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Meta-Analysis
. 2021 Jun 1:12:660277.
doi: 10.3389/fendo.2021.660277. eCollection 2021.

Reference Intervals for Serum Thyroid-Stimulating Hormone Based on a Recent Nationwide Cross-Sectional Study and Meta-Analysis

Xichang Wang  1 , Yongze Li  1 , Xiaodan Zhai  2 , Haoyu Wang  1 , Fan Zhang  1 , Xiaotong Gao  1 , Shengyu Liu  1 , Weiping Teng  1 , Zhongyan Shan  1
Affiliations
Meta-Analysis

Reference Intervals for Serum Thyroid-Stimulating Hormone Based on a Recent Nationwide Cross-Sectional Study and Meta-Analysis

Xichang Wang et al. Front Endocrinol (Lausanne). .

Abstract

Objective: The aim of our study was to compare the reference intervals (RIs) [median (2.5th-97.5th percentiles)] for thyroid-stimulating hormone (TSH) between subgroups stratified by ethnicity and iodine status in a global context.

Design and methods: Primary data were derived from a recently published cross-sectional study in mainland China. Secondary data were obtained from online databases. The RIs for TSH were calculated in the reference population according to the National Academy of Clinical Biochemistry (NACB) standard and in the disease-free population. A meta-analysis of ethnicity- and iodine status-specific TSH RIs was performed.

Results: The primary data showed that the TSH RI (mU/L) in the disease-free population was 2.33 (0.67, 7.87), which is wider than the published RI [2.28 (0.74, 7.04)] in the reference population. The meta-analysis showed that whether in the reference or disease-free population, the RIs in Yellows were much higher than those in Caucasians. In the reference population, the median and 2.5th percentile in the iodine-sufficient subgroup were both lower than the iodine-deficient or more-than-adequate subgroup, while the 97.5th percentile showed a positive trend with increasing sufficiency of iodine. However, in the disease-free population, the iodine-sufficient subgroup had a lower median and 97.5th percentile but higher 2.5th percentile than the iodine-deficient subgroup.

Conclusion: Yellows have a higher TSH RI than Caucasians. In the reference population, both the median and 2.5th percentile TSH in the iodine-sufficient population were the lowest among the different iodine status subgroups, while the 97.5th percentile of TSH showed an upward trend with increasing iodine sufficiency.

Keywords: TSH; cross-sectional study; ethnicity; iodine status; meta-analysis; reference interval.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram for the literature process.
Figure 2
Figure 2
Ethnicity standardized forest plots of the pooled relative descent rate (%) of median TSH (50th percentile) in NACB populations. F, female; M, male.
Figure 3
Figure 3
Ethnicity standardized forest plots of the pooled relative descent rate (%) of TSH lower limits (2.5th percentile) in NACB populations.
Figure 4
Figure 4
Ethnicity standardized forest plots of the pooled relative descent rate (%) of TSH upper limits (97.5th percentile) in NACB populations.
Figure 5
Figure 5
Iodine status standardized forest plots of the pooled relative descent rate (%) of median TSH (50th percentile) in NACB populations.
Figure 6
Figure 6
Iodine status standardized forest plots of the pooled relative descent rate (%) of TSH lower limits (2.5th percentile) in NACB populations.
Figure 7
Figure 7
Iodine status standardized forest plots of the pooled relative descent rate (%) of TSH upper limits (97.5th percentile) in NACB populations.
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