The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Reference interval for thyrotropin in a ultrasonography screened Korean population

  • Kim, Mijin (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Tae Yong (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Soo Han (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Yunkyoung (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Su-yeon (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Hyung-Don (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kwon, Hyemi (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Yun Mi (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jang, Eun Kyung (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jeon, Min Ji (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Won Gu (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Shong, Young Kee (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Won Bae (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2014.07.24
  • Accepted : 2014.10.06
  • Published : 2015.05.01
⟨ Previous Next ⟩

Abstract

Background/Aims: The diagnostic accuracy of thyroid dysfunctions is primarily affected by the validity of the reference interval for serum thyroid-stimulating hormone (TSH). Thus, the present study aimed to establish a reference interval for TSH using a normal Korean population. Methods: This study included 19,465 subjects who were recruited after undergoing routine health check-ups. Subjects with overt thyroid disease, a prior history of thyroid disease, or a family history of thyroid cancer were excluded from the present analyses. The reference range for serum TSH was evaluated in a normal Korean reference population which was defined according to criteria based on the guidelines of the National Academy of Clinical Biochemistry, ultrasound (US) findings, and smoking status. Sex and age were also taken into consideration when evaluating the distribution of serum TSH levels in different groups. Results: In the presence of positive anti-thyroid peroxidase antibodies or abnormal US findings, the central 95 percentile interval of the serum TSH levels was widened. Additionally, the distribution of serum TSH levels shifted toward lower values in the current smokers group. The reference interval for TSH obtained using a normal Korean reference population was 0.73 to 7.06 mIU/L. The serum TSH levels were higher in females than in males in all groups, and there were no age-dependent shifts. Conclusions: The present findings demonstrate that the serum TSH reference interval in a normal Korean reference population was higher than that in other countries. This result suggests that the upper and lower limits of the TSH reference interval, which was previously defined by studies from Western countries, should be raised for Korean populations.

