Applying a uniform reference range across all adults for serum levels of thyroid stimulating hormone and thyroid hormones makes establishing a diagnosis of thyroid dysfunction challenging and could lead to potentially unnecessary treatment. For the results of thyroid function tests to be meaningful, the reference ranges should reflect individual variation in thyroid function.
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References
Cooper, D. S. & Biondi, B. Subclinical thyroid disease. Lancet 379, 1142–1154 (2012).
Jonklaas, J. & Razvi, S. Reference intervals in the diagnosis of thyroid dysfunction: treating patients not numbers. Lancet Diabetes Endocrinol. 7, 473–483 (2019).
Walsh, J. P. Thyroid function across the lifespan: do age-related changes matter? Endocrinol. Metab. 37, 208–219 (2022).
Hollowell, J. G. et al. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J. Clin. Endocrinol. Metab. 87, 489–499 (2002).
Javaid, U., Kennedy, D., Addison, C., Tsatlidis, V. & Razvi, S. Frequency, determinants and costs of thyroid function testing in a laboratory serving a large population. Eur. J. Endocrinol. 186, 553–560 (2022).
Yamada, S. et al. The impact of age- and sex-specific reference ranges for serum thyrotropin and free thyroxine on the diagnosis of subclinical thyroid dysfunction: a multicentre study from Japan. Thyroid 33, 428–439 (2023).
Shan, Z. et al. Iodine status and prevalence of thyroid disorders after introduction of mandatory universal salt iodization for 16 years in China: a cross-sectional study in 10 cities. Thyroid 26, 1125–1130 (2016).
Ehrenkranz, J. et al. Circadian and circannual rhythms in thyroid hormones: determining the TSH and free T4 reference intervals based upon time of day, age, and sex. Thyroid 25, 954–961 (2015).
Razvi, S. et al. Variation in the reference range limits of thyroid function tests and association with the prevalence of levothyroxine treatment. Eur. J. Endocrinol. 188, K5–K9 (2023).
Taylor, P. N. et al. Falling threshold for treatment of borderline elevated thyrotropin levels-balancing benefits and risks: evidence from a large community-based study. JAMA Intern. Med. 174, 32–39 (2014).
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Razvi, S. Thyroid-function reference ranges in the diagnosis of thyroid dysfunction in adults. Nat Rev Endocrinol 20, 253–254 (2024). https://doi.org/10.1038/s41574-024-00972-2
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DOI: https://doi.org/10.1038/s41574-024-00972-2