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Salvatore Benvenga Department of Clinical and Experimental Medicine, Italy
Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina School of Medicine, Italy
Interdepartmental Program of Molecular and Clinical Endocrinology, and Women's Endocrine Health, University Hospital Policlinico G. Martino, Messina, Italy

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Roberto Vita Department of Clinical and Experimental Medicine, Italy

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Flavia Di Bari Department of Clinical and Experimental Medicine, Italy

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Poupak Fallahi Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

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Alessandro Antonelli Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

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carbonate and 7,000 IU/week of vitamin D 3 because of borderline low calcemia (8.0 mg/dl, 2.0 mmol/l). She was referred because 1 month earlier her serum TSH had reached 7.0 mU/l (reference range: 0.25-4.0) under 150 μg/day (2.3 μg/kg body weight/day) of L

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Mitsuaki Tokumaru Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan

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Kenji Ohba Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan

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Kennichi Kakudo Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi, Japan

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Takafumi Suda Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan

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Yutaka Oki Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan

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Yoshie Goto Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan

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hospital visit. Palpation revealed a painless, firm, 2.5 × 2.0-cm nodule on the right side of her neck. Thyroid function tests revealed a euthyroid status. Anti-thyroglobulin and anti-thyroperoxidase antibodies levels were high (1,490 IU/mL [reference range

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Claire L Wood Department of Paediatric Endocrinology, Great North Children’s Hospital, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, UK

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Niamh Morrison Department of Paediatric Endocrinology, Great North Children’s Hospital, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK

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Michael Cole Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, UK

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Malcolm Donaldson Department of Child Health, University of Glasgow School of Medicine, Glasgow, UK

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David B Dunger Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
Wellcome Trust-MRC Institute of Metabolic Sciences, University of Cambridge, Cambridge, UK

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Ruth Wood Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK

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Simon H S Pearce Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, UK
Department of Endocrinology, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK

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Timothy D Cheetham Department of Paediatric Endocrinology, Great North Children’s Hospital, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, UK

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on behalf of the British Society for Paediatric Endocrinology and Diabetes (BSPED)

thyroxine (FT4) response in the two groups; specifically the time taken for TSH levels to rise or for FT4 concentrations to fall within the local reference ranges. Free tri-iodothyroinine (FT3) concentrations were not measured routinely in this trial

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Jun Yang Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

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Meng-Jie Dong Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

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Qin Xu Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

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smoke. Abnormal laboratory tests included high free thyroxine and free triiodothyronine levels, a markedly low thyrotropin titer, thyroperoxidase antibody (TPOAb) level of >6,500 IU/mL (reference range, 0–100 IU/mL), and TRAb level of >40 IU/L (reference

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Leonidas H. Duntas Endocrine Unit, Evgenidion Hospital, University of Athens, Athens, Greece

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Georg Brabant Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany

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Fabio Monzani Department of Clinical and Experimental Medicine, Università di Pisa, Pisa, Italy

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Simon H.S. Pearce Institute of Genetic Medicine, Newcastle University, UK
Royal Victoria Infirmary, Newcastle upon Tyne, UK

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Robin Patrick Peeters Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands

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Salman Razvi Institute of Genetic Medicine, Newcastle University, UK
Queen Elizabeth Hospital, Gateshead, UK

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Jean-Louis Wemeau Clinique Endocrinologique Marc-Linquette, CHU, Lille, France

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age (60-70 years as moderately old, >70 years as older and >80-85 years as oldest old) is essential for the establishment of a diagnosis that should also consider ‘age-specific reference ranges for serum TSH' (recommendation 14) in older people. It has

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Diogo Mendes Center for Health Technology Assessment and Drug Research, Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal

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Carlos Alves Center for Health Technology Assessment and Drug Research, Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
Laboratory of Social Pharmacy and Public Health, School of Pharmacy, University of Coimbra, Coimbra, Portugal

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Nuno Silverio Merck S.A., Algés, Portugal

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Francisco Batel Marques Center for Health Technology Assessment and Drug Research, Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
Laboratory of Social Pharmacy and Public Health, School of Pharmacy, University of Coimbra, Coimbra, Portugal

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a decreased level of serum free thyroxin (fT 4 ) as compared to the reference ranges in the general population. Subclinical hypothyroidism is defined as an elevated serum TSH level in combination with a normal serum fT 4 level [ 1 , 2 ]. The

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Stine Linding Andersen Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark

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Stig Andersen Department of Geriatrics, Aalborg University Hospital, Aalborg, Denmark
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

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population-based reference ranges. TSH is also the first-line thyroid function test for the diagnosis of thyroid dysfunction in pregnant women, but the physiological alterations in pregnancy necessitate the use of a pregnancy-specific reference range [ 12

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David J. Stott University of Glasgow, Glasgow, UK

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Douglas C. Bauer University of California, San Francisco, Calif., USA

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Ian Ford University of Glasgow, Glasgow, UK

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Patricia Kearney University College of Cork, Cork, Ireland

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Jacobijn Gussekloo Leiden University Medical Centre, Leiden

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Terence J. Quinn University of Glasgow, Glasgow, UK

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Nicolas Rodondi Inselspital, Bern University Hospital, Bern, Switzerland

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Jan Smit Radboud University Medical Centre, Nijmegen, The Netherlands

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Rudi Westerdorp Leyden Academy on Vitality and Ageing, Leiden

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mU/l) and by age (<70 years categorised as ‘younger' and over 80 or 85 years as ‘oldest old'). It is stated that ‘age-specific local reference ranges for serum TSH should be considered in order to establish a diagnosis of SCH in older people' [ 1

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Stasa Ivkovic Clinical Center of Serbia, Clinic of Otorhinolaryngology and Maxillofacial Surgery, Belgrade, Serbia

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Dear Sir, Five months after radioactive iodine treatment for Graves’ hyperthyroidism, I developed severe hypothyroidism. Three months after treatment, TSH, FT4 and FT3 values were within reference range (0.44 mlU/l, 15.9 and 4.5 pmol

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Roberto Fiore Division of Endocrinology, Diabetes and Metabolism, University Hospital of Lausanne and University of Lausanne, Hôtel des Patients, Lausanne, Switzerland

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Stefano La Rosa Unit of Pathology, Department of Medicine and Surgery, University of Insubria, Varese, Italy

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Silvia Uccella Unit of Pathology, Department of Medicine and Surgery, University of Insubria, Varese, Italy

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Deborah Marchiori Unit of Pathology, Department of Medicine and Surgery, University of Insubria, Varese, Italy

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Peter A Kopp Division of Endocrinology, Diabetes and Metabolism, University Hospital of Lausanne and University of Lausanne, Hôtel des Patients, Lausanne, Switzerland

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4.5 mU/L (reference range 0.27-4.2 mU/L), with normal levels of fT4 (16 pmol/L, reference range 12.0–22.0 pmol/L) and fT3 (4 pmol/L, reference range 3.1–6.8 pmol/L) ( Table 1 ). He was subsequently started on systemic therapy with the tyrosine kinase

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