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Distribution of T4 TSH values in children--the Shifa experience
Insights
Thyroid Stimulating Hormone (TSH) and Thyroxin (T4) levels in children show distinct age-related distributions. Establishing age-specific reference ranges is crucial for accurate pediatric thyroid function assessment.
Area of Science:
- Pediatric Endocrinology
- Clinical Chemistry
- Neonatal Medicine
Background:
- Thyroid hormones, Thyroxin (T4) and Thyroid Stimulating Hormone (TSH), are vital for growth and development.
- Establishing accurate reference ranges for T4 and TSH in pediatric populations is essential for diagnosing thyroid dysfunction.
Purpose of the Study:
- To determine the age-specific distribution of T4 and TSH values in children aged 0-5 years.
- To evaluate existing reference intervals for T4 and TSH across different pediatric age groups.
Main Methods:
- Retrospective review of T4 and TSH levels from 1148 and 1142 samples, respectively.
- Non-parametric methods were employed to establish 2.5th, 5th, 50th, 95th, and 97.5th centiles.
- Analysis was conducted across age groups: 0-4 days, 5-7 days, 1 week-1 month, 1 month-1 year, and 1-5 years.
Main Results:
- A significant TSH surge was observed in the first 4 days of life, followed by a gradual decline.
- T4 levels also exhibited a gradual downward trend with increasing age.
- Specific 5th-95th centile ranges were determined for TSH and T4 across the studied age intervals.
Conclusions:
- Separate reference values for T4 and TSH are recommended for different pediatric age groups.
- Large-scale studies in Pakistan are needed to establish definitive age-specific reference values.
- A national center for neonatal thyroid screening is highly recommended.
Objective:
To evaluate the distribution of Thyroxin (T4) and Thyroid Stimulating Hormone (TSH) values in children of various age groups attending our hospital.
Method:
We have retrospectively reviewed the T4, TSH levels recorded at our hospital in children from birth to 5 years and evaluated the reference intervals for T4 TSH amongst different ages. Non parametric methods were used to establish a 97.5th, 95th, 50th, 5th and 2.5th centiles.
Results:
In T4 (n=1148) and TSH (n=1142) samples reviewed a TSH surge following delivery showed a sharp decline in the first 4 days of life. This was followed by a more gradual downward trend. Data on T4 estimations showed a similar but more gradual downward trend in advancing age groups. The 5th-95th centile reference range for TSH showed values between 1.7-22.5 (0-4 days; n=992), 0.6-13.3 (5-7 days; n=38), 0.9-14.0 (1 week-1 month; n=38), 0.5-13.6 (1 month-1 year, n=38) and 0.4-12.8 (1-5 years; n=38) microlU/mL. The 5th-95th centile reference range for T4 showed values between 10.7-25.0 (0-4 days; n=995), 6.5-20.4 (5-7 days; n=35), 8.0-18.1 (1 week-1 month; n=38), 6.0-16.1 (1 month-1 year; n=41), 6.9-15.3 (1-5 years; n=39) micro gm/dl.
Conclusion:
We recommend using separate T4 and TSH reference values for children in different age groups. Further large-scale studies should be done in Pakistan to establish these reference values within age groups. A national center for neonatal thyroid screening is highly recommended.