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Lars C. Moeller Department of Endocrinology and Metabolism, University of Duisburg-Essen, Essen, Germany

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Yaw Appiagyei-Dankah Medical University of South Carolina, Charleston, S.C., USA

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Birgit Köhler Institut für Experimentelle Pädiatrische Endokrinologie, Charité-Universitätsmedizin Berlin, Berlin, Germany

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

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Onno E. Janssen Department of Endocrinology and Metabolism, University of Duisburg-Essen, Essen, Germany

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

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Introduction In serum, thyroid hormone (TH) is mainly bound to transport proteins. The major proportion of circulating TH, 75% of T 4 and 70% of T 3 is bound to thyroxine-binding globulin [TBG; HUGO Gene Nomenclature Committee approved name

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Kevin Stroek Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

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Annemieke C. Heijboer Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands

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Marja van Veen-Sijne Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

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Annet M. Bosch Division of Metabolic Disorders, Department of Pediatrics, Emma Children’s Hospital, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

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Catharina P.B. van der Ploeg Department of Child Health, Netherlands Organization for Applied Scientific Research TNO, Leiden, The Netherlands

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

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Robert de Jonge Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit & University of Amsterdam, Amsterdam, The Netherlands

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

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Anita Boelen Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

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concentrations, and in order to detect CH-C, thyroxine-binding globulin (TBG) is measured in the lowest 5% of T4 concentrations enabling calculation of a modified T4/TBG ratio that serves as an indirect measure of free T4 (FT4). With this approach, low T4 values

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Hiroyuki Iwaki Division of Endocrinology, Department of Internal Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan

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Kenji Ohba Medical Education Center, Hamamatsu University School of Medicine, Hamamatsu, Japan

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Eisaku Okada Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan

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Takeshi Murakoshi Obstetrics and Gynecology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan

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Yumiko Kashiwabara Division of Endocrinology, Department of Internal Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan

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Chiga Hayashi Division of Endocrinology, Department of Internal Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan

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Akio Matsushita Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan

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Shigekazu Sasaki Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, 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 Metabolism and Endocrinology, Hamamatsu-Kita Hospital, Hamamatsu, Japan

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Rieko Gemma Division of Endocrinology, Department of Internal Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan

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dosage that ensures maternal serum free thyroxine (FT4) levels at or moderately above the upper limit of the reference range is reported to be appropriate for fetal euthyroid status [ 2 ]. This recommendation was incorporated into the 2017 American

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Laura P.B. Elbers Department of Internal Medicine, Medical Center Slotervaart, University of Amsterdam, Amsterdam
Departments of Vascular Medicine, University of Amsterdam, Amsterdam

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Hjalmar A. Boon Department of Internal Medicine, Medical Center Slotervaart, University of Amsterdam, Amsterdam

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Maaike I. Moes Department of Internal Medicine, Medical Center Slotervaart, University of Amsterdam, Amsterdam

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Bregje van Zaane Department of Internal Medicine, Medical Center Slotervaart, University of Amsterdam, Amsterdam
Departments of Vascular Medicine, University of Amsterdam, Amsterdam

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Dees P.M. Brandjes Department of Internal Medicine, Medical Center Slotervaart, University of Amsterdam, Amsterdam
Departments of Vascular Medicine, University of Amsterdam, Amsterdam

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Eric Fliers Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam

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Harry R. Büller Departments of Vascular Medicine, University of Amsterdam, Amsterdam

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Suzanne Cannegieter Department of Clinical Epidemiology, Leiden University Medical Center
Einthoven Laboratory for Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands

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Victor E.A. Gerdes Department of Internal Medicine, Medical Center Slotervaart, University of Amsterdam, Amsterdam
Departments of Vascular Medicine, University of Amsterdam, Amsterdam

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thromboembolism (VTE) or bleeding. Higher plasma levels of free thyroxine (FT 4 ) have been associated with an increased VTE risk [ 1 , 2 , 3 ]. Conversely, lower levels of FT 4 seem to be associated with a bleeding tendency [ 4 , 5 ]. An observational cohort

