Marwaha R K, Tandon Nikhil, Desai Ankush, Kanwar Ratnesh, Grewal Khushi, Aggarwal Rashmi, Sastry Aparna, Singh Satveer, Ganguly S K, Mani Kalaivani
Department of Endocrinology and Thyroid Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.
Clin Endocrinol (Oxf). 2008 Mar;68(3):369-74. doi: 10.1111/j.1365-2265.2007.03048.x. Epub 2007 Sep 24.
There is an ongoing debate on narrowing the TSH reference range in adults. In view of the scarce data on normal values of thyroid function tests in children from India, we planned to establish a reference range for thyroid hormones in school-age children.
All children (N = 9527; 6-19 years) from six schools representing various zones of Delhi were evaluated for clinical evidence of goitre, thyroid ultrasound, serum free T3 (FT3), free T4 (FT4) and TSH and anti-thyroid peroxidase (anti-TPO) antibodies. From this sample, a reference population (N = 5122) was obtained by excluding those with a personal or family history of thyroid disease, use of thyroid medications, goitre, hypoechogenicity/nodularity on ultrasound or serum anti-TPO antibodies.
Thyroid hormone (FT3, FT4 and TSH) reference ranges were established for each year of life for the total and reference populations.
In the reference population, mean serum FT3 was in the range 4.19-4.84 pm/l for boys and 4.03-4.47 pm/l for girls, mean serum FT4 14.69-17.36 pm/l for boys and 14.32-15.88 pm/l for girls, and mean serum TSH 2.57-3.6 mIU/l for boys and 1.83-3.58 mIU/l for girls. For TSH, the 97th percentile was in the range 6.01-8.4 mIU/l for boys and 5.28-8.04 mIU/l for girls, suggesting that at least in children there may not be a need to reduce the upper limit of normal for serum TSH.
This study provides mean reference intervals for FT3, FT4 and TSH for each year of life for both the sexes separately using strict exclusion criteria.
关于缩小成人促甲状腺激素（TSH）参考范围的争论仍在继续。鉴于印度儿童甲状腺功能测试正常值的数据稀缺，我们计划建立学龄儿童甲状腺激素的参考范围。
对来自代表德里不同区域的六所学校的所有儿童（N = 9527；6 - 19岁）进行了甲状腺肿临床证据、甲状腺超声、血清游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、TSH及抗甲状腺过氧化物酶（抗TPO）抗体的评估。从该样本中，通过排除有甲状腺疾病个人或家族史、使用甲状腺药物、甲状腺肿、超声检查显示低回声/结节或血清抗TPO抗体阳性的个体，获得了一个参考人群（N = 5122）。
为总体人群和参考人群分别确定了各年龄段的甲状腺激素（FT3、FT4和TSH）参考范围。
在参考人群中，男孩血清FT3平均范围为4.19 - 4.84 pm/l，女孩为4.03 - 4.47 pm/l；男孩血清FT4平均范围为14.69 - 17.36 pm/l，女孩为14.32 - 15.88 pm/l；男孩血清TSH平均范围为2.57 - 3.6 mIU/l，女孩为1.83 - 3.58 mIU/l。对于TSH，第97百分位数在男孩中为6.01 - 8.4 mIU/l，女孩中为5.28 - 8.04 mIU/l，这表明至少在儿童中可能无需降低血清TSH的正常上限。
本研究使用严格的排除标准，分别为男女各年龄段的FT3、FT4和TSH提供了平均参考区间。
