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Cowper B, Lyle AN, Vesper HW, Van Uytfanghe K, Burns C. Standardisation and harmonisation of thyroid-stimulating hormone measurements: historical, current, and future perspectives. Clin Chem Lab Med 2024; 62:824-829. [PMID: 38295422 DOI: 10.1515/cclm-2023-1332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/18/2024] [Indexed: 02/02/2024]
Abstract
Thyroid-stimulating hormone (TSH) is an important clinical marker in the diagnosis and management of thyroid disease. TSH measurements are reported in milli-International Units per Litre (mIU/L), traceable to a World Health Organisation (WHO) reference material. There is a wide variety of commercial immunoassays for TSH measurements available, which have historically been poorly harmonised due to a lack of commutability of the WHO reference materials with patient samples. This led to the recent development of a serum-based reference panel for TSH, traceable to the WHO reference material, available via the International Federation for Clinical Chemistry and Laboratory Medicine (IFCC), aimed at harmonisation of TSH immunoassays. This report describes recent developments in the TSH reference system, including establishment of the 4th WHO International Standard for TSH, and aims to clarify the relationship between the available reference materials and their intended uses. This 4th WHO IS is widely available and defines the unit of TSH activity, therefore its continued existence is of paramount importance, however it continues to show a lack of commutability with patient in many TSH immunoassays. This makes the C-STFT TSH panel, albeit available in restricted numbers, a critical resource to ensure better TSH assay harmonisation.
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Affiliation(s)
- Ben Cowper
- Medicines and Healthcare Products Regulatory Agency (MHRA), South Mimms, Hertfordshire, UK
| | - Alicia N Lyle
- Centers for Disease Control and Prevention, Division of Laboratory Sciences, Atlanta, GA, USA
| | - Hubert W Vesper
- Centers for Disease Control and Prevention, Division of Laboratory Sciences, Atlanta, GA, USA
| | | | - Chris Burns
- Medicines and Healthcare Products Regulatory Agency (MHRA), South Mimms, Hertfordshire, UK
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2
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Zaninotto M, Graziani MS, Plebani M. The harmonization issue in laboratory medicine: the commitment of CCLM. Clin Chem Lab Med 2022; 61:721-731. [PMID: 36383396 DOI: 10.1515/cclm-2022-1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022]
Abstract
Abstract
The analytical quality of the clinical laboratory results has shown a significant improvement over the past decades, thanks to the joint efforts of different stakeholders, while the comparability among the results produced by different laboratories and methods still presents some critical issues. During these years, Clinical Chemistry and Laboratory Medicine (CCLM) published several papers on the harmonization issue over all steps in the Total Testing Process, training an important number of laboratory professionals in evaluating and monitoring all the criticisms inherent to the pre-analytical, as well as analytical and post analytical phases: from the consensus statement on the most informative testing in emergency setting, to the prevention and detection of hemolysis or to patients identification and tube labeling procedures, as far as to different approaches to harmonize hormones measurements or to describe new reference methods or to harmonize the laboratory report. During these years the commitment of the journal, devoted to the harmonization processes has allowed to improve the awareness on the topic and to provide specific instruments to monitor the rate of errors and to improve patients safety.
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3
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Kalaria T, Fenn J, Sharrod-Cole H, Sanders A, Ford C, Gama R. Samples spiked with pituitary-derived thyroid-stimulating hormone may disguise the extent of differences between thyroid-stimulating hormone assays. Ann Clin Biochem 2021; 58:638-645. [PMID: 34533384 DOI: 10.1177/00045632211042560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A large discordance in the diagnosis and potential management of hypothyroidism using Abbott and Roche thyroid assays has been reported recently. The difference in Abbott and Roche thyroid-stimulating hormone (TSH) results in these studies was larger than anticipated from the external quality assessment (EQA) reports. METHODS Abbott and Roche TSH method means in UK NEQAS for thyroid hormones distributions 430 to 454 were compared against the amount of TSH spiked. A TSH deplete serum pool was spiked with various concentrations of pooled high TSH serum and 3rd WHO International Standard for TSH (WHO-IS). Four serum pools with TSH close to clinical decision limits were spiked with two concentrations of WHO-IS. RESULTS On review of EQA data, median (IQR) Roche: Abbott TSH ratio was lower (p < 0.001) in 48 pools spiked with TSH (1.11 (1.07-1.16)) compared to 41 pools not spiked (1.29 (1.25-1.31)) and the decrease was proportionate to the contribution of spiked TSH to total TSH in the samples (ρ=-0.908, p < 0.001). In spiking experiments, the relationship of Roche and Abbott TSH was different in TSH deplete pool spiked with WHO-IS (RocheTSH=1.13*AbbottTSH-0.52) and high TSH serum (RocheTSH=1.43*AbbottTSH-0.50), respectively. The Roche: Abbott TSH ratio decreased and the method agreement improved on spiking serum pools with WHO-IS. CONCLUSION Abbott and Roche TSH assays are not in harmony in human serum samples but the agreement was better in samples spiked with WHO-IS which contains pituitary-derived TSH. Use of pituitary-derived TSH spiked samples, such as provided by EQA schemes, may mask clinically significant between-assay differences.
