The evidence for a narrower thyrotropin reference range is compelling
The evidence for a narrower thyrotropin reference range is compelling
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DOI：
10.1210/jc.2005-0455
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发表时间：
2005-09-01
影响因子：
5.8
通讯作者：
Dickey, RA
中科院分区：
文献类型：
--
作者：
Wartofsky, L;Dickey, RA
目前围绕最近一次共识会议的建议展开了辩论和争议，该会议审议了与早期、轻度或所谓的亚临床甲状腺功能减退症和甲状腺机能亢进症的管理有关的问题。与争议密切相关的是TSH正常参考范围的定义。很明显，以前接受的参考范围不再有效，这是因为更高灵敏度TSH检测的发展，以及认识到以前被认为正常的参考人群被患有不同程度甲状腺功能障碍的个体污染，这些个体有助于提高该组的平均TSH水平。美国国家临床生物化学研究院最近的实验室指南表明，超过95%的正常人TSH水平低于2.5亩/升。其余数值较高的是异常值，其中大多数人可能患有潜在的桥本甲状腺炎或其他原因的TSH升高。重要的是，数据表明，桥本甲状腺炎发病率非常低的非裔美国人的平均TSH水平为1.18亩/升，这有力地表明，对于正常人群来说，这个值是真正的正常平均值。识别和建立更准确、更真实的TSH正常范围，对筛查和治疗一般甲状腺疾病，特别是亚临床甲状腺疾病具有重要意义。
Debate and controversy currently surround the recommendations of a recent consensus conference that considered issues related to the management of early, mild, or so-called subclinical hypothyroidism and hyperthyroidism. Intimately related to the controversy is the definition of the normal reference range for TSH. It has become clear that previously accepted reference ranges are no longer valid as a result of both the development of more highly sensitive TSH assays and the appreciation that reference populations previously considered normal were contaminated with individuals with various degrees of thyroid dysfunction that served to increase mean TSH levels for the group. Recent laboratory guidelines from the National Academy of Clinical Biochemistry indicate that more than 95% of normal individuals have TSH levels below 2.5 mU/liter. The remainder with higher values are outliers, most of whom are likely to have underlying Hashimoto thyroiditis or other causes of elevated TSH. Importantly, data indicating that African-Americans with very low incidence of Hashimoto thyroiditis have a mean TSH level of 1.18 mU/liter strongly suggest that this value is the true normal mean for a normal population. Recognition and establishment of a more precise and true normal range for TSH have important implications for both screening and treatment of thyroid disease in general and subclinical thyroid disease in particular.