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. 2019 Mar 1;38(1):22-32.
doi: 10.2478/jomb-2018-0020. eCollection 2019 Mar.

Age and Assay Related Changes of Laboratory Thyroid Function Tests in the Reference Female Population

Najdana Gligorovic Barhanovic  1 , Tanja Antunovic  1 , Sreten Kavaric  2 , Aleksandar Djogo  2 , Vesna Kalimanovska Spasojevic  3
Affiliations

Age and Assay Related Changes of Laboratory Thyroid Function Tests in the Reference Female Population

Najdana Gligorovic Barhanovic et al. J Med Biochem. .

Abstract
in English, Serbian

Background: Laboratory thyroid function tests play a central role in the diagnosis of thyroid disorders. The aim of our cross-sectional study was to determine reference values for thyroid tests in a rigorously selected group of Montenegrin females, investigate the impact of possible age-related changes and the influence of the interassay bias between three frequently used immunoassays.

Methods: Female subjects were randomly selected, aged between 20 and 69 and 946 of them met the selection criteria. TSH, fT3, fT4, thyroid peroxidase and thyroglobulin antibodies were measured. Eighty samples were further analyzed on two other immunochemistry platforms.

Results: Median TSH progressively increased with age, there was no difference in fT3, while fT4 was significantly higher in the two oldest groups compared to the others. When using the age-related 97.5 percentile of TSH the percentage of reclassification was highest in the 20-29 years of age group (5.2%, p<0.05). In the oldest band, 7.7% had TSH values above cohort-specific and below the age-related upper reference limit. Bland-Altman bias plots revealed the highest interassay absolute mean difference between compared TSH assays of 24.5% and for fT4 assays of 13.8%.

Conclusions: The correlation coefficients between fT3 assays from different manufacturers were low. Serum TSH and fT4 concentrations increased with age and the implementation of age-specific TSH reference intervals would be of interest. The bias between the three commercial immunoassays indicated that the standardization of thyroid function tests is a task of great importance.

Uvod: Laboratorijski testovi za procjenu funkcije štitne žlijezde imaju centralno mjesto u dijagnostici poremećaja njene funkcije. Cilj našeg istraživanja bio je odrediti referentne vrijednosti za ove testove u rigorozno odabranoj grupi crnogorskih žena, istražiti uticaj starosne dobi, kao i interesej razlike između tri često korišćene imunohemijske platforme, na dobijene vrijednosti.

Metode: 946 ispitanica, slučajno odabranih u uzrastu između 20 i 69 godina, ispunile su kritriju me za izbor u referentnu populaciju. Mjereni su: TSH, fT3, fT4, tireoperoksidazna i tireoglobulinska antitijela. Osam deset uzoraka dodatno je analizirano na dvije različite imunohemijske platforme.

Rezultati: Medijana TSH progresivno je rasla sa godinama, nije bilo razlike u vrijednostima fT3, dok je fT4 bio znatno veći u dvije najstarije grupe u poređenju sa ostalim. Primjena 97,5 percentila vrijednosti TSH, karakterističnog za različite starosne grupe, uzrokovala je reklasifikaciju rezultata iz normalnih u patološke u svim grupama (najveći procenata u 20–29 godina grupi, 5,2%, p <0,05), izuzev najstarije. U najstarijoj grupi 7,7% ispitanica imalo je vrijednosti TSH iznad populacione, a u granicama za tu grupu dobijenih referentnih vrijednosti. Koncentracije serumskog TSH i fT4 rasle su sa godinama, te bi primjena referentnih vrijednosti specifičnih za datu starosnu grupu bila od značaja. Najveća apsolutna razlika srednjih vrijednosti između TSH testova bila je 24,5%, a između fT4 testova 13,8%.

Zaključak: Koeficijenti korelacije između fT3 testova različitih proizvo đača bili su niski. Odstupanje između tri često korišćena komercijalna imunohemijska određivanja ukazuje na važnost standardizacije testova za procjenu funkcije tireoidne žlijezde.

Keywords: age; assays; reference values; thyroid function tests.

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Conflict of interest statement

Conflict of interest statement The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Figures

Figure 1
Figure 1
Flow-chart showing selection criteria of female subjects.
Figure 2
Figure 2
TSH distribution in the youngest and oldest group.
Figure 3
Figure 3
Comparison of TSH assays: (A) Regression lines (95% confidence interval) and (B) Bland-Altman plots with mean ± 1.96 SD limits of agreement.
Figure 4
Figure 4
Comparison of fT4 assays: (A) Regression lines (95% confidence intervals) and (B) Bland-Altman plots with mean ±1.96 SD limits of agreement.
Figure 5
Figure 5
Comparison of fT3 assays: (A) Regression lines (95% confidence intervals) and (B) Bland-Altman plots with mean ±1.96 SD limits of agreement.
See this image and copyright information in PMC

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