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Affiliation(s)
- Tejas Kalaria
- New Cross Hospital, Black Country Pathology Services, 592016The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Jonathan Fenn
- New Cross Hospital, Black Country Pathology Services, 592016The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Hayley Sharrod-Cole
- New Cross Hospital, Black Country Pathology Services, 592016The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Anna Sanders
- Russells Hall Hospital, Black Country Pathology Services, 592016The Royal Wolverhampton NHS Trust, Dudley, UK
| | - Clare Ford
- New Cross Hospital, Black Country Pathology Services, 592016The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Rousseau Gama
- New Cross Hospital, Black Country Pathology Services, 592016The Royal Wolverhampton NHS Trust, Wolverhampton, UK.,School of Medicine and Clinical Practice, University of Wolverhampton, Wolverhampton, UK
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4
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Padoan A, Clerico A, Zaninotto M, Trenti T, Tozzoli R, Aloe R, Alfano A, Rizzardi S, Dittadi R, Migliardi M, Bagnasco M, Plebani M. Percentile transformation and recalibration functions allow harmonization of thyroid-stimulating hormone (TSH) immunoassay results. Clin Chem Lab Med 2021; 58:1663-1672. [PMID: 31927515 DOI: 10.1515/cclm-2019-1167] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/09/2019] [Indexed: 01/22/2023]
Abstract
Background The comparability of thyroid-stimulating hormone (TSH) results cannot be easily obtained using SI-traceable reference measurement procedures (RPMs) or reference materials, whilst harmonization is more feasible. The aim of this study was to identify and validate a new approach for the harmonization of TSH results. Methods Percentile normalization was applied to 125,419 TSH results, obtained from seven laboratories using three immunoassays (Access 3rd IS Thyrotropin, Beckman Coulter Diagnostics; Architect System, Abbott Diagnostics and Elecsys, Roche Diagnostics). Recalibration equations (RCAL) were derived by robust regressions using bootstrapped distribution. Two datasets, the first of 119 EQAs, the second of 610, 638 and 639 results from Access, Architect and Elecsys TSH results, respectively, were used to validate RCAL. A dataset of 142,821 TSH values was used to derive reference intervals (RIs) after applying RCAL. Results Access, Abbott and Elecsys TSH distributions were significantly different (p < 0.001). RCAL intercepts and slopes were -0.003 and 0.984 for Access, 0.032 and 1.041 for Architect, -0.031 and 1.003 for Elecsys, respectively. Validation using EQAs showed that before and after RCAL, the coefficients of variation (CVs) or among-assay results decreased from 10.72% to 8.16%. The second validation dataset was used to test RCALs. The median of between-assay differences ranged from -0.0053 to 0.1955 mIU/L of TSH. Elecsys recalibrated to Access (and vice-versa) showed non-significant difference. TSH RI after RCAL resulted in 0.37-5.11 mIU/L overall, 0.49-4.96 mIU/L for females and 0.40-4.92 mIU/L for males. A significant difference across age classes was identified. Conclusions Percentile normalization and robust regression are valuable tools for deriving RCALs and harmonizing TSH values.
