Subclinical hypothyroidism: A 'laboratory-induced' condition?

Karlien L.M. Coene, Ayse Y. Demir, Maarten A.C. Broeren, Pauline Verschuure, Eef G.W.M. Lentjes, Arjen Kars Boer

Research output: Contribution to journalArticleAcademicpeer-review

9 Citations (Scopus)


Objective: In current literature and guidelines, there is a tendency to define absolute TSH concentrations at which patient follow-up or even pharmaceutical intervention should be initiated. As TSH concentrations depend on the analytical method/platform used for TSH quantification, absolute cut-off values may pose threats for uniform clinical decision-making. In this study we therefore set out to clarify to what extent the method/platform and the reference values applied for TSH influence the clinical interpretation of thyroid parameters. Design and methods: We retrospectively analyzed anonymous TSH results from the Dutch external quality assessment program (EQAS) in relation to reference values advised by different manufacturers.We also examined TSH/free thyroxin (fT4) reference ranges and prevalence of thyroid pathology among different Dutch laboratories, including four cases in which a switch in the measuring platform was made. Results: Our data show that interpretation of thyroid parameters is not only influenced by between-method/platform variation, but is also substantially affected by the variation in TSH/fT4 reference intervals applied in individual laboratories. Additionally, we show that the transition to a novel analytical method/platform can result in a shift in the prevalence of thyroid pathology, especially for subclinical hypothyroidism. Conclusions: Subclinical hypothyroidism can be a 'laboratory-induced' condition. This is an undesirable situation in regard to the clinical implications such a diagnosis can have for patients.

Original languageEnglish
Pages (from-to)499-505
Number of pages7
JournalEuropean Journal of Endocrinology
Issue number4
Publication statusPublished - 1 Oct 2015


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