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The relationship between serum TSH and free T4 in older people
  1. Penny M Clark1,
  2. Roger L Holder2,
  3. Sayeed M Haque2,
  4. F D Richard Hobbs2,
  5. Lesley M Roberts2,
  6. 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}


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.

  • Thyroid endocrinology
  • thyroid
  • adrenal gland

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  • 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.