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Affiliation(s)
- Andrea Padoan
- Department of Medicine (DIMED), University of Padova, via Giustiniani 2, 35128, Padova, Italy.,Department of Laboratory Medicine, University-Hospital of Padova, via Giustiniani 2, 35128, Padova, Italy
| | - Aldo Clerico
- Laboratory of Cardiovascular Endocrinology and Cell Biology, Department of Laboratory Medicine, Fondazione CNR-Regione Toscana Gabriele Monasterio, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Martina Zaninotto
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Tommaso Trenti
- Dipartimento di Medicina di Laboratorio e Anatomia Patologica, Azienda Ospedaliera Universitaria e USL di Modena, Modena, Italy
| | - Renato Tozzoli
- Clinical Pathology Laboratory, Department of Laboratory Medicine, Azienda per l'Assistenza Sanitaria n.5, Pordenone Hospital, Pordenone, Italy
| | - Rosalia Aloe
- Dipartimento di Biochimica ad Elevata Automazione, Dipartimento Diagnostico, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Antonio Alfano
- Clinical Pathology, Hospital ASL TO4, Ciriè, Turin, Italy
| | - Sara Rizzardi
- Laboratorio Analisi Aziendale (SC), Azienda Socio-Sanitaria Territoriale di Cremona, Istituti Ospitalieri, Cremona, Italy
| | - Ruggero Dittadi
- U.O.C. Laboratorio Analisi, Ospedale dell'Angelo, AULSS3 Serenissima, Mestre, Venezia, Italy
| | - Marco Migliardi
- S.C. Laboratorio Analisi, A.O. Ordine Mauriziano di Torino, Turin, Italy
| | | | - Mario Plebani
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy.,Department of Medicine (DIMED), University of Padova, Padova, Italy
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Markus C, Coat S, Marschall HU, Williamson C, Dixon P, Fuller M, Matthews S, Rankin W, Metz M, Hague WM. The BACH project protocol: an international multicentre total Bile Acid Comparison and Harmonisation project and sub-study of the TURRIFIC randomised trial. Clin Chem Lab Med 2021; 59:1921-1929. [PMID: 34355544 DOI: 10.1515/cclm-2021-0496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/22/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Multicentre international trials relying on diagnoses derived from biochemical results may overlook the importance of assay standardisation from the participating laboratories. Here we describe a study protocol aimed at harmonising results from total bile acid determinations within the context of an international randomised controlled Trial of two treatments, URsodeoxycholic acid and RIFampicin, for women with severe early onset Intrahepatic Cholestasis of pregnancy (TURRIFIC), referred to as the Bile Acid Comparison and Harmonisation (BACH) study, with the aims of reducing inter-laboratory heterogeneity in total bile acid assays. METHODS We have simulated laboratory data to determine the feasibility of total bile acid recalibration using a reference set of patient samples with a consensus value approach and subsequently used regression-based techniques to transform the data. RESULTS From these simulations, we have demonstrated that mathematical recalibration of total bile acid results is plausible, with a high probability of successfully harmonising results across participating laboratories. CONCLUSIONS Standardisation of bile acid results facilitates the commutability of laboratory results and collation for statistical analysis. It may provide the momentum for broader application of the described techniques in the setting of large-scale multinational clinical trials dependent on results from non-standardised assays.
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Affiliation(s)
- Corey Markus
- Automated Laboratory, SA Pathology, Adelaide, Australia.,Flinders University International Centre for Point-of-Care Testing, Flinders Health and Medical Research Institute, Bedford Park, Australia
| | - Suzette Coat
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | | | - Catherine Williamson
- Department of Women and Children's Health, School of Life Course Sciences, King's College, London, UK
| | - Peter Dixon
- Department of Women and Children's Health, School of Life Course Sciences, King's College, London, UK
| | - Maria Fuller
- Genetics and Molecular Pathology, SA Pathology, Adelaide, Australia.,Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Susan Matthews
- Flinders University International Centre for Point-of-Care Testing, Flinders Health and Medical Research Institute, Bedford Park, Australia
| | - Wayne Rankin
- Chemical Pathology Directorate, SA Pathology, Adelaide, Australia.,Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia.,Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Michael Metz
- Chemical Pathology Directorate, SA Pathology, Adelaide, Australia
| | - William M Hague
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia.,Obstetric Medicine, Women's and Children's Hospital, North Adelaide, Australia
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Tamura N, Watanabe E, Shirakawa R, Nakatani E, Yamada K, Hatakeyama H, Torii-Hanakita M, Kyo C, Kosugi R, Ogawa T, Kotani M, Usui T, Inoue T. Comparisons of plasma aldosterone and renin data between an automated chemiluminescent immunoanalyzer and conventional radioimmunoassays in the screening and diagnosis of primary aldosteronism. PLoS One 2021; 16:e0253807. [PMID: 34242264 PMCID: PMC8270132 DOI: 10.1371/journal.pone.0253807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/13/2021] [Indexed: 11/18/2022] Open
Abstract
Determining values of plasma renin activity (PRA) or plasma active renin concentration (ARC), plasma aldosterone concentration (PAC), and aldosterone-to-renin ratio (ARR) is essential to diagnose primary aldosteronism (PA), but it takes several days with conventional radioimmunoassays (RIAs). Chemiluminescent enzyme immunoassays for PAC and ARC using the Accuraseed® immunoanalyzer facilitated the determination, but relations between Accuraseed® immunoanalyzer-based and RIA-based values in samples of PA confirmatory tests and adrenal venous sampling remained to be elucidated. We addressed this issue in the present study. This is a prospective, cross-sectional study. ARC and PAC values were measured by the Accuraseed® immunoanalyzer in samples, in which PRA and PAC values had been measured by the PRA-FR® RIA and SPAC®-S Aldosterone kits, respectively. The relations between Accuraseed® immunoanalyzer-based and RIA-based values were investigated with regression analyses. The optimal cutoff of Accuraseed® immunoanalyzer-based ARR for PA screening was determined by the receiver operating characteristic analysis. After log-log transformations, linear relations with high coefficients of determination were observed between Accuraseed® immunoanalyzer-based and RIA-based data of renin and aldosterone. Following the PA guidelines of Japan Endocrine Society, Accuraseed® immunoanalyzer-based cutoffs were calculated from the regression equations: the basal PAC for PA screening >12 ng/dL, PAC for the saline infusion test >8.2 ng/dL, ARC for the furosemide-upright test <15 pg/mL, and ARR for the captopril challenge test >3.09 ng/dL per pg/mL. The optimal cutoff of Accuraseed® immunoanalyzer-based ARR for PA screening was >2.43 ng/dL over pg/mL not to overlook bilateral PA patients. The present study provided conversion formulas between Accuraseed® immunoanalyzer-based and RIA-based values of renin, aldosterone, and ARR, not only in basal samples but also in samples of PA confirmatory tests and adrenal venous sampling. Although validation studies are awaited, the present study will become priming water of harmonization of renin and aldosterone immunoassays.
