J Clin Pathol 65:463-465 doi:10.1136/jclinpath-2011-200433
  • Short report

The relationship between serum TSH and free T4 in older people

  1. Jayne A Franklyn3
  1. 1The Regional Endocrine Laboratories, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
  2. 2Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
  3. 3School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Penny M Clark, University Hospital Birmingham NHS Foundation Trust, The Regional Endocrine Laboratory, Birmingham B29 6JD, UK; penelope.clark{at}
  1. Contributors All authors contributed equally to this manuscript.

  • Accepted 17 December 2011
  • Published Online First 28 January 2012


The frequency distribution of serum thyroid stimulating hormone (TSH) shows a skewed pattern that may change with age. The set point of the hypothalamic-pituitary-thyroid axis for an individual is thought to be genetically determined and has been described as a log-linear relationship of serum TSH to free thyroxine (T4); however, the validity of this hypothesis has yet to be established in older people. The aim of the study was to describe the relationship between serum TSH and free T4 in older people and define factors influencing this relationship. We conducted a cross-sectional, observational study of thyroid function in a community population of older subjects over 65 years of age. The relationship between serum TSH and free T4 was not linear as previously described, but is best described as a fourth-order polynomial. Both gender and smoking status affected the relationship. This suggests that more complex modelling is required when investigating the hypothalamic-pituitary-thyroid axis.


  • Funding This work was supported by the Healthcare Foundation UK, the Primary Care Research and Clinical Trials Unit and MidRec (Midlands GP Research Consortium). This work was also supported by Queen Elizabeth Hospital Birmingham Charity. The funding organisations have not directly influenced the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript.

  • Competing interests None.

  • Ethics approval Ethics approval was obtained from the Multi Centre Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.