Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Laboratory Medicine, Endocrine Laboratory, Amsterdam, The Netherlands.
Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, The Netherlands.
Thyroid. 2024 Nov;34(11):1346-1355. doi: 10.1089/thy.2024.0346. Epub 2024 Sep 30.
Thyroid-stimulating hormone (TSH) and subsequent free thyroxine (FT4) concentrations outside the reference interval (RI) are used to diagnose thyroid diseases. Most laboratories do not provide age-specific RIs for TSH and FT4 beyond childhood, although TSH concentrations vary with age. Therefore, we aimed to establish TSH and FT4 age-specific RIs throughout life and aimed to determine whether using these RIs would result in reclassification of thyroid disease diagnoses in adults. This multicenter retrospective cross-sectional study used big data to determine indirect RIs for TSH and FT4. These RIs were determined by TMC and refineR-analysis, respectively, using four different immunoassay platforms (Roche, Abbott, Siemens, and Beckman Coulter). Retrospective data (2008-2022) from 13 Dutch laboratories for general practitioners and local hospitals were used. RIs were evaluated per manufacturer. Age groups were established from 2 to 20 years by 2-year categories and decade categories between 20 and 100 years. We included totally 7.6 million TSH and 2.2 million FT4 requests. TSH upper reference limits (URLs) and FT4 lower reference limits were higher in early childhood and decreased toward adulthood. In adulthood, TSH URLs increased from 60 years in men, and from 50 years in women, while FT4 URLs increased from 70 years onward. Using adult age-specific RIs resulted in a decrease in diagnoses of subclinical and overt hypothyroidism in women above 50 and men above 60 years in our Roche dataset. This study stressed the known importance of using age-specific RIs for TSH and FT4 in children. This study also showed the clinical relevance of using age-specific RIs for TSH in adulthood to reduce diagnoses of subclinical hypothyroidism in older persons. Therefore, implementation of adult TSH age-specific RIs should be strongly considered. Data are less uniform regarding FT4 age-specific RIs and more research should be performed before implementing these in clinical practice.
促甲状腺激素（TSH）和随后的游离甲状腺素（FT4）浓度超出参考区间（RI）用于诊断甲状腺疾病。尽管 TSH 浓度随年龄而变化，但大多数实验室并未提供儿童期后 TSH 和 FT4 的年龄特异性 RI。因此，我们旨在确定一生中 TSH 和 FT4 的年龄特异性 RI，并旨在确定使用这些 RI 是否会导致成年人甲状腺疾病诊断的重新分类。这项多中心回顾性横断面研究使用大数据确定 TSH 和 FT4 的间接 RI。这些 RI 分别由 TMC 和 refineR 分析使用四种不同的免疫分析平台（罗氏、雅培、西门子和贝克曼库尔特）确定。使用来自 13 家荷兰普通科医生和当地医院的回顾性数据（2008-2022 年）。按制造商评估 RI。年龄组通过每 2 年分类和 20 至 100 岁之间的十年分类从 2 岁到 20 岁建立。我们共纳入了 760 万次 TSH 和 220 万次 FT4 请求。儿童早期 TSH 上参考限（URL）和 FT4 下参考限较高，并随着成年而降低。在成年期，男性从 60 岁开始，女性从 50 岁开始，TSH URL 增加，而 FT4 URL 从 70 岁开始增加。在罗氏数据集，在女性 50 岁以上和男性 60 岁以上的成年人中使用年龄特异性 RI 会导致亚临床和显性甲状腺功能减退症的诊断减少。这项研究强调了在儿童中使用 TSH 和 FT4 年龄特异性 RI 的已知重要性。这项研究还表明，在成年期使用 TSH 的年龄特异性 RI 具有临床相关性，可减少老年人亚临床甲状腺功能减退症的诊断。因此，应强烈考虑实施成人 TSH 年龄特异性 RI。关于 FT4 年龄特异性 RI 的数据不太一致，在将其纳入临床实践之前，应进行更多研究。
