Republished: The relationship between serum TSH and free T4 in older people
Abstract
The frequency distribution of serum thyroid stimulating hormone (TSH) shows a skewed pattern that may change with age. The set point of the hypothalamic-pituitary-thyroid axis for an individual is thought to be genetically determined and has been described as a log-linear relationship of serum TSH to free thyroxine (T4); however, the validity of this hypothesis has yet to be established in older people. The aim of the study was to describe the relationship between serum TSH and free T4 in older people and define factors influencing this relationship. We conducted a cross-sectional, observational study of thyroid function in a community population of older subjects over 65 years of age. The relationship between serum TSH and free T4 was not linear as previously described, but is best described as a fourth-order polynomial. Both gender and smoking status affected the relationship. This suggests that more complex modelling is required when investigating the hypothalamic-pituitary-thyroid axis.
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Multiple factors such as age, gender, smoking, the presence of antithyroid antibodies, and the difference between prevailing thyroid hormone levels and an individual's set point influence the shape of the relationship between TSH and FT4 levels.
“Multiple factors, such as age, gender, smoking, the presence of antithyroid antibodies, and the difference between prevailing thyroid hormone levels and an individual's “set point” for HPT axis function (see above), influence the shape of the relationship between TSH and FT4 levels”
From Pharmacodynamic and Therapeutic Actions of Levothyroxine (2021) · cites this paper as [25]
Cites
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Applications of a New Chemiluminometric Thyrotropin Assay to Subnormal Measurement*
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“It has, however, been found that using the latter in vivo approach the log-linear relationship was not significant in all individuals.(7) The aim of this study was to determine the relationship between serum TSH and free T4 in an ambulant older population as an indicator of the pituitary set point and to establish som…”
BackgroundThyroid guidelines - are thyroid-stimulating hormone assays fit for purpose?
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Serum thyrotropin and triiodothyronine levels in levothyroxine-treated patients
Ettleson, M. D., Prieto, W. H., Russo, P. S. T., de Sa, J., Wan, W., Laiteerapong, N., Maciel, R. M. B., & Bianco, A. C. (2023) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac725 · Cited by 25 · see citing works
Pharmacodynamic and Therapeutic Actions of Levothyroxine
Hennessey, J. V. (2021) · 70 Years of Levothyroxine · doi:10.1007/978-3-030-63277-9_3 · Cited by 4 · see citing works
- Authors
- Clark, P. M., Holder, R. L., Haque, S. M., Hobbs, F. D. R., Roberts, L. M., & Franklyn, J. A.
- Affiliations
- University Hospitals Birmingham NHS Foundation Trust (GB)
- University of Birmingham (GB)
- Primary Care Clinical Sciences, University of Birmingham , Birmingham, UK
- Corresponding author
- Clark, Penny M
- Venue
- Postgraduate Medical Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-10-24
- Volume
- 88
- Issue
- 1045
- Pages
- 668-670
- ISSN
- 0032-5473 (ISSN-L)
- 1469-0756
- OpenAlex
- W2069515626
- Cited by
- 13
- References
- 14
- Citations by year
- 2026: 2 · 2022: 1 · 2021: 1 · 2020: 2 · 2019: 1 · 2018: 2 · 2016: 2 · 2013: 1 · 2012: 1
- FWCI
- 0.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Postgraduate Medical Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0611-10273)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Keywords
- thyroid-stimulating hormone, free thyroxine, hypothalamic-pituitary-thyroid axis, older adults, polynomial regression, gender differences, smoking, thyroid function
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