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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

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Serum thyrotropin and free thyroxine reference ranges as defined in a disease-free sample of French middle-aged adults

Carla Estaquio1, 2 / Pierre Valeix1, 2 / Laurence Leenhardt3, 4 / Elizabeth Modigliani5 / Marie-Christine Boutron-Ruault6 / Laurence Chérié-Challine3 / Marguerite Legrand7 / Serge Hercberg1, 2 / Katia Castetbon1, 2

1Unité de Surveillance et d'Epidémiologie Nutritionnelle, Institut de Veille Sanitaire, Université Paris 13, Cnam, Centre de Recherche en Nutrition Humaine (CRNH) Ile-de-France, Bobigny, France

2UMR U557 INSERM, U1125 INRA, CNAM, Paris 13, CRNH Ile-de-France, Bobigny, France

3Département Maladies Chroniques et Traumatismes, Institut de Veille Sanitaire, Saint-Maurice, France

4Service de Médecine Nucléaire, Hôpital Pitié-Salpêtrière, Paris, France

5Service d'Endocrinologie et Médecine Interne, Hôpital Avicenne, Bobigny, France

6INSERM ERI 20, Institut Gustave Roussy, Villejuif, France

7Centre Médical de Forcilles, Attilly, France

Corresponding author: Katia Castetbon, Unité de Surveillance et d'Epidémiologie Nutritionnelle, InVS-Paris 13-Cnam 74 rue Marcel Cachin, 93017 Bobigny Cedex, France Phone: +33 (0)1 48 38 73 73, Fax: +33 (0)1 48 38 73 74,

Citation Information: Clinical Chemistry and Laboratory Medicine. Volume 47, Issue 12, Pages 1497–1505, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: 10.1515/CCLM.2009.334, November 2009

Publication History

Published Online:


Background: The goal of this study was to provide reference ranges for thyrotropin (TSH) and free thyroxine (fT4) based on data collected from a disease-free sample of French middle-aged adults.

Methods: A total of 3218 subjects participating in the Supplémentation en Vitamines et Minéraux Antioxydants (SU.VI.MAX) study had measurements for TSH, fT4 and urinary iodine concentrations. Thyroid volume and structure were evaluated using standardized ultrasonography. We selected a disease-free sample which included 2338 subjects (1313 females aged 35–60 years and 1025 males aged 45–60 years) with normal thyroid imaging, no previously reported thyroid disease or use of thyroid medication, and no risk factors for thyroid dysfunction. Distribution of TSH and fT4 was estimated in males and females.

Results: The median (central 95% range) TSH serum concentrations for females were 1.79 mU/L (0.29–5.21 mU/L) for ages 35–44 years and 1.98 mU/L (0.27–6.94 mU/L) for ages 45–60 years (p<0.0001, for age). The median (central 95% range) for males 45–60-year-old was 1.63 mU/L (0.28–4.54 mU/L) (p<0.0001, for sex). Sex- and age-specific mean fT4 concentrations did not differ significantly (p=0.06) between males and females and (p=0.08) between female age groups. However, median fT4 concentrations between 45–60-year-old males and females differed (p<0.001).

Conclusions: In middle-aged adults, the TSH distribution was associated with gender and, among females, with age. Stratification according to gender and age should be considered when TSH ranges are used in the diagnosis, treatment and monitoring of thyroid disease.

Clin Chem Lab Med 2009;47:1497–505.

Keywords: adults; free thyroxin; ranges; thyrotropin; ultrasonography

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