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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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Sangeetha Sirigiri Departments of Endocrinology, Tirupati, India

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Suresh Vaikkakara Departments of Endocrinology, Tirupati, India

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Alok Sachan Departments of Endocrinology, Tirupati, India

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P.V.L.N. Srinivasarao Departments of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, India

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Sunil Epuri Departments of Endocrinology, Tirupati, India

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Sailaja Anantarapu Departments of Endocrinology, Tirupati, India

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Arun Mukka Departments of Endocrinology, Tirupati, India

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Srinivasa Rao Chokkapu Departments of Endocrinology, Tirupati, India

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Ashok Venkatanarasu Departments of Endocrinology, Tirupati, India

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Ravi Poojari Departments of Endocrinology, Tirupati, India

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elevated low-density lipoproteins and triglycerides [ 5 ]. Adequate treatment with thyroxine (T 4 ) is reported to improve both the insulin resistance as well as the dyslipidemia [ 5 , 6 ]. Abnormal body composition in the form of an increase in the

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Wilmar M. Wiersinga Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

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Leonidas Duntas Endocrine Unit, Evgenidion Hospital, University of Athens Medical School, Athens, Greece

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Valentin Fadeyev Federal Endocrinological Scientific Center, Moscow, Russia

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Birte Nygaard Department of Endocrinology, Herlev Hospital, Herlev, Denmark

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Mark P.J. Vanderpump Department of Endocrinology, Royal Free Hampstead NHS Trust, London, UK

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thyroid hormones by the thyroid gland. Thyroxine (T4) is produced exclusively by the thyroid gland; its daily production rate is about 100 µg at an average body surface area of 1.79 m 2 (56.2 µg/day/m 2 ). Daily production rate of triiodothyronine (T3

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P. Reed Larsen Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Harvard Institutes of Medicine, Boston, Mass., USA

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Ann Marie Zavacki Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Harvard Institutes of Medicine, Boston, Mass., USA

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Introduction When dietary iodine is sufficient, the major product of the thyroid gland is thyroxine (T4) which is secreted at a rate of 10-fold that of 3,5,3′-triiodothyronine (T3) in humans. Thus, a rate-limiting step in thyroid hormone

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Selwan Khamisi Department of Endocrinology and Diabetes, Uppsala University, Uppsala, Sweden

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Peter Lindgren Women's and Children's Health, University Hospital, Uppsala University, Uppsala, Sweden

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F. Anders Karlsson Department of Endocrinology and Diabetes, Uppsala University, Uppsala, Sweden

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/l (reference value 16.5 ± 5.3, mean ± SD [ 11 ]). Treatment with intra-amniotic injections of thyroxine was initiated and given in conjunction with ultrasound every 7-10 days with a dose 10 µg thyroxine/kg of estimated fetal weight per day on six occasions. The

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Luca Persani Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy

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Georg Brabant Experimental and Clinical Endocrinology Medical Clinic I – University of Lübeck, Lübeck, Germany

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Mehul Dattani Genetics and Genomic Medicine Programme, UCL GOS Institute of Child Health, London, United Kingdom

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Marco Bonomi Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy

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Ulla Feldt-Rasmussen Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

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Eric Fliers Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

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Annette Gruters Department for Pediatric Endocrinology and Diabetes, Charité University Medicine, Berlin, Germany
University Hospital Heidelberg, Heidelberg, Germany

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Dominique Maiter Department of Endocrinology and Nutrition, UCL Cliniques Saint-Luc, Brussels, Belgium

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Nadia Schoenmakers University of Cambridge Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke’s Hospital and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke’s Hospital, Cambridge, United Kingdom

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A.S. Paul van Trotsenburg Department of Pediatric Endocrinology, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

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onset of treatment causes irreversible neurological defects. More frequently, diagnosis is made biochemically and should be suspected in every individual with low circulating free thyroxine (FT4) concentrations (free thyroxine index, FTI, can be a

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