Serum Thyrotropin Measurements in the Community: Five-Year Follow-up in a Large Network of Primary Care Physicians
Abstract
BACKGROUND: Subclinical thyroid disease is common; however, screening recommendations using serum thyrotropin (TSH) level determinations are controversial. METHODS: To study the use of serum TSH by primary care physicians and define populations at risk for having an abnormal TSH level at follow-up, based on initial TSH levels, we conducted an observational study of a large health care database in the setting of a health management organization. All outpatients without thyroid disease or pregnancy or taking medication that may alter thyroid function in whom the TSH level was measured in 2002 and during 5-year follow-up were included in this study. Repeated TSH level determinations were compared with the initial TSH level values. RESULTS: In 422 242 patients included, 95% of the initial serum TSH concentrations were within normal limits (0.35-5.5 mIU/L), 1.2% were decreased (<0.35 mIU/L), 3.0% were elevated (>5.5 to 10 mIU/L). In 346 549 patients without thyroid-specific medications, the TSH levels became normal in 27.2%, 62.1%, and 51.2%, whose initial serum TSH level was highly elevated, elevated, and decreased, respectively, and remain normal in 98% of the patients with normal initial TSH levels. When the initial serum TSH level was elevated, patients in the highest quintile of this group, who had a shorter interval between the first and second measurements, had a higher probability of a second highly elevated TSH concentration (P < .001). CONCLUSIONS: When the serum TSH level is normal, the likelihood of an abnormal level within 5 years is low (2%). More than 50% of patients with elevated or decreased serum TSH levels have normal levels in repeated measurements.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A TSH level of 10 mIU/L is chosen as levels above this are unlikely to return to the normal population reference range.
“A TSH level of 10 mIU/L is chosen as levels above this are unlikely to return to the normal population reference range.145”
From Hypothyroidism (2024) · cites this paper as [145]
Low serum TSH levels may normalize in 25-50% of patients with grade 1 subclinical hyperthyroidism.
“Low serum TSH levels may normalize in 25-50% of patients with grade 1 SHyper, as reported in two prospective studies with a long-term follow-up [33,34] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [34]
In one study, 51.2% of patients had spontaneously developed a normal TSH when first checked at some time within 5 years (mean time to repeat TSH, 13 months).
“In one study (372), 51.2% of patients had spontaneously developed a normal TSH when first checked at some time within 5 years (mean time to repeat TSH, 13 months).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [372]
The natural history of SH is variable, with annualized rates of 0.5%-7% progression to overt hyperthyroidism and 5%-12% reversion to normal TSH levels.
“The natural history of SH is variable (367,370-377), with annualized rates of 0.5%-7% progression to overt hyperthyroidism and 5%-12% reversion to normal TSH levels.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [372]
Cites
Hollowell, J. G., Staehling, N. W., Flanders, W. D., Hannon, W. H., Gunter, E. W., Spencer, C. A., & Braverman, L. E. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.87.2.489 · Cited by 4,279 · see citing works
The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey
Vanderpump, M. P. J., Tunbrldge, W. M. G., French, J. M., Appleton, D., Bates, D., Clark, F., Evans, J. G., Hasan, D. M., Rodgers, H., Tunbridge, F., et al. (1995) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1995.tb01894.x · Cited by 2,432 · see citing works
Subclinical Thyroid Disease: Scientific Review and Guidelines for Diagnosis and Management
Surks, M. I., Ortiz, E., Daniels, G. H., Sawin, C. T., Col, N. F., Cobin, R. H., Franklyn, J. A., Hershman, J. M., Burman, K. D., Denke, M. A., et al. (2004) · JAMA · doi:10.1001/jama.291.2.228 · Cited by 1,800 · see citing works
Hak, A. E., Pols, H. A. P., Visser, T. J., Drexhage, H. A., Hofman, A., & Witteman, J. C. M. (2000) · Annals of Internal Medicine · doi:10.7326/0003-4819-132-4-200002150-00004 · Cited by 1,336 · see citing works
Thyroid Status, Disability and Cognitive Function, and Survival in Old Age
Gussekloo, J. (2004) · JAMA · doi:10.1001/jama.292.21.2591 · Cited by 899 · see citing works
Thyroid Status, Cardiovascular Risk, and Mortality in Older Adults
Cappola, A. R., Fried, L. P., Arnold, A. M., Danese, M. D., Kuller, L. H., Burke, G. L., Tracy, R. P., & Ladenson, P. W. (2006) · JAMA · doi:10.1001/jama.295.9.1033 · Cited by 862 · see citing works
American Thyroid Association guidelines for detection of thyroid dysfunction.
