Yeap Bu B, Manning Laurens, Chubb S A Paul, Hankey Graeme J, Golledge Jonathan, Almeida Osvaldo P, Flicker Leon
School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
Department of Endocrinology and Diabetes, Fiona Stanley and Fremantle Hospitals, Perth, Western Australia, Australia.
J Gerontol A Biol Sci Med Sci. 2017 Mar 1;72(3):444-449. doi: 10.1093/gerona/glw132.
In older adults, thyroid-stimulating hormone (TSH) concentrations are raised and higher free thyroxine (FT4) is associated with poorer health outcomes. As use of nonage-appropriate reference ranges could lead to suboptimal management, we aimed to define reference intervals for TSH and FT4 in older men.
We conducted the study on community-dwelling men aged 70-89 years. Baseline TSH and FT4 levels were assayed (Elecsys 2010, Roche Diagnostics). Conventional reference intervals for TSH and FT4 were 0.4-4.0 mIU/L and 10-23 pmol/L, respectively. Incident deaths were ascertained using data linkage.
Of the 3,885 men included in the analysis, the 2.5th and 97.5th centiles for TSH and FT4 were 0.64-5.9 mIU/L and 12.1-20.6 pmol/L (0.94-1.60ng/dL), respectively. Of the 411 very healthy men defined by excellent or very good self-rated health and absence of major medical comorbidities, 2.5th to 97.5th centiles for TSH and FT4 were 0.67-4.98 mIU/L and 12.1-20.5 pmol/L (0.94-1.59ng/dL), respectively. TSH was not associated with mortality, whereas higher FT4 was associated with increased mortality. Applying intervals based on very healthy older men to the cohort as a whole led to the reclassification of 310 men (8.0%). More men were classified as being hyperthyroid or hypothyroid, or having subclinical hyperthyroidism, and fewer as having subclinical hypothyroidism.
In older men, the reference interval for TSH in older men is shifted upward, whereas the reference interval for FT4 is compressed compared with the conventional reference ranges. Applying reference intervals based on healthy older men identifies a substantial number of older men as having overt thyroid disease or subclinical hyperthyroidism and reduces the number classified as having subclinical hypothyroidism.
在老年人中，促甲状腺激素（TSH）浓度升高，游离甲状腺素（FT4）水平较高与较差的健康结局相关。由于使用不适合年龄的参考范围可能导致管理欠佳，我们旨在确定老年男性TSH和FT4的参考区间。
我们对年龄在70 - 89岁的社区居住男性进行了研究。测定基线TSH和FT4水平（罗氏诊断公司的Elecsys 2010）。TSH和FT4的传统参考区间分别为0.4 - 4.0 mIU/L和10 - 23 pmol/L。通过数据链接确定死亡事件。
在纳入分析的3885名男性中，TSH和FT4的第2.5百分位数和第97.5百分位数分别为0.64 - 5.9 mIU/L和12.1 - 20.6 pmol/L（0.94 - 1.60 ng/dL）。在411名被定义为自我健康评分优秀或非常好且无主要医疗合并症的非常健康的男性中，TSH和FT4的第2.5百分位数至第97.5百分位数分别为0.67 - 4.98 mIU/L和12.1 - 20.5 pmol/L（0.94 - 1.59 ng/dL）。TSH与死亡率无关，而较高的FT4与死亡率增加相关。将基于非常健康的老年男性的区间应用于整个队列导致310名男性（8.0%）的重新分类。更多男性被归类为甲状腺功能亢进或减退，或患有亚临床甲状腺功能亢进，而被归类为亚临床甲状腺功能减退的男性减少。
在老年男性中，与传统参考范围相比，老年男性TSH的参考区间向上移动，而FT4的参考区间变窄。应用基于健康老年男性的参考区间可将大量老年男性识别为患有显性甲状腺疾病或亚临床甲状腺功能亢进，并减少被归类为亚临床甲状腺功能减退的人数。
