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Paolo Cavarzere Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy

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Laura Palma Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy

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Lara Nicolussi Principe Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy

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Monica Vincenzi Pediatric Section, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
Regional Center for Newborn Screening, Diagnosis and Treatment of Congenital Metabolic and Endocrinological Diseases, Verona, Italy

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Silvana Lauriola Neonatal Intensive Cure Unit, Department of Pediatrics, University Hospital of Verona, Verona, Italy

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Rossella Gaudino Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy
Pediatric Section, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy

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Virginia Murri Pediatric Division, Hospital of San Bonifacio, Verona, Italy

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Luigi Lubrano Pediatric Division, Hospital of Legnago, Verona, Italy

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Giuliana Rossi Pediatric Division, Hospital of Mestre, Venezia, Italy

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Alessia Sallemi Pediatric Division, Hospital of Venezia, Venezia, Italy

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Ermanna Fattori Pediatric Division, Hospital of Negrar, Verona, Italy

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Marta Camilot Pediatric Section, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
Regional Center for Newborn Screening, Diagnosis and Treatment of Congenital Metabolic and Endocrinological Diseases, Verona, Italy

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Franco Antoniazzi Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy
Pediatric Section, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
Regional Center for the Diagnosis and Treatment of Children and Adolescents Rare Skeletal Disorders, Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy

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pregnancy. The median values are represented as a horizontal line. The edges represent respectively the 25th and the 75th centile of the cohort. Vertical lines represent the range. FT4, free thyroxine; LT4, levothyroxine; DBS, dried blood spot; TSH, thyroid

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Irene Campi Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy

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Marco Dell’Acqua Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy

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Elisa Stellaria Grassi Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy

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Maria Cristina Vigone Department of Paediatrics, IRCCS San Raffaele Hospital, Milan, Italy

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Luca Persani Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy

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-Ab, anti-thyroid peroxidase antibodies. TSH and free thyroxine (fT4) have a complex, nonlinear relationship, and small variations in fT4 circulating levels result in substantial changes in serum TSH ( 5 ). For this reason, the TSH is the most

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Hideyuki Imai Department of Internal Medicine, Ito Hospital, Tokyo, Japan

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Natsuko Watanabe Department of Internal Medicine, Ito Hospital, Tokyo, Japan

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Rei Hirose Department of Internal Medicine, Ito Hospital, Tokyo, Japan

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Masakazu Koshibu Department of Internal Medicine, Ito Hospital, Tokyo, Japan

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Masahiro Ichikawa Department of Internal Medicine, Ito Hospital, Tokyo, Japan

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Akiko Sankoda Department of Internal Medicine, Ito Hospital, Tokyo, Japan

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Shigenori Hiruma Department of Internal Medicine, Ito Hospital, Tokyo, Japan

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Nami Suzuki Department of Internal Medicine, Ito Hospital, Tokyo, Japan

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Masako Matsumoto Department of Internal Medicine, Ito Hospital, Tokyo, Japan

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Miho Fukushita Department of Internal Medicine, Ito Hospital, Tokyo, Japan

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Ai Yoshihara Department of Internal Medicine, Ito Hospital, Tokyo, Japan

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Jaeduk Yoshimura Noh Department of Internal Medicine, Ito Hospital, Tokyo, Japan

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Kiminori Sugino Department of Surgery, Ito Hospital, Tokyo, Japan

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Koichi Ito Department of Surgery, Ito Hospital, Tokyo, Japan

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between the pregnancy and non-pregnancy groups. Assay Serum free thyroxine (FT4), free triiodothyronine (FT3), and thyrotropin or thyroid stimulating hormone (TSH) levels were measured using electrochemiluminescence immunoassay kits (ECLusys FT4

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Manassawee Korwutthikulrangsri Department of Medicine, University of Chicago, Chicago, Illinois, USA
Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

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Chrysoula Dosiou Department of Medicine, Stanford University School of Medicine, Stanford, California, USA

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Alexandra M. Dumitrescu Department of Medicine, University of Chicago, Chicago, Illinois, USA
Committee on Molecular Metabolism and Nutrition, University of Chicago, Chicago, Illinois, USA

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Samuel Refetoff Department of Medicine, University of Chicago, Chicago, Illinois, USA
Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
Committee on Genetics, University of Chicago, Chicago, Illinois, USA

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free thyroxine (FT4) and TSH levels and presented a mix of hypothyroid and hyperthyroid symptoms. TFT results while she was taking 137 µg of LT4 daily are shown in Figure 1 . The proband had elevated serum total thyroxine (TT4), FT4 index (FT4I), total

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Giorgio Radetti Marienklinik, Bolzano, Italy

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Franco Rigon Department of Paediatrics, University of Padua, Padua, Italy

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Alessandro Salvatoni Department of Medicine and Surgery, University of Insubria, Varese, Italy

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Irene Campi Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy

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Tiziana De Filippis Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy

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Valentina Cirello Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy

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Silvia Longhi Department of Paediatrics, Regional Hospital of Bolzano, Bolzano, Italy

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Fabiana Guizzardi Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy

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Marco Bonomi Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy
Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy

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Luca Persani Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy
Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy

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demonstrated ( 4 , 5 , 6 , 7 ). RTHβ, firstly described by Refetoff in 1967 ( 8 ), is characterized by elevated circulating free thyroxine (fT4) and free tri-iodothyronine (fT3) together with an unsuppressed thyroid-stimulating hormone (TSH). RTHβ is

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Ying Sun Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, China
Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China

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Di Teng Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, China

