ECE2024 Rapid Communications Rapid Communications 6: Thyroid | Part I (5 abstracts)
Age-specific reference intervals for TSH and FT4 to optimize diagnosis of thyroid disease
Heleen Jansen 1,2,3 , Niek Dirks 2,4,5 , Jacquelien Hillebrand 2,3 , Edwin Ten Boekel 5 , Jacoline Brinkman 6 , Madelon Buijs 4 , Ayse Demir 7 , Ineke Dijkstra 8 , Silvia Endenburg 9 , Paula Engbers 10 , Jeannette Gootjes 4 , Marcel Janssen 11 , Stephan Kamphuis 12 , Wilhelmina Kniest-de Jong 13 , Adrian Kruit 14 , Etienne Michielsen 15 , Albert Wolthuis 16 , A.S. Paul van Trotsenburg 3,17 , Martin den Heijer 3,18 , Eveline Bruinstroop 3,19 , Anita Boelen 2,3,20 , Annemieke C Heijboer 1,2,3,20 & Wendy den Elzen 21,22
1Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Laboratory Medicine, Endocrine Laboratory, Amsterdam, Netherlands; 2Amsterdam UMC location University of Amsterdam, Department of Laboratory Medicine, Endocrine Laboratory, Amsterdam, Netherlands; 3Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, Netherlands; 4Atalmedial Diagnostic Centers, Amsterdam, Amsterdam, Netherlands; 5Northwest Clinics, Alkmaar, Department of Clinical Chemistry, Hematology & Immunology, Alkmaar, Netherlands; 6St. Jansdal Hospital, Harderwijk, Department of Clinical Chemistry, Harderwijk, Netherlands; 7Meander Medical Center, Amersfoort, Laboratory for Clinical Chemistry and Hematology, Amersfoort, Netherlands; 8St Antonius Hospital, Nieuwegein, Department of Clinical Chemistry, Nieuwegein, Netherlands; 9Dicoon, Gelderse Vallei Hospital, Ede, Department of Clinical Chemistry and Hematology, Ede, Netherlands, 10Treant Zorggroep, Hoogeveen, Department of Clinical Chemistry, Hoogeveen, Netherlands, 11VieCuri Medical Center, Venlo, Laboratory of Clinical Chemistry and Hematology, Venlo, Netherlands, 12Eurofins Clinical Diagnostics, Eurofins Gelre, Apeldoorn, Netherlands, 13Saltro Diagnostic Center, Unilabs Netherlands, Utrecht, Netherlands, 14Nij Smellinghe Hospital, Drachten, Medical Laboratory, Drachten, Netherlands, 15Diagnostiek voor U, Eindhoven, Eindhoven, Netherlands, 16Stichting Certe Medische Diagnostiek en Advies, Groningen, Groningen, Netherlands, 17Emma Children’s Hospital, Amsterdam UMC location University of Amsterdam, Department of Paediatric Endocrinology, Amsterdam, Netherlands, 18Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Endocrinology and Metabolism, Amsterdam, Netherlands, 19Amsterdam UMC location University of Amsterdam, Department of Endocrinology and Metabolism, Amsterdam, Netherlands, 20Amsterdam Reproduction & Development Research Institute, Amsterdam, Netherlands, 21Amsterdam UMC location University of Amsterdam, Department of Laboratory Medicine, Laboratory Specialized Diagnostics & Research, Amsterdam, Netherlands, 22Amsterdam Public Health, Amsterdam, Netherlands
Introduction: Thyroid disorders are generally diagnosed based on thyroid stimulating hormone (TSH) outside the reference interval (RI), and subsequent free thyroxine (FT4) concentrations. Most laboratories do not provide age-specific RIs for TSH and FT4 beyond childhood, although it is known that TSH concentrations vary with age which may be important to take into account. Therefore, we aimed to establish age-specific RIs for TSH and FT4 throughout life using an indirect method for four commonly used immunoassay platforms. Also, we determined whether using age-specific RIs would result in reclassification of thyroid disease diagnoses in adults.
Methods: Indirect RIs for TSH (TMC) and FT4 (RefineR) using four different immunoassay platforms (Roche, Abbott, Siemens, Beckman) were established using retrospective data from 13 Dutch laboratories (>7 million TSH and >2 million FT4 unique requests). RIs were evaluated per manufacturer. Age groups were established from 2 to 20 years by 2-year categories, followed by decade categories between 20 and 100 years.
Results: TSH upper reference limits (URLs) and FT4 lower reference limits (LRLs) were higher until the age of 10 to 12 years and decreased towards adulthood. The URLs of FT4 were stable with a dip during puberty. In adulthood, TSH URLs increased from the age of 60 years onwards, and even from 50 years in women, while FT4 URLs increased from 70 years onwards. The LRLs of TSH and FT4 remained stable during ageing. The use of our adult age-specific RIs resulted in a decrease in diagnoses of subclinical and overt hypothyroidism in women above 50 (15.7 to 7.3% and 2.7 to 2.3%, respectively), and in men above 60 years of age (13.7 to 8% and 2.0 to 1.6%, respectively) in our Roche dataset.
Conclusion: This study stressed the known importance of using age-specific RIs in children. In adulthood, age-specific reference intervals are currently not used in clinical practice. However, this study showed an important clinical relevance by reducing the diagnoses of subclinical hypothyroidism, and to a lesser extent, overt hypothyroidism. Therefore, implementation of adult TSH age-specific RIs in clinical practice should be strongly considered. Data is less uniform regarding FT4 age-specific RIs and more research should be performed before implementing these in clinical practice.
Volume 99
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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