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Ladan Mehran Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

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Atieh Amouzegar Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

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Hengameh Abdi Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

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Negar Delbari Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

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Elham Madreseh Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

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Maryam Tohidi Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

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Mohammad Ali Mansournia Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

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Fereidoun Azizi Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

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. 2009 Jan 25 ; 10 : 5 http://dx.doi.org/10.1186/1745-6215-10-5 . 17 Amouzegar A , Delshad H , Mehran L , Tohidi M , Khafaji F , Azizi F . Reference limit of thyrotropin (TSH) and free thyroxine (FT4) in thyroperoxidase positive

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Irene Campi Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy

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Marco Dell’Acqua Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy

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Elisa Stellaria Grassi Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy

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Maria Cristina Vigone Department of Paediatrics, IRCCS San Raffaele Hospital, Milan, Italy

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Luca Persani Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy

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-Ab, anti-thyroid peroxidase antibodies. TSH and free thyroxine (fT4) have a complex, nonlinear relationship, and small variations in fT4 circulating levels result in substantial changes in serum TSH ( 5 ). For this reason, the TSH is the most

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Anita Boelen Endocrine Laboratory, Department of Laboratory Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands

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Nitash Zwaveling-Soonawala Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands

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Annemieke C Heijboer Endocrine Laboratory, Department of Laboratory Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
Endocrine Laboratory, Department of Laboratory Medicine, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

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A S Paul van Trotsenburg Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands

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brain damage resulting in mental retardation and impaired motor function ( 1 , 2 , 3 , 4 ). Radioimmunoassays, developed in the 1970s, made measurement of blood thyroxine (T4) concentrations in the nanomoles per liter range possible, allowing early

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Hicham Benabdelkamel Proteomics Resource Unit, Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia

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Malak A Jaber Pharmaceutical Medicinal Chemistry & Pharmacognosy, Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan

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Lina A Dahabiyeh Division of Pharmaceutical Sciences, School of Pharmacy, The University of Jordan, Amman, Jordan

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Afshan Masood Proteomics Resource Unit, Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia

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Reem H Almalki Metabolomics Section, Department of Clinical Genomics, Center for Genome Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia

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Mohthash Musambil Proteomics Resource Unit, Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia

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Anas M Abdel Rahman Metabolomics Section, Department of Clinical Genomics, Center for Genome Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Department of Medicine, College of Medicine and King Saud Medical City, King Saud University, Riyadh, Saudi Arabia

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Assim A Alfadda Proteomics Resource Unit, Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
Department of Biochemistry and Molecular Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia

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Introduction The thyroid hormone affects almost every organ system in the body, including the cardiovascular, central nervous, skeletal, and gastrointestinal systems and metabolism. Tetraiodothyronine or thyroxine (T 4 ) and triiodothyronine

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Paolo Cavarzere Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy

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Laura Palma Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy

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Lara Nicolussi Principe Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy

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Monica Vincenzi Pediatric Section, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
Regional Center for Newborn Screening, Diagnosis and Treatment of Congenital Metabolic and Endocrinological Diseases, Verona, Italy

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Silvana Lauriola Neonatal Intensive Cure Unit, Department of Pediatrics, University Hospital of Verona, Verona, Italy

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Rossella Gaudino Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy
Pediatric Section, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy

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Virginia Murri Pediatric Division, Hospital of San Bonifacio, Verona, Italy

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Luigi Lubrano Pediatric Division, Hospital of Legnago, Verona, Italy

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Giuliana Rossi Pediatric Division, Hospital of Mestre, Venezia, Italy

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Alessia Sallemi Pediatric Division, Hospital of Venezia, Venezia, Italy

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Ermanna Fattori Pediatric Division, Hospital of Negrar, Verona, Italy

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Marta Camilot Pediatric Section, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
Regional Center for Newborn Screening, Diagnosis and Treatment of Congenital Metabolic and Endocrinological Diseases, Verona, Italy

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Franco Antoniazzi Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy
Pediatric Section, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
Regional Center for the Diagnosis and Treatment of Children and Adolescents Rare Skeletal Disorders, Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy

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pregnancy. The median values are represented as a horizontal line. The edges represent respectively the 25th and the 75th centile of the cohort. Vertical lines represent the range. FT4, free thyroxine; LT4, levothyroxine; DBS, dried blood spot; TSH, thyroid

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Kamilla R Riis Department of Endocrinology, Odense University Hospital, Odense, Denmark
Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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Camilla B Larsen Department of Endocrinology, Odense University Hospital, Odense, Denmark
Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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Bjarke R Medici Department of Medicine, Copenhagen University Hospital – Herlev and Gentofte, Denmark

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Christian Z Jensen Department of Medicine, Copenhagen University Hospital – Herlev and Gentofte, Denmark

