Using Hashimoto thyroiditis as gold standard to determine the upper limit value of thyroid stimulating hormone in a Chinese cohort.
Using Hashimoto thyroiditis as gold standard to determine the upper limit value of thyroid stimulating hormone in a Chinese cohort.
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以桥本甲状腺炎为金标准确定中国队列促甲状腺激素上限值
DOI：
10.1186/s12902-016-0137-3
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发表时间：
2016-11-06
影响因子：
2.7
通讯作者：
Yang JK
中科院分区：
文献类型：
--
作者：
Li Y;Chen DN;Cui J;Xin Z;Yang GR;Niu MJ;Yang JK
亚临床甲减是心血管疾病的危险因素，常由桥本甲状腺炎（HT）引起。这种疾病被定义为仅仅具有升高的血清促甲状腺激素（TSH）水平。然而，TSH参考范围的上限最近有争议。本研究以桥本甲状腺炎的患病率作为“金标准”，确定一个队列中TSH正常上限的临界值。研究对象为2856名每年参加健康体检的医务人员。检测血清游离三碘甲状腺原氨酸（FT 3）、游离甲状腺素（FT 4）、促甲状腺激素（TSH）、甲状腺过氧化物酶抗体（TPAb）、甲状腺球蛋白抗体（TGAb）等生化指标。同时进行甲状腺超声检查。HT的诊断基于甲状腺抗体（TPAb和TGAb）的存在和甲状腺超声检查的异常。我们使用两种不同的方法来估计基于HT患病率的TSH临界点。联合点回归分析显示，当TSH值为2.9mU/L时，HT患病率显著增加。ROC曲线显示TSH临界值为2.6mU/L，诊断HT的敏感性和特异性最高。使用新定义的TSH临界值可以更有效地检测高脂血症患者，这可能表明我们定义TSH上限的方法从临床角度来看更有意义。TSH在2.6- 2.9mU/L者HT患病率明显增高，可作为确定TSH正常上限的临界值。
Subclinical hypothyroidism, commonly caused by Hashimoto thyroiditis (HT), is a risk factor for cardiovascular diseases. This disorder is defined as merely having elevated serum thyroid stimulating hormone (TSH) levels. However, the upper limit of reference range for TSH is debated recently. This study was to determine the cutoff value for the upper normal limit of TSH in a cohort using the prevalence of Hashimoto thyroiditis as “gold” calibration standard. The research population was medical staff of 2856 individuals who took part in health examination annually. Serum free triiodothyronine (FT3), free thyroxine (FT4), TSH, thyroid peroxidase antibody (TPAb), thyroglobulin antibody (TGAb) and other biochemistry parameters were tested. Meanwhile, thyroid ultrasound examination was performed. The diagnosis of HT was based on presence of thyroid antibodies (TPAb and TGAb) and abnormalities of thyroid ultrasound examination. We used two different methods to estimate the cutoff point of TSH based on the prevalence of HT. Joinpoint regression showed the prevalence of HT increased significantly at the ninth decile of TSH value corresponding to 2.9 mU/L. ROC curve showed a TSH cutoff value of 2.6 mU/L with the maximized sensitivity and specificity in identifying HT. Using the newly defined cutoff value of TSH can detect patients with hyperlipidemia more efficiently, which may indicate our approach to define the upper limit of TSH can make more sense from the clinical point of view. A significant increase in the prevalence of HT occurred among individuals with a TSH of 2.6–2.9 mU/L made it possible to determine the cutoff value of normal upper limit of TSH.