Document Detail

Age- and race-based serum thyrotropin reference limits.
MedLine Citation:
PMID:  19965925     Owner:  NLM     Status:  MEDLINE    
CONTEXT: TSH reference limits, particularly the upper limit, are controversial. The traditional and prevailing method for setting limits uses TSH distribution of thyroid disease-free individuals. The curve is not Gaussian, but skewed to higher concentrations, even after log-transformation; values in the skewed area are assumed to reflect mild hypothyroidism. The underlying assumption for this traditional approach, which has not previously been tested, is that the limits derived from this curve are applicable to all people. However, recent studies suggest that distinct subpopulations have unique TSH distribution and reference limits that are significantly different from limits established by the traditional approach.
EVIDENCE ACQUISITION: A search was focused on articles that provide the basis for current recommendations for setting TSH reference limits as well as articles that suggest that the traditional method does not reflect accurately the TSH distribution and reference limits of distinct subpopulations within the United States.
EVIDENCE SYNTHESIS: TSH distribution and reference limits shift to higher concentrations with age, even up to centenarians, and are unique for different racial/ethnic groups, being at higher concentrations in Caucasians than either Blacks or Hispanics originating from Puerto Rico or the Dominican Republic. The distribution curve derived by the traditional approach represents a composite of curves from specific subpopulations that do not provide appropriate reference limits for those unique groups.
CONCLUSIONS: Age- and race-specific TSH distribution and reference limits, possibly influenced by genetic factors, should be employed to provide clinicians accurate limits for specific populations and guidance for further evaluation of thyroid dysfunction.
Martin I Surks; Laura Boucai
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Publication Detail:
Type:  Journal Article; Review     Date:  2009-12-04
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  95     ISSN:  1945-7197     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-05     Completed Date:  2010-03-02     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  496-502     Citation Subset:  AIM; IM    
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MeSH Terms
African Continental Ancestry Group
Age Factors
European Continental Ancestry Group
Middle Aged
Reference Values
Thyroid Diseases / classification
Thyrotropin / blood*
Thyroxine / blood
Reg. No./Substance:
9002-71-5/Thyrotropin; Q51BO43MG4/Thyroxine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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