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Affiliation(s)
- Naohisa Tamura
- Research Support Center, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
- * E-mail:
| | - Erika Watanabe
- Department of Clinical Laboratory Medicine, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Rumi Shirakawa
- Department of Clinical Laboratory Medicine, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Eiji Nakatani
- Research Support Center, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Kanako Yamada
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Hiroshi Hatakeyama
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Mizuki Torii-Hanakita
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Chika Kyo
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Rieko Kosugi
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
- Department of Medical Genetics, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Tatsuo Ogawa
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Masato Kotani
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Takeshi Usui
- Research Support Center, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
- Department of Medical Genetics, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Tatsuhide Inoue
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
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7
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Zhang S, Cheng F, Wang H, Wen J, Zeng J, Zhang C, Liu W, Wang N, Jia T, Wang M, Zhang R, Yue Y, Xu J, Wang Z, Li Y, Chen W, Wang Q. Comparability of thyroid-stimulating hormone immunoassays using fresh frozen human sera and external quality assessment data. PLoS One 2021; 16:e0253324. [PMID: 34129644 PMCID: PMC8205121 DOI: 10.1371/journal.pone.0253324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/03/2021] [Indexed: 12/04/2022] Open
Abstract
Background This study aimed to assess the comparability among assays using freshly frozen human sera and external quality assessment (EQA) data in China. Methods Twenty-nine serum samples and two commercial EQA materials, obtained from the National Center for Clinical Laboratories (NCCL), were analyzed in triplicate using eight routine TSH assays. The commutability of commercial EQA materials (NCCL materials) was evaluated in accordance with the CLSI EP30-A and IFCC bias analysis. Median values obtained for the NCCL EQA materials were used to determine the systematic and commutability-related biases among immunoassays through back-calculation. The comparability of TSH measurements from a panel of clinical samples and NCCL EQA data was determined on the basis of Passing–Bablok regression. Furthermore, human serum pools were used to perform commutable EQA. Results NCCL EQA materials displayed commutability among three or five of seven assay combinations according CLSI or IFCC approach, respectively. The mean of systematic bias ranged from -13.78% to 9.85% for the eight routine TSH assays. After correcting for systematic bias, averaged commutability-related biases ranged between -42.26% and 12.19%. After correction for systematic and commutability -related biases, the slopes indicating interassay relatedness ranged from 0.801 to 1.299 using individual human sera, from 0.735 to 1.254 using NCCL EQA data, and from 0.729 to 1.115 using pooled human serum EQA(the commutable EQA). Conclusions The harmonization of TSH measurement is challenging; hence, systematic and commutability-related biases should be determined and corrected for accurate comparisons among assays when using human individual serum and the commercial EQA materials.