Ladenson, P., Singer, P., Ain, K., Bagchi, N., Bigos, S., Levy, E., Smith, S. A., Daniels, G., & Cohen, H. D. (2000) · Archives of Internal Medicine · doi:10.1001/archinte.160.11.1573 · Cited by 658 · see citing works
Fade, J. V., Franklyn, J. A., Cross, K. W., Jones, S. C., & Sheppard, M. C. (1991) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1991.tb01739.x · Cited by 567 · see citing works
Subclinical thyroid dysfunction as a risk factor for cardiovascular disease
Walsh, J. P., Bremner, A. P., Bulsara, M. K., O’Leary, P., Leedman, P. J., Feddema, P., & Michelangeli, V. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.21.2467 · Cited by 536 · see citing works
Subclinical hypothyroidism and the risk of heart failure, other cardiovascular events, and death
Rodondi, N., Newman, A. B., Vittinghoff, E., de Rekeneire, N., Satterfield, S., Harris, T. B., & Bauer, D. C. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.21.2460 · Cited by 503 · see citing works
Huber, G., Staub, J.-J., Meier, C., Mitrache, C., Guglielmetti, M., Huber, P., & Braverman, L. E. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.87.7.8678 · Cited by 418 · see citing works
Helfand, M. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-140-2-200401200-00015 · Cited by 302 · see citing works
The Thyrotropin Reference Range Should Remain Unchanged
Surks, M. I., Goswami, G., & Daniels, G. H. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-0170 · Cited by 287 · see citing works
Jorde, R., Waterloo, K. K., Storhaug, H. M., Nyrnes, A., Sundsfjord, J., & Jenssen, T. G. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-1775 · Cited by 242 · see citing works
Roberts, L. M., Pattison, H., Roalfe, A., Franklyn, J., Wilson, S., Hobbs, F. D. R., & Parle, J. V. (2006) · Annals of Internal Medicine · doi:10.7326/0003-4819-145-8-200610170-00006 · Cited by 239 · see citing works
Low Serum Thyrotropin (Thyroid-Stimulating Hormone) in Older Persons Without Hyperthyroidism
Sawin, C. T. (1991) · Archives of Internal Medicine · doi:10.1001/archinte.1991.00400010159025 · Cited by 138 · see citing works
Spontaneous Normalization of Thyrotropin Concentrations in Patients with Subclinical Hypothyroidism
Díez, J. J., Iglesias, P., & Burman, K. D. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-0375 · Cited by 125 · see citing works
Biochemical testing of thyroid function.
Klee, G., & Hay, I. D. (1997) · Endocrinology and metabolism clinics of North America (Print) · doi:10.1016/s0889-8529(05)70281-4 · Cited by 65 · see citing works
van Wijk, M. A., van der Lei, J., Mosseveld, M., et al. (2002) · Clinical Chemistry · doi:10.1093/clinchem/48.1.55 · Cited by 44 · see citing works
Patterns of physicians' use of medical resources in ambulatory settings.
