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Cited by 27Thyroid Disorders and TreatmentsGrowth Hormone and Insulin-like Growth FactorsClinical Laboratory Practices and Quality Control

Improved diagnosis of mild hypothyroidism using time-of-day normal ranges for thyrotropin

Rose, Susan R.·2010·The Journal of Pediatrics
DOI 10.1016/j.jpeds.2010.04.047
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Abstract

Objective To assess clinical utility of time-of-day-based thyrotropin (TSH) ranges.Study design Ranges for TSH at 8 am, 4 pm, and am/pm TSH ratio were developed from prior data in 94 typical children (age, 5 to 18 years). Data for these values in 227 short children (1.5 to 18 years) were compared with those in typical children.Results Short children included idiopathic short stature (ISS, n=153), central hypothyroidism (Central, n=42), and mild primary hypothyroidism (Primary, n=32), referred for evaluation of growth. In typical children, ISS, and Primary, 8 am TSH was greater than 4 pm TSH (P<.05). In Primary, 8 am TSH was greater than normal. Only 4 with Primary had elevated 4 pm TSH (using usual laboratory range of 0.5 to 4 mU/L). In contrast, only 63% of 4 pm TSHs in Primary were elevated. compared with 95% confidence limits in typical children. In Central, 8 am TSH and 4 pm TSH were within normal time-of-day range, and FT4 was in lowest one-third of normal. am/pm TSH ratio was less than 95% confidence limits in 76% of those with Central.Conclusions Either 8 am TSH or 4 pm TSH (compared with time-of-day normal range) can identify TSH elevation. Low am/pm TSH ratio (FT4 in lowest one-third of normal) confirms central hypothyroidism. Thus, time-of-day TSH ranges should be used for accurate diagnosis and more appropriate cost-effective treatment of mild hypothyroidism.

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Crossref · 10.1016/j.jpeds.2010.04.047

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  • AM to PM TSH ratios under 1.3 associated with low normal FT4 are consistent with blunting of the TSH surge, confirming central hypothyroidism.

    “AM to PM TSH ratios under 1.3 associated with a low normal FT4 are consistent with blunting of the TSH surge, confirming central hypothyroidism [68].”

    From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [68]

  • The current most sensitive method for confirming central hypothyroidism requires recognition of the circadian pattern of TSH secretion.

    “The current most sensitive method for confirming central hypothyroidism (TSHD) requires recognition of the circadian pattern of TSH secretion [68].”

    From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [68]

  • An a.m./p.m. TSH ratio below 1.3 is considered indicative of central hypothyroidism.

    “An a.m./p.m. TSH ratio below 1.3 is considered indicative of central hypothyroidism [62].”

    From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [62]

  • The suggested mechanism for central hypothyroidism with elevated TSH is abnormal glycosylation of TSH alpha and beta subunits, so secreted TSH is not biologically active.

    “The suggested mechanism for central hypothyroidism with elevated TSH is abnormal glycosylation of the TSH alpha and beta subunits, thus the TSH secreted is not biologically active [67,68].”

    From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [68]

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Authors
Rose, S. R.
Affiliations
Cincinnati Children's Hospital Medical Center (US)
Corresponding author
Rose, Susan R.
ORCID
Rose, Susan R.
Venue
The Journal of Pediatrics
Publisher
Elsevier BV
Published
2010-10
Volume
157
Issue
4
Pages
662-667.e1
ISSN
0022-3476 (ISSN-L)
DOI
10.1016/j.jpeds.2010.04.047
OpenAlex
W1992265363
Cited by
27
References
40
Citations by year
2025: 1 · 2024: 2 · 2022: 2 · 2021: 1 · 2020: 1 · 2019: 2 · 2017: 2 · 2016: 1 · 2015: 4 · 2014: 2 · 2013: 2 · 2012: 4
FWCI
2.17
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Journal of Pediatrics (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
  • Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
Keywords
mild hypothyroidism, thyroid-stimulating hormone, central hypothyroidism, idiopathic short stature, free thyroxine, children, growth assessment
MeSH terms
Adolescent, Body Height, Child, Child, Preschool, Cost-Benefit Analysis, Female, Humans, Hypothyroidism, Male, Reference Values, Severity of Illness Index, Growth Hormone, Thyrotropin, Time Factors, Treatment Outcome

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