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Sophie Demartin Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium

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Stefan Matei Constantinescu Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium

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Kris G Poppe Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Rue Haute, Brussels, Belgium

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Dominique Maiter Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium

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Raluca Maria Furnica Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium

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Orsalia Alexopoulou Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium

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Chantal Daumerie Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium

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Frederic Debiève Department of Obstetrics, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium

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Maria-Cristina Burlacu Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium

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within the trimester-specific pregnancy reference range or, when not available, to the following reference range upper limits: first trimester, 2.5 mU/L; second trimester, 3.0 mU/L; third trimester, 3.5 mU/L ( 2 ). The more recent American Thyroid

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Elske T. Massolt Division of Endocrinology, Erasmus MC, Rotterdam, The Netherlands
Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands

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Mahdi  Salih Division of Endocrinology, Erasmus MC, Rotterdam, The Netherlands

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Carolien M. Beukhof Division of Endocrinology, Erasmus MC, Rotterdam, The Netherlands
Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands

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Boen L.R. Kam Department of Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands

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J.W. Burger Division of Surgical Oncology, Department of Surgery, Erasmus MC, Rotterdam, The Netherlands

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W. Edward Visser Division of Endocrinology, Erasmus MC, Rotterdam, The Netherlands
Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands

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Ewout J. Hoorn Department of Nephrology and Transplantation, Erasmus MC, Rotterdam, The Netherlands

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Robin P. Peeters Division of Endocrinology, Erasmus MC, Rotterdam, The Netherlands
Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands

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participants. Laboratory Measurements Serum free T4 (FT4; reference range 11.0–25.0 pmol/L), total T4 (reference range 58.0–128.0 nmol/L), and total T3 (reference range 1.4–2.5 nmol/L) concentrations were measured by chemoluminescence assays (Vitros ECI

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David Shaki Pediatric Endocrinology Unit, Saban Pediatric Medical Center for Israel, Beer Sheva, Israel
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel

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Marina Eskin-Schwartz Genetics Institute at Soroka University Medical Center and the Morris Kahn Laboratory of Human Genetics, National Center for Rare Diseases, at the Faculty of Health Sciences and National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer Sheva, Israel

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Noam Hadar Genetics Institute at Soroka University Medical Center and the Morris Kahn Laboratory of Human Genetics, National Center for Rare Diseases, at the Faculty of Health Sciences and National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer Sheva, Israel

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Emily Bosin Endocrinology Lab, Soroka University Medical Center, Beer Sheva, Israel

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Lior Carmon Pediatric Endocrinology Unit, Saban Pediatric Medical Center for Israel, Beer Sheva, Israel
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel

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Samuel Refetoff Departments of Medicine and Pediatrics and the Committee on Genetics, The University of Chicago, Chicago, Illinois, USA

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Eli Hershkovitz Pediatric Endocrinology Unit, Saban Pediatric Medical Center for Israel, Beer Sheva, Israel
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel

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Ohad S Birk Genetics Institute at Soroka University Medical Center and the Morris Kahn Laboratory of Human Genetics, National Center for Rare Diseases, at the Faculty of Health Sciences and National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer Sheva, Israel

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Alon Haim Pediatric Endocrinology Unit, Saban Pediatric Medical Center for Israel, Beer Sheva, Israel
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel

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heterozygotes have been reported to have reduced TSH levels within the reference range. The R75G variant has been reported to be prevalent in individuals of South Asian ethnicity ( 2 ) including Pakistan and India ( 3 ). Clinically, individuals homozygous for

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Flora Veltri Department of Endocrinology, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium

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Kris Poppe Department of Endocrinology, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium

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between 3.5 and 18% (depending on the reference range for serum TSH and the iodine intake of the population), and the main cause is the presence of TAI, most often diagnosed by increased levels of TPO-Abs [ 1 , 3 ]. In a pilot study by Andersen et al

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Jesper Karmisholt Department of Medical Endocrinology, Aalborg University Hospital, Aalborg, Denmark
Clinical Institute, Aalborg University, Aalborg, Denmark

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

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Introduction Subclinical hypothyroidism (SCH) is a frequent condition defined by serum values of thyrotropin (TSH) above and thyroxine (T4) within the population-based reference ranges[ 1 - 3 ]. It may reflect mild thyroid failure with only

