Age- and Sex-Specific TSH Upper-Limit Reference Intervals in the General French Population: There Is a Need to Adjust Our Actual Practices

Raverot, Véronique; Bonjour, Maxime; Payrat, Juliette Abeillon du; Perrin, P.; Roucher‐Boulez, Florence; Lasolle, Hélène; Subtil, Fabien; Borson‐Chazot, Françoise

doi:10.3390/jcm9030792

Cited by 28 publications

(20 citation statements)

References 24 publications

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“…This yielded a reference value for TSH from 0.62 to 6.86 mIU/L, which significantly lowers the percentage of individuals with subclinical hypothyroidism compared to our reference values. A study in France suggested the use of age-specific and sex-specific reference values for TSH, with upper-limit reference values >5.0 mIU/L for women over the age of 70 [39]. This might partly explain the large number of individuals with a normal FT4 in combination with a slightly elevated TSH in the current study.…”

Section: Plos Onementioning

confidence: 82%

Epidemiology of thyroid disorders in the Lifelines Cohort Study (the Netherlands)

et al. 2020

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Background Thyroid hormone plays a pivotal role in human metabolism. In epidemiologic studies, adequate registration of thyroid disorders is warranted. We examined the prevalence of thyroid disorders, reported thyroid medication use, thyroid hormone levels, and validity of thyroid data obtained from questionnaires in the Lifelines Cohort Study. Methods We evaluated baseline data of all 152180 subjects (aged 18–93 years) of the Lifelines Cohort Study. At baseline, participants were asked about previous thyroid surgery and current and previous thyroid hormone use. At follow-up (n = 136776, after median 43 months), incident thyroid disorders could be reported in an open, non-structured question. Data on baseline thyroid hormone measurements (TSH, FT4 and FT3) were available in a subset of 39935 participants. Results Of the 152180 participants, mean (±SD) age was 44.6±13.1 years and 58.5% were female. Thyroid medication was used by 4790 participants (3.1%); the majority (98.2%) used levothyroxine, and 88% were females. 59.3% of levothyroxine users had normal TSH levels. The prevalence of abnormal TSH levels in those not using thyroid medication was 10.8%; 9.4% had a mildly elevated (4.01–10.0 mIU/L), 0.7% had suppressed (<0.40 mIU/L), while 0.7% had elevated (>10.0 mIU/L) TSH levels. Over 98% of subjects with TSH between 4 and 10 mIU/L had normal FT4. Open text questions allowing to report previous thyroid surgery and incident thyroid disorders proved not to be reliable and severely underestimated the true incidence and prevalence of thyroid disorders. Conclusions Undetected thyroid disorders were prevalent in the general population, whereas the prevalence of thyroid medication use was 3.1%. Less than 60% of individuals using levothyroxine had a normal TSH level. The large group of individuals with subclinical hypothyroidism (9.4%) offers an excellent possibility to prospectively follow the natural course of this disorder. Both structured questions as well as linking to G.P.’s and pharmacists’ data are necessary to improve the completeness and reliability of Lifelines’ data on thyroid disorders.

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Section: Plos Onementioning

confidence: 82%

Epidemiology of thyroid disorders in the Lifelines Cohort Study (the Netherlands)

et al. 2020

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“…Twenty-three articles were included, of which 7 articles contained a survey on both reference and disease-free populations. In addition, the TIDE study was also included in the present meta-analysis; thus, 31 studies were included (12,19,20,.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Specifically, the disease-free population includes subjects without reported thyroid disease, goiter, or use of treatments affecting thyroid function (2). Although the RI for TSH calculated based on the disease-free standard is not as accurate as the NACB standard, several large-scale studies based on this method have provided valuable information about the specific RIs for TSH in different regions (19,20).…”

Section: Introductionmentioning

confidence: 99%

Reference Intervals for Serum Thyroid-Stimulating Hormone Based on a Recent Nationwide Cross-Sectional Study and Meta-Analysis

Wang

Zhai

et al. 2021

Front. Endocrinol.