Hartley, R. M., Charlton, J. R. H., Harris, C. M., et al. (1987) · American Journal of Public Health · doi:10.2105/ajph.77.5.565 · Cited by 39 · see citing works
Medicare Coverage of Routine Screening for Thyroid Dysfunction
Institute of Medicine (2003) · National Academies Press eBooks · doi:10.17226/10682 · Cited by 34 · see citing works
Recombinant human thyrotropin (rhTSH) in the management of differentiated thyroid cancer
Durski, J. M., Weigel, R. J., & McDougall, I. R. (2000) · Nuclear Medicine Communications · doi:10.1097/00006231-200006000-00004 · Cited by 28 · see citing works
Recombinant human thyrotropin (rhTSH) in the management of differentiated thyroid carcinoma
McDougall, I. R. (1999) · Nuclear Medicine Communications · doi:10.1097/00006231-199910000-00001 · Cited by 26 · see citing works
Low serum thyrotropin (thyroid-stimulating hormone) in older persons without hyperthyroidism
Sawin, C. T. (1991) · Archives of Internal Medicine · doi:10.1001/archinte.151.1.165 · Cited by 26 · see citing works
Nakar, S., Vinker, S., Neuman, S., et al. (2002) · Journal of Medical Screening · doi:10.1136/jms.9.3.133 · Cited by 20 · see citing works
The status of physician office labs since CLIA '88.
Higgins, J. C. (2003) · PubMed · Cited by 5 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., Rivkees, S. A., Samuels, M., Sosa, J. A., Stan, M. N., et al. (2016) · Thyroid® · doi:10.1089/thy.2016.0229 · Cited by 2,938 · see citing works
Global epidemiology of hyperthyroidism and hypothyroidism
Taylor, P. N., Albrecht, D., Scholz, A., Gutierrez-Buey, G., Lazarus, J. H., Dayan, C. M., & Okosieme, O. E. (2018) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2018.18 · Cited by 1,552 · see citing works
Bahn, R. S., Burch, H. B., Cooper, D. S., Garber, J. R., Greenlee, M. C., Klein, I., Laurberg, P., McDougall, I. R., Montori, V. M., Rivkees, S. A., et al. (2011) · Endocrine Practice · doi:10.4158/ep.17.3.456 · Cited by 1,098 · see citing works
Cooper, D. S., & Biondi, B. (2012) · The Lancet · doi:10.1016/s0140-6736(11)60276-6 · Cited by 1,039 · see citing works
The American Thyroid Association and American Association of Clinical Endocrinologists Taskforce on Hyperthyroidism and Other Causes of Thyrotoxicosis, Bahn, R. S., Burch, H. B., Cooper, D. S., Garber, J. R., Greenlee, M. C., Klein, I., Laurberg, P., McDougall, I. R., Montori, V. M., et al. (2011) · Thyroid · doi:10.1089/thy.2010.0417 · Cited by 898 · see citing works
2013 ETA Guideline: Management of Subclinical Hypothyroidism
Pearce, S. H. S., Brabant, G., Duntas, L. H., Monzani, F., Peeters, R. P., Razvi, S., & Wemeau, J.-L. (2013) · European Thyroid Journal · doi:10.1159/000356507 · Cited by 877 · see citing works
Subclinical Hypothyroidism: A Review
Biondi, B., Cappola, A. R., & Cooper, D. S. (2019) · JAMA · doi:10.1001/jama.2019.9052 · Cited by 604 · see citing works
Subclinical Thyroid Dysfunction and Fracture Risk: A Meta-analysis
Blum, M. R., Bauer, D. C., Collet, T.-H., Fink, H. A., Cappola, A. R., da Costa, B. R., Wirth, C. D., Peeters, R. P., Åsvold, B. O., den Elzen, W. P. J., et al. (2015) · JAMA · doi:10.1001/jama.2015.5161 · Cited by 343 · see citing works
Biondi, B., Bartalena, L., Cooper, D. S., Hegedüs, L., Laurberg, P., & Kahaly, G. J. (2015) · European Thyroid Journal · doi:10.1159/000438750 · Cited by 323 · see citing works