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Torquil Watt Department of Endocrinology, Copenhagen University Hospital Rigshospitalet
Institute of Public Health, University of Copenhagen

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Laszlo Hegedüs Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark

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Jakob Bue Bjorner Institute of Public Health, University of Copenhagen
National Research Centre for the Working Environment, Copenhagen

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Mogens Groenvold Institute of Public Health, University of Copenhagen
Department of Palliative Medicine, Bispebjerg Hospital

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Steen Joop Bonnema Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark

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Åse Krogh Rasmussen Department of Endocrinology, Copenhagen University Hospital Rigshospitalet

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Ulla Feldt-Rasmussen Department of Endocrinology, Copenhagen University Hospital Rigshospitalet

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patients with autoimmune hypothyroidism (defined as any degree of serum thyroid-stimulating hormone (TSH) above the reference range at two consecutive measurements, with or without associated thyroid hormone levels below the reference range, and TPOAb level

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Tetsuya Mizokami Tajiri Thyroid Clinic, Kumamoto, Japan

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Katsuhiko Hamada Tajiri Thyroid Clinic, Kumamoto, Japan

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Tetsushi Maruta Tajiri Thyroid Clinic, Kumamoto, Japan

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Kiichiro Higashi Tajiri Thyroid Clinic, Kumamoto, Japan

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Junichi Tajiri Tajiri Thyroid Clinic, Kumamoto, Japan

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Inc., Tokyo; reference ranges <2.0 IU/l and <16 IU/ml, respectively). In some patients, autoantibody levels to the thyroid microsomal antigen were measured by means of particle agglutination using commercial kits (Serodia-AMC; Fujirebio Inc., Tokyo

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Earn H. Gan Institute of Genetic Medicine, International Centre for Life, Newcastle upon Tyne, United Kingdom

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Anna L. Mitchell Institute of Genetic Medicine, International Centre for Life, Newcastle upon Tyne, United Kingdom

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Ruth Plummer Institute of Genetic Medicine, International Centre for Life, Newcastle upon Tyne, United Kingdom

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Simon Pearce Institute of Genetic Medicine, International Centre for Life, Newcastle upon Tyne, United Kingdom

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Petros Perros Institute of Genetic Medicine, International Centre for Life, Newcastle upon Tyne, United Kingdom

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clinical evidence of Graves orbitopathy. Biochemical tests showed a serum thyroid-stimulating hormone (TSH) which was fully suppressed with a raised free T3 of 13.0 pmol/L (reference range 3.5–6.5) and free T4 of 27.6 pmol/L (reference range 9

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Hsu-Hua Tseng Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

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Yen-Bo Lin Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan

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Kuan-Yu Lin Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Douliu City, Taiwan

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Chia-Hung Lin Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan

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Hung-Yuan Li Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

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Chia-Hsuin Chang Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

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Yi-Ching Tung Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan

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Pei-Lung Chen Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Graduate Institute of Medical Genomics and Proteomics, National Taiwan University College of Medicine, Taipei, Taiwan
Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan

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Chih-Yuan Wang Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

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Wei-Shiung Yang Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

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Shyang-Rong Shih Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
Center of Anti-Aging and Health Consultation, National Taiwan University Hospital, Taipei, Taiwan

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hyperthyroidism group. The diagnosis of AIT was made in patients with at least one positive thyroid autoantibody, including anti-thyroid peroxidase antibody (anti-TPO Ab, reference range: <5.61 IU/mL, Abbott Architect i2000SR using reagents provided by Abbott

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Dagmar Führer Department of Endocrinology and Metabolism, University Hospital Essen, University Duisburg-Essen, Essen, Germany

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Klaudia Brix Department of Life Sciences and Chemistry, Jacobs University Bremen, Bremen, Germany

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Heike Biebermann Institut für Experimentelle Pädiatrische Endokrinologie, Charité-Universitätsmedizin Berlin, Berlin, Germany

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below reference ranges were found in 3.5% (SHIP) to 1.7% (KORA) of the study populations [ 16 ]. Overall, the prevalence of TSH concentrations outside the assay reference ranges was higher in women than men, and this has been observed in most

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