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Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population: implications for the prevalence of subclinical hypothyroidism.

Abstract

CONTEXT

Measurements from all age groups defined the upper limit of the TSH reference range in National Health and Nutrition Examination Survey III. The TSH median, 97.5 centile and prevalence of subclinical hypothyroidism (SCH), normal serum T(4) and TSH greater than 4.5 mIU/liter, increased progressively with age. Age-adjusted reference ranges would include many people with TSH greater than 4.5 mIU/liter.

OBJECTIVE

We determined whether increasing 50 and 97.5 centiles with age resulted from more patients with SCH in populations with normal TSH distribution or whether age-specific population shifts to higher serum TSH might account for these findings.

DESIGN/SETTING/PATIENTS

We analyzed TSH, antithyroid antibodies, and TSH frequency distribution curves for specific age deciles in populations without thyroid disease, with or without antithyroid antibodies.

RESULTS

Without thyroid disease, 10.6% of 20- to 29-yr-olds had TSH greater than 2.5 mIU/liter, increasing to 40% in the 80+ group, 14.5% of whom had TSH greater than 4.5 mIU/liter. When TSH was greater than 4.5 mIU/liter, the percentage with antibodies was 67.4% (age 40-49 yr) and progressively decreased to 40.5% in the 80+ group. TSH frequency distribution curves of the 80+ group with or without antibodies was displaced to higher TSH, including TSH at peak frequency. The 97.5 centiles for the 20-29 and 80+ groups were 3.56 and 7.49 mIU/liter, respectively. Seventy percent of older patients with TSH greater than 4.5 mIU/liter were within their age-specific reference range.

CONCLUSION

TSH distribution progressively shifts toward higher concentrations with age. The prevalence of SCH may be significantly overestimated unless an age-specific range for TSH is used.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York 10467, USA. msurks@westnet.com

    Source

    MeSH

    Adolescent
    Adult
    Aged
    Aged, 80 and over
    Aging
    Autoantibodies
    Child
    Data Interpretation, Statistical
    Female
    Humans
    Hypothyroidism
    Iodide Peroxidase
    Male
    Middle Aged
    Reference Values
    Thyrotropin
    Thyroxine
    United States

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    17911171

    Citation

    Surks, Martin I., and Joseph G. Hollowell. "Age-specific Distribution of Serum Thyrotropin and Antithyroid Antibodies in the US Population: Implications for the Prevalence of Subclinical Hypothyroidism." The Journal of Clinical Endocrinology and Metabolism, vol. 92, no. 12, 2007, pp. 4575-82.
    Surks MI, Hollowell JG. Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population: implications for the prevalence of subclinical hypothyroidism. J Clin Endocrinol Metab. 2007;92(12):4575-82.
    Surks, M. I., & Hollowell, J. G. (2007). Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population: implications for the prevalence of subclinical hypothyroidism. The Journal of Clinical Endocrinology and Metabolism, 92(12), pp. 4575-82.
    Surks MI, Hollowell JG. Age-specific Distribution of Serum Thyrotropin and Antithyroid Antibodies in the US Population: Implications for the Prevalence of Subclinical Hypothyroidism. J Clin Endocrinol Metab. 2007;92(12):4575-82. PubMed PMID: 17911171.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population: implications for the prevalence of subclinical hypothyroidism. AU - Surks,Martin I, AU - Hollowell,Joseph G, Y1 - 2007/10/02/ PY - 2007/10/4/pubmed PY - 2008/2/8/medline PY - 2007/10/4/entrez SP - 4575 EP - 82 JF - The Journal of clinical endocrinology and metabolism JO - J. Clin. Endocrinol. Metab. VL - 92 IS - 12 N2 - CONTEXT: Measurements from all age groups defined the upper limit of the TSH reference range in National Health and Nutrition Examination Survey III. The TSH median, 97.5 centile and prevalence of subclinical hypothyroidism (SCH), normal serum T(4) and TSH greater than 4.5 mIU/liter, increased progressively with age. Age-adjusted reference ranges would include many people with TSH greater than 4.5 mIU/liter. OBJECTIVE: We determined whether increasing 50 and 97.5 centiles with age resulted from more patients with SCH in populations with normal TSH distribution or whether age-specific population shifts to higher serum TSH might account for these findings. DESIGN/SETTING/PATIENTS: We analyzed TSH, antithyroid antibodies, and TSH frequency distribution curves for specific age deciles in populations without thyroid disease, with or without antithyroid antibodies. RESULTS: Without thyroid disease, 10.6% of 20- to 29-yr-olds had TSH greater than 2.5 mIU/liter, increasing to 40% in the 80+ group, 14.5% of whom had TSH greater than 4.5 mIU/liter. When TSH was greater than 4.5 mIU/liter, the percentage with antibodies was 67.4% (age 40-49 yr) and progressively decreased to 40.5% in the 80+ group. TSH frequency distribution curves of the 80+ group with or without antibodies was displaced to higher TSH, including TSH at peak frequency. The 97.5 centiles for the 20-29 and 80+ groups were 3.56 and 7.49 mIU/liter, respectively. Seventy percent of older patients with TSH greater than 4.5 mIU/liter were within their age-specific reference range. CONCLUSION: TSH distribution progressively shifts toward higher concentrations with age. The prevalence of SCH may be significantly overestimated unless an age-specific range for TSH is used. SN - 0021-972X UR - https://www.unboundmedicine.com/medline/citation/17911171/Age_specific_distribution_of_serum_thyrotropin_and_antithyroid_antibodies_in_the_US_population:_implications_for_the_prevalence_of_subclinical_hypothyroidism_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2007-1499 DB - PRIME DP - Unbound Medicine ER -