factor levels in twin pregnancy differ significantly between women that will later develop pre-eclampsia and those that will not.

A systematic review and combined meta-analysis of concentration of oral amisulpride.

Amisulpride, a first-line schizophrenia treatment, has shown large interindividual variability in plasma/serum levels, often outside the reference range (100-320 ng/mL). This study aims to clarify the impact of dose, sex, age and related factors for the interpatient variability in amisulpride plasma/serum concentration. Both English and Chinese databases were searched from their inception to May 16, 2019, using the terms: amisulpride and (plasma OR serum OR blood OR "drug monitoring" OR concentration). Studies reporting concentrations and either a dose, associated factor, clinical outcome or side effect were included. Fourteen studies with 1628 participants were eventually included. Eligible articles yielded data on drug concentration and dose, averaging 333.9 (95% confidence interval [CI]: 294.5-373.3) ng/mL and 636.2 (95% CI: 549.7-722.6) mg/d, respectively. The calculated mean concentration-to-dose (C/D) ratio was 0.60 (95% CI: 0.52-0.67) (ng/mL)/mg. Subgroup analysis suggested that female patients on combined lithium-amisulpride have higher concentration levels and C/D ratios. Age was slight positive associated with C/D ratio while not for plasma level. Smoker patients have high concentration level than nonsmoking patients but not for C/D. Responsive and nonresponsive groups did not differ in concentration and C/D. Pooled concentration levels of amisulpride were higher than recommended with wide individual variation, especially in older patients, female patients and patients taking amisulpride combined with lithium. The specific therapeutic reference range for amisulpride may require reconstruction, which should consider the influence of age, sex, kidney function, drug-drug interactions, different dose regimens and sampling times in future study.

Haematological and biochemical analysis of healthy neonatal puppies during the immediate foetal-to-neonatal transition.

For the neonatal patient, precocity of diagnosis is crucial for effectiveness of medical approach. However, the newborn has its own physiological peculiarities due to ongoing adaptive mechanism for extrauterine life and deserves special attention in order to underline a specific management or clinical approach. The objective of this work was to verify clinical adaptations and biochemical balance of neonates during immediate period, with special reference to haematological, renal and metabolic functions. Neonatal puppies (n=51) were physically examined for vitality and rectal temperature at birth, 5 and 60min post-birth. Blood was collected at birth and 60min post-birth for analysis of glucose, sodium, potassium, chlorine, blood urea nitrogen (BUN), haematocrit and haemoglobin. Neonatal vitality was lower at birth compared with 5min and 60min post-birth. Progressive decline in rectal temperature (36.5±0.3°C, 34.2±0.2°C, 32.3±0.5°C) was observed at birth, 5min and 60min post-birth, respectively. Puppies presented slight hyponatremia (140.7±0.5mmol/L) at birth and hypopotassemia (3.5±0.1mmol/L) and blood urea nitrogen (13.1±0.7mg/dl) during the first hour, and high haematocrit (45.1±1.0%) and haemoglobin (15.3±0.3g/dl) concentration. In conclusion, puppies had rapid evolution of vitality. Marked decrease in rectal temperature occurred at 5min post-birth. Haematological values of neonates immediately after birth reflected mainly the dam's blood status, not being useful for a blood panel at this time point. The peculiar pattern of BUN, sodium and potassium observed during transition period, suggested that specific reference range should be considered for neonatal puppies.

Establishment and correlation of age specific reference range of psa and psa density in patients of benign prostatic hyperplasia

Establishment and correlation of age specific reference range of psa and psa density in patients of benign prostatic hyperplasia

Variations of plasma D-dimer level at various points of normal pregnancy and its trends in complicated pregnancies: A retrospective observational cohort study.

D-Dimer (DD) is the smallest fragment of plasmin-mediated cleavage of fibrin. There is a progressive increase in DD concentration with advancing gestation in normal pregnancies, making the upper limit of 0.5 μg/ml used in non-pregnant population an unfavorable marker during pregnancy. Coagulation and fibrinolysis parameters are also markedly disturbed in pregnancies complicated by various pathologies.We designed this retrospective observational cohort study to investigate the trimester specific reference range for DD throughout normal pregnancy, and to compare the distribution of DD in third trimester healthy pregnancies and those complicated by preeclampsia (PE), severe preeclampsia (SPE), gestational diabetes mellitus (GDM), premature rupture of membranes (PROM) and preterm premature rupture of membranes (PPROM). In addition, we aimed to determine the diagnostic value of DD in PE and SPE.In this retrospective observational cohort study, 250 normal and 178 complicated pregnancies were included. Normal pregnancies included 88-first trimester, 101-second trimester and 61-third trimester pregnancies. Complicated pregnancy included 34 PE, 44 SPE, 32 GDM, 33 PROM, and 35 PPROM cases during the third trimester. Predefined exclusion criteria were used.The period of gestation (POG) accounted for 41.9% of the variance in DD, with strong correlation between the POG and DD. The trimester specific reference intervals were computed. The distribution for severe preeclampsia was statistically different compared to other categories in the third trimester. This exceptional distribution led to the generation of a receiver operating characteristic (ROC) curve with an area under curve of 0.828, attesting its possible role in predicting severe preeclampsia.We determined trimester specific reference intervals of DD. The role of DD has been explored, and it may be of diagnostic value in severe preeclampsia.

