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Latar Belakang: Penelitian ini bertujuan untuk mengetahui faktor-faktor yang memengaruhi terjadinya kekambuhan seperti, faktor klinis yaitu usia dan jenis kelamin, riwayat keluarga, besarnya ukuran kelenjar tiroid, ada tidaknya oftalmopati; faktor genetik yang berperan pada kejadian GD; dan faktor imunologi yaitu jumlah sel T regulator, kadar interleukin 10 (IL-10), interleukin 17 (IL-17) dan antibodi pada reseptor tiroid (TRAb). Metode: Penelitian ini merupakan studi kasus kontrol yang membandingkan 36 pasien GD yang kambuh dan 36 pasien GD yang tidak kambuh. Pemeriksaan polimorfisme gen dilakukan dengan metode PCR RFLP. Pemeriksaan jumlah sel T regulator dengan flowsitometri. Pemeriksaan IL-10, IL-17 dan TRAb dengan ELISA. Hasil: Analisis hasil penelitian membuktikan hubungan antara kekambuhan dengan faktor keluarga (p 0,008), usia saat didiagnosis (p 0,021), oftalmopati derajat 2 (p 0,001), kelenjar tiroid yang membesar melebihi tepi lateral muskulus sternokleidomastoideus (p 0,040), lamanya periode remisi (p 0,029), genotip GG gen CTLA-4 nukleotida 49 kodon 17 pada ekson 1 (p 0,016), genotip CC gen tiroglobulin nukleotida 5995 kodon 1980 pada ekson 33 (p 0,017), genotip CC gen TSHR SNP rs2268458intron 1 (p 0,003), jumlah sel T regulator (p 0,001), kadar IL-10 (p 0,012) dan kadar TRAb (p 0,002). Penelitian ini juga membuktikan hubungan antara faktor klinis yaitu faktor keluarga, usia, oftalmopati, pembesaran kelenjar tiroid dan lamanya periode remisi; dengan faktor genetik dan respons imun. Simpulan: Polimorfisme genotip gen CTLA-4 nukleotida 49 kodon 17 ekson 1, gen tiroglobulin nukleotida 5995 kodon 1980 ekson 33, gen TSHR SNP rs2268458 intron 1 dan sel T regulator berperan sebagai faktor risiko kambuh pada pasien penyakit Graves. ...... Background: The management of Graves? disease (GD) is initiated with the administration of antithyroid drugs; however, it requires a long time to achieve remission and more than 50 percent of patients who had remission may be at risk for relapse after the drug is stopped. This study was aimed to identify factors affecting relapse of Graves? Disease Methods: This was a case-control study comparing 36 patients relapsed GD and 36 patients who did not relapse. Genetic polymorphism examination was performed using PCR-RFLP. The number of regulatory T cells was counted using flow cytometry analysis and ELISA was used to measure serum IL-10, IL-17 and TRAb. Results: The analysis of this study demonstrated that there was a correlation between relapse of disease and family factors (p 0.008), age at diagnosis (p 0.021), 2nd degree of Graves? ophthalmopathy (p 0.001), enlarged thyroid gland, which exceeded the lateral edge of the sternocleidomastoid muscles (p 0.040), duration of remission period (p 0.029), GG genotype of CTLA-4 gene on the nucleotide 49 at codon 17 of exon 1 (p 0.016), CC genotype of thyroglobulin gene on the nucleotide 5995 at codon 1980 of exon 33 (p 0.017), CC genotype of TSHR gene on the rs2268458 of intron 1 (p 0.003), the number of regulatory T cells (p 0.001), the levels of IL-10 (p 0.012) and TRAb levels (p 0.002). This study also showed the association between clinical factors, which included family factors, age at diagnosis, ophthalmopathy, thyroid gland enlargement and the long periods of remission with genetic factors and immune response. Conclusion: Genetic polymorphisms of CTLA-4 gene on the nucleotide 49 at codon 17 of exon 1, thyroglobulin gene on the nucleotide 5995 at codon 1980 of exon 33, TSHR gene SNP rs2268458 of intron 1 and regulatory T cells play a role as risk factors for relapse in patients with Graves? disease.

