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Salman Razvi Institute of Genetic Medicine, Newcastle University, Newcastle, United Kingdom
Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom

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Vicky Ryan Institute of Health and Society, Newcastle University, Newcastle, United Kingdom

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Lorna Ingoe Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom
Department of Endocrinology, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom

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Simon H. Pearce Institute of Genetic Medicine, Newcastle University, Newcastle, United Kingdom
Department of Endocrinology, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom

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Scott Wilkes School of Medicine, University of Sunderland, Sunderland, United Kingdom

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treated as a homogenous group irrespective of age to aim for serum thyroid-stimulating Hormone (TSH) levels within the population reference range (generally in the range of 0.4–4.0 mU/L) [ 8 ]. But, thyroxine metabolism is altered in advanced age, and “age

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Solène Castellnou Hospices Civils de Lyon, Groupement Hospitalier Est, Fédération d’Endocrinologie, Bron, France

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Patricia Bretones Service d’Endocrinologie Pédiatrique, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France

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Juliette Abeillon Hospices Civils de Lyon, Groupement Hospitalier Est, Fédération d’Endocrinologie, Bron, France

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Myriam Moret Hospices Civils de Lyon, Groupement Hospitalier Est, Fédération d’Endocrinologie, Bron, France

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Pauline Perrin Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Groupement Hospitalier Est, LBMMS, Bron, France

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Karim Chikh Centre de Biologie et de Pathologie Sud, Hospices Civils de Lyon, Groupement Hospitalier Sud, LBMMS, Saint Genis Laval, France

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Véronique Raverot Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Groupement Hospitalier Est, LBMMS, Bron, France

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reference range. Introduction The most common causes of thyroid dysfunction are autoimmune diseases, some of which can be caused by antibodies such as TSH receptor antibodies (TRAbs). Two types of TRAbs can be distinguished: TSH receptor

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João Sérgio Neves Unidade de Investigação Cardiovascular, Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal

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Ricardo Fontes-Carvalho Unidade de Investigação Cardiovascular, Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
Department of Cardiology, Centro Hospitalar Gaia/Espinho, Vila Nova de Gaia, Portugal

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Marta Borges-Canha Unidade de Investigação Cardiovascular, Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal

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Ana Rita Leite Unidade de Investigação Cardiovascular, Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal

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Sandra Martins Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal
EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal

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Ana Oliveira Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal

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João Tiago Guimarães Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal
Department of Biomedicine, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal

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Davide Carvalho Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal

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Adelino Leite-Moreira Unidade de Investigação Cardiovascular, Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal

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Ana Azevedo EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal

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[ 17 , 18 ]. While the effects of overt and subclinical thyroid dysfunction on cardiac function have been well characterized [ 19 , 20 ], the association of thyroid hormone levels within the reference range with cardiac function remains uncertain

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Carolina Castro Porto Silva Janovsky Hospital Israelita Albert Einstein, Sao Paulo, Brazil
Department of Medicine, Thyroid Outpatient Clinic, Division of Endocrinology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, Brazil

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Fernando H. Cesena Hospital Israelita Albert Einstein, Sao Paulo, Brazil

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Viviane Arevalo Tabone Valente Hospital Israelita Albert Einstein, Sao Paulo, Brazil

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Raquel Dilguerian de Oliveira Conceição Hospital Israelita Albert Einstein, Sao Paulo, Brazil

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Raul D. Santos Hospital Israelita Albert Einstein, Sao Paulo, Brazil
Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil

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Márcio Sommer Bittencourt Hospital Israelita Albert Einstein, Sao Paulo, Brazil
School of Medicine, Faculdade Israelita de Ciências da Saúde Albert Einstein, Sao Paulo, Brazil
Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, Sao Paulo, Brazil

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TSH levels within the reference range (0.46–1.44, 1.45–1.97, 1.98–2.68, and 2.69–4.68 mUI/L). The international physical activity questionnaire (iPAQ) was used to evaluate the physical activity level in the last week [ 30 ]. The presence of NAFLD

