Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands.
Department of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands.
J Clin Endocrinol Metab. 2017 Aug 1;102(8):2853-2861. doi: 10.1210/jc.2017-00410.
Reference ranges of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) are defined by their distribution in apparently healthy populations (2.5th and 97.5th percentiles), irrespective of disease risk, and are used as cutoffs for defining and clinically managing thyroid dysfunction.
To provide proof of concept in defining optimal health ranges of thyroid function based on cardiovascular disease (CVD) mortality risk.
In all, 9233 participants from the Rotterdam Study (mean age, 65.0 years) were followed up (median, 8.8 years) from baseline to date of death or end of follow-up period (2012), whichever came first (689 cases of CVD mortality).
We calculated 10-year absolute risks of CVD mortality (defined according to the SCORE project) using a Fine and Gray competing risk model per percentiles of TSH and FT4, modeled nonlinearly and with sex and age adjustments.
Overall, FT4 level >90th percentile was associated with a predicted 10-year CVD mortality risk >7.5% (P = 0.005). In men, FT4 level >97th percentile was associated with a risk of 10.8% (P < 0.001). In participants aged ≥65 years, absolute risk estimates were <10.0% below the 30th percentile (∼14.5 pmol/L or 1.10 ng/dL) and ≥15.0% above the 97th percentile of FT4 (∼22 pmol/L or 1.70 ng/dL).
We describe absolute 10-year CVD mortality risks according to thyroid function (TSH and FT4) and suggest that optimal health ranges for thyroid function can be defined according to disease risk and are possibly sex and age dependent. These results need to be replicated with sufficient samples and representative populations.
促甲状腺激素（TSH）和游离甲状腺素（FT4）的参考范围是根据健康人群的分布情况定义的（第 2.5 和 97.5 个百分位数），无论疾病风险如何，这些参考范围被用作定义和临床管理甲状腺功能障碍的标准。
基于心血管疾病（CVD）死亡率，提供甲状腺功能最佳健康范围定义的概念验证。
共有 9233 名来自鹿特丹研究（平均年龄 65.0 岁）的参与者从基线开始接受随访（中位数为 8.8 年），直至死亡或随访期结束（2012 年），以先到者为准（CVD 死亡率 689 例）。
我们使用 Fine 和 Gray 竞争风险模型，根据 SCORE 项目，计算了 TSH 和 FT4 每百分位的 10 年 CVD 死亡率绝对风险（非线性建模，并进行了性别和年龄调整）。
总的来说，FT4 水平超过第 90 百分位与预测的 10 年 CVD 死亡率风险超过 7.5%相关（P = 0.005）。在男性中，FT4 水平超过第 97 百分位与 10.8%的风险相关（P < 0.001）。在年龄≥65 岁的参与者中，绝对风险估计值在 FT4 的第 30 百分位（约 14.5 pmol/L 或 1.10 ng/dL）以下<10.0%，在第 97 百分位以上（约 22 pmol/L 或 1.70 ng/dL）则≥15.0%。
我们根据甲状腺功能（TSH 和 FT4）描述了绝对 10 年 CVD 死亡率风险，并提出甲状腺功能的最佳健康范围可以根据疾病风险来定义，并且可能与性别和年龄有关。这些结果需要用足够的样本和有代表性的人群进行复制。