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Penggunaan jangka panjang insektisida klorpirifos (CPF) akan menimbulkan efek pada Thyroid Stimulating Hormone (TSH) dan hormon-hormon tiroid (triidiotironin/T3 dan tirotoksin/T4). Studi ini bertujuan untuk mengetahui pengaruh insektisida CPF terhadap kadar TSH dan hormon-hormon tiroid pada petani sayur dari tinjauan aspek genetik populasi. Studi ini dilakukan dengan desain potong lintang. Terdapat 273 petani sayur yang menjadi subjek, yang diambil pada tiga populasi suku, yaitu Jawa, Sunda, dan Makassar. Terdapat variasi genetik paraoxonase 1 (PON1) pada ketiga populasi dan alel Q banyak ditemukan pada semua populasi. PON1 dapat menjadi prediktor terjadinya gangguan pada kadar hormon-hormon tiroid dan TSH. TCP sebagai metabolit CPF merupakan biomarker kemampuan metabolisme individu terhadap CPF. Pada masyarakat petani yang terpajan klorpirifos, TCP urin yang tidak terdeteksi berperan dalam terjadinya kadar FT3 rendah dan kadar TCP urin yang rendah berperan dalam terjadinya kadar FT4 tertil rendah dan kadar TSH tinggi. Efek CPF terhadap ketiga hormon ini diduga terjadi melalui mekanisme terganggunya sistem neurotransmitter dan proses deyodinasi pada perifer dan hati.

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Long-term use of chlorpyrifos (CPF) insecticide will affects Stimulating Thyroid Hormone (TSH) and thyroid hormones (triidiotironin/T3 and tirotoksin/ T4). This study aimed to assess the effect of insecticide CPF on levels of TSH and thyroid hormones of the vegetable farmers as the reviews of population genetic aspects. This study was conducted with a cross-sectional design. There were 273 vegetable farmers as subjects, taken in three population, namely Java, Sunda, and Makassar. There was genetic variation of paraoxonase 1 (PON1) in a population of in the three populations and Q alleles found in all populations. PON1 may be a predictor of causing interference to the levels of thyroid hormones and TSH. TCP as CPF metabolite was a biomarker of individual metabolic capabilities toward CPF. In exposed CPF farming communities, undetected TCP urine played a role in occurrence of low FT3 levels while low levels of TCP urine play a role for lower tertile FT4 level and high TSH level. CPF effect to the hormones possiblyoccured through the mechanism of disruption of neurotransmitter system and deiodinase process in peripheral and liver

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Latar Belakang: Program Skrining Hipotiroid Kongenital Nasional di Indonesia menunjukkan angka insidensi hipotiroid kongenital cukup tinggi. Salah satu faktor risiko yang bertanggung jawab adalah bayi berat lahir rendah. Pada bayi berat lahir rendah, maturitas organ relatif belum matur, sehingga mengganggu fungsi organ termasuk kelenjar tiroid dan hipofisis. Tujuan: Penelitian cross-sectional ini bertujuan untuk mengetahui persentase bayi berat lahir rendah di Indonesia, nilai rujukan TSH neonatus berdasarkan berat lahir, korelasi antara berat lahir bayi dengan fungsi kelenjar tiroid, serta hubungan antara status berat lahir dengan nilai rerata TSH neonatus. Metode: Dari 2.987 subjek yang didapatkan dari 10 provinsi pada program skrining hipotiroid kongenital nasional pada bulan Mei sampai Juni 2017 di Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo, sebanyak 1.700 subjek memenuhi kriteria inklusi dan eksklusi yang diperoleh melalui teknik consecutive sampling. Nilai TSH didapatkan melalui metode Fluorometri dengan reagen Labsystem. Subjek dibagi menjadi dua kelompok yaitu 1.573 subjek untuk kelompok bayi berat lahir normal dan 127 subjek untuk kelompok bayi berat lahir rendah. Sampel kemudian dianalisis menggunakan uji Mann-Whitney dengan SPSS versi 20.0 untuk diketahui hubungannya dengan nilai rerata TSH neonatus dan MedCalc versi 17.9 untuk menghitung nilai rujukan TSH neonatus.

