Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
Pathwest Laboratory Medicine, Nedlands, WA, Australia.
J Clin Endocrinol Metab. 2020 Apr 1;105(4). doi: 10.1210/clinem/dgz331.
There are no large, longitudinal studies of thyroid function across adolescence. The aims of this study were to examine longitudinal trends in thyrotropin (TSH), free triiodothyronine (fT3) and free thyroxine (fT4) and determine age-specific reference ranges.
Thyroid function was assessed in 3415 participants in the Brisbane Longitudinal Twin Study at ages 12, 14, and 16, using the Abbott ARCHITECT immunoassay. Longitudinal analyses were adjusted for body mass index and puberty.
In girls, mean fT4 (± SE) increased between age 12 and 14 (by 0.30 ± 0.08 pmol/L; P < 0.001), while remaining unchanged in boys; from age 14 to 16, fT4 increased in both girls (by 0.42 ± 0.07 pmol/L; P < 0.001) and boys (0.64 ± 0.07 pmol/L, P < 0.001). There was a slight increase in fT3 from age 12 to 14 years in girls (by 0.07 ± 0.03 pmol/L; P = 0.042), with a more marked increase in boys (0.29 ± 0.03 pmol/L; P < 0.001), followed by a decrease from age 14 to 16 in both sexes (girls, by 0.53 ± 0.02 pmol/L; P < 0.001; boys, by 0.62 ± 0.03 pmol/L; P < 0.001). From age 12 to 14, TSH showed no significant change in girls or boys, then levels increased from age 14 to 16 in both sexes (in girls, by 4.9%, 95% CI: 2.4%-10.3%, P = 0.020; in boys, by 7.2%, 95% CI: 3.0%-11.6%, P = 0.001). Reference ranges differed substantially from adults, particularly for fT4 and fT3.
Thyroid function tests in adolescents display complex, sexually dimorphic patterns. Implementation of adolescence-specific reference ranges may be appropriate.
目前尚缺乏青少年时期甲状腺功能的大型纵向研究。本研究旨在探讨促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（fT3）和游离甲状腺素（fT4）的纵向变化趋势，并确定年龄特异性参考范围。
使用 Abbott ARCHITECT 免疫分析法，在布里斯班纵向双胞胎研究中对 3415 名参与者在 12、14 和 16 岁时进行甲状腺功能评估。纵向分析根据体重指数和青春期进行了调整。
在女孩中，fT4 的平均值（± SE）在 12 岁至 14 岁之间增加（增加 0.30 ± 0.08 pmol/L；P < 0.001），而男孩中则保持不变；从 14 岁到 16 岁，fT4 在女孩（增加 0.42 ± 0.07 pmol/L；P < 0.001）和男孩（增加 0.64 ± 0.07 pmol/L，P < 0.001）中均增加。女孩的 fT3 从 12 岁到 14 岁略有增加（增加 0.07 ± 0.03 pmol/L；P = 0.042），男孩增加更为明显（增加 0.29 ± 0.03 pmol/L；P < 0.001），随后在两性中从 14 岁到 16 岁下降（女孩，下降 0.53 ± 0.02 pmol/L；P < 0.001；男孩，下降 0.62 ± 0.03 pmol/L；P < 0.001）。从 12 岁到 14 岁，女孩或男孩的 TSH 均无明显变化，然后从 14 岁到 16 岁，两性的 TSH 水平均升高（女孩升高 4.9%，95%CI：2.4%-10.3%，P = 0.020；男孩升高 7.2%，95%CI：3.0%-11.6%，P = 0.001）。参考范围与成人有很大差异，尤其是 fT4 和 fT3。
青少年的甲状腺功能检查呈现复杂的、性别二态的模式。实施青春期特异性参考范围可能是合适的。
