Reference values for TSH may be inadequate to define hypothyroidism in persons with morbid obesity: Di@bet.es study
Open accessAbstract
Objective: To analyze the reference range of thyroid‐stimulating hormone (TSH) in different BMI categories and its impact on the classification of hypothyroidism. Methods: The study included 3,928 individuals free of thyroid disease (without previous thyroid disease, no interfering medications, TSH <10 µUI/mL and thyroid peroxidase antibodies [TPO Abs] <50 IU/mL) who participated in a national, cross‐sectional, population‐based study and were representative of the adult population of Spain. Data gathered included clinical and demographic characteristics, physical examination, and blood and urine sampling. TSH, free thyroxine, free triiodothyronine, and TPO Ab were analyzed by electrochemiluminescence (E170, Roche Diagnostics, Basel, Switzerland). Results: The reference range (p2.5‐97.5) for TSH was estimated as 0.6 to 4.8 µUI/mL in the underweight category (BMI<20 kg/m 2), 0.6 to 5.5 µUI/mL in the normal‐weight category (BMI 20‐24.9 kg/m 2), 0.6 to 5.5 µUI/mL in the overweight category (BMI 25‐29.9 kg/m 2), 0.5 to 5.9 µUI/mL in the obesity category (BMI 30‐39.9 kg/m 2), and 0.7 to 7.5 µUI/mL in the morbid obesity category (BMI ≥40). By using the reference criteria for the normal‐weight population, the prevalence of high TSH levels increased threefold in the morbid obesity category (P < 0.01). Conclusions: Persons with morbid obesity might be inappropriately classified if the standard ranges of normality of TSH for the normal‐weight population are applied to them.
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14% of obese patients have subclinical hypothyroidism, often without thyroid antibodies.
“The rising worldwide prevalence of obesity is of concern in this context, because 14% of obese patients have subclinical hypothyroidism, often without thyroid antibodies [58–60].”
From T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity (2021) · cites this paper as [59]
The Methods describe a study population with low thyroid-peroxidase antibody levels, and the Discussion reports elevated TSH in some people with morbid obesity without evidence of autoimmunity. But the paper does not report that 14% of obese patients have subclinical hypothyroidism; it cautions that elevated TSH in this setting may not indicate hypothyroidism. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSerum TSH is significantly higher in obese patients than in normal weight controls; subclinical hypothyroidism is recorded in 13.7% of obese patients, but thyroid autoimmunity is not a major cause.
“Serum TSH is significantly higher in obese patients than in normal weight controls; subclinical hypothyroidism is recorded in 13.7% of obese patients, but thyroid autoimmunity is not a major cause [58–60].”
From T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity (2021) · cites this paper as [59]
The TSH reference ranges according to BMI section (page unavailable) reports a rise in median TSH with increasing BMI, and the Original Article reports more high-TSH results in the morbid-obesity group than in normal-weight participants. The paper does not report subclinical hypothyroidism in 13.7% of obese patients. Its Methods exclude participants with elevated thyroid-peroxidase antibodies, so its findings cannot establish that thyroid autoimmunity is not a major cause in obese patients generally. (LLM, conf=0.88)
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- Authors
- Valdés, S., Maldonado‐Araque, C., Lago‐Sampedro, A., Lillo‐Muñoz, J. A., Garcia‐Fuentes, E., Perez‐Valero, V., Gutiérrez‐Repiso, C., Garcia‐Escobar, E., Goday, A., Urrutia, I., Peláez, L., Calle‐Pascual, A., Bordiú, E., Castaño, L., Castell, C., Delgado, E., Menéndez, E., Franch‐Nadal, J., Gaztambide, S., Girbés, J., Ortega, E., Vendrell, J., Chacón, M. R., Javier Chaves, F., Soriguer, F., & Rojo‐Martínez, G.
- Affiliations
- Instituto de Salud Carlos III (ES)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) Instituto de Salud Carlos III, Madrid Spain
- Hospital Regional Universitario de Málaga (ES)
- Department of Endocrinology and Nutrition Hospital Regional Universitario de Málaga, IBIMA Málaga Spain
- Hospital Del Mar (ES)
- University of the Basque Country (ES)
- Laboratorio de Bioquímica Hospital Universitario S. Carlos de Madrid Spain
- Generalitat de Catalunya (ES)
- Department of Endocrinology and Nutrition Hospital Central de Asturias Oviedo Spain
- Diabetes Unit Hospital Arnau de Vilanova Valencia Spain
- Corresponding author
- Valdés, Sergio
- ORCID
- Venue
- Obesity
- Publisher
- Wiley
- Published
- 2017-03-09
- Volume
- 25
- Issue
- 4
- Pages
- 788-793
- ISSN
- 1930-7381 (ISSN-L)
- 1930-739X
- OpenAlex
- W2593465750
- Cited by
- 50
- References
- 39
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 8 · 2023: 6 · 2022: 2 · 2021: 6 · 2020: 9 · 2019: 8 · 2018: 4
- FWCI
- 4.54
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Obesity (publishedVersion)
- PubMed (publishedVersion)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
- Funders
- Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas
- Instituto de Salud Carlos III (PI11/, PI14/00710, PI14/)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- thyroid-stimulating hormone, TSH reference range, morbid obesity, hypothyroidism, body mass index, thyroid function, thyroid peroxidase antibodies, underweight, overweight
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Autoantibodies, Cross-Sectional Studies, Female, Humans, Hypothyroidism, Male, Middle Aged, Obesity, Morbid, Reference Values, Spain, Thinness, Thyroid Function Tests, Thyrotropin, Thyroxine, Triiodothyronine, Observer Variation, Prevalence, Overweight, Young Adult
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