Using Hashimoto thyroiditis as gold standard to determine the upper limit value of thyroid stimulating hormone in a Chinese cohort

Abstract

BackgroundSubclinical hypothyroidism, commonly caused by Hashimoto thyroiditis (HT), is a risk factor for cardiovascular diseases. This disorder is defined as merely having elevated serum thyroid stimulating hormone (TSH) levels. However, the upper limit of reference range for TSH is debated recently. This study was to determine the cutoff value for the upper normal limit of TSH in a cohort using the prevalence of Hashimoto thyroiditis as “gold” calibration standard.MethodsThe research population was medical staff of 2856 individuals who took part in health examination annually. Serum free triiodothyronine (FT3), free thyroxine (FT4), TSH, thyroid peroxidase antibody (TPAb), thyroglobulin antibody (TGAb) and other biochemistry parameters were tested. Meanwhile, thyroid ultrasound examination was performed. The diagnosis of HT was based on presence of thyroid antibodies (TPAb and TGAb) and abnormalities of thyroid ultrasound examination. We used two different methods to estimate the cutoff point of TSH based on the prevalence of HT.ResultsJoinpoint regression showed the prevalence of HT increased significantly at the ninth decile of TSH value corresponding to 2.9 mU/L. ROC curve showed a TSH cutoff value of 2.6 mU/L with the maximized sensitivity and specificity in identifying HT. Using the newly defined cutoff value of TSH can detect patients with hyperlipidemia more efficiently, which may indicate our approach to define the upper limit of TSH can make more sense from the clinical point of view.ConclusionsA significant increase in the prevalence of HT occurred among individuals with a TSH of 2.6–2.9 mU/L made it possible to determine the cutoff value of normal upper limit of TSH.

High normal TSH is associated with lower mannan-binding lectin in women of childbearing age

“…This is in agreement with our previous results [14] showing that women with TSH ≥ 2.5 mIU/l have less favorable lipid profiles which is in turn associated with higher oxidative damage to membrane lipids. This is also in line with suggestion to substantially decrease the TSH cut-off for diagnosing of Hashimoto thyroiditis [15].…”

Joinpoint regression analysis with time-on-study as time-scale. Application to three Italian population-based cohort studies

“…However, although it is easy to implement, such technique has nearly always been applied using calendar year as time-scale [5][6][7][8]. Only few studies have considered a different time-scale, including deciles of thyroid stimulating hormone value [9], number of telephone calls [10], age [11,12] and time-on-study [13][14][15][16][17]. The latter characterizes the epidemiological studies in which the starting date of the follow-up period can be easily identified (e.g., when the disease is detected or a drug treatment begins).…”