Using Hashimoto thyroiditis as gold standard to determine the upper limit value of thyroid stimulating hormone in a Chinese cohort.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Physical Examination Department, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
Yu
Y
Li
Physical Examination Department, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
Dong-Ning
DN
Chen
Physical Examination Department, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
Jing
J
Cui
Department of Endocrinology, Beijing Key Laboratory of Diabetes Research and Care, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
Zhong
Z
Xin
Department of Endocrinology, Beijing Key Laboratory of Diabetes Research and Care, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
Guang-Ran
GR
Yang
Department of Endocrinology, First Hospital of Qinghuangdao, Qinghuangdao, 066000, China.
Ming-Jia
MJ
Niu
Department of Endocrinology, Beijing Key Laboratory of Diabetes Research and Care, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China. jkyang@ccmu.edu.cn.
Jin-Kui
http://orcid.org/0000-0002-5430-2149
JK
Yang
D000328:Adult; D015331:Cohort Studies; D005260:Female; D050031:Hashimoto Disease / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D018828:Immunoglobulins, Thyroid-Stimulating / Q000097:blood; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012372:ROC Curve; D012016:Reference Values; D012044:Regression Analysis; D012307:Risk Factors; D013961:Thyroid Gland / Q000000981:diagnostic imaging; D013972:Thyrotropin / Q000097:blood*; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood; D014463:Ultrasonography
D018828:Immunoglobulins, Thyroid-Stimulating; D014284:Triiodothyronine; D013972:Thyrotropin; D013974:Thyroxine