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Thyroid-stimulating hormone reference range and factors affecting it in a nationwide random sample

  • Ville L. Langén EMAIL logo , Teemu J. Niiranen , Juhani Mäki , Jouko Sundvall and Antti M. Jula
Published/Copyright: June 20, 2014
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 52 Issue 12

Abstract

Background: Previous studies with mainly selected populations have proposed contradicting reference ranges for thyroid-stimulating hormone (TSH) and have disagreed on how screening, age and gender affect them. This study aimed to determine a TSH reference range on the Abbott Architect ci8200 integrated system in a large, nationwide, stratified random sample. To our knowledge this is the only study apart from the NHANES III that has addressed this issue in a similar nationwide setting. The effects of age, gender, thyroid peroxidase antibody (TPOAb)-positivity and medications on TSH reference range were also assessed.

Methods: TSH was measured from 6247 participants randomly drawn from the population register to represent the Finnish adult population. TSH reference ranges were established of a thyroid-healthy population and its subpopulations with increasing and cumulative rigour of screening: screening for overt thyroid disease (thyroid-healthy population, n=5709); screening for TPOAb-positivity (risk factor-free subpopulation, n=4586); and screening for use of any medications (reference subpopulation, n=1849).

Results: The TSH reference ranges of the thyroid-healthy population, and the risk factor-free and reference subpopulations were 0.4–4.4, 0.4–3.7 and 0.4–3.4 mU/L (2.5th–97.5th percentiles), respectively. Although the differences in TSH between subgroups for age (p=0.002) and gender (p=0.005) reached statistical significance, the TSH distribution curves of the subgroups were practically superimposed.

Conclusions: We propose 0.4–3.4 mU/L as a TSH reference range for adults for this platform, which is lower than those presently used in most laboratories. Our findings suggest that intensive screening for thyroid risk factors, especially for TPOAb-positivity, decreases the TSH upper reference limit.

Keywords: adult population; reference interval; reference range; thyroid dysfunction; thyroid peroxidase antibody (TPOAb); thyroid-stimulating hormone (TSH)
Corresponding author: Ville L. Langén, MD, Population Studies Unit, National Institute for Health and Welfare, Peltolantie 3, 20720 Turku, Finland, Phone: +358 29 524 6000, E-mail:

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Supplemental Material

The online version of this article (DOI 10.1515/cclm-2014-0287) offers supplementary material, available to authorized users.

Received: 2014-3-14
Accepted: 2014-5-19
Published Online: 2014-6-20
Published in Print: 2014-12-1

©2014 by De Gruyter

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https://doi.org/10.1515/cclm-2014-0287
Keywords for this article
adult population; reference interval; reference range; thyroid dysfunction; thyroid peroxidase antibody (TPOAb); thyroid-stimulating hormone (TSH)

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. CCLM Award for The Most Cited Paper Recently Published
  4. Laboratory preparedness to face infectious outbreaks. Ebola and beyond
  5. Reviews
  6. Determination of reference limits: statistical concepts and tools for sample size calculation
  7. Recent advances in physiological lipoprotein metabolism
  8. New laboratory markers for the management of rheumatoid arthritis patients
  9. General Clinical Chemistry and Laboratory Medicine
  10. The impact of repeat-testing of common chemistry analytes at critical concentrations
  11. Performance of CKD-EPI equation to estimate glomerular filtration rate as compared to MDRD equation in South Brazilian individuals in each stage of renal function
  12. The serum uromodulin level is associated with kidney function
  13. Efficient assessment of peripheral blood lymphocytosis in adults: developing new thresholds for blood smear review by pathologists
  14. Performance evaluation of Sysmex XN hematology analyzer in umbilical cord blood: a comparison study with Sysmex XE-2100
  15. UF-1000i: validation of the body fluid mode for counting cells in body fluids
  16. Newborn screening for haemoglobinopathies by high performance liquid chromatography (HPLC): diagnostic utility of different approaches in resource-poor settings
  17. Progressive chromogenic anti-factor Xa assay and its use in the classification of antithrombin deficiencies
  18. Reference Values and Biological Variations
  19. Thyroid-stimulating hormone reference range and factors affecting it in a nationwide random sample
  20. Reference ranges for serum β-trace protein in neonates and children younger than 1 year of age
  21. A multicenter nationwide reference intervals study for common biochemical analytes in Turkey using Abbott analyzers
  22. Serum reference intervals of homoarginine, ADMA, and SDMA in the Study of Health in Pomerania
  23. Cancer Diagnostics
  24. Low SOX17 expression: prognostic significance in de novo acute myeloid leukemia with normal cytogenetics
  25. Results of first proficiency test for KRAS testing with formalin-fixed, paraffin-embedded cell lines in China
  26. Aberrant hypermethylation of CTNNA1 gene is associated with higher IPSS risk in patients with myelodysplastic syndrome
  27. Cardiovascular Diseases
  28. Association between SNP rs13376333 and rs1131820 in the KCNN3 gene and atrial fibrillation in the Chinese Han population
  29. Acknowledgment
  30. Acknowledgment
  31. Letters to the Editor
  32. Interference in thyroid hormones with Roche immunoassays: an unfinished story
  33. Discrepant results in plasma, but not serum in the Beckman Coulter DxI Access HYPERsensitive hTSH 3rd generation assay affect the management of differentiated thyroid cancer and hyperthyroid patients
  34. Improper serum separation on gel tubes: a trivial laboratory problem or an indicator of monoclonal gammopathy?
  35. Analytical comparison of the new point-of-care troponin T immunoassay on AQT90Flex® analyzer (Radiometer) and the high-sensitivity troponin T immunoassay on ModularE170® (Roche Diagnostics)
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  40. Enzymatic and endpoint methods yield comparable adenosine deaminase activity in pleural fluid samples
  41. Congress Abstract
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