{"title":"按年龄、性别和种族划分的甲状腺功能参考间隔：一项横断面研究。","authors":"Qihang Li, Yida Tang, Xuefeng Yu, Guijun Qin, Limin Tian, Lianjiang Cheng, Yi Lu, Zhigang Zhao, Libin Liu, Kai Zhang, Changjun Wang, Shuqing Zhang, Yong Xu, Guangyao Song, Fang Zhong, Xiude Fan, Zhixiang Wang, Yafei Wu, Yongfeng Song, Jiajun Zhao","doi":"10.7326/ANNALS-24-01559","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Current clinical practice uses a one-size-fits-all approach to define reference intervals for the results of diagnostic tests about thyroid function. This approach does not recognize subgroup differences according to age, sex, or race.</p><p><strong>Objective: </strong>To identify age-, sex-, and race-specific reference intervals for the common diagnostic tests that measure thyroid function and to examine how these new reference intervals reclassify persons into disease categories when compared with current reference intervals.</p><p><strong>Design: </strong>Cross-sectional analysis.</p><p><strong>Setting: </strong>Data from the U.S. NHANES (National Health and Nutrition Examination Survey) supplemented with data from a multicenter Chinese study.</p><p><strong>Participants: </strong>A nationally representative sample from NHANES aged 20 years or older (<i>n</i> = 8308) supplemented with a Chinese database of routine health checkups from 49 hospitals in 10 provinces aged 18 years or older (<i>n</i> = 314 302).</p><p><strong>Measurements: </strong>The thyroid function reference interval was defined as the interval of diagnostic indicator levels from the 2.5th (lower limit) to the 97.5th (upper limit) percentile by age, sex, and race subgroups.</p><p><strong>Results: </strong>In 8308 NHANES participants, the 97.5th percentile levels of thyroid-stimulating hormone (TSH) increased with age, whereas total triiodothyronine (TT<sub>3</sub>) levels declined with age and total thyroxine (TT<sub>4</sub>) levels were stable across different ages. Women had higher TT<sub>4</sub> levels, and White participants had higher TSH levels. Using current reference intervals, the prevalence of subclinical hypothyroidism increased from 2.4% for ages 20 to 29 years to 5.9% for ages 70 years and older. In contrast, using age-, sex-, and race-specific reference intervals reclassified 48.5% of persons with subclinical hypothyroidism as normal, especially women and White participants, and reclassified 31.2% of persons with subclinical hyperthyroidism as normal, especially women, Black participants, and Hispanic participants. When compared with the findings from U.S. participants, many of the findings from 314 302 Chinese participants were similar.</p><p><strong>Limitation: </strong>Cross-sectional data; sample size limitations for subgroup.</p><p><strong>Conclusion: </strong>These findings should help establish more accurate reference intervals for thyroid diseases and facilitate development of a consensus about how to define and manage those diseases.</p><p><strong>Primary funding source: </strong>National Key Research and Development Program of China and National Natural Science Foundation.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"921-929"},"PeriodicalIF":19.6000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Thyroid Function Reference Intervals by Age, Sex, and Race : A Cross-Sectional Study.\",\"authors\":\"Qihang Li, Yida Tang, Xuefeng Yu, Guijun Qin, Limin Tian, Lianjiang Cheng, Yi Lu, Zhigang Zhao, Libin Liu, Kai Zhang, Changjun Wang, Shuqing Zhang, Yong Xu, Guangyao Song, Fang Zhong, Xiude Fan, Zhixiang Wang, Yafei Wu, Yongfeng Song, Jiajun Zhao\",\"doi\":\"10.7326/ANNALS-24-01559\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Current clinical practice uses a one-size-fits-all approach to define reference intervals for the results of diagnostic tests about thyroid function. This approach does not recognize subgroup differences according to age, sex, or race.</p><p><strong>Objective: </strong>To identify age-, sex-, and race-specific reference intervals for the common diagnostic tests that measure thyroid function and to examine how these new reference intervals reclassify persons into disease categories when compared with current reference intervals.</p><p><strong>Design: </strong>Cross-sectional analysis.</p><p><strong>Setting: </strong>Data from the U.S. NHANES (National Health and Nutrition Examination Survey) supplemented with data from a multicenter Chinese study.</p><p><strong>Participants: </strong>A nationally representative sample from NHANES aged 20 years or older (<i>n</i> = 8308) supplemented with a Chinese database of routine health checkups from 49 hospitals in 10 provinces aged 18 years or older (<i>n</i> = 314 302).</p><p><strong>Measurements: </strong>The thyroid function reference interval was defined as the interval of diagnostic indicator levels from the 2.5th (lower limit) to the 97.5th (upper limit) percentile by age, sex, and race subgroups.