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Background: National Congenital Hypothyroidism Screening Program in Indonesia showed high incidence of Congenital Hypothyroidism. One of responsible risk factors is low birth weight. In low birth weight, organ maturity is relatively immature, thus disrupting organ function including thyroid and hypophysis gland. Objective: This cross-sectional study was aimed to determine the percentage of low birth weight in Indonesia, neonatal TSH reference values based on birth weight, the correlation between birth weight and thyroid gland function, as well as the association between birth weight status with neonatal TSH level. Methods: Of the 2,987 subjects obtained from 10 provinces in national congenital hypothyroidism screening program data from May to June 2017 in Dr. Cipto Mangunkusumo National General Hospital, as many as 1,700 subjects fulfilled the inclusion and exclusion criteria obtained through consecutive sampling. TSH value was obtained by Fluorometri method with Labsystem reagent. Subjects were divided into two groups, 1,573 subjects for normal birth weight and 127 subjects for low birth weight. Then, samples were analyzed by Mann-Whitney test with SPSS version 20.0 to investigate association to neonatal TSH level and MedCalc version 17.9 to calculate neonatal TSH reference values. Results: Low birth weight was 7.5%. The TSH reference value in all neonates, normal birth weight, and low birth weight were 1.40-8.04 mU/L with median 3.10 (1.00-19.80), 1.50-8.06 mU/L with median 3.20 (1.00-19.80), and 1.00-9.06 mU/L with median 2.50 (1.00-13.80) respectively. There was a positive significant correlation between low birth weight and thyroid function (r = 0.367, P<0.001). There was also a significant difference between birth weight status with neonatal TSH level (P<0.001). Discussion: The percentage of low birth weight in Indonesia is half the percentage of babies born in the world according to WHO. The neonatal TSH reference values in Indonesia is close to 10 mU/L as cut off in developed countries. Birth weight influences neonatal TSH level. It correlates with delayed in hypothalamus-hypophysis-thyroid axis maturity.

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Nilai rujukan thyroid stimulating hormone TSH penting digunakan dalam skrining penyakit hipotiroid kongenital HK yang saat ini insidensinya di Indonesia lebih tinggi dibandingkan insidensi di dunia. Nilai rujukan merupakan nilai normal yang ditentukan dari individu sehat dan dapat dipengaruhi kondisi fisiologis, seperti usia dan jenis kelamin, dan kondisi patologis. Penelitian cross-sectional ini bertujuan untuk mengetahui perbandingan nilai rujukan TSH neonatus di Indonesia berdasarkan kelompok usia dan jenis kelamin. Sebanyak 3.320 sampel diperoleh dari data skrining hipotiroid kongenital SHK Nasional bulan Mei-Juli 2017 dengan metode fluorometri dengan reagen Labsystem di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo RSUPN-CM . Pengelompokkan total sampel dilakukan berdasarkan dua variabel bebas, yaitu lima kelompok usia dan kelompok jenis kelamin, dan dianalisis perbedaan nilai TSH antar kelompok tiap variabel bebas menggunakan SPSS versi 20. Interval rujukan TSH berdasarkan kedua variabel bebas akan dianalisis menggunakan MedCalc versi 17.9.7. Hasil menunjukkan bahwa terdapat perbedaan nilai TSH yang bermakna.

