Frequency, determinants and costs of thyroid function testing in a laboratory serving a large population
Abstract
Objective: To assess the rationale and frequency of thyroid function testing and to analyse factors that influence serum thyrotropin (TSH) levels. Patients, design and main outcome measures: Serum TSH levels were evaluated in a hospital laboratory serving a population of 604 000 in 2018. Patients on medications or with conditions affecting thyroid function were excluded. Frequency of thyroid function testing by age and sex was assessed and the relationship between serum TSH with potential predictor variables was analysed using ordinary least square regression analysis allowing for potential non-linearity. Results: Twenty-eight percent of the local population had their thyroid function tested at least once in 2018 with significant differences by sex (28.2% women vs 23.4% men) and by age groups, with less than 2% of <16-year-old people and more than 50% of >80-year-old people being tested. Most of the symptoms commonly attributed to thyroid dysfunction were not higher in the thyroid dysfunction groups. Serum TSH levels were higher in older people particularly after the age of 60 years, in women (by 0.1 mIU/L), during the early hours of the morning, and in winter and spring seasons. There was remarkable uniformity in the frequency of subclinical thyroid dysfunction, as well as substantial cost savings, if TSH reference intervals were recalculated across sexes, age groups, time-periods and seasons. Conclusions: Serum TSH is frequently tested in the population but is not a good discriminant of symptoms attributed to thyroid dysfunction. Furthermore, considering the influence of factors on TSH reference limits could significantly impact patient care and resource utilisation.
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In iodine replete populations, serum TSH levels increase after age 60 years.
“In iodine replete populations, serum TSH levels increase after the age of 60 years (66).”
From ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism (2025) · cites this paper as [66]
The Factors affecting serum TSH levels section (p. 10) reports that TSH increased with age, particularly after 60, and the Discussion (p. 15) reiterates this finding. The paper does not identify the studied population as iodine replete, so it does not support that qualifier. (LLM, conf=0.86)
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Self-citation
- Authors
- Javaid, U., Kennedy, D., Addison, C., Tsatlidis, V., & Razvi, S.
- Affiliations
- Gateshead Health NHS Foundation Trust (GB)
- Corresponding author
- Razvi, Salman
- ORCID
- Razvi, Salman
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2022-05-01
- Volume
- 186
- Issue
- 5
- Pages
- 553-560
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W4220849664
- Cited by
- 14
- References
- 25
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 3 · 2023: 5
- FWCI
- 1.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Keywords
- thyroid function tests, serum thyrotropin, TSH reference intervals, subclinical thyroid dysfunction, age and sex differences, seasonal variation, health care costs
- MeSH terms
- Adolescent, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Reference Values, Thyroid Diseases, Thyroid Function Tests, Thyrotropin, Thyroxine
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