Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany.
Horm Metab Res. 2011 Jun;43(6):422-6. doi: 10.1055/s-0031-1275326. Epub 2011 Apr 11.
Promptly detecting pediatric thyroid dysfunction requires age-appropriate reference ranges for serum thyroid-stimulating hormone (TSH), serum free thyroxine (FT4), and serum free triiodothyronine (FT3). We sought to establish such ranges, employing the widely-used Immulite® 2000 automated immunoluminometric assays in a large population. We assayed the analytes according to manufacturer's instructions in serum samples from 359 male and 297 female university hospital patients, aged between newborn to 18 years, without evidence of thyroid or pituitary dysfunction. As data were not normally distributed, the reference ranges were assumed to lie between the 2.5th and 97.5th percentiles. Curves for age-related changes in the reference ranges were calculated using the linearity, median and skewness method. TSH, FT4, and FT3 reference ranges showed a wide spread immediately after birth, rapidly decreasing within the first 2 years of life. Reference range width was fairly stable after about age 4 years. However, from that time, the ranges' lower and upper limits steadily declined, essentially reaching (FT3) or approximating (TSH, FT4) healthy adult values by age 18 years. Age-specific reference ranges should be used when measuring TSH, FT4, and FT3 in children. During very early life, values of these analytes range widely, making it challenging to interpret measurements in infants, and, especially, newborns.
及时检测小儿甲状腺功能障碍需要针对血清促甲状腺激素（TSH）、游离甲状腺素（FT4）和游离三碘甲状腺原氨酸（FT3）制定适合年龄的参考范围。我们采用广泛应用的 Immulite® 2000 自动化免疫化学发光分析系统，对新生儿至 18 岁无甲状腺或垂体功能障碍的 359 名男性和 297 名女性大学医院患者的血清样本进行了分析，旨在建立此类参考范围。我们按照制造商的说明在血清样本中检测了这些分析物。由于数据呈非正态分布，因此假设参考范围位于第 2.5 百分位数和第 97.5 百分位数之间。采用线性、中位数和偏度法计算与年龄相关的参考范围变化曲线。TSH、FT4 和 FT3 参考范围在出生后立即广泛分布，在生命的前 2 年内迅速下降。大约 4 岁以后，参考范围的宽度相当稳定。然而，从那时起，范围的下限和上限逐渐下降，到 18 岁时基本达到（FT3）或接近（TSH、FT4）健康成年人的值。在测量儿童 TSH、FT4 和 FT3 时应使用特定年龄的参考范围。在生命早期，这些分析物的数值范围很广，这使得婴儿尤其是新生儿的测量值难以解释。
