title: Serum thyrotropin is a better predictor of future thyroid dysfunction than thyroid autoantibody status in biochemically euthyroid patients with diabetes: implications for screening.
abstract: OBJECTIVE
  To ascertain the predictive values of thyroid autoantibodies and thyrotropin (TSH) levels for subsequent thyroid dysfunction in patients with diabetes.
  
  
  METHODS
  Review of records of 467 patients who had attended diabetes clinics for a mean of 6.1 years. Baseline autoantibody and TSH results and thyroid status at annual review were determined.
  
  
  RESULTS
  Thyroid disorders were known in 29 patients (6.2%), and newly identified in 32 (6.9%), at presentation. Of 406 patients with normal baseline thyroid status, 24 (5.9%) developed thyroid dysfunction during 6.1 years of mean follow-up. Higher baseline TSH concentration was associated with subsequent hypothyroidism; a threshold of 1.53 mU/L, approximately defining the top quartile, provided 75% sensitivity and specificity. Both TSH greater than 1.53 mU/L and positive autoantibody status predicted thyroid dysfunction, but only TSH was significant in multivariable analysis (odds ratio, 7.74, p < 0.001). No overt thyroid dysfunction developed in 293 patients with baseline TSH levels less than 1.53 mU/l.
  
  
  CONCLUSIONS
  Baseline TSH level may be a better predictor of thyroid dysfunction than thyroid autoantibodies in people with diabetes. Patients with TSH levels below the top quartile have a risk of thyroid dysfunction similar to the general population. It may be appropriate to stop annual thyroid screening in this group, although confirmation is required.
authors.affiliation: Department of Diabetes, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Roderick E
authors.initials: RE
authors.lastname: Warren
authors.forename: Petros
authors.initials: P
authors.lastname: Perros
authors.forename: Moffat J
authors.initials: MJ
authors.lastname: Nyirenda
authors.forename: Brian M
authors.initials: BM
authors.lastname: Frier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood*; D048909:Diabetes Complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013959:Thyroid Diseases / Q000175:diagnosis*; D013961:Thyroid Gland / Q000276:immunology*; D013972:Thyrotropin / Q000097:blood*
chemical_list: D001323:Autoantibodies; D013972:Thyrotropin