Taylor, P. N., Iqbal, A., Minassian, C., Sayers, A., Draman, M. S., Greenwood, R., Hamilton, W., Okosieme, O., Panicker, V., Thomas, S. L., et al. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.11312 · Cited by 300 · see citing works
Franklyn, J. A., & Boelaert, K. (2012) · The Lancet · doi:10.1016/s0140-6736(11)60782-4 · Cited by 262 · see citing works
Walsh, J. P., Bremner, A. P., Feddema, P., Leedman, P. J., Brown, S. J., & O'Leary, P. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-1977 · Cited by 252 · see citing works
Thyroid hormones treatment for subclinical hypothyroidism: a clinical practice guideline
Bekkering, G. E., Agoritsas, T., Lytvyn, L., Heen, A. F., Feller, M., Moutzouri, E., Abdulazeem, H., Aertgeerts, B., Beecher, D., Brito, J. P., et al. (2019) · BMJ · doi:10.1136/bmj.l2006 · Cited by 240 · see citing works
Nanchen, D., Gussekloo, J., Westendorp, R. G. J., Stott, D. J., Jukema, J. W., Trompet, S., Ford, I., Welsh, P., Sattar, N., Macfarlane, P. W., et al. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-1978 · Cited by 211 · see citing works
Haentjens, P., Van Meerhaeghe, A., Poppe, K., & Velkeniers, B. (2008) · European Journal of Endocrinology · doi:10.1530/eje-08-0110 · Cited by 174 · see citing works
Boekholdt, S. M., Titan, S. M., Wiersinga, W. M., Chatterjee, K., Basart, D. C. G., Luben, R., Wareham, N. J., & Khaw, K. (2010) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2009.03640.x · Cited by 167 · see citing works
Lillevang-Johansen, M., Abrahamsen, B., Jørgensen, H. L., Brix, T. H., & Hegedüs, L. (2018) · Thyroid · doi:10.1089/thy.2017.0517 · Cited by 150 · see citing works
Gronich, N., Lavi, I., & Rennert, G. (2011) · Canadian Medical Association Journal · doi:10.1503/cmaj.110463 · Cited by 135 · see citing works
Biondi, B., & Cooper, D. S. (2018) · New England Journal of Medicine · doi:10.1056/nejmcp1709318 · Cited by 135 · see citing works
Taylor, P. N., Medici, M. M., Hubalewska-Dydejczyk, A., & Boelaert, K. (2024) · The Lancet · doi:10.1016/s0140-6736(24)01614-3 · Cited by 128 · see citing works
Prevalence of undiagnosed hypothyroidism in Europe: a systematic review and meta-analysis.
Mendes, D., Alves, C., Silverio, N., & Batel Marques, F. (2019) · European Thyroid Journal · doi:10.1159/000499751 · Cited by 113 · see citing works
Lillevang-Johansen, M., Abrahamsen, B., Jørgensen, H. L., Brix, T. H., & Hegedüs, L. (2019) · European Journal of Endocrinology · doi:10.1530/eje-19-0006 · Cited by 100 · see citing works
Levothyroxine overuse: time for an about face?
Rodriguez-Gutierrez, R., Maraka, S., Ospina, N. S., Montori, V. M., & Brito, J. P. (2017) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(16)30276-5 · Cited by 100 · see citing works
Variation in thyroid function tests in patients with stable untreated subclinical hypothyroidism
Karmisholt, J., Andersen, S., & Laurberg, P. (2008) · Thyroid · doi:10.1089/thy.2007.0241 · Cited by 97 · see citing works
Kahapola‐Arachchige, K. M., Hadlow, N., Wardrop, R., Lim, E. M., & Walsh, J. P. (2012) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2012.04463.x · Cited by 95 · see citing works
Rosario, P. W. (2010) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2009.03696.x · Cited by 88 · see citing works
Karmisholt, J., Andersen, S., & Laurberg, P. (2011) · European Journal of Endocrinology · doi:10.1530/eje-10-1021 · Cited by 86 · see citing works
The TSH upper reference limit: where are we at?
