The Relationship Between TSH and Free T4 in a Large Population Is Complex and Nonlinear and Differs by Age and Sex

被引:128
作者
Hadlow, Narelle C. [1 ,2 ,3 ]
Rothacker, Karen M. [1 ,5 ]
Wardrop, Robert [1 ]
Brown, Suzanne J. [5 ]
Lim, Ee Mun [1 ,5 ]
Walsh, John P. [4 ,5 ]
机构
[1] Queen Elizabeth II Med Ctr, Dept Clin Biochem, PathWest Lab Med, Nedlands, WA 6009, Australia
[2] Western Diagnost Pathol, Myaree, WA 6154, Australia
[3] Univ Western Australia, Sch Pathol & Lab Med, Crawley, WA 6009, Australia
[4] Univ Western Australia, Sch Med & Pharmacol, Crawley, WA 6009, Australia
[5] Sir Charles Gairdner Hosp, Dept Endocrinol & Diabet, Nedlands, WA 6009, Australia
关键词
THYROID-STIMULATING HORMONE; TANDEM MASS-SPECTROMETRY; SERUM THYROTROPIN; FREE-THYROXINE; REFERENCE LIMITS; FUNCTION TESTS; FREE T4; HYPOTHYROIDISM; AXIS; IMMUNOASSAY;
D O I
10.1210/jc.2012-4223
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context: The relationship between TSH and T-4 is thought to be inverse log-linear, but recent studies have challenged this. There are limited data regarding age and sex differences in the TSH-T-4 relationship. Objective: The purpose of this study was to evaluate the TSH-free T-4 relationship in a large sample. Methods: In a cross-sectional, retrospective study, we analyzed TSH and free T4 results from 152 261 subjects collected over 12 years by a single laboratory. For each free T-4 value (in picomoles per liter), the median TSH was calculated and analyzed by sex and age (in 20-year bands). Results: The relationship between log TSH and free T-4 was nonlinear. Mathematical modeling confirmed that it was described by 2 sigmoid curves with inflexion points at free T-4 concentrations of 7 and 21 pmol/L. For free T4 within the reference range (10-20 pmol/L), median TSH was higher in men than in women (P < .001) and increased across age bands with the highest values in those 80 years and older (P < .001). In contrast, in overt hypothyroidism (n = 4403), TSH was lower in older age groups than in those aged 20-39 years (P < .001). Conclusions: The TSH-free T-4 relationship is not inverse log-linear but can be described by 2 overlapping negative sigmoid curves. At physiological free T-4 concentrations, TSH is higher in men and in older people, whereas the TSH response to hypothyroidism is more robust in younger people. These results advance understanding of the TSH-free T-4 relationship, which is central to thyroid pathophysiology and laboratory diagnosis of thyroid disease.
引用
收藏
页码:2936 / 2943
页数:8
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