Reference range for thyrotropin

Larisch, Rolf; Giacobino, A; Eckl, Walter; Wahl, H-G; Midgley, J. E. M.; Hoermann, Rudolf

doi:10.3413/nukmed-0671-14-06

Cited by 23 publications

(21 citation statements)

References 27 publications

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“…It should be noted that the laboratory-evaluated reference intervals for the local population were generally wider than those obtained from the present control group (24). Their discrepancy rate to the composite limits was lower, but still substantial.…”

Section: Discussioncontrasting

confidence: 64%

“…Inter-assay imprecision measured in duplicate over 10 consecutive days was 0.9 -2.9%. At a TSH value of 0.52 mIU/L, the intra-assay CV was 1.4%, the inter-assay CV 2.2%, but at the functional sensitivity (TSH of 0.008 mIU/L), the inter-assay CV rose to 14.1% (24).…”

Section: Laboratory Methodsmentioning

confidence: 89%

“…Although a composite reference system can be expected to make the classification and distinction between euthyroidism and thyroid dysfunction more reliable and better comparable among populations, TSH owing to its physiological role as an indirect and adaptive measure still displays a high index of individuality as defined by the ratio of intra-individual and inter-individual variation (24,31). This renders the adoption of population-based reference limits for individual decision making more difficult.…”

Section: Discussionmentioning

confidence: 99%

“…A strength of the study is the use of well-characterized data sets and methods, one from a prospective study whose main outcome on homeostatic equilibria has been reported, as have further details pertinent to the performance and characteristics of the used assays in the local population (18,24,27,33). In particular, the importance and relevance of additional FT3 measurement has been underscored by another study in the same local population demonstrating a u-shaped relationship of FT3, but none of FT4 or TSH, with a clinical outcome marker, mood disorders (34).…”

Section: Discussionmentioning

confidence: 99%

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Derivation of a multivariate reference range for pituitary thyrotropin and thyroid hormones: diagnostic efficiency compared with conventional single-reference method

Hoermann

Larisch

Dietrich

et al. 2016

European Journal of Endocrinology

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Although pituitary thyrotropin (TSH) and thyroid hormones are physiologically interrelated, interpretation of measurements is conventionally done separately. Classification of subclinical thyroid dysfunction depends by definition solely on an abnormal TSH. This study examines a composite multivariate approach to disease classification. Methods: Bivariate and trivariate reference limits were derived from a thyroid-healthy control group (n = 271) and applied to a clinically diverse sample (n = 820) from a prospective study, comparing their diagnostic efficiency with the conventional method. Results:The following 95% reference limits were derived from the control group: (i) separate reference intervals for TSH, free thyroxine (FT4) and free triiodothyronine (FT3); (ii) bivariate composite reference limits for the logarithmically transformed TSH and FT4, and (iii) trivariate composite reference limits including all three parameters. A multivariate approach converts the "rectangular" or "cuboid" graphical representations of the independent parameters into an ellipse or ellipsoid. When applying these reference limits to the clinical sample, thyroid dysfunctions were classified differently, compared with the separate method, in 6.3 or 12% of all cases by the bivariate or trivariate method respectively. Of the established dysfunctions according to the separate intervals, 26% were reclassified to "euthyroid" by using the bivariate limit. Discrepancies from the laboratory-evaluated reference range were less pronounced. Conclusions: Frequent divergencies between composite multivariate reference limits and a combination of separate univariate reference intervals suggest that statistical analytic techniques may heavily influence thyroid disease classification. This challenges the validity of the conjoined roles of TSH currently employed as both a sensitive screening test and a reliable classification tool for thyroid disease. 174:6735-743 R Hoermann and others Composite reference range for thyroid hormones

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Section: Discussioncontrasting

confidence: 64%

Section: Laboratory Methodsmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Derivation of a multivariate reference range for pituitary thyrotropin and thyroid hormones: diagnostic efficiency compared with conventional single-reference method

Hoermann

Larisch

Dietrich

et al. 2016

European Journal of Endocrinology

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“…A TSH range from 0.006 to 160 mU/l was linear, and coefficient of variations of inter-assay imprecision ranged from 0.9% to 2.4%. Reference intervals were laboratory established and pre-evaluated for the local population, using 10-23 pmol/l for FT 4 , 3.1-6.8 pmol/l for FT 3 and 0.4-4.0 mU/l for TSH (23).…”