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

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

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

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

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Robin P. 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
Queen Elizabeth Hospital, Gateshead, UK

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

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within reference range serum FT 4 on two occasions separated by at least 3 months. This algorithm is meant as a guide and clinicians are expected to use their discretion and judgement in interpreting the age threshold around 70 years. * Depending on

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Georgiana Sitoris Endocrine Unit Centre Hospitalier Universitaire (CHU) Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium

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Flora Veltri Endocrine Unit Centre Hospitalier Universitaire (CHU) Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium

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Pierre Kleynen Endocrine Unit Centre Hospitalier Universitaire (CHU) Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium

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Malika Ichiche Endocrine Unit Centre Hospitalier Universitaire (CHU) Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium

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Serge Rozenberg Department of Gynecology and Obstetrics, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium

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

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-specific reference range has not been established yet. Actually, for the determination of TSH pregnancy-specific reference range, the European Thyroid Association and American Thyroid Association (ATA) guidelines propose to exclude the following conditions: TAI

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Louise Knøsgaard Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

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

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Annebirthe Bo Hansen Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark

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Peter Vestergaard Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark

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

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physiological changes in maternal thyroid function occur, and it is well-established that these changes necessitate pregnancy-specific reference ranges for thyroid function tests in pregnant women ( 3 ). The use of trimester-specific reference ranges is

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John Lazarus Thyroid Research Group, Institute of Molecular Medicine, Cardiff University, University Hospital of Wales, Cardiff

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Rosalind S. Brown Clinical Trials Research Division of Endocrinology, Children's Hospital Boston, Harvard Medical School, Boston, Mass., USA

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Chantal Daumerie Endocrinologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

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Alicja Hubalewska-Dydejczyk Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland

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Roberto Negro Division of Endocrinology, V. Fazzi Hospital, Lecce, Italy

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Bijay Vaidya Department of Endocrinology, Royal Devon and Exeter Hospital and University of Exeter Medical School, Exeter, UK

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Introduction Subclinical hypothyroidism (SCH) in pregnancy is defined by a serum thyroid-stimulating hormone (TSH) concentration higher than the upper limit of the pregnancy-related reference range associated with a normal serum thyroxine [T 4

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Till Ittermann Institute for Community Medicine, Germany
DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany

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Roberto Lorbeer Institute for Community Medicine, Germany

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Daniel Tiller Institute of Medical Epidemiology, Biostatistics and Informatics, Germany

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Ina Lehmphul Institut für Experimentelle Endokrinologie, Charité-Universitätsmedizin Berlin, Berlin, Germany

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Alexander Kluttig Institute of Medical Epidemiology, Biostatistics and Informatics, Germany

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Stephan B. Felix Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Germany
DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany

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Karl Werdan Department of Medicine III, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany

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Karin Halina Greiser German Cancer Research Centre, Division of Cancer Epidemiology, Heidelberg, Germany

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Josef Köhrle Institut für Experimentelle Endokrinologie, Charité-Universitätsmedizin Berlin, Berlin, Germany

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Henry Völzke Institute for Community Medicine, Germany
DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany

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Marcus Dörr Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Germany
DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany

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1 ). In all three studies individuals with a TSH <0.3 mIU/l were in the median older than individuals with a TSH in the reference range. This difference was more pronounced in the SHIP studies than in CARLA. In the SHIP studies, individuals with a

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Rudolf Hoermann Department of Nuclear Medicine, Klinikum Luedenscheid, Luedenscheid, Germany

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John E.M. Midgley North Lakes Clinical, Ilkley, UK

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Rolf Larisch Department of Nuclear Medicine, Klinikum Luedenscheid, Luedenscheid, Germany

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Johannes W. Dietrich Medical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum
Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Bochum, Germany

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3 ) and FT 4 , which also maintain interdependent equilibrium positions. While allowing for greater flexibility in the physiological responses of individuals across the euthyroid reference range, this may demand significant variation in the

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