Interpretation of TSH results can be improved by reference values fluctuating in time.

IF 1.1 Q4 BIOCHEMISTRY & MOLECULAR BIOLOGY Hormone Molecular Biology and Clinical Investigation Pub Date : 2024-10-01 DOI:10.1515/hmbci-2024-0043
Joris R Delanghe, Jan Van Elslande, Maaike Godefroid, Marijn M Speeckaert, Thomas M Maenhout
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Abstract

Objectives: The secretion of thyroid stimulating hormone (thyrotropin, TSH), is characterized by a marked circadian rhythm. Plasma or serum TSH values are significantly lower in the afternoon and in the evening as compared to the early morning. As in clinical practice, blood sampling time shows an important variation, a reliable assessment of thyroid status is often not an easy task for the clinician. The biological variation of TSH plays a major role in the intra-individual variability of TSH results in serum or plasma. The observed intra-day variation largely exceeds the reported inter-vendor variation and the coefficient of variation of clinical TSH assays. Therefore, a mathematical solution was sought for correcting interpretation of TSH results for sampling time.

Methods: We have developed a cosinor model which allows to compensate TSH decision values for the fluctuating serum or plasma TSH concentrations throughout the day.

Results: The following mathematical function could be derived: corrected TSH cutoff_value (mIU/L)=0.40 + 0.24*cos(((π/12) *T) + 6) in which T represents the time (hours). This mathematical function can be easily implemented into a laboratory's informatics system and furthermore allows a better tailored diagnosis of (subclinical) hyperthyroidism, regardless the blood sampling time.

Conclusions: Implementing the corrected cut-off values result in a marked reduction of apparent (false positive) hyperthyroidism diagnosis, in particular in the afternoon.

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参考值随时间波动,可提高 TSH 结果的解释能力。
目的:促甲状腺激素(TSH)的分泌有明显的昼夜节律。与清晨相比,下午和傍晚的血浆或血清促甲状腺激素值明显较低。在临床实践中,采血时间会出现很大的变化,因此对临床医生来说,可靠地评估甲状腺状态往往不是一件容易的事。促甲状腺激素的生物变异在血清或血浆中促甲状腺激素结果的个体内变异中起着重要作用。观察到的日内变异在很大程度上超过了报告的供应商间变异和临床 TSH 检测的变异系数。因此,我们正在寻求一种数学解决方案,以校正采样时间对 TSH 结果的解释:方法:我们建立了一个 cosinor 模型,该模型可以根据血清或血浆 TSH 浓度在一天中的波动对 TSH 决定值进行补偿:可以得出以下数学函数:校正 TSH 临界值(mIU/L)=0.40 + 0.24*cos(((π/12) *T)+ 6),其中 T 代表时间(小时)。这个数学函数可以很容易地应用到实验室的信息系统中,而且还能更好地诊断(亚临床)甲状腺功能亢进症,而不受采血时间的影响:结论:采用校正后的临界值可显著减少甲状腺功能亢进的明显(假阳性)诊断,尤其是在下午。
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来源期刊
Hormone Molecular Biology and Clinical Investigation
Hormone Molecular Biology and Clinical Investigation BIOCHEMISTRY & MOLECULAR BIOLOGY-
CiteScore
2.60
自引率
0.00%
发文量
55
期刊介绍: Hormone Molecular Biology and Clinical Investigation (HMBCI) is dedicated to the provision of basic data on molecular aspects of hormones in physiology and pathophysiology. The journal covers the treatment of major diseases, such as endocrine cancers (breast, prostate, endometrium, ovary), renal and lymphoid carcinoma, hypertension, cardiovascular systems, osteoporosis, hormone deficiency in menopause and andropause, obesity, diabetes, brain and related diseases, metabolic syndrome, sexual dysfunction, fetal and pregnancy diseases, as well as the treatment of dysfunctions and deficiencies. HMBCI covers new data on the different steps and factors involved in the mechanism of hormone action. It will equally examine the relation of hormones with the immune system and its environment, as well as new developments in hormone measurements. HMBCI is a blind peer reviewed journal and publishes in English: Original articles, Reviews, Mini Reviews, Short Communications, Case Reports, Letters to the Editor and Opinion papers. Ahead-of-print publishing ensures faster processing of fully proof-read, DOI-citable articles.
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