Institute for Community Medicine, Ernst Moritz Arndt University Greifswald, Germany.
Horm Metab Res. 2010 Oct;42(11):809-14. doi: 10.1055/s-0030-1263121. Epub 2010 Aug 31.
A controversy exists on the value of upper thyrotropin (TSH) reference level. Currently available studies are based on cross-sectional data leaving uncertainty about the prognostic significance of the upper TSH reference level. With the present study we sought to establish reference values for serum thyroid function tests that are of both diagnostic and prognostic significance. We used data from the prospective population-based Study of Health in Pomerania (SHIP) with a 5 year follow-up (6080 person-years). We included data from 1203 subjects (525 women) without prevalent subclinical or manifest thyroid disorders. An event-free reference population was separated comprising 1053 subjects (473 women). When comparing reference values as analyzed from either the whole reference population or the event-free reference population, we observed notable differences in TSH reference intervals. While the lower TSH reference values were similar in both populations, the upper value was 1.95 mIU/l and thus by 7.6% lower in subjects without incident events compared to the whole reference population. Both populations did not substantially differ with respect to serum FT3 and FT4 reference intervals. The upper TSH reference value is lower than recommended when both diagnostic and prognostic significance are considered in the definition of the TSH reference range.
关于上甲状腺刺激素 (TSH) 参考水平的价值存在争议。目前的研究基于横断面数据，对 TSH 参考上限的预后意义仍存在不确定性。本研究旨在建立具有诊断和预后意义的血清甲状腺功能检测参考值。我们使用了前瞻性基于人群的什未林健康研究 (SHIP) 的数据，随访时间为 5 年 (6080 人年)。我们纳入了 1203 名（525 名女性）无明显亚临床或显性甲状腺疾病的受试者的数据。分离出一个无事件参考人群，包含 1053 名（473 名女性）受试者。当比较从整个参考人群或无事件参考人群中分析的参考值时，我们观察到 TSH 参考区间有显著差异。虽然两个群体的 TSH 参考下限相似，但无事件受试者的 TSH 参考上限为 1.95mIU/L，比整个参考人群低 7.6%。两个群体在血清 FT3 和 FT4 参考区间方面没有显著差异。在定义 TSH 参考范围时，如果同时考虑诊断和预后意义，上 TSH 参考值低于推荐值。
