Serum thyrotropin measurements in the community: Five-year follow-up in a large network of primary care physicians

Joseph Meyerovitch, Pnina Rotman-Pikielny, Michael Sherf, Erez Battat, Yair Levy, Martin I. Surks

Research output: Contribution to journalArticle

123 Citations (Scopus)

Abstract

Background: Subclinical thyroid disease is common; however, screening recommendations using serum thyrotropin (TSH) level determinations are controversial. Methods: To study the use of serum TSH by primary care physicians and define populations at risk for having an abnormal TSH level at follow-up, based on initial TSH levels, we conducted an observational study of a large health care database in the setting of a health management organization. All outpatients without thyroid disease or pregnancy or taking medication that may alter thyroid function in whom the TSH level was measured in 2002 and during 5-year follow-up were included in this study. Repeated TSH level determinations were compared with the initial TSH level values. Results: In 422 242 patients included, 95% of the initial serum TSH concentrations were within normal limits (0.35-5.5 mIU/L), 1.2% were decreased (<0.35 mIU/L), 3.0% were elevated (>5.5 to ≤10 mIU/L) and 0.7% were highly elevated (>10 mIU/L). In 346 549 patients without thyroid-specific medications, the TSH levels became normal in 27.2%, 62.1%, and 51.2%, whose initial serum TSH level was highly elevated, elevated, and decreased, respectively, and remain normal in 98% of the patients with normal initial TSH levels. When the initial serum TSH level was elevated, patients in the highest quintile of this group, who had a shorter interval between the first and second measurements, had a higher probability of a second highly elevated TSH concentration (P<.001). Conclusions: When the serum TSH level is normal, the likelihood of an abnormal level within 5 years is low (2%). More than 50% of patients with elevated or decreased serum TSH levels have normal levels in repeated measurements.

Original languageEnglish (US)
Pages (from-to)1533-1538
Number of pages6
JournalArchives of Internal Medicine
Volume167
Issue number14
DOIs
StatePublished - Jul 23 2007

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Primary Care Physicians
Thyrotropin
Serum
Thyroid Diseases
Thyroid Gland
Observational Studies
Outpatients
Organizations
Databases
Delivery of Health Care
Pregnancy
Health

ASJC Scopus subject areas

  • Internal Medicine

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Serum thyrotropin measurements in the community : Five-year follow-up in a large network of primary care physicians. / Meyerovitch, Joseph; Rotman-Pikielny, Pnina; Sherf, Michael; Battat, Erez; Levy, Yair; Surks, Martin I.

In: Archives of Internal Medicine, Vol. 167, No. 14, 23.07.2007, p. 1533-1538.

Research output: Contribution to journalArticle

Meyerovitch, Joseph ; Rotman-Pikielny, Pnina ; Sherf, Michael ; Battat, Erez ; Levy, Yair ; Surks, Martin I. / Serum thyrotropin measurements in the community : Five-year follow-up in a large network of primary care physicians. In: Archives of Internal Medicine. 2007 ; Vol. 167, No. 14. pp. 1533-1538.
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abstract = "Background: Subclinical thyroid disease is common; however, screening recommendations using serum thyrotropin (TSH) level determinations are controversial. Methods: To study the use of serum TSH by primary care physicians and define populations at risk for having an abnormal TSH level at follow-up, based on initial TSH levels, we conducted an observational study of a large health care database in the setting of a health management organization. All outpatients without thyroid disease or pregnancy or taking medication that may alter thyroid function in whom the TSH level was measured in 2002 and during 5-year follow-up were included in this study. Repeated TSH level determinations were compared with the initial TSH level values. Results: In 422 242 patients included, 95{\%} of the initial serum TSH concentrations were within normal limits (0.35-5.5 mIU/L), 1.2{\%} were decreased (<0.35 mIU/L), 3.0{\%} were elevated (>5.5 to ≤10 mIU/L) and 0.7{\%} were highly elevated (>10 mIU/L). In 346 549 patients without thyroid-specific medications, the TSH levels became normal in 27.2{\%}, 62.1{\%}, and 51.2{\%}, whose initial serum TSH level was highly elevated, elevated, and decreased, respectively, and remain normal in 98{\%} of the patients with normal initial TSH levels. When the initial serum TSH level was elevated, patients in the highest quintile of this group, who had a shorter interval between the first and second measurements, had a higher probability of a second highly elevated TSH concentration (P<.001). Conclusions: When the serum TSH level is normal, the likelihood of an abnormal level within 5 years is low (2{\%}). More than 50{\%} of patients with elevated or decreased serum TSH levels have normal levels in repeated measurements.",
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