Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Comment
  • Published:

Thyroid-function reference ranges in the diagnosis of thyroid dysfunction in adults

Subjects

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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

References

  1. Cooper, D. S. & Biondi, B. Subclinical thyroid disease. Lancet 379, 1142–1154 (2012).

    Article  PubMed  Google Scholar 

  2. Jonklaas, J. & Razvi, S. Reference intervals in the diagnosis of thyroid dysfunction: treating patients not numbers. Lancet Diabetes Endocrinol. 7, 473–483 (2019).

    Article  PubMed  Google Scholar 

  3. Walsh, J. P. Thyroid function across the lifespan: do age-related changes matter? Endocrinol. Metab. 37, 208–219 (2022).

    Article  CAS  Google Scholar 

  4. 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).

    Article  CAS  PubMed  Google Scholar 

  5. 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).

    Article  CAS  PubMed  Google Scholar 

  6. 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).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. 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).

    Article  CAS  PubMed  Google Scholar 

  8. 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).

    Article  CAS  PubMed  Google Scholar 

  9. 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).

    Article  Google Scholar 

  10. 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).

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Salman Razvi.

Ethics declarations

Competing interests

The author declares no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41574-024-00972-2

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing