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The Thyrotropin Reference Range Should Remain Unchanged
Abstract
CONTEXT: Recent recommendations to decrease the upper limit of the TSH reference range from 4.5 to 2.5 mIU/liter, based on the high proportion of normal people whose serum TSH is less than 2.5 mIU/liter and the observation that those with TSH between 2.5 and 4.5 mIU/liter [upper reference range (URR)] have increased risk of progression to overt hypothyroidism (Whickham, 20-yr data), have not been subjected to critical analysis. STUDY SUBJECTS: The study subjects were from the Reference Group of NHANES III, 14,333 people more than 12 yr old, without known thyroid disease or antithyroid antibodies; 85% had TSH levels below 2.5 mIU/liter, and 2.3% had subclinical hypothyroidism (SCH). An additional 9.7% had URR TSH, representing 20.6 million Americans, who would also be identified as SCH if the upper TSH limit were decreased. Many with URR TSH do not have thyroid disease. INTERVENTION: The time of phlebotomy is important, because the TSH level varies throughout the day, with early morning values greater than later ones, and is accentuated by sleep deprivation, strenuous exercise, or working during the night or evening shifts. Repeated measurements in the same individual vary considerably over months. RESULTS: About half of those with URR TSH probably have thyroid disease, but most with thyroid disease, antithyroid peroxidase antibodies, have TSH below 2.5 mIU/liter. Those with URR TSH with thyroid disease probably have minimal thyroid deficiency, without any reported adverse health consequences or benefit of treatments with levothyroxine. CONCLUSION: Because routine levothyroxine treatment is not recommended for SCH, it is certainly not warranted in individuals with URR TSH. For all patients with URR TSH, it is reasonable to determine serum TSH every 1-2 yr.
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“Thus, lowering the TSH upper limit would classify 15–20% of the elderly population as subclinical hypothyroidism, a condition for which treatment benefits are unproven [55].”
From Age-related variation in thyroid function – a narrative review highlighting important implications for research and clinical practice (2023) · cites this paper as [55]
In the citing paper
“An alternative argument accepts that a substantial proportion of people in the upper part of the TSH reference range will indeed have some form of occult thyroid disease but with a sufficiently benign prognosis that it is unnecessary to alter reference ranges to reclassify these by defining healthy people as thyroid patients [57].”
From Challenges in Interpreting Thyroid Stimulating Hormone Results in the Diagnosis of Thyroid Dysfunction (2019) · cites this paper as [57]
Citations
Cites
Grundy, S. M., Bilheimer, D. W., Chait, A., Clark, L. T., Denke, M. A., Havel, R. J., Hazzard, W. R., Hulley, S. B., Hunninghake, D. B., Kreisberg, R. A., et al. (1993) · JAMA · doi:10.1001/jama.269.23.3015 · Cited by 27,944
Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L., Jones, D. W., Materson, B. J., Oparil, S., Wright, J. T., et al. (2003) · Hypertension · doi:10.1161/01.hyp.0000107251.49515.c2 · Cited by 13,271
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
Follow-up report on the diagnosis of diabetes mellitus
The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus* (2003) · Diabetes Care · doi:10.2337/diacare.26.11.3160 · Cited by 3,784
The Colorado Thyroid Disease Prevalence Study
Canaris, G. J., Manowitz, N. R., Mayor, G., & Ridgway, E. C. (2000) · Archives of Internal Medicine · doi:10.1001/archinte.160.4.526 · Cited by 2,824
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
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
Self-citationHak, 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
Low Serum Thyrotropin Concentrations as a Risk Factor for Atrial Fibrillation in Older Persons
Sawin, C. T., Geller, A., Wolf, P. A., Belanger, A. J., Baker, E., Bacharach, P., Wilson, P., Benjamin, E. J., & D'Agostino, R. B. (1994) · New England Journal of Medicine · doi:10.1056/nejm199411103311901 · Cited by 1,259
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
Andersen, S., Pedersen, K. M., Bruun, N. H., & Laurberg, P. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.87.3.8165 · Cited by 686
Baskin, H. J., Cobin, R. H., Duick, D. S., Gharib, H., Guttler, R. B., Kaplan, M. M., Segal, R. L., Garber, J. R., Hamilton Jr, C. R., Handelsman, Y., et al. (2002) · Endocrine Practice · doi:10.4158/1934-2403-8.6.457 · Cited by 673
Parle, J. V., Maisonneuve, P., Sheppard, M. C., Boyle, P., & Franklyn, J. A. (2001) · The Lancet · doi:10.1016/s0140-6736(01)06067-6 · Cited by 669
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
Self-citationFade, 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
Saravanan, P., Chau, W. ‐., Roberts, N., Vedhara, K., Greenwood, R., & Dayan, C. M. (2002) · Clinical Endocrinology · doi:10.1046/j.1365-2265.2002.01654.x · Cited by 514
Risk for fracture in women with low serum levels of thyroid-stimulating hormone
Bauer, D. C., Ettinger, B., Nevitt, M. C., Stone, K. L., & for the Study of Osteoporotic Fractures Research Group (2001) · Annals of Internal Medicine · doi:10.7326/0003-4819-134-7-200104030-00009 · Cited by 467
Taddei, S., Caraccio, N., Virdis, A., Dardano, A., Versari, D., Ghiadoni, L., Salvetti, A., Ferrannini, E., & Monzani, F. (2003) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-030039 · Cited by 431
Danese, M. D., Ladenson, P. W., Meinert, C. L., & Powe, N. R. (2000) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.85.9.2993 · Cited by 423
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
Monzani, F., Caraccio, N., Kozàkowà, M., Dardano, A., Vittone, F., Virdis, A., Taddei, S., Palombo, C., & Ferrannini, E. (2004) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-031669 · Cited by 399
Risk for Ischemic Heart Disease and All-Cause Mortality in Subclinical Hypothyroidism
Imaizumi, M., Akahoshi, M., Ichimaru, S., Nakashima, E., Hida, A., Soda, M., Usa, T., Ashizawa, K., Yokoyama, N., Maeda, R., et al. (2004) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-031089 · Cited by 373
Fish, L. H., Schwartz, H. L., Cavanaugh, J., Steffes, M. W., Bantle, J. P., & Oppenheimer, J. H. (1987) · New England Journal of Medicine · doi:10.1056/nejm198703263161302 · Cited by 353
Subclinical hyperthyroidism as a risk factor for atrial fibrillation
Auer, J., Scheibner, P., Mische, T., Langsteger, W., Eber, O., & Eber, B. (2001) · American Heart Journal · doi:10.1067/mhj.2001.119370 · Cited by 314
Caraccio, N., Ferrannini, E., & Monzani, F. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.87.4.8378 · Cited by 294
Vestergaard, P., & Mosekilde, L. (2002) · Thyroid · doi:10.1089/105072502760043503 · Cited by 289
American Thyroid Association Guidelines for Use of Laboratory Tests in Thyroid Disorders
Surks, M. I. (1990) · JAMA · doi:10.1001/jama.1990.03440110095035 · Cited by 283
Self-citationPhysiological regulation of circadian and pulsatile thyrotropin secretion in normal man and woman
BRABANT, G., PRANK, K., RANFT, U., SCHUERMEYER, T., WAGNER, T. O. F., HAUSER, H., KUMMER, B., FEISTNER, H., HESCH, R. D., & MÜHLEN, A. V. Z. (1990) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-70-2-403 · Cited by 282
Díez, J. J., & Iglesias, P. (2004) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-032061 · Cited by 281
Beck-Peccoz, P., Amr, S., Menezes-Ferreira, M. M., Faglia, G., & Weintraub, B. D. (1985) · New England Journal of Medicine · doi:10.1056/nejm198504253121703 · Cited by 261
Christ‐Crain, M., Meier, C., Guglielmetti, M., Huber, P., Riesen, W., Staub, J.-J., & Müller-Stich, B. P. (2003) · Atherosclerosis · doi:10.1016/s0021-9150(02)00372-6 · Cited by 243
Biologic Variation is Important for Interpretation of Thyroid Function Tests
Andersen, S., Bruun, N. H., Pedersen, K. M., & Laurberg, P. (2003) · Thyroid · doi:10.1089/105072503770867237 · Cited by 241
Maes, M., Mommen, K., Hendrickx, D., Peeters, D., D’Hondt, P., Ranjan, R., De Meyer, F., & Scharpe, S. (1997) · Clinical Endocrinology · doi:10.1046/j.1365-2265.1997.1881002.x · Cited by 231
A 6-month randomized trial of thyroxine treatment in women with mild subclinical hypothyroidism
Kong, W. M., Sheikh, M. H., Lumb, P. J., Freedman, D. B., Crook, M. A., Doré, C. J., & Finer, N. (2002) · The American Journal of Medicine · doi:10.1016/s0002-9343(02)01022-7 · Cited by 223
CARR, D., MCLEOD, D. T., PARRY, G., & THORNES, H. M. (1988) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1988.tb01219.x · Cited by 210
Vanderpump, M. P. J., Tunbridge, W. M. G., French, J. M., Appleton, D. R., Bates, D., Clark, F., Evans, J. G., Rodgers, H., Tunbridge, F. K. E., & Young, E. T. (1996) · PubMed · doi:10.1089/thy.1996.6.155 · Cited by 207
Current status and performance goals for serum thyrotropin (TSH) assays.
Spencer, C., Takeuchi, M., & Kazarosyan, M. (1996) · Clinical Chemistry · doi:10.1093/clinchem/42.1.140 · Cited by 197
Surks, M. I., & Ocampo, E. L. (1996) · The American Journal of Medicine · doi:10.1016/s0002-9343(97)89462-4 · Cited by 192
Self-citationCol, N. F., Surks, M. I., & Daniels, G. H. (2004) · JAMA · doi:10.1001/jama.291.2.239 · Cited by 192
Self-citationBuxton, O. M., Frank, S. A., L’Hermite‐Balériaux, M., Leproult, R., Turek, F. W., & Cauter, E. V. (1997) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.1997.273.3.e536 · Cited by 167
Germline Mutations of TSH Receptor Gene as Cause of Nonautoimmune Subclinical Hypothyroidism
Alberti, L., Proverbio, M. C., Costagliola, S., Romoli, R., Boldrighini, B., Vigone, M. C., Weber, G., Chiumello, G., Beck‐Peccoz, P., & Persani, L. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.87.6.8536 · Cited by 153
CIRCADIAN AND 30 MINUTES VARIATIONS IN SERUM TSH AND THYROID HORMONES IN NORMAL SUBJECTS
Weeke, J., & Gundersen, H. J. G. (1978) · European Journal of Endocrinology · doi:10.1530/acta.0.0890659 · Cited by 134
PARKER, D. C., Pekary, A. E., & Hershman, J. M. (1976) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-43-2-318 · Cited by 134
Labelling in hypertension: A review of the behavioural and psychological consequences
Macdonald, L. A., Sackett, D. L., Haynes, R. B., & Taylor, D. W. (1984) · Journal of Chronic Diseases · doi:10.1016/0021-9681(84)90070-5 · Cited by 130
Plasma Thyrotropin, Thyroxine, and Triiodothyronine Relationships in Man
AZUKIZAWA, M., Pekary, A. E., Hershman, J. M., & PARKER, D. C. (1976) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-43-3-533 · Cited by 114
Heterophilic Antibodies Remain a Problem for the Immunoassay Laboratory
Ward, G., Mckinnon, L., Badrick, T. C., & Hickman, P. E. (1997) · American Journal of Clinical Pathology · doi:10.1093/ajcp/108.4.417 · Cited by 112
Lindeman, R. D., Romero, L. J., Schade, D. S., Wayne, S., Baumgartner, R. N., & Garry, P. J. (2003) · Thyroid · doi:10.1089/105072503322238863 · Cited by 100
Browning, M. C., Ford, R. P., Callaghan, S. J., & Fraser, C. G. (1986) · Clinical Chemistry · doi:10.1093/clinchem/32.6.962 · Cited by 94
Long-term variability in serum thyroglobulin and thyroid related hormones in healthy subjects
Feldt-Rasmussen, U., Petersen, P. H., Blaabjerg, O., & Hørder, M. (1980) · Acta Endocrinologica · doi:10.1530/acta.0.0950328 · Cited by 75
SAMUELS, M. H., VELDHUIS, J. D., HENRY, P., & RIDGWAY, E. C. (1990) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-71-2-425 · Cited by 75
Total sleep deprivation and the thyroid axis: effects of sleep and waking activity.
Gary, K. A., Winokur, A., Douglas, S. D., Kapoor, S. C., Zaugg, L., & Dinges, D. F. (1996) · PubMed · Cited by 73
Tonacchera, M., Perri, A., Marco, G. D., Agretti, P., Banco, M., Cosmo, C. D., Grasso, L., Vitti, P., Chiovato, L., & Pinchera, A. (2004) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-1243 · Cited by 72
Xie, J. H., Pannain, S., Pohlenz, J., Weiss, R. E., Moltz, K. C., Morlot, M., Asteria, C., Persani, L., Beck‐Peccoz, P., Parma, J., et al. (1997) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.82.12.4418 · Cited by 70
Incidence and mechanism of spurious increase in serum thyrotropin.