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TSH reference value was important in detection of congenital hypothyroidism, which incidence was higher in Indonesia than in the world. Reference value was a normal categorized value obtained from a healthy individual and influenced by physiological conditions, like age and sex differences, and pathological conditions. This cross sectional study aimed to analyze the comparison of neonatal TSH reference value in Indonesia according to age and sex difference. 3,320 subjects were obtained from National Congenital Hypothyroidism Screening data from May July 2017 by fluorometry method with Labsystem reagent in National Referral Hospital Cipto Mangunkusumo. Groupings were done based on two independent variables five age groups and gender groups, which were analyzed by using SPSS version 20. Neonatal TSH reference interval according to both independent variables were analyzed by using MedCalc version 17.9.7. There was significant difference in TSH value p

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Latar belakang: Hipotiroid kongenital merupakan suatu kelainan endokrin dimana terjadi penurunan sintesis hormon tiroid saat bayi baru lahir. Hipotiroid kongenital merupakan salah satu penyebab paling umum dari penurunan kecerdasaan intelektual retardasi mental yang sebenarnya dapat dicegah. Salah satu faktor risiko yang mendukung kejadian hipotiroid kongenital adalah status konsumsi garam beriodium ibu.Tujuan: Penelitian cross-sectional ini dilakukan untuk melihat apakah terdapat perbedaan antara nilai TSH neonatus dengan status konsumsi garam beriodium cukup ibu.Metode: Penelitian ini melibatkan 2.978 subjek yang terdiri atas bayi dan anak yang memperoleh uji saring hipotiroid kongenital di Rumah Sakit Umum Pusat Nasional RSUPN Dr. Cipto Mangunkusumo pada Bulan Mei hingga Bulan Juni 2017. Dari seluruh peserta uji saring hipotiroid kongenital tersebut, terdapat 1.687 subjek yang memenuhi kriteria inklusi dan eksklusi peneliti, kemudian dibagi menjadi dua kelompok, yaitu kelompok bayi yang dilahirkan oleh ibu yang tinggal di daerah dengan persentase konsumsi garam beriodium cukup per rumah tangganya rendah 90 . Jumlah sampel minimal yang harus dipenuhi oleh peneliti dengan menggunakan rumus besar sampel analitik numerik tidak berpasangan adalah 322 sampel. Setelah ditelaah, terdapat 149 subjek untuk kelompok bayi yang dilahirkan oleh ibu yang tinggal di daerah dengan persentase konsumsi garam beriodium cukup per rumah tangganya tinggi dan 173 bayi yang dilahirkan oleh ibu yang tinggal di daerah dengan persentase konsumsi garam beriodium cukup per rumah tangganya rendah. Sampel kemudian dianalisis menggunakan uji Mann-Whitney untuk diketahui hubungannya dengan nilai rerata TSH neonatus.Hasil dan Diskusi: Terdapat perbedaan bermakna nilai rerata TSH pada bayi yang dilahirkan oleh ibu yang tinggal di daerah dengan persentase konsumsi garam beriodium cukup per rumah tangganya rendah dan kelompok bayi yang dilahirkan oleh ibu yang tinggal di daerah dengan tingkat konsumsi garam beriodium cukup per rumah tangganya tinggi.

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Background Congenital hypothyroidism is an endocrine disorder in which there is a decrease in thyroid hormone synthesis at birth. Congenital hypothyroidism is one of the most common causes of a decline in intellectual intelligence mental retardation that can be prevented. One of the risk factors that affects the incidence of congenital hypothyroidism is the consumption status of the mother 39 s iodized salt.Objective This cross sectional study was conducted to see if there was any difference between neonatal TSH value and iodized salt consumption status.Methods The study involved 2,978 subjects consisting of infants and children who received a congenital hypothyroid filter test at the National General Hospital RSUPN . Cipto Mangunkusumo from May to June 2017. From the congenital hypothyroid test participants, 1,687 subjects fulfilled the inclusion and exclusion criteria of the researcher, then divided into two groups, the group of neonates born to mothers living in the area with the percentage of consumption iodized salt per household is low 90 . The minimum number of samples that must be met by the researcher by using the formula of unpaired numerical analytic sample is 322 samples. Upon examination, there were 149 subjects for groups of neonates born to mothers living in areas with a high percentage of iodized salt intake per household and 173 neonates born to mothers living in areas with sufficient iodized salt intake percentage per household. The samples were then analyzed using the Mann Whitney test to be known to correlate with the mean values of neonatal TSH.Results and Discussions There was a significant difference in mean TSH values in neonates born to mothers living in areas with a moderate percentage of low iodized salt intake per household and neonates born to mothers living in areas with high iodized salt intake per household P 0.001 . This is in line with the theory that if the diet of iodized salt is adequate then TSH levels in the circulation will be normal, whereas if the iodized salt diet is inadequate then TSH levels in the circulation will be high, due to negative feedback of the least amount of thyroid hormones in the circulation due to the raw material of its formation , ie iodides derived from iodized salt are not met. Also there was a significant difference in mean birth weight of neonates born to mothers living in areas with a fairly low percentage of iodized salt intake per household and neontaes born to mothers living in areas with sufficient iodized salt intake per household P