</p><p><strong>Results: </strong>In 8308 NHANES participants, the 97.5th percentile levels of thyroid-stimulating hormone (TSH) increased with age, whereas total triiodothyronine (TT<sub>3</sub>) levels declined with age and total thyroxine (TT<sub>4</sub>) levels were stable across different ages. Women had higher TT<sub>4</sub> levels, and White participants had higher TSH levels. Using current reference intervals, the prevalence of subclinical hypothyroidism increased from 2.4% for ages 20 to 29 years to 5.9% for ages 70 years and older. In contrast, using age-, sex-, and race-specific reference intervals reclassified 48.5% of persons with subclinical hypothyroidism as normal, especially women and White participants, and reclassified 31.2% of persons with subclinical hyperthyroidism as normal, especially women, Black participants, and Hispanic participants. When compared with the findings from U.S. participants, many of the findings from 314 302 Chinese participants were similar.</p><p><strong>Limitation: </strong>Cross-sectional data; sample size limitations for subgroup.</p><p><strong>Conclusion: </strong>These findings should help establish more accurate reference intervals for thyroid diseases and facilitate development of a consensus about how to define and manage those diseases.</p><p><strong>Primary funding source: </strong>National Key Research and Development Program of China and National Natural Science Foundation.</p>\",\"PeriodicalId\":7932,\"journal\":{\"name\":\"Annals of Internal Medicine\",\"volume\":\" \",\"pages\":\"921-929\"},\"PeriodicalIF\":19.6000,\"publicationDate\":\"2025-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Internal Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.7326/ANNALS-24-01559\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/5/6 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Internal Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.7326/ANNALS-24-01559","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/5/6 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Thyroid Function Reference Intervals by Age, Sex, and Race : A Cross-Sectional Study.
Background: Current clinical practice uses a one-size-fits-all approach to define reference intervals for the results of diagnostic tests about thyroid function. This approach does not recognize subgroup differences according to age, sex, or race.
Objective: To identify age-, sex-, and race-specific reference intervals for the common diagnostic tests that measure thyroid function and to examine how these new reference intervals reclassify persons into disease categories when compared with current reference intervals.
Design: Cross-sectional analysis.
Setting: Data from the U.S. NHANES (National Health and Nutrition Examination Survey) supplemented with data from a multicenter Chinese study.
Participants: A nationally representative sample from NHANES aged 20 years or older (n = 8308) supplemented with a Chinese database of routine health checkups from 49 hospitals in 10 provinces aged 18 years or older (n = 314 302).
Measurements: The thyroid function reference interval was defined as the interval of diagnostic indicator levels from the 2.5th (lower limit) to the 97.5th (upper limit) percentile by age, sex, and race subgroups.
Results: In 8308 NHANES participants, the 97.5th percentile levels of thyroid-stimulating hormone (TSH) increased with age, whereas total triiodothyronine (TT3) levels declined with age and total thyroxine (TT4) levels were stable across different ages. Women had higher TT4 levels, and White participants had higher TSH levels. Using current reference intervals, the prevalence of subclinical hypothyroidism increased from 2.4% for ages 20 to 29 years to 5.9% for ages 70 years and older. In contrast, using age-, sex-, and race-specific reference intervals reclassified 48.5% of persons with subclinical hypothyroidism as normal, especially women and White participants, and reclassified 31.2% of persons with subclinical hyperthyroidism as normal, especially women, Black participants, and Hispanic participants. When compared with the findings from U.S. participants, many of the findings from 314 302 Chinese participants were similar.
Limitation: Cross-sectional data; sample size limitations for subgroup.
Conclusion: These findings should help establish more accurate reference intervals for thyroid diseases and facilitate development of a consensus about how to define and manage those diseases.
Primary funding source: National Key Research and Development Program of China and National Natural Science Foundation.
期刊介绍：
Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.
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