title: Unexpected Elevated Free Thyroid Hormones in Pregnancy.
abstract: The use of thyrotropin and free thyroid hormone assays to evaluate thyroid function is widespread, but in some situations the results are inconsistent with the patient's thyroid status.
  
  
  
  A 35-year-old woman with a known diagnosis of chronic autoimmune thyroiditis was referred to the authors' clinic at week 26 of her second pregnancy. The patient was clinically euthyroid. Consistent with this, her serum thyrotropin (TSH) was normal (0.79 mIU/L), but she had elevated free thyroid hormones-free triiodothyronine (fT3) and free thyroxine (fT4)-as determined by a one-step chemiluminescent assay. The patient was taking levothyroxine replacement therapy (125 μg/day), and the dose was confirmed. Previous blood tests showed concordance between TSH and free thyroid hormone values. The patient was followed up throughout gestation and at 12 months postpartum. During gestation, her free thyroid hormones remained high using one-step methods, while the total thyroid hormone concentration values were within the reference range, in agreement with the TSH values. Postpartum fT4 and fT3 values returned progressively to normality, in agreement with the TSH values. The presence of circulating thyroid hormone autoantibodies (THAb) was hypothesized, which are known to interfere, although to a variable extent, with thyroid hormone one-step assays. Using stored frozen sera, this hypothesis was confirmed indirectly by measuring normal levels of fT3 and fT4 with a two-step method, and directly by demonstrating THAb against the two hormones.
  
  
  
  Despite their relative rarity, circulating THAb may be suspected when laboratory data are not consistent and contrast with the clinical picture. To the authors' knowledge, no previous case of transient appearance of THAb in pregnancy has been described.
authors.affiliation: 1 Endocrinology Unit, Department of Internal Medicine and Medical Specialties and Center of Excellence for Biomedical Research, University of Genova , IRCCS AOU San Martino-IST, Genova, Italy .
authors.forename: Claudia
authors.initials: C
authors.lastname: Teti
authors.affiliation: 1 Endocrinology Unit, Department of Internal Medicine and Medical Specialties and Center of Excellence for Biomedical Research, University of Genova , IRCCS AOU San Martino-IST, Genova, Italy .
authors.forename: Elena
authors.initials: E
authors.lastname: Nazzari
authors.affiliation: 2 Endocrinology Section, Department of Clinical and Experimental Medicine, University of Messina , Messina, Italy .
authors.forename: Marina Raffaella
authors.initials: MR
authors.lastname: Galletti
authors.affiliation: 2 Endocrinology Section, Department of Clinical and Experimental Medicine, University of Messina , Messina, Italy .
authors.forename: Mattia Grazia
authors.initials: MG
authors.lastname: Mandolfino
authors.affiliation: 3 Autoimmunity Unit, Department of Internal Medicine and Medical Specialties and Center of Excellence for Biomedical Research, University of Genova , IRCCS AOU San Martino-IST, Genova, Italy .
authors.forename: Francesca
authors.initials: F
authors.lastname: Pupo
authors.affiliation: 3 Autoimmunity Unit, Department of Internal Medicine and Medical Specialties and Center of Excellence for Biomedical Research, University of Genova , IRCCS AOU San Martino-IST, Genova, Italy .
authors.forename: Giampaola
authors.initials: G
authors.lastname: Pesce
authors.affiliation: 4 Laboratory of Clinical Pathology, ASL2 Savonese , Savona, Italy .
authors.forename: Flavia
authors.initials: F
authors.lastname: Lillo
authors.affiliation: 1 Endocrinology Unit, Department of Internal Medicine and Medical Specialties and Center of Excellence for Biomedical Research, University of Genova , IRCCS AOU San Martino-IST, Genova, Italy .|3 Autoimmunity Unit, Department of Internal Medicine and Medical Specialties and Center of Excellence for Biomedical Research, University of Genova , IRCCS AOU San Martino-IST, Genova, Italy .
authors.forename: Marcello
authors.initials: M
authors.lastname: Bagnasco
authors.affiliation: 2 Endocrinology Section, Department of Clinical and Experimental Medicine, University of Messina , Messina, Italy .|5 Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina , Messina, Italy .|6 Interdepartmental Program on Molecular and Clinical Endocrinology, and Women's Endocrine Health, University Hospital of Messina , Messina, Italy .
authors.forename: Salvatore
authors.initials: S
authors.lastname: Benvenga
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000032:analysis; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood* / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology; D047929:Term Birth; D013961:Thyroid Gland / Q000276:immunology / Q000378:metabolism / Q000503:physiopathology; D013967:Thyroiditis, Autoimmune / Q000097:blood* / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology; D013972:Thyrotropin / Q000097:blood* / Q000378:metabolism; D013974:Thyroxine / Q000097:blood* / Q000378:metabolism / Q000627:therapeutic use; D014284:Triiodothyronine / Q000097:blood* / Q000378:metabolism; D015854:Up-Regulation
chemical_list: D001323:Autoantibodies; D014284:Triiodothyronine; D013972:Thyrotropin; D013974:Thyroxine
keywords: hypothyroidism in pregnancy; thyroid autoantibodies; thyroid autoimmunity; thyroid function in pregnancy; thyroid hormone autoantibodies