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Affiliation(s)
- Shunli Zhang
- Department of Clinical Laboratory, Beijing Chaoyang Hospital, Beijing Center for Clinical Laboratories, The Third Clinical Medical College of Capital Medical University, Beijing, P.R. China
| | - Fei Cheng
- Department of Clinical Laboratory, Wangjing Hospital, China Academy of Traditional Chinese Medicine, Beijing, P.R. China
| | - Hua Wang
- Department of Clinical Laboratory, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Jiangping Wen
- Department of Clinical Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China
| | - Jie Zeng
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Beijing, P.R. China
| | - Chuanbao Zhang
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Beijing, P.R. China
| | - Wensong Liu
- Department of Clinical Laboratory, Beijing Hospital, Beijing, P.R. China
| | - Ning Wang
- Department of Clinical Laboratory, Beijing Chaoyang Hospital, The Third Clinical Medical College of Capital Medical University, Beijing, P.R. China
| | - Tingting Jia
- Department of Clinical Laboratory, Beijing Chaoyang Hospital, Beijing Center for Clinical Laboratories, The Third Clinical Medical College of Capital Medical University, Beijing, P.R. China
| | - Mo Wang
- Department of Clinical Laboratory, Beijing Chaoyang Hospital, Beijing Center for Clinical Laboratories, The Third Clinical Medical College of Capital Medical University, Beijing, P.R. China
| | - Rui Zhang
- Department of Clinical Laboratory, Beijing Chaoyang Hospital, Beijing Center for Clinical Laboratories, The Third Clinical Medical College of Capital Medical University, Beijing, P.R. China
| | - Yuhong Yue
- Department of Clinical Laboratory, Beijing Chaoyang Hospital, Beijing Center for Clinical Laboratories, The Third Clinical Medical College of Capital Medical University, Beijing, P.R. China
| | - Jing Xu
- Department of Clinical Laboratory, Beijing Chaoyang Hospital, The Third Clinical Medical College of Capital Medical University, Beijing, P.R. China
| | - Zhanyong Wang
- Department of Clinical Laboratory, Beijing Chaoyang Hospital, The Third Clinical Medical College of Capital Medical University, Beijing, P.R. China
| | - Yilong Li
- Department of Clinical Laboratory, Beijing Hospital, Beijing, P.R. China
| | - Wenxiang Chen
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Beijing, P.R. China
- * E-mail: (WC); (QW)
| | - Qingtao Wang
- Department of Clinical Laboratory, Beijing Chaoyang Hospital, Beijing Center for Clinical Laboratories, The Third Clinical Medical College of Capital Medical University, Beijing, P.R. China
- * E-mail: (WC); (QW)
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8
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Vesper HW, Van Uytfanghe K, Hishinuma A, Raverot V, Patru MM, Danilenko U, van Herwaarden AE, Shimizu E. Implementing reference systems for thyroid function tests - A collaborative effort. Clin Chim Acta 2021; 519:183-6. [PMID: 33933427 DOI: 10.1016/j.cca.2021.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 04/05/2021] [Accepted: 04/23/2021] [Indexed: 11/23/2022]
Abstract
Measurements of thyroid stimulating hormone (TSH) and free thyroxine (fT4) are critical for the early detection of thyroid diseases and for monitoring treatment. The IFCC Committee for Standardization of Thyroid Function Tests (C-STFT) established reference systems for TSH harmonization and FT4 standardization, and is now working national partners on implementing these reference systems. These implementation activities include the maintenance of the reference systems, their use to standardize and harmonize assays, and educational activities to inform stakeholders about anticipated changes in measurement values as a result of standardization and harmonization. The IFCC C-STFT formed a network of reference laboratories for FT4 and is creating a new harmonization panel for TSH. The U.S. Centers for Disease Control and Prevention is a member of the reference laboratory network and is launching a formal standardization program for FT4. In Japan, national organizations successfully implemented TSH harmonization and established harmonized reference intervals for TSH. The C-STFT made available on its website research findings about potential concerns, communication needs and benefits of FT4 standardization and is assisting local organizations with communicating changes related to these standardization and harmonization efforts. Implementation of fT4 standardization and TSH harmonization is a complex, continuous task that requires collaboration with IVD manufacturers, laboratories, physicians and health care providers. C-STFT is working successfully with national organizations and local groups on improving FT4 and TSH measurements.
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9
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Abstract
Abstract
The goal of harmonizing laboratory information is to contribute to quality in patient care, ultimately improving upon patient outcomes and safety. The main focus of harmonization and standardization initiatives has been on analytical processes within the laboratory walls, clinical chemistry tests in particular. However, two major evidences obtained in recent years show that harmonization should be promoted not only in the analytical phase but also in all steps of the testing process, encompassing the entire field of laboratory medicine, including innovative areas (e.g. “omics”) rather than just conventional clinical chemistry tests. A large body of evidence demonstrates the vulnerability of the extra-analytical phases of the testing cycle. Because only “good biological samples” can assure good analytical quality, a closer interconnection between the different phases of the cycle is needed. In order to provide reliable and accurate laboratory information, harmonization activities should cover all steps of the cycle from the “pre-pre-analytical” phase (right choice of test at right time for right patient) through the analytical steps (right results with right report) to the “post-post-analytical” steps (right and timely acknowledgment of laboratory information, right interpretation and utilization with any necessary advice as to what to do next with the information provided). In addition, modern clinical laboratories are performing a broad menu of hundreds of tests, covering both traditional and innovative subspecialties of the discipline. In addition, according to a centered viewpoint, harmonization initiatives should not be addressed exclusively to clinical chemistry tests but should also include all areas of laboratory medicine.
