An Age-Specific Serum Thyrotropin Reference Range for the Diagnosis of Thyroid Diseases in Older Adults: A Cross-Sectional Survey in China

Zhai, Xiaodan; Zhang, Le; Chen, Lulu; Lian, Xiaolan; Liu, Chao; Shi, Bingyin; Shi, Lei; Tong, Nanwei; Shu, Wang; Weng, Jianping; Zhao, Jiajun; Teng, Xiaochun; Yu, Xiao‐Juan; Lai, Yaxin; Wang, Weiwei; Li, Chenyan; Mao, Jinyuan; Li, Yongze; Fan, Chenling; Li, Ling; Shan, Zhongyan; Wang, Teng

doi:10.1089/thy.2017.0715

Cited by 44 publications

(50 citation statements)

References 45 publications

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“…We found that TSH values increased with age and that females and older adults (70s age group and over 80s group) had lower FT3 and lower FT3/FT4 ratios, while FT4 level remained stable. Serum thyrotropin increased progressively with age, which agrees with the results of previous studies (3,5,6). Both the females and males showed progressive changes in TSH levels with age.…”

Section: Discussionsupporting

confidence: 91%

“…Zhai and cols. (6) examined the prevalence of thyroid disease in older adults aged ≥ 65 years and found that the serum TSH level increases with age, which may represent a normal compensatory phenomenon in that age group. The evidence from such studies suggests that TSH levels increase with age and that an age-specific reference limit for TSH is essential.…”

Section: Introductionmentioning

confidence: 99%

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Relationship of gender and age on thyroid hormone parameters in a large Chinese population

Chen

Zheng

Ding

et al. 2019

Archives of Endocrinology and Metabolism

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Objective: This study aimed to present the impact of age and gender on thyroid hormone levels in a large Chinese population with sufficient iodine intake. Subjects and methods: A total of 83643 individuals were included and were stratified by age and gender. The median, 2.5th and 97.5th of thyrotropin (TSH), free triiodothyronine (FT3), free thyroxine (FT4) and FT3/FT4 ratio were calculated for both genders for every decade from 18 to over 80 years. TSH, FT3, FT4, FT3/FT4 distribution in each age group was evaluated for females and males using smoothing splines in the generalized additive models (GAM). TSH concentrations were compared in the different age groups in gender. Results: In the over 80s age group, the TSH level (median: 2.57 mIU/L, 2.5th-97.5th: 0.86-7.56 mIU/L) was significantly higher than other age groups, irrespective to gender (P<0.001). Females had a higher TSH value than males in all age groups (P<0.001). Results of the smoothing curves showed that TSH increased with age, FT3 concentration was higher in males than in females and the tendency of the FT3/FT4 ratio was basically similar to that of FT3. TSH concentration in the 50s age group (median 2.48 mIU/L for females versus 2.00 mIU/L for males) was significantly higher than that in the 30s age group (median 2.18 mIU/L for females versus median 1.85 mIU/L for males). Conclusions: In accord with increasing TSH values during aging, females and older adults have lower FT3 values and lower FT3/FT4 ratios, while the FT4 values remain stable.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Relationship of gender and age on thyroid hormone parameters in a large Chinese population

Chen

Zheng

Ding

et al. 2019

Archives of Endocrinology and Metabolism

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“…For median TSH values, this was more heterogeneous. The median TSH value was similar to that found in the NHANES III cohort and the study reported by Yoshihara et al in Japan [2,15], but lower than in studies conducted in Spain and China [16,17]. This might be related to the age of the patients included and also to the iodine status of the population.…”

