Indirect estimation of age-related reference limits of thyroid parameters: A cross-sectional study of outpatients’ results

Milinković, Neda; Ignjatović, Svetlana; Žarković, Miloš; Jovičić, Snežana; Radosavljević, Branimir; Singh, Sandra; Majkić-Singh, Nada

doi:10.3109/00365513.2014.898324

Cited by 19 publications

(10 citation statements)

References 23 publications

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“…The overall reference range for TSH at 0.44 mU/L – 4.13 mU/L was similar to one proposed in the 2012 American Association of Clinical Endocrinologists (AACE) and American Thyroid Association (ATA) guidelines for a third generation TSH assay in iodine sufficient areas (0.45 mU/L – 4.12 mU/L) (18). The upper limit was very similar to the one reported in a study conducted in another part of the Balkan region (4.20 mU/L) based on the indirect estimate of reference limits (12), but the values for different age bands were not in agreement. The calculated upper reference interval in our study was higher with regard to the data obtained from iodine deficient areas (14, 15).…”

Section: Discussionsupporting

confidence: 81%

“…As previously mentioned, in a study performed in another part of the Balkan region (12) based on the indirect estimate of TFT reference ranges, the 97.5 percentile of the TSH values in the youngest subjects (3.82 mU/L) was higher compared to ours (3.21 mU/L). The probable causes of this are related to the different approach used in subject selection and the inclusion of subjects younger than 20 years old in the Serbian study.…”

Section: Discussioncontrasting

confidence: 52%

“…The difficulties in the upper TSH limit determination are partly caused by differences in the TSH reference values established in some of the studies conducted so far (12, 13, 14, 15). These discrepancies can be partially explained by different preanalytical and analytical factors.…”

Section: Introductionmentioning

confidence: 99%

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Age and Assay Related Changes of Laboratory Thyroid Function Tests in the Reference Female Population

Barhanović¹,

Antunović²,

Kavaric³

et al. 2019

Journal of Medical Biochemistry

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Summary Background: Laboratory thyroid function tests play a central role in the diagnosis of thyroid disorders. The aim of our cross-sectional study was to determine reference values for thyroid tests in a rigorously selected group of Montenegrin females, investigate the impact of possible age-related changes and the influence of the interassay bias between three frequently used immunoassays. Methods: Female subjects were randomly selected, aged between 20 and 69 and 946 of them met the selection criteria. TSH, fT3, fT4, thyroid peroxidase and thyroglobulin antibodies were measured. Eighty samples were further analyzed on two other immunochemistry platforms. Results: Median TSH progressively increased with age, there was no difference in fT3, while fT4 was significantly higher in the two oldest groups compared to the others. When using the age-related 97.5 percentile of TSH the percentage of reclassification was highest in the 20–29 years of age group (5.2%, p<0.05). In the oldest band, 7.7% had TSH values above cohort-specific and below the age-related upper reference limit. Bland-Altman bias plots revealed the highest interassay absolute mean difference between compared TSH assays of 24.5% and for fT4 assays of 13.8%. Conclusions: The correlation coefficients between fT3 assays from different manufacturers were low. Serum TSH and fT4 concentrations increased with age and the implementation of age-specific TSH reference intervals would be of interest. The bias between the three commercial immunoassays indicated that the standardization of thyroid function tests is a task of great importance.

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Section: Discussionsupporting

confidence: 81%

Section: Discussioncontrasting

confidence: 52%

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Age and Assay Related Changes of Laboratory Thyroid Function Tests in the Reference Female Population

Barhanović¹,

Antunović²,

Kavaric³

et al. 2019

Journal of Medical Biochemistry

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“…Indirect method of setting up reference value depends on the huge data collected in the laboratory . Compared to the direct method, indirect method is simpler, faster, and cost‐effective.…”

Section: Introductionmentioning

confidence: 99%

“…6 Indirect method of setting up reference value depends on the huge data collected in the laboratory. [6][7][8][9][10] Compared to the direct method, indirect method is simpler, faster, and cost-effective. It is a convenient way for clinical laboratory to set up own reference intervals.…”

mentioning

confidence: 99%

Establishment of reference intervals for serum thyroid-stimulating hormone, free and total thyroxine, and free and total triiodothyronine for the Beckman Coulter DxI-800 analyzers by indirect method using data obtained from Chinese population in Zhejiang

Wang

Zhang²,

Zhou³

et al. 2016

J Clin Lab Anal

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Background In order to establish suitable reference intervals of thyroid‐stimulating hormone (TSH), free (unbound) T4 (FT4), free triiodothyronine (FT3), total thyroxine (T4), and total triiodothyronine (T3) for the patients collected in Zhejiang, China, an indirect method was developed using the data from the people presented for routine health check‐up. Methods Fifteen thousand nine hundred and fifty‐six person's results were reviewed. Box‐Cox or Case Rank was used to transform the data to normal distribution. Tukey and Box‐Plot methods were used to exclude the outliers. Nonparametric method was used to establish the reference intervals following the EP28‐A3c guideline. Pearson correlation was used to evaluate the correlation between hormone levels and age, while Mann‐Whitney U test was employed for quantification of concentration differences on the people who are younger and older than 50 years old. Results Reference intervals were 0.66–4.95 mIU/L (TSH), 8.97–14.71 pmol/L (FT4), 3.75–5.81 pmol/L (FT3), 73.45–138.93 nmol/L (total T4), and 1.24–2.18 nmol/L (total T3) in male; conversely, reference intervals for female were 0.72–5.84 mIU/L (TSH), 8.62–14.35 pmol/L (FT4), 3.59–5.56 pmol/L (FT3), 73.45–138.93 nmol/L (total T4), and 1.20–2.10 nmol/L (total T3). FT4, FT3, and total T3 levels in male and FT4 level in female had an inverse correlation with age. Total T4 and TSH levels in female were directly correlated. Significant differences in these hormones were also found between younger and older than 50 years old except FT3 in female. Conclusions Indirect method can be applied for establishment of reference intervals for TSH, FT4, FT3, total T4, and total T3. The reference intervals are narrower than those previously established. Age factor should also be considered.

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Reference intervals for thyrotropin in an area of Northern Italy: the Pordenone thyroid study (TRIPP)

Tozzoli¹,

D’Aurizio

Metus³

et al. 2018

J Endocrinol Invest

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Indirect estimation of age-related reference limits of thyroid parameters: A cross-sectional study of outpatients’ results

Abstract: This cross-sectional study indicates change in TSH and fT4 levels with ageing and gender-related upper limits. This suggests that by using indirect estimation a laboratory could provide clinicians with more accurate gender- and age-specific RLs for thyroid parameters.

Cited by 19 publications

References 23 publications

Age and Assay Related Changes of Laboratory Thyroid Function Tests in the Reference Female Population

Age and Assay Related Changes of Laboratory Thyroid Function Tests in the Reference Female Population

Establishment of reference intervals for serum thyroid-stimulating hormone, free and total thyroxine, and free and total triiodothyronine for the Beckman Coulter DxI-800 analyzers by indirect method using data obtained from Chinese population in Zhejiang

Reference intervals for thyrotropin in an area of Northern Italy: the Pordenone thyroid study (TRIPP)

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