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Pediatric reference values of TSH should be personalized according to BMI and ethnicity

Tal Oron1,2, Liora Lazar1,2, Ilan Feldhamer3

  • 1The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.

European Journal of Endocrinology
|July 21, 2020
PubMed

Insights

Thyroid-stimulating hormone (TSH) reference values in children vary significantly with body mass index (BMI) and ethnicity. Personalizing these TSH reference intervals is crucial for accurate diagnosis and treatment decisions in pediatric endocrinology.

Area of Science:

  • Pediatric Endocrinology
  • Clinical Chemistry
  • Public Health

Background:

  • Thyroid function tests, particularly thyroid-stimulating hormone (TSH), are vital for diagnosing thyroid disorders.
  • Existing TSH reference ranges in children may not accurately reflect diverse populations, potentially leading to misdiagnosis.
  • Personalization of TSH reference values has been proposed to enhance diagnostic accuracy.

Purpose of the Study:

  • To determine thyroid-stimulating hormone (TSH) reference values in a large cohort of children.
  • To investigate the influence of age, sex, body mass index (BMI), and ethnicity on TSH levels.
  • To propose updated, personalized TSH reference intervals for pediatric populations.

Main Methods:

  • A population-based cohort study involving 75,549 healthy children aged 5-18 years.
  • Analysis of demographic data (age, gender, ethnicity) and anthropometric data (BMI).
  • Multivariate logistic regression was used to assess associations between TSH, FT4, and other parameters.

Main Results:

  • TSH levels were significantly lower in the Jewish population compared to the non-Jewish population.
  • TSH levels increased as BMI deviated from the normal weight range, with the highest levels in obese children.
  • Both the 2.5th and 97.5th percentiles of TSH were influenced by BMI and ethnicity, necessitating adjusted reference intervals.

Conclusions:

  • Pediatric TSH reference values are demonstrably affected by individual BMI and ethnicity.
  • Individualized TSH reference intervals are essential for improving the accuracy of clinical decision-making and treatment strategies.
  • The study highlights the limitations of universal TSH reference ranges and advocates for personalized approaches.
Abstract

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