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Amir Bashkin Department of Endocrinology, Galilee Medical Center, Nahariya, Israel
Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel

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Eliran Yaakobi Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel

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Marina Nodelman Department of Endocrinology, Galilee Medical Center, Nahariya, Israel
Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel

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Ohad Ronen Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
Department of Otolaryngology Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel

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Introduction Routine TSH blood level screening test for thyroid function in hospitalized patients with other acute disease is not recommended by the leading associations of thyroid medicine ( 1 , 2 , 3 , 4 ). Thyroid dysfunction during

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Xi Cao Beijing Diabetes Institute, Beijing Tongren Hospital, Capital Medical University, Beijing, China

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Ming Lu Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China

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Rong-Rong Xie Beijing Diabetes Institute, Beijing Tongren Hospital, Capital Medical University, Beijing, China

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Li-Ni Song Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China

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Wei-Li Yang Beijing Diabetes Institute, Beijing Tongren Hospital, Capital Medical University, Beijing, China

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Zhong Xin Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China

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Guang-Ran Yang Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China

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Jin-Kui Yang Beijing Diabetes Institute, Beijing Tongren Hospital, Capital Medical University, Beijing, China

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population ( 6 ). Subclinical hypothyroidism (SCH), which is characterized by elevated thyroid-stimulating hormone (TSH), has attracted increasing attention, as it interacts with many metabolic diseases ( 7 , 8 ). Thyroid hormones, including TSH, have been

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David P Sonne Department of Medicine, Department of Biomedical Sciences, Department of Endocrinology, Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark
Department of Medicine, Department of Biomedical Sciences, Department of Endocrinology, Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark

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Asger Lund Department of Medicine, Department of Biomedical Sciences, Department of Endocrinology, Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark
Department of Medicine, Department of Biomedical Sciences, Department of Endocrinology, Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark

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Jens Faber Department of Medicine, Department of Biomedical Sciences, Department of Endocrinology, Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark

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Jens J Holst Department of Medicine, Department of Biomedical Sciences, Department of Endocrinology, Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark

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Tina Vilsbøll Department of Medicine, Department of Biomedical Sciences, Department of Endocrinology, Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark
Department of Medicine, Department of Biomedical Sciences, Department of Endocrinology, Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark

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Filip K Knop Department of Medicine, Department of Biomedical Sciences, Department of Endocrinology, Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark
Department of Medicine, Department of Biomedical Sciences, Department of Endocrinology, Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark

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yielded conflicting results regarding the association between circulating bile acids and thyroid function parameters. Patti et al . (5) have found that bile acids in serum correlated inversely with thyroid-stimulating hormone (TSH) in non

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Alessandro Brancatella Endocrine Unit 1, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

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Claudio Marcocci Endocrine Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

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of treatment is to replace thyroid function but, in the latter condition, an additional aim is to keep the serum thyroid-stimulating hormone (TSH) at the lower limit of the normal range and possibly below (TSH suppressive therapy) to improve the

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John E M Midgley
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Rolf Larisch North Lakes Clinical, Department of Nuclear Medicine, Medical Department I, Ruhr Center for Rare Diseases (CeSER), 20 Wheatley Avenue, Ilkley LS29 8PT, UK

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Johannes W Dietrich North Lakes Clinical, Department of Nuclear Medicine, Medical Department I, Ruhr Center for Rare Diseases (CeSER), 20 Wheatley Avenue, Ilkley LS29 8PT, UK
North Lakes Clinical, Department of Nuclear Medicine, Medical Department I, Ruhr Center for Rare Diseases (CeSER), 20 Wheatley Avenue, Ilkley LS29 8PT, UK

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Rudolf Hoermann North Lakes Clinical, Department of Nuclear Medicine, Medical Department I, Ruhr Center for Rare Diseases (CeSER), 20 Wheatley Avenue, Ilkley LS29 8PT, UK

