Reference intervals in the diagnosis of thyroid dysfunction: treating patients not numbers

The Lancet. Diabetes & Endocrinology
Jacqueline Jonklaas, Salman Razvi

Abstract

Although assigning a diagnosis of thyroid dysfunction appears quite simple, this is often not the case. Issues that make it unclear whether thyroid function is normal include transient changes in thyroid parameters, inter-individual and intra-individual differences in thyroid parameters, age-related differences, and ethnic variations. In addition, a statistically calculated distribution of thyroid analytes does not necessarily coincide with intervals or cutoffs that have predictive value for beneficial or adverse health outcomes. Based on current clincial trial data, it is unclear which individuals with mild thyroid-stimulating hormone elevations will benefit from levothyroxine treatment. For example, only a small number of patients with thyroid-stimulating hormone values of more than 10 mIU/L have been studied in a randomised manner. Even if therapy is initiated for abnormal thyroid function, not all treated individuals are maintained at the desired treatment target, and therefore might still be at risk. The consequence of this is that each patient's thyroid function needs to be assessed on an individual basis with the entire clinical picture in mind. Monitoring also needs to be vigilant, and the targets for treatment reassess...Continue Reading

Citations

Feb 19, 2019·Thyroid Research·Owain Leng, Salman Razvi
Dec 10, 2019·European Journal of Clinical Investigation·Rudolf HoermannJohannes W Dietrich
Nov 27, 2019·The Journal of Clinical Endocrinology and Metabolism·Salman RazviAzfar Zaman
Sep 13, 2019·Scientific Reports·Nermin DiabElizabeth Selvin
Sep 5, 2019·Endocrine·Leonidas H Duntas, Paul Michael Yen
Jan 23, 2020·Medicina·Jan Calissendorff, Henrik Falhammar
Dec 17, 2019·Scandinavian Journal of Clinical and Laboratory Investigation·Bosa Mirjanic-AzaricZana Radic
Mar 29, 2020·Expert Review of Endocrinology & Metabolism·Owain Leng, Salman Razvi
Sep 7, 2019·Thyroid : Official Journal of the American Thyroid Association·Anna M SawkaJacqueline Jonklaas
Jul 30, 2019·Frontiers in Endocrinology·Elizabeth A McAninch, Antonio C Bianco
Oct 31, 2019·Journal of Thyroid Research·Salman RazviSanaa Mrabeti
Jun 17, 2020·Experimental and Clinical Endocrinology & Diabetes : Official Journal, German Society of Endocrinology [and] German Diabetes Association·Josef Köhrle, Keith H Richards
Feb 9, 2021·EClinicalMedicine·Yongze LiUNKNOWN Thyroid Disorders, Iodine Status and Diabetes Epidemiological Survey Group
Aug 17, 2021·Statistics in Medicine·Óscar Lado-BaleatoFrancisco Gude
Sep 21, 2021·Endocrine Reviews·Jacqueline Jonklaas
Jan 19, 2022·Environmental Science & Technology·Liwei XuChuanlai Xu

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