Keywords

Acknowledgement

Supported by : Asan Institute

References

  1. Kim YA, Park YJ. Prevalence and risk factors of subclinical thyroid disease. Endocrinol Metab 2014;29:20-29. https://doi.org/10.3803/EnM.2014.29.1.20
  2. Baloch Z, Carayon P, Conte-Devolx B, et al. Laboratory medicine practice guidelines: laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 2003;13:3-126. https://doi.org/10.1089/105072503321086962
  3. Hamilton TE, Davis S, Onstad L, Kopecky KJ. Thyrotropin levels in a population with no clinical, autoantibody, or ultrasonographic evidence of thyroid disease: implications for the diagnosis of subclinical hypothyroidism. J Clin Endocrinol Metab 2008;93:1224-1230. https://doi.org/10.1210/jc.2006-2300
  4. Belin RM, Astor BC, Powe NR, Ladenson PW. Smoke exposure is associated with a lower prevalence of serum thyroid autoantibodies and thyrotropin concentration elevation and a higher prevalence of mild thyrotropin concentration suppression in the third National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2004;89:6077-6086. https://doi.org/10.1210/jc.2004-0431
  5. Vadiveloo T, Donnan PT, Murphy MJ, Leese GP. Age- and gender-specific TSH reference intervals in people with no obvious thyroid disease in Tayside, Scotland: the Thyroid Epidemiology, Audit, and Research Study (TEARS). J Clin Endocrinol Metab 2013;98:1147-1153. https://doi.org/10.1210/jc.2012-3191
  6. Surks MI, Boucai L. Age- and race-based serum thyrotropin reference limits. J Clin Endocrinol Metab 2010;95:496-502. https://doi.org/10.1210/jc.2009-1845
  7. 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;92:4575-4582. https://doi.org/10.1210/jc.2007-1499
  8. Konno N, Makita H, Yuri K, Iizuka N, Kawasaki K. Association between dietary iodine intake and prevalence of subclinical hypothyroidism in the coastal regions of Japan. J Clin Endocrinol Metab 1994;78:393-397.
  9. Kim JY, Moon SJ, Kim KR, Sohn CY, Oh JJ. Dietary iodine intake and urinary iodine excretion in normal Korean adults. Yonsei Med J 1998;39:355-362. https://doi.org/10.3349/ymj.1998.39.4.355
  10. Choi YM, Kim WG, Kim TY, et al. Low levels of serum vitamin D3 are associated with autoimmune thyroid disease in pre-menopausal women. Thyroid 2014;24:655-661. https://doi.org/10.1089/thy.2013.0460
  11. Jeon MJ, Park JW, Han JM, et al. Serum antithyroglobulin antibodies interfere with thyroglobulin detection in fine-needle aspirates of metastatic neck nodes in papillary thyroid carcinoma. J Clin Endocrinol Metab 2013;98:153-160. https://doi.org/10.1210/jc.2012-2369
  12. Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002;87:489-499. https://doi.org/10.1210/jcem.87.2.8182
  13. Lee MW, Shin DY, Kim KJ, Hwang S, Lee EJ. The biochemical prognostic factors of subclinical hypothyroidism. Endocrinol Metab 2014;29:154-162. https://doi.org/10.3803/EnM.2014.29.2.154
  14. Kratzsch J, Fiedler GM, Leichtle A, et al. New reference intervals for thyrotropin and thyroid hormones based on National Academy of Clinical Biochemistry criteria and regular ultrasonography of the thyroid. Clin Chem 2005;51:1480-1486. https://doi.org/10.1373/clinchem.2004.047399
  15. Anderson L, Middleton WD, Teefey SA, et al. Hashimoto thyroiditis: part 1, sonographic analysis of the nodular form of Hashimoto thyroiditis. AJR Am J Roentgenol 2010;195:208-215. https://doi.org/10.2214/AJR.09.2459
  16. Rago T, Chiovato L, Grasso L, Pinchera A, Vitti P. Thyroid ultrasonography as a tool for detecting thyroid autoimmune diseases and predicting thyroid dsfunction in apparently healthy subjects. J Endocrinol Invest 2001;24:763-769. https://doi.org/10.1007/BF03343925
  17. Pedersen OM, Aardal NP, Larssen TB, Varhaug JE, Myking O, Vik-Mo H. The value of ultrasonography in predicting autoimmune thyroid disease. Thyroid 2000;10:251-259. https://doi.org/10.1089/thy.2000.10.251
  18. Langer JE, Khan A, Nisenbaum HL, et al. Sonographic appearance of focal thyroiditis. AJR Am J Roentgenol 2001;176:751-754. https://doi.org/10.2214/ajr.176.3.1760751
  19. Strieder TG, Prummel MF, Tijssen JG, Endert E, Wiersinga WM. Risk factors for and prevalence of thyroid disorders in a cross-sectional study among healthy female relatives of patients with autoimmune thyroid disease. Clin Endocrinol 2003;59:396-401. https://doi.org/10.1046/j.1365-2265.2003.01862.x
  20. Cho NH, Choi HS, Kim KW, et al. Interaction between cigarette smoking and iodine intake and their impact on thyroid function. Clin Endocrinol 2010;73:264-270.
  21. Kim BH, Kim WB, Kim TY, et al. Association between cigarette smoking and thyroid function in adults without previous history of thyroid disease. J Korean Endocr Soc 2008;23:123-128. https://doi.org/10.3803/jkes.2008.23.2.123
  22. Pedersen IB, Laurberg P, Knudsen N, et al. Smoking is negatively associated with the presence of thyroglobulin autoantibody and to a lesser degree with thyroid peroxidase autoantibody in serum: a population study. Eur J Endocrinol 2008;158:367-373. https://doi.org/10.1530/EJE-07-0595
  23. Nizri E, Irony-Tur-Sinai M, Lory O, Orr-Urtreger A, Lavi E, Brenner T. Activation of the cholinergic anti-inflammatory system by nicotine attenuates neuroinflammation via suppression of Th1 and Th17 responses. J Immunol 2009;183:6681-6688. https://doi.org/10.4049/jimmunol.0902212
  24. Wiersinga WM. Smoking and thyroid. Clin Endocrinol 2013;79:145-151. https://doi.org/10.1111/cen.12222
  25. Lee HS, Min H. Iodine intake and tolerable upper intake level of iodine for Koreans. Korean J Nutr 2011;44:82-91. https://doi.org/10.4163/kjn.2011.44.1.82
  26. Teng W, Shan Z, Teng X, et al. Effect of iodine intake on thyroid diseases in China. N Engl J Med 2006;354:2783-2793. https://doi.org/10.1056/NEJMoa054022
  27. Guan H, Shan Z, Teng X, et al. Influence of iodine on the reference interval of TSH and the optimal interval of TSH: results of a follow-up study in areas with different iodine intakes. Clin Endocrinol 2008;69:136-141. https://doi.org/10.1111/j.1365-2265.2007.03150.x
  28. Choi HS, Park YJ, Kim HK, et al. Prevalence of subclinical hypothyroidism in two population based-cohort: Ansung and KLoSHA cohort in Korea. J Korean Thyroid Assoc 2010;3:32-40.
  29. Jang HW, Lee JI, Shin HW, et al. Reference range of serum TSH with aging and prevalence of subclinical hypothyroidism in patients without history of thyroid disease for the general medical examination. J Korean Thyroid Assoc 2009;2:28-32.