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Latar Belakang: Hipotiroid kongenital merupakan salah satu penyebab paling umum terjadinya retardasi mental. Padahal, terjadinya komplikasi hipotiroid kongenital dapat dicegah sejak dini. Oleh karena itu, skrining hipotiroid kongenital dengan mengukur kadar TSH menjadi penting terutama pada bayi yang berisiko lebih tinggi terkena hipotiroid kongenital. Usia prematur diduga menjadi salah satu faktor risiko hipotiroid kongenital karena terkait imaturitas organ.Tujuan: Penelitian ini dilakukan dengan tujuan mengetahui persentase bayi prematur, nilai rujukan TSH neonatus di Indonesia, dan hubungan antara kadar TSH neonatus dan status prematuritas.Metode: Desain penelitian yang digunakan adalah studi potong lintang dengan subjek berasal dari data skrining hipotiroid kongenital RSUPN Dr. Cipto Mangunkusumo yang sampel darahnya dianalisis dengan cara Fluorometri dengan reagen Labsystem. Data berasal dari bulan Mei dan Juni 2017 yang diperoleh melalui teknik consecutive sampling. Dari 2987 subjek, terdapat 1700 subjek yang memenuhi kriteria inklusi dan eksklusi. Subjek dibagi menjadi kelompok bayi prematur n=111 dan bayi lahir cukup bulan n=1589 . Sampel kemudian dianalisis menggunakan SPSS versi 20.0 untuk mengetahui hubungan kadar TSH dan status prematuritas dengan uji Mann-Whitney dan uji korelasi, serta MedCalc versi 17.9 untuk mencari nilai rujukan TSH neonatus di Indonesia.Hasil: Persentase bayi prematur yang didapatkan yaitu sebesar 6,5 . Nilai rujukan TSH neonatus berdasarkan kelahiran prematur didapatkan nilai 1,0-8,9 mU/L dengan median 2,5 1,0-12,8 mU/L dan berdasarkan kelahiran cukup bulan sebesar 1,5-8,0 mU/L dengan median 3,2 1,0-19,8 mU/L. Analisis menggunakan uji Mann-Whitney, didapatkan hubungan bermakna antara kadar TSH neonatus dan status prematuritas p.

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Background Congenital hypothyroid is one of the most common causes of mental retardation. Actually, this complication can be prevented since earlier. Therefore, congenital hypothyroid screening by measuring TSH level is important to every infants, especially in higher risk of developing congenital hypothyroid. Prematurity is hypothesised as one of risk factor for congenital hypothyroid related to organ immaturity.Objective The aim of this study is to determine the percentage of preterm birth, neonatal TSH reference values in Indonesia, and association between neonatal TSH level with prematurity status.Methods This cross sectional study used subjects which was obtained from congenital hypothyroid screening data in General National Hospital Dr. Cipto Mangunkusumo from May to June 2017 by consecutive sampling. The screening of congenital hypothyroid used Fluorometry with Labsystem reagen to analyse blood samples. From 2987 subjects, 1700 subjects fulfilled the inclusion and exclusion criteria. Subjects were divided into two groups preterm infants n 111 and term infants n 1589 . Then, samples were analysed with SPSS version 20.0 to investigate association between neonatal TSH level with prematurity status by Mann Whitney test and correlation test, also MedCalc version 17.9 to calculate neonatal TSH reference values.Results The percentage of preterm infants was 6.5 . Neonatal TSH reference values based on preterm birth infants were 1.0 8.9 mU L with median 2.5 1.0 12.8 mU L and based on term infants were 1.5 8.0 mU L with median 3.2 1.0 19.8 mU L. There was also a significant association between neonatal TSH level and prematurity status Mann Whitney test, p

