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Reference interval by the indirect approach of serum thyrotropin (TSH) in a Mediterranean adult population and the association with age and gender

  • Bruna Lo Sasso , Matteo Vidali , Concetta Scazzone , Luisa Agnello and Marcello Ciaccio EMAIL logo
Published/Copyright: June 11, 2019
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 57 Issue 10

Abstract

Background

The serum concentration of thyrotropin (TSH) represents a first-line test in diagnostic algorithms. The estimation of TSH reference intervals (RIs) is still a matter of debate due to the high prevalence of subclinical disease making difficult the definition of truly healthy subjects. The aim of this study was to estimate TSH RIs in healthy subjects and to evaluate the effect of age and gender on TSH concentration.

Methods

Forty-four thousand one hundred and fifty-six TSH data were collected between July 2012 and April 2018 at the Department of Laboratory Medicine, University-Hospital, Palermo. Common and sex-specific RIs were estimated by Arzideh’s indirect method after exclusion of individuals younger than 15 years, subjects with repeated TSH tests and with abnormal free thyroxine (fT4), free triiodothyronine (fT3) or anti-thyroid-peroxidase antibodies. The combined effect of age and gender on TSH values was evaluated.

Results

RIs estimated in the selected individuals (n = 22602) were, respectively, 0.18–3.54 mIU/L (general), 0.19–3.23 mIU/L (men) and 0.18–3.94 mIU/L (women). Women showed significantly higher median TSH than men (1.46 vs. 1.39 mIU/L; p < 0.0001). Both in men and in women, median TSH decreased along with age; however, although up to 60 years in both men and women showed similar values, afterwards women showed constantly higher TSH than men. Accordingly, statistical analysis showed a significant interaction between gender and age (p = 0.001), suggesting that the effect of age on TSH is different between genders.

Conclusions

Our findings suggest that the indirect method, with appropriate cleaning of data, could be useful to define TSH RIs.

Keywords: indirect method; laboratory information systems; reference intervals; thyroid disease; thyrotropin; TSH
Corresponding author: Marcello Ciaccio, MD, PhD, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy; and Department of Laboratory Medicine, University Hospital, Via del Vespro, 129, CAP 90127, Palermo, Italy, Phone: +39 091 23865701, Fax: +39 091 655 3275

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2018-08-31
Accepted: 2019-02-27
Published Online: 2019-06-11
Published in Print: 2019-09-25

©2019 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2018-0957
Keywords for this article
indirect method; laboratory information systems; reference intervals; thyroid disease; thyrotropin; TSH

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Blood biomarkers in neurology: “a call to arms” for laboratory professionals
  4. Reviews
  5. Diagnostic accuracy of glycated hemoglobin for gestational diabetes mellitus: a systematic review and meta-analysis
  6. Laboratory medicine: health evaluation in elite athletes
  7. Prostate cancer screening: guidelines review and laboratory issues
  8. Opinion Papers
  9. Extra-analytical sources of uncertainty: which ones really matter?
  10. Benefits and harms of wellness initiatives
  11. Genetics and Molecular Diagnostics
  12. Analytical and clinical validation of a novel amplicon-based NGS assay for the evaluation of circulating tumor DNA in metastatic colorectal cancer patients
  13. General Clinical Chemistry and Laboratory Medicine
  14. Pre-analytical practices for routine coagulation tests in European laboratories. A collaborative study from the European Organisation for External Quality Assurance Providers in Laboratory Medicine (EQALM)
  15. Preanalytical robustness of blood collection tubes with RNA stabilizers
  16. Continual improvement of the pre-analytical process in a public health laboratory with quality indicators-based risk management
  17. Comparison of six commercial serum exosome isolation methods suitable for clinical laboratories. Effect in cytokine analysis
  18. A multicenter study to evaluate harmonization of assays for N-terminal propeptide of type I procollagen (PINP): a report from the IFCC-IOF Joint Committee for Bone Metabolism
  19. Correlations between serum and CSF pNfH levels in ALS, FTD and controls: a comparison of three analytical approaches
  20. Dynamics of extracellular matrix proteins in cerebrospinal fluid and serum and their relation to clinical outcome in human traumatic brain injury
  21. Free light chains in the cerebrospinal fluid. Comparison of different methods to determine intrathecal synthesis
  22. Reference Values and Biological Variations
  23. Reference interval by the indirect approach of serum thyrotropin (TSH) in a Mediterranean adult population and the association with age and gender
  24. Next-generation reference intervals for pediatric hematology
  25. Hematology and Coagulation
  26. Preliminary evaluation of a new flow cytometry method for the routine hematology workflow
  27. Diabetes
  28. Trueness assessment of HbA1c routine assays: are processed EQA materials up to the job?
  29. Infectious Diseases
  30. Utility of procalcitonin for differentiating cryptogenic organising pneumonia from community-acquired pneumonia
  31. A high C-reactive protein/procalcitonin ratio predicts Mycoplasma pneumoniae infection
  32. Letters to the Editor
  33. Evaluation of reference change values for a hs-cTnI immunoassay using both plasma samples of healthy subjects and patients and quality control samples
  34. Outlier removal methods for skewed data: impact on age-specific high-sensitive cardiac troponin T 99th percentiles
  35. Comparison of precision and operational performances across six immunochemistry analyzers
  36. Evaluation of the possible interference of abiraterone therapy on testosterone immunoassay
  37. Erroneous thyroid and steroid hormones profile due to anti-streptavidin antibodies
  38. Reference values for 24,25-dihydroxyvitamin D and the 25-hydroxyvitamin D/24,25-dihydroxyvitamin D ratio
  39. Pre-analytical error in a hematology laboratory: an avoidable cause of compromised quality in reporting
  40. Stability of tubular damage markers epidermal growth factor and heparin-binding EGF-like growth factor in urine
  41. Blood from heparin tubes is an acceptable alternative to assess hematocrit determination
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