Cited by

  1. Age-specific reference interval of serum TSH levels is high in adolescence in an iodine excess area: Korea national health and nutrition examination survey data vol.57, pp.3, 2015, https://doi.org/10.1007/s12020-017-1375-5
  2. Excessive Iodine Intake and Thyrotropin Reference Interval: Data from the Korean National Health and Nutrition Examination Survey vol.27, pp.7, 2015, https://doi.org/10.1089/thy.2017.0078
  3. The Relationship between Subclinical Thyroid Disease and Cardiovascular Disease Risk Score in Koreans vol.32, pp.10, 2015, https://doi.org/10.3346/jkms.2017.32.10.1626
  4. Thyroid Stimulating Hormone Reference Range and Prevalence of Thyroid Dysfunction in the Korean Population: Korea National Health and Nutrition Examination Survey 2013 to 2015 vol.32, pp.1, 2015, https://doi.org/10.3803/enm.2017.32.1.106
  5. Letter: Thyroid Stimulating Hormone Reference Range and Prevalence of Thyroid Dysfunction in the Korean Population: Korea National Health and Nutrition Examination Survey 2013 to 2015 ( Endocrinol Met vol.32, pp.2, 2015, https://doi.org/10.3803/enm.2017.32.2.302
  6. Response: Thyroid Stimulating Hormone Reference Range and Prevalence of Thyroid Dysfunction in the Korean Population: Korea National Health and Nutrition Examination Survey 2013 to 2015 ( Endocrinol M vol.32, pp.2, 2015, https://doi.org/10.3803/enm.2017.32.2.304
  7. TSH cut off point based on depression in hypothyroid patients vol.17, pp.None, 2017, https://doi.org/10.1186/s12888-017-1478-9
  8. Evaluation of Thyroid Hormone Levels and Urinary Iodine Concentrations in Koreans Based on the Data from Korea National Health and Nutrition Examination Survey VI (2013 to 2015) vol.33, pp.2, 2015, https://doi.org/10.3803/enm.2018.33.2.160
  9. Circulating thyrotropin is upregulated by estradiol vol.11, pp.None, 2018, https://doi.org/10.1016/j.jcte.2018.02.002
  10. Age- and gender-specific reference intervals of TSH and free T4 in an iodine-replete area: Data from Korean National Health and Nutrition Examination Survey IV (2013–2015) vol.13, pp.2, 2015, https://doi.org/10.1371/journal.pone.0190738
  11. Subclinical thyroid dysfunction, bone mineral density, and osteoporosis in a middle-aged Korean population vol.31, pp.3, 2015, https://doi.org/10.1007/s00198-019-05205-1
  12. Reference Intervals for Thyroid-Associated Hormones and the Prevalence of Thyroid Diseases in the Chinese Population vol.41, pp.1, 2015, https://doi.org/10.3343/alm.2021.41.1.77
  13. Sex Bias in Differentiated Thyroid Cancer vol.22, pp.23, 2015, https://doi.org/10.3390/ijms222312992