Section: Discussionsupporting

confidence: 87%

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

Raverot

Bonjour

Payrat

et al. 2020

JCM

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It is well known that thyroid dysfunction increases with age. This study is aimed to determine reference intervals, in males and females, suitable for thyroid disease exploration during adult life using routinely collected serum thyrotropin (TSH) data in a tertiary center from 2007 to 2018. Over 11 years, 295,775 TSH levels were measured in a single lab. Among the 156,025 TSH results available for analysis, 90,538 values were from female subjects, 82,019 were from patients aged >60 years and 26,825 were from patients aged >80 years. By using an indirect approach, we determined reference values of TSH adapted to age and sex, and we then evaluated the proportion of patients who would have been reclassified with these reference values. The median TSH ranged from 1.2-1.4 mUI/L during the study period. The upper limit of reference range of TSH increased with age; in females the median to 97.5th percentile values increased continuously from the age of 30 years to the oldest age group. Using new calculated reference values in patients with TSH above the conventional upper-limit reference value (4 mUI/L), the proportion of results reclassified as within the reference interval among patients aged >60 years ranged, according to age group, from 50.5% to 65.1% of females and from 33.0% to 37.7% of males. The use of TSH age-specific and sex-specific upper-limit reference values led to the reclassification of a great number of samples, notably among women. This suggests that age-specific TSH upper-limit reference intervals in daily practice should be used in order to avoid misclassification.

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“…When measured by an electrochemiluminescence immunoassay method using a Cobas 601 analyzer (Roche Diagnostics, Switzerland) in regions of China in 2017, and when the reference range for the general population was used, it was found that the prevalence of hypothyroidism and subclinical hypothyroidism in individuals aged ≥ 65 years was significantly higher than that of individuals aged < 65 years. When using age-specific reference ranges, the prevalence of hypothyroidism in individuals aged ≥ 65 years was lower than that of the general population [ 24 ]. There are certain difficulties in standardization and consistency owing to the different detection methods (the use of different antibodies); the differences between the detection results are large, and the results are difficult to compare.…”

Section: Discussionmentioning

confidence: 99%

“…and subclinical hypothyroidism in individuals aged � 65 years was significantly higher than that of individuals aged < 65 years. When using age-specific reference ranges, the prevalence of hypothyroidism in individuals aged � 65 years was lower than that of the general population [24]. There are certain difficulties in standardization and consistency owing to the different detection methods (the use of different antibodies); the differences between the detection results are large, and the results are difficult to compare.…”

Section: Plos Onementioning

confidence: 98%

Study of reference intervals for free triiodothyronine, free thyroxine, and thyroid-stimulating hormone in an elderly Chinese Han population

Xiong

Liu

et al. 2020

PLoS ONE

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The clinical manifestations of thyroid diseases in elderly patients are often atypical. This study aimed to establish reference intervals for thyroid function in the elderly in order to help diagnose thyroid diseases in this population. A total of 5345 healthy individuals were examined and divided into three groups according to their age: 4297 individuals aged < 65 years (19-64), 719 individuals aged between 65 and 79 years, and 329 individuals aged between 80 and 100 years. Levels of free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), thyroid peroxidase antibody, and thyroglobulin antibody were measured in these subjects by using a fully automated analyzer. The following free triiodothyronine, free thyroxine, and thyroid-stimulating hormone reference intervals were obtained from each age group: For individuals aged < 65 years (19-64 years), FT3, FT4, and TSH were 3.40-6.44, 10.26-19.25 pmol/L and 0.50-4.81 μIU/mL, respectively. For individuals aged between 65 and 79 years, FT3, FT4 and TSH ranged between 3.01-5.91, 10.04-19.76 pmol/L, and 0.54-5.51 μIU/mL, respectively. For individuals aged between 80 and 100 years, FT3, FT4, and TSH varied between 2.82-5.57, 9.79-21.22 pmol/L, 0.31-6.28 μIU/mL respectively. FT3 concentration was lower and the concentrations of FT4 and TSH were higher in individuals aged � 65 years than in those aged <65 years (P<0.0001; P = 0.0039; P<0.0001, respectively). In conclusion, establishment of a reference interval would allow clinicians to diagnose diseases more accurately and easily.

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An Age-Specific Serum Thyrotropin Reference Range for the Diagnosis of Thyroid Diseases in Older Adults: A Cross-Sectional Survey in China

Cited by 44 publications

References 45 publications

Relationship of gender and age on thyroid hormone parameters in a large Chinese population

Relationship of gender and age on thyroid hormone parameters in a large Chinese population

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

Study of reference intervals for free triiodothyronine, free thyroxine, and thyroid-stimulating hormone in an elderly Chinese Han population

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