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ObjectiveThe aim of our study was to compare the reference intervals (RIs) [median (2.5th-97.5th percentiles)] for thyroid-stimulating hormone (TSH) between subgroups stratified by ethnicity and iodine status in a global context.Design and MethodsPrimary data were derived from a recently published cross-sectional study in mainland China. Secondary data were obtained from online databases. The RIs for TSH were calculated in the reference population according to the National Academy of Clinical Biochemistry (NACB) standard and in the disease-free population. A meta-analysis of ethnicity- and iodine status-specific TSH RIs was performed.ResultsThe primary data showed that the TSH RI (mU/L) in the disease-free population was 2.33 (0.67, 7.87), which is wider than the published RI [2.28 (0.74, 7.04)] in the reference population. The meta-analysis showed that whether in the reference or disease-free population, the RIs in Yellows were much higher than those in Caucasians. In the reference population, the median and 2.5th percentile in the iodine-sufficient subgroup were both lower than the iodine-deficient or more-than-adequate subgroup, while the 97.5th percentile showed a positive trend with increasing sufficiency of iodine. However, in the disease-free population, the iodine-sufficient subgroup had a lower median and 97.5th percentile but higher 2.5th percentile than the iodine-deficient subgroup.ConclusionYellows have a higher TSH RI than Caucasians. In the reference population, both the median and 2.5th percentile TSH in the iodine-sufficient population were the lowest among the different iodine status subgroups, while the 97.5th percentile of TSH showed an upward trend with increasing iodine sufficiency.

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“…After reading the remaining 216 articles, 195 articles were excluded. Finally, the remaining 21 [4][5][6][7][8][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] studies were included in this meta-analysis (16 published in English and 5 in Chinese). The ow chart is as follows (Figure 1).…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

Factors Influencing the Reference Interval of Thyroid Stimulating Hormone in Healthy Adults: A Systematic Review and Meta-analysis

Xing

Zhou

et al. 2020

Preprint

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Background: Thyroid stimulating hormone (TSH) is an important indicator for evaluating thyroid function. Many studies have reported that the TSH reference interval is susceptible to external factors. This paper summarizes the related studies published in recent years and comprehensively analyzes the effects of these factors on the TSH reference interval in healthy people.Methods: Articles published from January 1980 to January 2020 were searched in PubMed, EMBASE, Cochrane, Scopus, Medline English databases and CNKI, WanFang and CQVIP Chinese databases. In total, 21 studies were ultimately included. All data were analyzed using Review Manager 5.3 software and STATA 16.0 software. Microsoft Excel 2010 was used to draw the TSH concentration curve changing with age, and GraphPad 6.0 was used to draw the TSH concentration curve with sex.Results: The TSH reference interval was significantly influenced by sex and age. The overall trend of TSH concentration reveals that males are lower than females. The TSH reference interval is divided into 20~59-year-old, 60~69-year-old and over 70-year-old age groups for males and 20~39-year-old, 40~49-year-old, 50~69-year-old and over 70-year-old age groups for females. Regardless of sex, TSH concentrations all increase with age. In iodine-deficient areas, TSH reference intervals are generally lower than those in iodine-sufficient or iodine-excessive areas. The TSH reference interval in Asia and North American countries is generally higher than that in most European countries. Even the detection methods are consistent, different detection instruments can affect the TSH reference interval. Sample size and race are also important factors.Conclusion: The TSH reference interval was significantly influenced by sex and age, race, region, iodine intake, sample size, detection instruments and methods, but other factors should not be ignored. Therefore, it is necessary for each laboratory to validate an appropriate TSH reference interval based on local conditions.

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Age- and Sex-Specific TSH Upper-Limit Reference Intervals in the General French Population: There Is a Need to Adjust Our Actual Practices

Cited by 28 publications

References 24 publications

Epidemiology of thyroid disorders in the Lifelines Cohort Study (the Netherlands)

Epidemiology of thyroid disorders in the Lifelines Cohort Study (the Netherlands)

Reference Intervals for Serum Thyroid-Stimulating Hormone Based on a Recent Nationwide Cross-Sectional Study and Meta-Analysis

Factors Influencing the Reference Interval of Thyroid Stimulating Hormone in Healthy Adults: A Systematic Review and Meta-analysis

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