Laurberg, P., Andersen, S., Carlé, A., Karmisholt, J., Knudsen, N., & Pedersen, I. B. (2011) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2011.13 · Cited by 86 · see citing works
Thyroid dysfunction in the elderly
Boelaert, K. (2013) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2013.30 · Cited by 84 · see citing works
TSH enhancement of FT4 to FT3 conversion is age dependent
Strich, D., Karavani, G., Edri, S., & Gillis, D. (2016) · European Journal of Endocrinology · doi:10.1530/eje-16-0007 · Cited by 72 · see citing works
Effect of seasonal changes on the transition between subclinical hypothyroid and euthyroid status
Kim, T. H., Kim, K. W., Ahn, H. Y., Choi, H. S., Won, H., Choi, Y., Cho, S. W., Moon, J. H., Yi, K. H., Park, D. J., et al. (2013) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-1607 · Cited by 70 · see citing works
Medici, B. B., Nygaard, B., la Cour, J. L., Grand, M. K., Siersma, V., Nicolaisdottir, D. R., Lind, B., Olivarius, N. D. F., & Andersen, C. L. (2019) · Thyroid® · doi:10.1089/thy.2018.0539 · Cited by 63 · see citing works
Subclinical Thyroid Dysfunction and Functional Capacity Among Elderly
Virgini, V. S., Wijsman, L. W., Rodondi, N., Bauer, D. C., Kearney, P. M., Gussekloo, J., den Elzen, W. P. J., Jukema, J. W., Westendorp, R. G. J., Ford, I., et al. (2014) · Thyroid® · doi:10.1089/thy.2013.0071 · Cited by 44 · see citing works
Ross, D. S. (2022) · Journal of Internal Medicine · doi:10.1111/joim.13410 · Cited by 42 · see citing works
Ahluwalia, R., Baldeweg, S. E., Boelaert, K., Chatterjee, K., Dayan, C., Okosieme, O., Priestley, J., Taylor, P., Vaidya, B., Zammitt, N., et al. (2023) · Clinical Endocrinology · doi:10.1111/cen.14935 · Cited by 34 · see citing works
“14,19 However, in reality, many patients with subclinical hypothyroidism (TSH: 5 – 10 mU/L) are now treated with levothyroxine, 20,21 fuelling a rise in its use, such that it is now the third most frequently prescribed medication in the United Kingdom.”
BackgroundRationalizing Thyroid Function Testing: Which TSH Cutoffs Are Optimal for Testing Free T4?
Henze, M., Brown, S. J., Hadlow, N. C., & Walsh, J. P. (2017) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2017-01322 · Cited by 31 · see citing works
Improved diagnosis of mild hypothyroidism using time-of-day normal ranges for thyrotropin
Rose, S. R. (2010) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2010.04.047 · Cited by 27 · see citing works
Pediatric reference values of TSH should be personalized according to BMI and ethnicity
Oron, T., Lazar, L., Feldhamer, I., Manor, M., Koren-Morag, N., Tenenbaum, A., & Meyerovitch, J. (2020) · European Journal of Endocrinology · doi:10.1530/eje-20-0239 · Cited by 10 · see citing works
Self-citation
- Authors
- Meyerovitch, J.
- Affiliations
- Clalit Health Services (IL)
- Corresponding author
- Meyerovitch, Joseph
- ORCID
- Meyerovitch, Joseph
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2007-07-23
- Volume
- 167
- Issue
- 14
- Pages
- 1533
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2040509133
- Cited by
- 245
- References
- 26
- Citations by year
- 2026: 2 · 2025: 13 · 2024: 16 · 2023: 16 · 2022: 15 · 2021: 16 · 2020: 17 · 2019: 18 · 2018: 13 · 2017: 16 · 2016: 15 · 2015: 14 · 2014: 6 · 2013: 19 · 2012: 16
- FWCI
- 5.12
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- serum thyrotropin, TSH screening, subclinical thyroid dysfunction, primary care, TSH suppression, thyroid function, health management organization
- MeSH terms
- Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Male, Middle Aged, Physicians, Family, Thyroid Diseases, Thyrotropin
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