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Kristian H Winther Department of Endocrinology, Odense University Hospital, Odense, Denmark

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Emil L Larsen Department of Clinical Pharmacology, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark

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Christina Ellervik Department of Laboratory Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, United States of America
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Department of Data and Data Support, Region Zealand, Sorø, Denmark

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Jeppe L la Cour Department of Medicine, Copenhagen University Hospital – Herlev and Gentofte, Denmark

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Laszlo Hegedüs Department of Endocrinology, Odense University Hospital, Odense, Denmark
Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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Thomas H Brix Department of Endocrinology, Odense University Hospital, Odense, Denmark

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Henrik E Poulsen Department of Endocrinology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Denmark
Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
Department of Cardiology, University Hospital Nordsjælland, Hillerød, Denmark

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Filip K Knop Department of Medicine, Copenhagen University Hospital – Herlev and Gentofte, Denmark
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Steno Diabetes Center Copenhagen, Herlev, Denmark
Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark

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Birte Nygaard Department of Medicine, Copenhagen University Hospital – Herlev and Gentofte, Denmark
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

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Steen J Bonnema Department of Endocrinology, Odense University Hospital, Odense, Denmark
Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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the reference range of 0.3–4.0 mIU/L and total plasma thyroxine (TT4) below the reference range of 60–130 nmol/L) or mild (plasma TSH above the reference range, and plasma TT4 within the reference range). Exclusion criteria were pregnancy or planned

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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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thyroxine (T4). Deiodination of the outer ring generates the active thyroid hormone triiodothyronine (T3), whereas that of the inner ring converts T4 to reverse T3 (rT3), and T3 to 3,3’-diiodo- l -thyronine (T2), which are both biologically inactive

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Camilla Bøgelund Larsen Department of Endocrinology, Odense University Hospital, Denmark
Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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Kristian Hillert Winther Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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Per Karkov Cramon Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

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Åse Krogh Rasmussen Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

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Ulla Feldt-Rasmussen Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
Institute of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark

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Nils Jakob Knudsen Department of Endocrinology, Bispebjerg University Hospital, Copenhagen, Denmark

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Jakob Bue Bjorner Department of Public Health, Copenhagen University, Copenhagen, Denmark
QualityMetric Inc, Johnston, Lincoln, Rhode Island, USA

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Lutz Schomburg Institute for Experimental Endocrinology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

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Kamil Demircan Institute for Experimental Endocrinology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

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Thilo Samson Chillon Institute for Experimental Endocrinology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

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Jeppe Gram Medical Department, Endocrinology, University Hospital of South-West Jutland, Esbjerg, Denmark

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Stinus Gadegaard Hansen Medical Department, Endocrinology, University Hospital of South-West Jutland, Esbjerg, Denmark

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Frans Brandt Department of Clinical Research, University of Southern Denmark, Odense, Denmark
Internal Medicine Research Unit, University Hospital of Southern Jutland, Aabenraa, Denmark

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Birte Nygaard Department of Endocrinology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark

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Torquil Watt Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
Institute of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark

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Laszlo Hegedüs Department of Endocrinology, Odense University Hospital, Denmark
Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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Steen Joop Bonnema Department of Endocrinology, Odense University Hospital, Denmark
Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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.9 ± 17.6 83.1 ± 18.7 0.219 Statistically significant difference ( P < 0.05) is highlighted in bold. FT3I, free T3 index; FT4, free thyroxine; LT4, levothyroxine; T3, triiodothyronine; TSH, thyrotropin; TPOAb, thyroid peroxidase

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Maja Hjelm Lundgaard Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark

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Allan Carlé Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark

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Ulla Birgitte Christiansen Department of Gynaecology and Obstetrics, Aalborg University Hospital, Aalborg, Denmark

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Anne Sørensen Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
Department of Gynaecology and Obstetrics, Aalborg University Hospital, Aalborg, Denmark

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Søren Risom Kristensen Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
Department of Clinical Medicine, Aalborg University, 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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biochemical evaluation with the measurement of thyroid-stimulating hormone (TSH). Results revealed an elevated plasma level of TSH (>100 mIU/L). Simultaneous measurements of total thyroxine (T4) as well as total triiodothyronine (T3) showed that the plasma

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Frederick Keen Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, UK

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Anuja Chalishazar Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, UK

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Kelly Mitchem Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, UK

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Alan Dodd Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, UK

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Atul Kalhan Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, UK

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,000 to 1 in 100,000 ( 1 , 2 ). The signs and symptoms associated with CeH are generally milder, compared to primary hypothyroidism, often leading to a delay in diagnosis. The typical biochemical picture observed in CeH is of a low free thyroxine (FT4

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