Section: Patientsmentioning

confidence: 99%

Variation in the biochemical response to l-thyroxine therapy and relationship with peripheral thyroid hormone conversion efficiency

Midgley¹,

Larisch²,

Dietrich³

et al. 2015

Endocrine Connections

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Several influences modulate biochemical responses to a weight-adjusted levothyroxine (L-T 4 ) replacement dose. We conducted a secondary analysis of the relationship of L-T 4 dose to TSH and free T 3 (FT 3 ), using a prospective observational study examining the interacting equilibria between thyroid parameters. We studied 353 patients on steady-state L-T 4 replacement for autoimmune thyroiditis or after surgery for malignant or benign thyroid disease. Peripheral deiodinase activity was calculated as a measure of T 4 -T 3 conversion efficiency. In euthyroid subjects, the median L-T 4 dose was 1.3 mg/kg per day (interquartile range (IQR) 0.94,1.60). The dose was independently associated with gender, age, aetiology and deiodinase activity (all P!0.001). Comparable FT 3 levels required higher L-T 4 doses in the carcinoma group (nZ143), even after adjusting for different TSH levels. Euthyroid athyreotic thyroid carcinoma patients (nZ50) received 1.57 mg/kg per day L-T 4 (IQR 1.40, 1.69), compared to 1.19 mg/kg per day (0.85,1.47) in autoimmune thyroiditis (P!0.01, nZ76) and 1.08 mg/kg per day (0.82, 1.44) in patients operated on for benign disease (P! 0.01, nZ80). Stratifying patients by deiodinase activity categories of !23, 23-29 and O29 nmol/s revealed an increasing FT 3 -FT 4 dissociation; the poorest converters showed the lowest FT 3 levels in spite of the highest dose and circulating FT 4 (P!0.001). An L-T 4 -related FT 3 -TSH disjoint was also apparent; some patients with fully suppressed TSH failed to raise FT 3 above the median level. These findings imply that thyroid hormone conversion efficiency is an important modulator of the biochemical response to L-T 4 ; FT 3 measurement may be an additional treatment target; and L-T 4 dose escalation may have limited success to raise FT 3 appropriately in some cases.

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The effect of TSH change per year on the risk of incident chronic kidney disease in euthyroid subjects

et al. 2016

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The objective of this study is to evaluate the predictive values of baseline thyroid-stimulating hormone and the rate of thyroid-stimulating hormone change within the euthyroid state on the development of chronic kidney disease. We conducted a longitudinal study in 17,067 Korean adults with normal thyroid function and no history of thyroid disease. Incident chronic kidney disease was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m. The rate of thyroid-stimulating hormone change was determined by subtracting the baseline thyroid-stimulating hormone level from the thyroid-stimulating hormone level measured at the last visit prior to the diagnosis of chronic kidney disease or at the final visit in subjects without chronic kidney disease, divided by the observation period (years). Subjects were stratified into quintiles according to rates of thyroid-stimulating hormone change. During 86,583 person-years of follow-up (median follow-up 5.2 years), there were 561 incident cases of chronic kidney disease. The risk of incident chronic kidney disease was significantly higher in subjects with rapid increases (quintile 5) or decreases (quintile 1) in thyroid-stimulating hormone levels compared to the reference group (quintile 3). In fully adjusted models, the hazard ratios of quintiles 1 and 5 were 3.15 (95 % confidence interval 2.34 to 4.24; p < 0.001) and 3.37 (95 % confidence interval 2.52 to 4.51; p < 0.001), respectively. However, there was no significant association between baseline thyroid-stimulating hormone and risk of incident chronic kidney disease. The development of chronic kidney disease is associated with the rate of changes in thyroid-stimulating hormone level rather than with baseline thyroid-stimulating hormone levels.

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Reference range for thyrotropin

Cited by 23 publications

References 27 publications

Derivation of a multivariate reference range for pituitary thyrotropin and thyroid hormones: diagnostic efficiency compared with conventional single-reference method

Derivation of a multivariate reference range for pituitary thyrotropin and thyroid hormones: diagnostic efficiency compared with conventional single-reference method

Variation in the biochemical response to l-thyroxine therapy and relationship with peripheral thyroid hormone conversion efficiency

The effect of TSH change per year on the risk of incident chronic kidney disease in euthyroid subjects

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