Howanitz, P. J., Howanitz, J. H., Hv, L., & Ennis, K. M. (1982) · Clinical Chemistry · doi:10.1093/clinchem/28.3.427 · Cited by 66
Effects of Subclinical Hypothyroidism and Its Treatment on Serum Lipids
Ineck, B. A., & Ng, T. M. H. (2003) · Annals of Pharmacotherapy · doi:10.1345/aph.1c376 · Cited by 65
Effects of Reducing the Upper Limit of Normal TSH Values
Fatourechi, V. (2003) · JAMA · doi:10.1001/jama.290.24.3195-b · Cited by 61
ZWEIG, M. H., Csákó, G., Benson, C. C., Weintraub, B. D., & Kahn, B. B. (1987) · Clinical Chemistry · doi:10.1093/clinchem/33.6.840 · Cited by 57
Pérez, A., Cubero, J. M., Sucunza, N., Ortega, E., Arcelús, R., Rodrı́guez-Espinosa, J., Ordóñez‐Llanos, J., & Blanco‐Vaca, F. (2004) · Metabolism · doi:10.1016/j.metabol.2004.05.016 · Cited by 52
Serum TSH variability in normal individuals: the influence of time of sample collection.
Scobbo, R. R., VonDohlen, T. W., Hassan, M., & Islam, S. (2004) · PubMed · Cited by 45
Heterophilic Serum Antibodies: A Cause for Falsely Elevated Serum Thyrotropin Levels
BRENNAN, M. D., Klee, G. G., Preissner, C. M., & HAY, I. D. (1987) · Mayo Clinic Proceedings · doi:10.1016/s0025-6196(12)65044-7 · Cited by 35
The circadian thyrotropin rhythm is delayed in regular night workers
Weibel, L., BRANDENBERGER, G., Goichot, B., Spiegel, K., Ehrhart, J., & FOLLENIUS, M. (1995) · Neuroscience Letters · doi:10.1016/0304-3940(95)11344-4 · Cited by 27
Thoughts on Prevention of Thyroid Disease in the United States
Cooper, D. S., & Ridgway, E. C. (2002) · Thyroid · doi:10.1089/105072502761016566 · Cited by 24
Artifactual elevation of thyroid-stimulating hormone
Wood, J. M., Gordon, D. L., Rudinger, A. N., & Brooks, M. M. (1991) · The American Journal of Medicine · doi:10.1016/0002-9343(91)80170-q · Cited by 22
Is Subclinical Hypothyroidism Associated With Hyperhomocysteinemia?
Aldasouqi, S. A., Nkansa-Dwamena, D., Bokhari, S., Alzahrani, A. S., Khan, M., Al-Reffi, A., & Merdad, A. (2004) · Endocrine Practice · doi:10.4158/ep.10.5.399 · Cited by 10
What does "functional sensitivity" mean?
Sadler, W. A., Murray, L. M., & Turner, J. G. (1996) · Clinical Chemistry · doi:10.1093/clinchem/42.12.2051 · Cited by 8
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Self-citation
Metadata
- Authors
- Surks, M. I., Goswami, G., & Daniels, G. H.
- Affiliations
- Albert Einstein College of Medicine (US)
- Harvard University (US)
- Corresponding author
- Surks, Martin I.
- ORCID
- Daniels, Gilbert H.
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2005-09
- Volume
- 90
- Issue
- 9
- Pages
- 5489-5496
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2098761773
- Cited by
- 287
- References
- 65
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 3 · 2023: 4 · 2022: 12 · 2021: 7 · 2020: 4 · 2019: 9 · 2018: 15 · 2017: 15 · 2016: 15 · 2015: 14 · 2014: 18 · 2013: 24 · 2012: 16
- FWCI
- 13.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Health Professions › Medical Laboratory Technology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- upper reference limit, subclinical hypothyroidism, levothyroxine therapy, thyroid peroxidase antibodies, thyroid dysfunction, NHANES III, thyroid screening
- MeSH terms
- Humans, Hypothyroidism, Reference Values, Thyrotropin, Thyroxine
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