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Related Experiment Videos

The thyrotropin reference range should remain unchanged.

Martin I Surks1, Gayotri Goswami, Gilbert H Daniels

  • 1Division of Endocrinology and Metabolism, Department of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, New York 10467, USA. msurks@westnet.com

The Journal of Clinical Endocrinology and Metabolism
|September 9, 2005
PubMed
Summary
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Lowering the TSH reference range may misdiagnose millions with subclinical hypothyroidism (SCH). Most individuals with upper reference range (URR) TSH levels do not require thyroid treatment.

Area of Science:

  • Endocrinology
  • Thyroid Function Testing

Background:

  • Recent TSH reference range adjustments from 4.5 to 2.5 mIU/L are based on limited analysis.
  • A significant portion of the population may be reclassified as having subclinical hypothyroidism (SCH) under the new range.

Purpose of the Study:

  • To critically analyze the implications of lowering the TSH upper reference range (URR) from 4.5 to 2.5 mIU/L.
  • To evaluate the prevalence and clinical significance of TSH levels within the URR.

Main Methods:

  • Analysis of NHANES III data from 14,333 individuals over 12 years old without known thyroid disease.
  • Examination of TSH levels, thyroid antibodies, and potential confounding factors like time of phlebotomy.

Main Results:

  • 85% of participants had TSH below 2.5 mIU/L; 2.3% had SCH.

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  • An additional 9.7% (20.6 million Americans) would be classified as SCH with the lower TSH limit.
  • Many with URR TSH lack thyroid disease, and those with it show minimal deficiency without adverse health consequences.

    • Conclusions:

    • Lowering the TSH URR may lead to overdiagnosis of SCH.
    • Routine levothyroxine treatment is not warranted for individuals with URR TSH.
    • Annual TSH monitoring is a reasonable approach for patients with URR TSH.