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Using population-wide thresholds assumes normal variation in thyroid hormone levels is the same across individuals which may leave patients (with varying medical histories) undiagnosed and untreated. This analysis aims to assess whether patient-specific thresholds for thyroid hormone laboratory tests are justifiable within a heterogeneous pediatric population. The study data, obtained from Cerner Real-World Data, consists of observations from January 2016 to December 2019 of pediatric patients with at least two laboratory records for thyrotropin (TSH), free thyroxine (T4), total T4, or free triiodothyronine (T3) tests. Linear mixed models were built to estimate patient-specific ranges and variance partition coefficients (VPCs) while controlling for various patient characteristics. Inclusion criteria resulted in 97,195 observations across 31,170 patients for TSH; 229,523 observations across 68,396 patients for free T4; 32,346 observations across 10,201 patients for total T4; and 6,994 observations across 2,557 patients for free T3. Decision-making inconsistencies occurred for 15.1% of TSH, 29.5% of free T4, 18.4% of total T4, and 17.9% of free T3 values. The average VPC estimates suggest inter-subject variation explains 21% (95% CI: 0.21–0.22), 28% (95% CI: 0.27–0.29), 41% (95% CI: 0.39–0.43), and 26% (95% CI: 0.23–0.29) of total variation in TSH, free T4, total T4, and free T3, respectively. Although commonly used, population ranges may lead to diagnostic errors. Inconsistencies were found in at least 15% of thyroid hormone laboratory values and inter-subject variation explains at least 20% of total variation in these thyroid hormone tests. This study’s results suggest patient-specific ranges are justifiable and may reduce diagnostic errors.

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Investigating the Need for Personalized Assessment: An Example from Thyroid Function Tests

  • 会议论文

  • 出版模式：

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  • 发表日期：

    2025年

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  • Ricardo A. Aguilar,
  • Louis Ehwerhemuepha,
  • Terence Sanger

摘要

Using population-wide thresholds assumes normal variation in thyroid hormone levels is the same across individuals which may leave patients (with varying medical histories) undiagnosed and untreated. This analysis aims to assess whether patient-specific thresholds for thyroid hormone laboratory tests are justifiable within a heterogeneous pediatric population. The study data, obtained from Cerner Real-World Data, consists of observations from January 2016 to December 2019 of pediatric patients with at least two laboratory records for thyrotropin (TSH), free thyroxine (T4), total T4, or free triiodothyronine (T3) tests. Linear mixed models were built to estimate patient-specific ranges and variance partition coefficients (VPCs) while controlling for various patient characteristics. Inclusion criteria resulted in 97,195 observations across 31,170 patients for TSH; 229,523 observations across 68,396 patients for free T4; 32,346 observations across 10,201 patients for total T4; and 6,994 observations across 2,557 patients for free T3. Decision-making inconsistencies occurred for 15.1% of TSH, 29.5% of free T4, 18.4% of total T4, and 17.9% of free T3 values. The average VPC estimates suggest inter-subject variation explains 21% (95% CI: 0.21–0.22), 28% (95% CI: 0.27–0.29), 41% (95% CI: 0.39–0.43), and 26% (95% CI: 0.23–0.29) of total variation in TSH, free T4, total T4, and free T3, respectively. Although commonly used, population ranges may lead to diagnostic errors. Inconsistencies were found in at least 15% of thyroid hormone laboratory values and inter-subject variation explains at least 20% of total variation in these thyroid hormone tests. This study’s results suggest patient-specific ranges are justifiable and may reduce diagnostic errors.