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needs. Dose adequacy is mainly defined by reference to suitable biochemical standards, particularly thyrotropin (TSH) (8) . This parameter has evolved into the main treatment target to be monitored and kept within an assumed euthyroid range (9) . A

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Till Ittermann Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany

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Rehman Mehmood Khattak Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
Department of Zoology, Islamia College Peshawar (CU), Peshawar, Pakistan

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Marcello R P Markus Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany

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Jens-Peter Kühn Institute of Radiology, University Hospital, Carl-Gustav-Carus University, Dresden, Germany

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Marie-Luise Kromrey Department of Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany

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Giovanni Targher Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy

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Antje Steveling Department of Internal Medicine A, University Medicine Greifswald, Greifswald, Germany

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Matthias Nauck Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine, Greifswald, Germany

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Henry Völzke Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany

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thyroid-stimulating hormone (TSH) levels with NAFLD was also reported ( 4 ). Conversely, a case–control study, matching individuals with subclinical hypothyroidism to euthyroid controls, showed a positive association between serum TSH levels and NAFLD but

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Jiashu Li Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, Liaoning, China

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Aihua Liu Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, Liaoning, China

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Haixia Liu Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, Liaoning, China
Department of Endocrinology and Metabolism, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China

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Chenyan Li Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, Liaoning, China

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Weiwei Wang Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, Liaoning, China

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Cheng Han Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, Liaoning, China

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Xinyi Wang Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, Liaoning, China

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Yuanyuan Zhang Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, Liaoning, China

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Weiping Teng Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, Liaoning, China

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Zhongyan Shan Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, Liaoning, China

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defined as manifesting a thyroid-stimulating hormone (TSH) concentration exceeding the trimester-specific reference value, with a normal free thyroxine (FT 4 ) concentration. However, because of the lack of specific clinical symptoms, SCH is often ignored

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M von Wolff Division of Gynaecological Endocrinology and Reproductive Medicine, University Women’s Hospital, Bern University Hospital, University of Bern, Bern, Switzerland

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C T Nakas University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Laboratory of Biometry, University of Thessaly, Volos, Greece

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M Tobler Division of Gynaecological Endocrinology and Reproductive Medicine, University Women’s Hospital, Bern University Hospital, University of Bern, Bern, Switzerland
Division of Pneumology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

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T M Merz Division of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

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M P Hilty Intensive Care Unit, University Hospital, Zurich, Switzerland

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J D Veldhuis Endocrine Research Unit, Department of Internal Medicine, Mayo School of Graduate Medical Education, Centre for Translational Science Activities, Mayo Clinic, Rochester, New York, USA

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A R Huber Centre for Laboratory Medicine, Cantonal Hospital, Aarau, Switzerland

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J Pichler Hefti Division of Pneumology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

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−80°C thereafter. Cortisol, prolactin, thyroid-stimulating hormone (TSH), free tetraiodothyronine (fT4), free triiodothyronine (fT3), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and total testosterone (testosterone) were analysed

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Sophie-Charlotte Drogge Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

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Mirjam Frank Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

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Carolin Girschik Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

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Karl-Heinz Jöckel Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

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Dagmar Führer-Sakel Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

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Börge Schmidt Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

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bone fractures ( 6 ). Even psychological symptoms such as depression ( 7 ) or reduced quality of life ( 8 ) are associated with subclinical thyroid dysfunction. Because thyroid-stimulating hormone (TSH) reacts strong to minor changes in thyroid hormone

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Nannan Bian Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China

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Xiaomeng Sun Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China

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Biao Zhou Departments of General Surgery and Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China

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Lin Zhang Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China

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Qiu Wang Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China

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Yu An Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China

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Xiaohui Li Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China

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Yinhui Li Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China

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Jia Liu Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China

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Hua Meng Departments of General Surgery and Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China

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Guang Wang Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China

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has been observed in obese individuals, such as elevated serum thyroid-stimulating hormone (TSH) level and high transformation of thyroxine (T4) to triiodothyronine (T3) ( 8 , 9 , 10 ). Serum TSH and free triiodothyronine (FT3) levels decreased in

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