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Affiliation(s)
- Mario Plebani
- Department of Laboratory Medicine , University-Hospital of Padova , Via Nicolo Giustiniani 2 , 35128 Padova , Italy
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10
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Budd JR, Weykamp C, Rej R, MacKenzie F, Ceriotti F, Greenberg N, Camara JE, Schimmel H, Vesper HW, Keller T, Delatour V, Panteghini M, Burns C, Miller WG. IFCC Working Group Recommendations for Assessing Commutability Part 3: Using the Calibration Effectiveness of a Reference Material. Clin Chem 2018; 64:465-474. [PMID: 29348164 DOI: 10.1373/clinchem.2017.277558] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 12/18/2017] [Indexed: 11/06/2022]
Abstract
A process is described to assess the commutability of a reference material (RM) intended for use as a calibrator based on its ability to fulfill its intended use in a calibration traceability scheme to produce equivalent clinical sample (CS) results among different measurement procedures (MPs) for the same measurand. Three sources of systematic error are elucidated in the context of creating the calibration model for translating MP signals to measurand amounts: calibration fit, calibrator level trueness, and commutability. An example set of 40 CS results from 7 MPs is used to illustrate estimation of bias and variability for each MP. The candidate RM is then used to recalibrate each MP, and its effectiveness in reducing the systematic error among the MPs within an acceptable level of equivalence based on medical requirements confirms its commutability for those MPs. The RM is declared noncommutable for MPs for which, after recalibration, the CS results do not agree with those from other MPs. When a lack of agreement is found, other potential causes, including lack of calibration fit, should be investigated before concluding the RM is noncommutable. The RM is considered fit for purpose for those MPs where commutability is demonstrated.
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Affiliation(s)
| | - Cas Weykamp
- Queen Beatrix Hospital, Winterswijk, the Netherlands
| | - Robert Rej
- Wadsworth Center for Laboratories and Research, New York State Department of Health, and School of Public Health, State University of New York at Albany, Albany, NY
| | - Finlay MacKenzie
- Birmingham Quality/UK NEQAS, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Johanna E Camara
- National Institute of Standards and Technology, Gaithersburg, MD
| | - Heinz Schimmel
- European Commission, Joint Research Centre (JRC), Directorate F, Geel, Belgium
| | | | | | - Vincent Delatour
- Laboratoire national de métrologie et d'essais (LNE), Paris, France
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Chris Burns
- National Institute for Biological Standards and Control, A Centre of the MHRA, Hertfordshire, UK
| | - W Greg Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, VA.
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11
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Thienpont LM, Van Uytfanghe K, De Grande LAC, Reynders D, Das B, Faix JD, MacKenzie F, Decallonne B, Hishinuma A, Lapauw B, Taelman P, Van Crombrugge P, Van den Bruel A, Velkeniers B, Williams P. Harmonization of Serum Thyroid-Stimulating Hormone Measurements Paves the Way for the Adoption of a More Uniform Reference Interval. Clin Chem 2017; 63:1248-1260. [PMID: 28522444 DOI: 10.1373/clinchem.2016.269456] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 04/04/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND The IFCC Committee for Standardization of Thyroid Function Tests developed a global harmonization approach for thyroid-stimulating hormone measurements. It is based on a multiassay method comparison study with clinical serum samples and target setting with a robust factor analysis method. Here we describe the Phase IV method comparison and reference interval (RI) studies conducted with the objective to recalibrate the participating assays and demonstrate the proof-of-concept. METHODS Fourteen manufacturers measured the harmonization and RI panel; 4 of them quantified the harmonization and first follow-up panel in parallel. All recalibrated their assays to the statistically inferred targets. For validation, we used desirable specifications from the biological variation for the bias and total error (TE). The RI measurements were done with the assays' current calibrators, but data were also reported after transformation to the new calibration status. We estimated the pre- and postrecalibration RIs with a nonparametric bootstrap procedure. RESULTS After recalibration, 14 of 15 assays met the bias specification with 95% confidence; 8 assays complied with the TE specification. The CV of the assay means for the harmonization panel was reduced from 9.5% to 4.2%. The RI study showed improved uniformity after recalibration: the ranges (i.e., maximum differences) exhibited by the assay-specific 2.5th, 50th, and 97.5th percentile estimates were reduced from 0.27, 0.89, and 2.13 mIU/L to 0.12, 0.29, and 0.77 mIU/L. CONCLUSIONS We showed that harmonization increased the agreement of results from the participating immunoassays, and may allow them to adopt a more uniform RI in the future.
