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Are traditional reference ranges adequate for geriatric individuals? an indirect approach to thyroid testing
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DOI：10.1515/tjb-2025-0424.png)
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Abstract
En 中文
Objectives Physiological changes during aging may complicate the interpretation of thyroid function tests in elderly individuals. This study aimed to establish age- and sex-specific indirect reference intervals for thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) in individuals aged 65 years and older.Methods Large-scale laboratory data collected between 2016 and 2025 were analyzed. Reference intervals were calculated using the refineR package with a Box-Cox transformation model and bootstrap resampling. Subgroup analyses were performed by age (65-74, 75-84, 85-96) and sex.Results The upper limit of TSH decreased with advancing age, particularly in female, while FT3 levels showed a significant decline in older age groups. FT4 intervals remained relatively stable across age groups, though female exhibited higher upper limits compared to male.Conclusions Manufacturer-provided adult reference intervals may be inadequate or less representative for the geriatric population. Implementing age- and sex-specific reference intervals in clinical practice will improve diagnostic accuracy and help prevent misdiagnosis and unnecessary treatment.
Keywords:
thyroid function tests
reference values
geriatrics
aging
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