Variation in Thyroid Function Tests in Patients with Stable Untreated Subclinical Hypothyroidism

OBJECTIVE: Knowledge of variation in thyroid function is important for interpretation of thyroid function tests. We aimed to describe intra-individual variation in thyroid function in patients with stable, untreated subclinical hypothyroidism (SCH) compared to euthyroid individuals to assess the importance of monitoring SCH patients. DESIGN: We measured thyrotropin (TSH), free thyroxine (fT4), and free triiodothyronine (fT3) monthly for 1 year in a longitudinal study of 15 untreated SCH patients with initial TSH 5-12 mU/L, without trends in TSH, and compared findings with results from 15 euthyroid individuals. MAIN OUTCOME: CV% was 17.0, 6.1, and 6.2 for TSH, fT4, and fT3, respectively. Overall CV% for TSH was lower in SCH patients than controls. Contrary to euthyroid individuals, CV% in SCH patients increased with rising mean TSH (r2 = 0.29, p = 0.04). Individual disease set points were established with 45, 6, and 6 tests for TSH, fT4, and fT3, with 95% confidence. Differences required between two test results were 40%, 15%, and 15%, respectively, with 90% confidence. CONCLUSION: Percent variation in TSH was lower in SCH than in euthyroid controls, but increased with higher mean TSH. The number of tests needed to establish disease set points was high. The difference required between two tests to be truly different was 40% for TSH and 15% for fT4 and fT3.