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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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Nadine Johnson Departments of Obstetrics and Gynaecology, University of the West Indies, Kingston, Jamaica

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Vikash Chatrani Departments of Obstetrics and Gynaecology, University of the West Indies, Kingston, Jamaica

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Anna-Kay Taylor-Christmas Departments of Obstetrics and Gynaecology, University of the West Indies, Kingston, Jamaica

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Eric Choo-Kang Departments of Chemical Pathology, University of the West Indies, Kingston, Jamaica

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Monica Smikle Departments of Microbiology, University of the West Indies, Kingston, Jamaica

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Rosemarie Wright-Pascoe Departments of Medicine, University of the West Indies, Kingston, Jamaica

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Karen Phillips Departments of Medicine, University of the West Indies, Kingston, Jamaica

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Marvin Reid Tropical Metabolism Research Institute, University of the West Indies, Kingston, Jamaica

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R3. For TPOAb-positive subjects' rates, reference values R1, R2 and R3 were 15% (3/20), 5% (1/20) and 20% (4/20), respectively. Table 1 Prevalence of thyroid hormone deficiency using three reference ranges Rates of positive TPOAb

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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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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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Mahdi Kamoun Endocrinology and Metabolism Department

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Michèle d'Herbomez Department of Nuclear Medicine, Lille University Hospital, Lille

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Christine Lemaire Department of Endocrinology, Regional Hospital of Béthune, Béthune

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Armelle Fayard Endocrinology and Metabolism Department

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Rachel Desailloud Endocrinology and Metabolism Department, Amiens University Hospital, Amiens, France

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Damien Huglo Department of Nuclear Medicine, Lille University Hospital, Lille

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Jean-Louis Wemeau Endocrinology and Metabolism Department

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TSH values, being persistently within the reference range despite use of different TSH assays, made this diagnosis less likely. Antibody interference in thyroid hormone immunoassays may result either from autoantibodies or heterophile antibodies [ 10

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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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Clotilde Saïe Thyroid and Endocrine Tumors Unit, Pitié-Salpêtrière Hospital APHP, Sorbonne University, Paris, France

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Cécile Ghander Thyroid and Endocrine Tumors Unit, Pitié-Salpêtrière Hospital APHP, Sorbonne University, Paris, France

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Samir Saheb Apheresis Unit, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France

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Christel Jublanc Department of Endocrinology, Pitié-Salpêtrière Hospital APHP, Sorbonne University, Paris, France

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Denis Lemesle Department of Anaesthesia, Pitié-Salpêtrière Hospital APHP, Sorbonne University, Paris, France

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Charlotte Lussey-Lepoutre Nuclear Medicine Department, Pitié-Salpêtrière Hospital APHP, Sorbonne Université, Inserm U970, Paris, France

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Laurence Leenhardt Thyroid and Endocrine Tumors Unit, Pitié-Salpêtrière Hospital APHP, Sorbonne University, Paris, France

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Fabrice Menegaux Department of Surgery, Pitié-Salpêtrière Hospital APHP, Sorbonne University, Paris, France

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Christophe Tresallet Department of Surgery, Avicennes Hospital, Paris, France

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Camille Buffet Thyroid and Endocrine Tumors Unit, Pitié-Salpêtrière Hospital APHP, Sorbonne University, Paris, France

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of 2017 were retrospectively included. Twenty-two patients were included (Table 1 ). There were 10 men (44%) and 12 women (56%) with a median age of 47 years (range 16–85 years). Graves’ disease (GD) was diagnosed in 13 patients (59%), 7 patients (32

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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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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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Linda M. Thienpont Mass Spectrometry Reference Laboratory, Laboratory for Analytical Chemistry, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium

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James D. Faix Clinical Chemistry and Immunology, Montefiore Medical Center, New York, N.Y., USA
Department of Pathology, Albert Einstein School of Medicine, New York, N.Y., USA

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Graham Beastall International Federation of Clinical Chemistry and Laboratory Medicine, Milan, Italy

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full Committee (C-STFT) and we authors are respectively chair, member and past president at IFCC. We have worked over the years towards the goal of standardization of free T 4 and TSH testing. Because, unlike free T 4 , there is no reference

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