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Affiliation(s)
- Linda M Thienpont
- Department of Pharmaceutical Analysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium; .,Current affiliation: Thienpont & Stöckl Wissenschaftliches Consulting GbR, Rennertshofen (OT Bertoldsheim), Germany
| | - Katleen Van Uytfanghe
- Ref4U, Laboratory of Toxicology, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Linde A C De Grande
- Department of Pharmaceutical Analysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Dries Reynders
- Department of Applied Mathematics, Computer Science, and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium
| | - Barnali Das
- Biochemistry and Immunology Laboratory, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - James D Faix
- Clinical Chemistry and Immunology, Montefiore Medical Center, and Department of Pathology, Albert Einstein School of Medicine, New York, NY
| | - Finlay MacKenzie
- Birmingham Quality/UK NEQAS, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Akira Hishinuma
- Department of Infection Control and Clinical Laboratory Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Bruno Lapauw
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Paul Taelman
- Laboratory of Endocrinology, Department of Laboratory Medicine, AZ Maria-Middelares Sint-Jozef, Campus Maria-Middelares, Ghent, Belgium
| | - Paul Van Crombrugge
- Department of Endocrinology, OLV Ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | | | - Brigitte Velkeniers
- Department of Endocrinology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Paul Williams
- Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, Australia
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12
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De Grande LA, Goossens K, Van Uytfanghe K, Das B, MacKenzie F, Patru MM, Thienpont LM. Monitoring the stability of the standardization status of FT4 and TSH assays by use of daily outpatient medians and flagging frequencies. Clin Chim Acta 2017; 467:8-14. [DOI: 10.1016/j.cca.2016.04.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/21/2016] [Accepted: 04/26/2016] [Indexed: 11/30/2022]
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13
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Zhang S, Wang W, Zhao H, He F, Zhong K, Yuan S, Wang Z. Status of internal quality control for thyroid hormones immunoassays from 2011 to 2016 in China. J Clin Lab Anal 2017; 32. [PMID: 28205257 DOI: 10.1002/jcla.22154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 12/29/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Internal quality control (IQC) plays a key role in the evaluation of precision performance in clinical laboratories. This report aims to present precision status of thyroid hormones immunoassays from 2011 to 2016 in China. METHODS Through Clinet-EQA reporting system, IQC information of Triiodothyronine and Thyroxine in the form of free and total (FT3, TT3, FT4, TT4), as well as Thyroid Stimulating Hormone (TSH) were collected from participant laboratories submitting IQC data in February, 2011-2016. For each analyte, current CVs were compared among different years and measurement systems. Percentages of laboratories meeting five allowable imprecision specifications (pass rates) were also calculated. Analysis of IQC practice was conducted to constitute a complete report. RESULTS Current CVs were decreasing significantly but pass rates increasing only for FT3 during 6 years. FT3, TT3, FT4, and TT4 had the highest pass rates comparing with 1/3TEa imprecision specification but TSH had this comparing with minimum imprecision specification derived from biological variation. Constituent ratios of four mainstream measurement systems changed insignificantly. In 2016, precision performance of Abbott and Roche systems were better than Beckman and Siemens systems for all analytes except FT3 had Siemens also better than Beckman. Analysis of IQC practice demonstrated wide variation and great progress in aspects of IQC rules and control frequency. CONCLUSION With change of IQC practice, only FT3 had precision performance improved in 6 years. However, precision status of five analytes in China was still unsatisfying. Ongoing investigation and improvement of IQC have yet to be achieved.
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Affiliation(s)
- Shishi Zhang
- National Center for Clinical Laboratories/Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Wang
- National Center for Clinical Laboratories/Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Haijian Zhao
- National Center for Clinical Laboratories/Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Falin He
- National Center for Clinical Laboratories/Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Kun Zhong
- National Center for Clinical Laboratories/Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Shuai Yuan
- National Center for Clinical Laboratories/Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Zhiguo Wang
- National Center for Clinical Laboratories/Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology, Beijing, China
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Abstract
Thyroid hormones are crucial for the growth and maturation of many target tissues, especially the brain and skeleton. During critical periods in the first trimester of pregnancy, maternal thyroxine is essential for fetal development as it supplies thyroid hormone-dependent tissues. The ontogeny of mature thyroid function involves organogenesis, and maturation of the hypothalamus, pituitary and the thyroid gland; and it is almost complete by the 12th-14th gestational week. In case of maternal hypothyroidism, substitution with levothyroxine must be started in early pregnancy. After the 14th gestational week, fetal brain development may already be irreversibly affected by lack of thyroid hormones. The prevalence of manifest hypothyroidism in pregnancy is about 0.3-0.5%. The prevalence of subclinical hypothyroidism varies between 4 and 17%, strongly depending on the definition of the upper TSH cutoff limit. Hyperthyroidism occurs in 0.1-1% of all pregnancies. Positivity for antibodies against thyroid peroxidase (TPOAb) is common in women of childbearing age with an incidence rate of 5.1-12.4%. TPOAb-positivity may be regarded as a manifestation of a general autoimmune state which may alter the fertilization and implantation processes or cause early missed abortions. Women positive for TPOAb are at a significant risk of developing hypothyroidism during pregnancy and postpartum. Laboratory diagnosis of thyroid dysfunction during pregnancy is based upon serum TSH concentration. TSH in pregnancy is physiologically lower than the non-pregnant population. Results of multiple international studies point toward creation of trimester-specific reference intervals for TSH in pregnancy. Screening for hypothyroidism in pregnancy is controversial and its implementation varies from country to country. Currently, the case-finding approach of screening high-risk women is preferred in most countries to universal screening. However, numerous studies have shown that one-third to one-half of women with thyroid disorders escape the case-finding approach. Moreover, the universal screening has been shown to be more cost-effective. Screening for thyroid disorders in pregnancy should include assessment of both TSH and TPOAb, regardless of the screening approach. This review summarizes the current knowledge on physiology of thyroid hormones in pregnancy, causes of maternal thyroid dysfunction and its effects on pregnancy course and fetal development. We discuss the question of case-finding versus universal screening strategies and we display an overview of the analytical methods and their reference intervals in the assessment of thyroid function and thyroid autoimmunity in pregnancy. Finally, we present our results supporting the implementation of universal screening.