Utility of serum IGF-1 for diagnosis of growth hormone deficiency following traumatic brain injury and sport-related concussion

BackgroundGrowth hormone deficiency (GHD) is a potential consequence of traumatic brain injury (TBI), including sport-related concussion (SRC). GH stimulation testing is required for definitive diagnosis; however, this is resource intensive and can be associated with adverse symptoms or risks. Measurement of serum IGF-1 is more practical and accessible, and pituitary tumour patients with hypopituitarism and low serum IGF-1 have been shown to have a high probability of GHD. We aimed to evaluate IGF-1 measurement for diagnosing GHD in our local TBI population.MethodsWe conducted a retrospective chart review of patients evaluated for GHD at the TBI clinic and referred for GH stimulation testing with insulin tolerance test (ITT) or glucagon stimulation test (GST) since December 2013. We obtained demographics, TBI severity, IGF-1, data pertaining to pituitary function, and GH stimulation results. IGF-1 values were used to calculate z-scores per age and gender specific reference ranges. Receiver operator curve analysis was performed to evaluate diagnostic threshold of IGF-1 z-score for determining GHD by GST or ITT.ResultsSixty four patient charts were reviewed. 48 patients had mild, six had moderate, eight had severe TBI, and two had non-traumatic brain injuries. 47 patients underwent ITT or GST. 27 were confirmed to have GHD (peak hGH < 5 μg/L). IGF-1 level was within the age and gender specific reference range for all patients with confirmed GHD following GH stimulation testing. Only one patient had a baseline IGF-1 level below the age and gender specific reference range; this patient had a normal response to GH stimulation testing. ROC analysis showed IGF-1 z-score AUC f, confirming lack of diagnostic utility.ConclusionBaseline IGF-1 is not a useful predictor of GHD in our local TBI population, and therefore has no value as a screening tool. TBI patients undergoing pituitary evaluation will require a dynamic test of GH reserve.

Assessment of normal range of thyroid function tests in healthy Egyptian pregnant women

Background: Gestational thyroid dysfunction has been associated with a variety of adverse pregnancy outcomes. This study aimed to determine trimester-specific reference intervals of thyroid function tests for normal pregnant Egyptian women. Subjects and Methods: A cross-sectional study was conducted at the Obstetric Clinic, Ain Shams University Hospitals. The total enrolled pregnant women were 360, who were divided into the following three groups according to gestational age: Group 1 included 120 participants in the first trimester; Group 2 included 120 participants in the second trimester; and Group 3 included 120 participants in the third trimester. All women were healthy with uncomplicated single intrauterine gestations. A detailed obstetric history, clinical examination, estimation of thyroid-stimulating hormone (TSH), free tetraiodothyronine (FT4), free triiodothyronine (FT3), antithyroid peroxidase antibodies, and thyroglobulin antibodies were done for all participated women. Results: TSH value increased with advancing pregnancy from 1.43 ± 1.16 μIU/mL in the first trimester to 1.78 ± 1.19 μIU/mL in the third trimester, and the difference between each trimester was statistically significant. The FT4 level decreased from 1.16 ± 0.23 ng/dL in the first trimester to 0.98 ± 0.17 ng/dL in the third trimester, and the difference was statistically significant. The FT3 level decreased from 3.18 ± 0.52 pg/ml in the first trimester to 2.79 ± 0.38 pg/ml in the third trimester, and the difference was statistically significant. Conclusion: There were significant changes of thyroid function test during each trimester of pregnancy, the reference ranges in this study are different from previous studies outside Egypt. Accordingly, it is necessary to use trimester specific reference range for every population.

P 16 Cross sectional study of placental growth factor in multiple pregnancy

Introduction Pre-eclampsia is a complex complication of pregnancy which may result in serious morbidity to both mother and baby. Women with a multiple pregnancy have a 2-3-fold increased risk of developing pre-eclampsia. Placental growth factor (PlGF) is an angiogenic biomarker for pre-eclampsia. The integration of its use into routine care in assessment of women presenting with suspected pre term pre-eclampsia is currently the subject of a number of international randomised controlled trials. Currently no reference range exists for PlGF specific to multiple pregnancy. Objectives To develop a multiple pregnancy specific reference range for PlGF using an enzyme-linked immunosorbent assay (ELISA). Methods Prospective cross sectional study of multiple pregnancies attending a tertiary maternity hospital from July 2015–March 2017. PIGF levels were measured in maternal plasma samples by Quantikine® ELISA. Results 200 samples were analysed, 160/200 from Dichorionic Diamniotic (DCDA) twin pregnancies and 32/200 from Monochorionic Diamniotic (MCDA) twin pregnancies. Gestational age ranged from 12–36 + 6 weeks” and PlGF ranged from 15 to 4720 pg/ml. The mean gestational PlGF tracks development of the placenta with a peak at 24–27 + 6 weeks” gestation and a reduction thereafter. See Table. Conclusion There does not appear to be a difference in mean gestational PlGF between DCDA and MCDA pregnancies to date however sample numbers are small. This twin specific reference range for PlGF may be used in assessment of a pregnant patient presenting with suspected preterm pre-eclampsia.