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Lei Zhao Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, China
Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Heping District, Shenyang, Liaoning, China

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Xiaoguang Shi Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, China
Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China

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Yongze Li Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, China

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Zhongyan Shan Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, China

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Weiping Teng Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, China

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. TSH, TPOAb, and TgAb levels were measured via electrochemiluminescence immunoassays with a Cobas 601 analyzer (Roche Diagnostic). Free thyroxine (fT4) and free triiodothyronine (fT3) were measured when the participant’s TSH levels were outside the

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Eftychia G. Koukkou Endocrine Unit, E Venizelou Hospital, Athens

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Ioannis Ilias Endocrine Unit, E Venizelou Hospital, Athens

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Irene Mamalis Division of Endocrinology, University Medical School, University Hospital, Rion-Patras, Greece

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Kostas B. Markou Division of Endocrinology, University Medical School, University Hospital, Rion-Patras, Greece

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.2 (first) to 1.68 ± 1.0 (second) and 2.02 ± 1.2 mU/l (third; p < 0.001), and serum-free thyroxine (fT 4 ) decreased from 1.22 ± 0.34 (first) to 1.01 ± 0.21 (second) and 0.96 ± 0.2 ng/ml (third; p < 0.05). Serum Tg levels did not change significantly during

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Ilaria Muller Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, United Kingdom

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Lucy S. Kilburn Institute of Cancer Research – Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom

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Peter N. Taylor Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, United Kingdom

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Peter J. Barrett-Lee Academic Breast Department, Velindre Cancer Centre, Cardiff, United Kingdom

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Judith M. Bliss Institute of Cancer Research – Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom

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Paul Ellis Guy’s Hospital and King’s College, London, United Kingdom

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Marian E. Ludgate Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, United Kingdom

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Colin M. Dayan Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, United Kingdom

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women’s next follow-up visit. Plasma samples were stored at –20°C for 6.5–13 years (range) at The Institute of Cancer Research (London, UK), and transferred to the Thyroid Research Group (Cardiff, UK) for TPOAb, thyrotropin (TSH), and free-thyroxine (FT4

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Giulia Brigante Unit of Endocrinology and Metabolism, Department of Biomedical, Metabolic and Neural Sciences
Azienda USL, Modena, Italy

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Giorgia Spaggiari Unit of Endocrinology and Metabolism, Department of Biomedical, Metabolic and Neural Sciences
Azienda USL, Modena, Italy

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Daniele Santi Unit of Endocrinology and Metabolism, Department of Biomedical, Metabolic and Neural Sciences
Azienda USL, Modena, Italy

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Katia Cioni Unit of Endocrinology and Metabolism, Department of Biomedical, Metabolic and Neural Sciences
Azienda USL, Modena, Italy

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Valentina Gnarini Unit of Endocrinology and Metabolism, Department of Biomedical, Metabolic and Neural Sciences
Azienda USL, Modena, Italy

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Chiara Diazzi Unit of Endocrinology and Metabolism, Department of Biomedical, Metabolic and Neural Sciences
Azienda USL, Modena, Italy

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Elisa Pignatti Unit of Endocrinology and Metabolism, Department of Biomedical, Metabolic and Neural Sciences
Center of Genomic Research, University of Modena and Reggio Emilia

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Livio Casarini Unit of Endocrinology and Metabolism, Department of Biomedical, Metabolic and Neural Sciences
Center of Genomic Research, University of Modena and Reggio Emilia

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Marco Marino Unit of Endocrinology and Metabolism, Department of Biomedical, Metabolic and Neural Sciences
Center of Genomic Research, University of Modena and Reggio Emilia

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Frank Tüttelmann Institute of Human Genetics, University of Munster, Munster, Germany

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Cesare Carani Unit of Endocrinology and Metabolism, Department of Biomedical, Metabolic and Neural Sciences
Azienda USL, Modena, Italy

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Manuela Simoni Unit of Endocrinology and Metabolism, Department of Biomedical, Metabolic and Neural Sciences
Center of Genomic Research, University of Modena and Reggio Emilia
Azienda USL, Modena, Italy

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) and free thyroxine (fT 4 ) [ 2 ]. Many factors are involved in thyroid hormone requirement [ 3 ], such as age [ 4 ], body weight [ 5 ], residual thyroid function [ 6 ], timing of LT 4 administration [ 7 ], food and beverages [ 8 ], concomitant

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Nadine Johnson Departments of Obstetrics and Gynaecology, University of the West Indies, Kingston, Jamaica

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Vikash Chatrani Departments of Obstetrics and Gynaecology, University of the West Indies, Kingston, Jamaica

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Anna-Kay Taylor-Christmas Departments of Obstetrics and Gynaecology, University of the West Indies, Kingston, Jamaica

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Eric Choo-Kang Departments of Chemical Pathology, University of the West Indies, Kingston, Jamaica

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Monica Smikle Departments of Microbiology, University of the West Indies, Kingston, Jamaica

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Rosemarie Wright-Pascoe Departments of Medicine, University of the West Indies, Kingston, Jamaica

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Karen Phillips Departments of Medicine, University of the West Indies, Kingston, Jamaica

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Marvin Reid Tropical Metabolism Research Institute, University of the West Indies, Kingston, Jamaica

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Introduction Hypothyroidism is the most common disorder of thyroid function in pregnancy [ 1 ]. Subclinical hypothyroidism (SCH) is defined as serum thyroid-stimulating hormone (TSH) >97.5% and normal free thyroxine (FT 4 ), with or without

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