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Affiliation(s)
- Drahomira Springer
- a Institute of Medical Biochemistry and Laboratory Medicine, 1st Faculty of Medicine, Charles University and General University Hospital , Prague , Czech Republic
| | - Jan Jiskra
- b 3rd Department of Medicine - Clinical Department of Endocrinology and Metabolism , 1st Faculty of Medicine, Charles University and General University Hospital , Prague , Czech Republic , and
| | - Zdenka Limanova
- b 3rd Department of Medicine - Clinical Department of Endocrinology and Metabolism , 1st Faculty of Medicine, Charles University and General University Hospital , Prague , Czech Republic , and
| | - Tomas Zima
- a Institute of Medical Biochemistry and Laboratory Medicine, 1st Faculty of Medicine, Charles University and General University Hospital , Prague , Czech Republic
| | - Eliska Potlukova
- c Division of Internal Medicine , University Hospital Basel , Basel , Switzerland
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Abstract
Iodine is an essential component of thyroid hormone. Because thyroid hormone synthesis is affected by iodine deficiency on the one hand and by excess iodine intake on the other, thyroid function biomarkers may be useful for assessing iodine status and studying the effects of iodine supplementation. However, reference intervals for some of the most useful thyroid function biomarkers, including serum concentrations of thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroglobulin, vary widely due to variability in the commercially available immunoassays for these tests. Recognizing the need for standardization of thyroid function testing, the International Federation of Clinical Chemistry and Laboratory Medicine established a working group, later restructured as the Committee for Standardization of Thyroid Function Tests, to examine its feasibility. The committee has established a conventional reference measurement procedure for FT4 and an approach to harmonization of results for TSH. Panels of single-donation human blood specimens that span the measuring interval of the immunoassays were used to assess the performance of commercially available immunoassays and form the basis for their recalibration. Recalibration of the manufacturers' methods for both FT4 and TSH has shown that the variability among immunoassays can be successfully eliminated for euthyroid individuals as well as for patients with thyroid disease. The committee is not investigating the standardization of thyroglobulin at the present time.
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Thienpont LM, Faix JD, Beastall G. Standardization of Free T4 and Harmonization of TSH Measurements: A Request for Input from Endocrinologists and Other Physicians. Eur Thyroid J 2015; 4:271-2. [PMID: 26835432 PMCID: PMC4716420 DOI: 10.1159/000440614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/21/2015] [Indexed: 11/19/2022] Open
Affiliation(s)
- Linda M. Thienpont
- Mass Spectrometry Reference Laboratory, Laboratory for Analytical Chemistry, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- *Linda M. Thienpont, Laboratory for Analytical Chemistry, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, BE-9000 Ghent (Belgium), E-Mail
| | - James D. Faix
- Clinical Chemistry and Immunology, Montefiore Medical Center, New York, N.Y., USA
- Department of Pathology, Albert Einstein School of Medicine, New York, N.Y., USA
| | - Graham Beastall
- International Federation of Clinical Chemistry and Laboratory Medicine, Milan, Italy
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Thienpont LM, Faix JD, Beastall G. Standardization of Free Thyroxine and Harmonization of Thyrotropin Measurements: A Request for Input from Endocrinologists and Other Physicians. Thyroid 2015; 25:1379-80. [PMID: 26413772 PMCID: PMC4684666 DOI: 10.1089/thy.2015.0309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Linda M. Thienpont
- Laboratory for Analytical Chemistry, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - James D. Faix
- Department of Clinical Chemistry and Immunology, Montefiore Medical Center, Bronx, New York
- Department of Pathology, Albert Einstein School of Medicine, New York, New York
| | - Graham Beastall
- International Federation of Clinical Chemistry & Laboratory Medicine, Glasgow, United Kingdom
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