Current status of screening and management of thyroid diseases during pregnancy

Objective To investigate the current status of screening and management of thyroid diseases during pregnancy, and to provide evidence for further improvement of clinical management. Methods Clinical data of 5 981 pregnant women who delivered at Peking University First Hospital between September 1, 2013 and September 30, 2014 were analyzed retrospectively. Their average age was (30±4) years (18-47 years) and average gestational week was (39.2±1.6) weeks (25.5-42.0 weeks). The reference range of thyroid stimulating hormone (TSH) was 0.1-2.5 mU/L recommended by the American Thyroid Association (ATA). The reference range of free thyroxine (FT4) was 11.48-22.70 pmol/L and the cut-off value of thyroid peroxidase antibody (TPOAb) was 34 U/ml both recommended by the kit. The specific reference range of TSH was obtained from normal pregnant women in this study (0.23-4.08 mU/L in the first trimester). Pregnant women with hypothyroidism were divided into two groups according to their TSH level at the first trimester: TSH≥2.5-<4.08 mU/L group and TSH≥4.08 mU/L group. T test, Chi-square or Fisher's exact test were applied for statistical analysis. Results (1) Screening status: Of the 5 981 pregnant women, there were 13 cases (0.2%) of hyperthyroidism and 146 cases (2.4%) of hypothyroidism diagnosed before conception (133 cases of Hashimoto thyroiditis, eight cases after operation for thyroid cancer, and five cases after 131I therapy because of hyperthyroidism). Among the 5 822 cases requiring screening, 4 044 cases (69.5%) received screening tests of TSH, FT4 and TPOAb during early pregnancy according to Chinese Guidelines, and 1 778 cases received neither standard screening nor screening test. (2) Treatment of hypothyroidism: Hypothyroidism treatment rate was only 61.5% (107/174) according to the reference range recommended by the ATA, lower than that of 88.1% (52/59) according to the reference range of this study (χ2=14.430, P<0.05). There were 60 cases receiving no treatment in TSH≥2.5-<4.08 mU/L group. Forty-three of these cases were reexamined, and one of them was abnormal, with a rate of 2.3% (1/43). There were seven cases without treatment in TSH≥4.08 mU/L group; six of them were reexamined among which one was abnormal, with a rate of 1/6. (3) Thyrotoxicosis: Among the 4 044 pregnant women, 99 cases had TSH <0.1 mU/L, including 11 cases with FT4 ≥22.70 pmol/L (22.82-60.96 pmol/L). Only three cases were positive for thyrotrophin receptor antibody, and then diagnosed as hyperthyroidism and treated with propylthiouracil. (4) Thyroid cancer: Among the 5 981 pregnant women, six cases were diagnosed as thyroid cancer during pregnancy and lactation, with an incidence of 100.3/100 000. Of the six cases, five were diagnosed during pregnancy, and one at one month postpartum. All of the six cases underwent operation and were confirmed to be papillocarcinoma by pathology. Conclusions The screening rate of thyroid diseases during pregnancy is high, but the clinical management is not fully standardized. We suggested that each center should established its own normal reference range for thyroid function test. The incidence of thyroid cancer during pregnancy is increasing, thus attention should be paid to its diagnosis. Key words: Thyroid diseases; Pregnancy complications; Thyrotropin; Thyroxine; Iodide peroxidase; Reference values

Bone turnover markers and bone mineral density in healthy mother-daughter pairs from South India.

To derive ethnicity specific reference range for BTMs and to study their correlation with Bone Mineral Density (BMD) in a cohort of healthy postmenopausal women and their premenopausal daughters and to look at the impact of maternal bone mineral status on daughters bone health. This community based cross sectional study included 300 subjects (150 mother-daughter pairs). Demographic details were collected. Fasting blood and a second void morning urine samples were obtained for measurement of BTMs (sCTX, sPTNP1, sOC and urine DPD respectively) and bone mineral parameters. BMD was measured by DXA scan. Osteoporosis was seen in 44·7% of the postmenopausal women. Ethnicity specific reference ranges of BTMs were derived for the study population. Significant inverse correlation was found between all BTMs (except urine DPD) and BMD(P < 0·05). Daughters of mothers with osteoporosis at spine and femoral neck had lower BMD, compared to daughters of mothers without osteoporosis(P = 0·03 & 0·05). Apart from deriving the ethnicity specific reference range for BTMs and finding a significant inverse correlation between BTM and BMD, this study found significantly lower BMD in daughters of mothers with osteoporosis at spine and femoral neck implicating the probable interplay of genetic, epigenetic and similar environmental factors.