Age-specific Reference Interval of Serum TSH Levels is High in Adolescence in an Iodine Excess Area: Korea National Health and Nutrition Examination Survey Data

Purpose: Serum thyroid-stimulating hormone level was influenced by several factors, including age, gender, thyroid auto-antibodies, race, and intake of dietary iodine. We evaluated age-specific reference interval of serum thyroid-stimulating hormone levels in Korea, an iodine excess area.

Methods: This nationwide population-based cross-sectional study included representative civilian, non-institutional population (n = 6564) who underwent thyroid function tests from Korea National Health and Nutrition Examination Survey VI (2013-2015). The reference interval of serum thyroid-stimulating hormone levels was defined between the 2.5th and 97.5th percentiles in the reference population.

Results: The geometric mean of serum thyroid-stimulating hormone levels in the reference population was 2.17 mIU/L with a reference interval of 0.62-6.84 mIU/L. In the reference population, the geometric mean of serum TSH levels in each age group of 10-18, 19-29, 30-39, 40-49, 50-59, 60-69, and equal or older than 70 years was 2.47, 2.20, 2.07, 2.04, 2.23, 2.12, and 2.27 mIU/L, with a reference interval of 0.74-7.35, 0.67-6.42, 0.63-6.04, 0.62-6.20, 0.56-7.37, 0.57-6.90, and 0.42-6.58 mIU/L, respectively. In the reference population, the urinary iodine concentrations were consistently high in all age groups (median 298.5 μg/L). Subjects aged 10-18 years had the highest urinary iodine concentrations.

Conclusions: There was no shift toward higher levels with age in the distribution of serum thyroid-stimulating hormone levels. The reference interval of serum thyroid-stimulating hormone levels was consistently high in all age group, especially from adolescence 10-18 years in a Korean population who had excessive intake of dietary iodine.