Investigations of thyroid hormones and antibodies based on a community health survey: the Busselton thyroid study.
OBJECTIVE
Overt or subclinical thyroid dysfunction is common within the community, yet the significance of subtle anomalies in thyroid function tests remains contentious. The aims of this study were to: (a) establish reference intervals for serum-free thyroxine (FT4), thyroid-stimulating hormone (TSH) and thyroid antibodies (antithyroperoxidase, TPOAb and antithyroglobulin, TgAb) in the Busselton community of south-western Western Australia; and (b) determine the prevalence of thyroid hormone anomalies in this community.


METHODS
In 1981, 2115 adults residing in Busselton participated in a cross-sectional health survey that involved blood collection and a questionnaire on lifestyle and general health history.


METHODS
Serum samples were analysed for FT4, TSH, TPOAb and TgAb by immunochemiluminescent assays.


RESULTS
Based on standard statistical approaches and using guidelines recommended by the National Academy of Clinical Biochemistry (NACB), reference intervals were derived for each analyte: 9-23 pmol/l for FT4, 0.4-4.0 mIU/l (TSH), < 35 KIU/l (TPOAb) and < 55 KIU/l (TgAb). The prevalence of elevated thyroid antibodies was 12.4% among subjects without a history of thyroid disease and is more common in women than in men. Elevated thyroid antibody levels were observed at both extremes of TSH abnormality, but were more commonly increased when TSH levels were above 4.0 mIU/l (63% subjects) than for those with TSH levels 0.4-4.0 mIU/l (7.8% subjects).


CONCLUSIONS
This study establishes the prevalence of antibodies to thyroperoxidase and thyroglobulin in a community-based sample and reference intervals for free T4 and TSH. When the NACB decision limits are applied to older men or women, there is a markedly increased number with 'elevated' autoantibody levels compared to sex- and age-specific reference intervals.
O'Leary
Peter C
PC
Clinical Biochemistry, Women's and Children's Health Service, Princess Margaret Hospital, Subiaco Western Australia, Australia. peter.oleary@health.wa.gov.au
Feddema
Peter H
PH
Michelangeli
Valdo P
VP
Leedman
Peter J
PJ
Chew
Gerard T
GT
Knuiman
Matthew
M
Kaye
Joey
J
Walsh
John P
JP
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies / Q000097:blood*; D001323:Autoantibodies / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D007453:Iodide Peroxidase / Q000276:immunology*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012015:Reference Standards; D012016:Reference Values; D012737:Sex Factors; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000276:immunology*; D013963:Thyroid Hormones / Q000097:blood*; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D014904:Western Australia
D000906:Antibodies; D001323:Autoantibodies; D013963:Thyroid Hormones; C006606:anti-thyroglobulin; D013972:Thyrotropin; D007453:Iodide Peroxidase; D013974:Thyroxine