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Pemeriksaan thyroid-stimulating hormon TSH) merupakan salah satu pemeriksaan utama dalam mendiagnosis kelainan pada kelenjar tiroid. World Health Organization (WHO) merekomendasikan pemeriksaan kadar TSH menggunakan bahan serum. Penggunaan plasma dapat membantu pencapaian turn around time (TAT) laboratorium namun perbedaan hasil pengukuran antara serum dan plasma belum diketahui. Pada penelitian dibandingkan hasil pengukuran kadar TSH menggunakan tabung penampung serum dengan clot activator tanpa gel pemisah (Tabung I), tabung penampung plasma dengan antikoagulan heparin tanpa gel pemisah (Tabung II), dan tabung penampung plasma dengan antikoagulan heparin dan gel pemisah (Tabung III). Selain itu juga dilihat gambaran kadar TSH berdasarkan jenis kelamin, usia, dan kadar glukosa darah sewaktu. Desain penelitian adalah potong lintang dengan menggunakan 89 subjek penelitian yang dipilih secara censecutive sampling. Didapatkan median kadar TSH pada tabung I, II, dan III secara berturut-turut sebesar 1,380 (0,032-7,420) µIU/mL, 1,380 (0,030-7,480) µIU/mL, dan 1,360 (0,030-7,460) µIU/mL. Tidak didapatkan perbedaan bermakna kadar TSH ketiga tabung secara statistik. Median selisih kadar TSH antara tabung II dan III dengan tabung I secara proporsional didapatkan sebesar -0,9% (-7,2 - 2,2)% dan -1,7% (-8,0 - 1,6)%. Penyimpangan kadar TSH tabung II dan III yang didapatkan telah sesuai dengan nilai ketidaktepatan yang dapat diterima menurut Ricos. Didapatkan gambaran median kadar TSH pada kelompok laki-laki dan perempuan secara berturut-turut sebesar 1,500 (0,032-4,250) µIU/mL dan 1,345 (0,058-7,420) µIU/mL. Median kadar TSH pada kelompok usia 31-40 tahun dan >61 tahun secara berturut-turut sebesar 1,190 (0,609-3,240) µIU/mL dan 1,730 (0,088-5,760) µIU/mL. Pada kelompok glukosa darah sewaktu <200 mg/dL didapatkan nilai median glukosa darah sewaktu pada kelompok kadar TSH di atas nilai rujukan, dalam rentang nilai rujukan dan dibawah nilai rujukan secara berturut-turut sebesar 175 (151-199) mg/dL, 89 (60-190) mg/dL, dan 107 (73-117) mg/dL. Dari hasil yang diperoleh dapat disimpulkan bahwa spesimen dari ketiga tabung penampung dapat digunakan untuk pemeriksaan kadar TSH tanpa memberikan perbedaan hasil yang bermakna baik secara statistik maupun secara klinis. Gambaran kadar TSH yang didapatkan menunjukkan nilai median kadar TSH lebih tinggi pada laki-laki dibandingkan perempuan, terdapat pola peningkatan kadar TSH pada kelompok usia yang lebih tua, dan nilai median glukosa lebih tinggi pada kelompok kadar TSH di atas rentang nilai rujukan.

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Thyroid-stimulating hormone (TSH) is one of the important laboratory parameters in diagnosing the thyroid gland abnormalities. The World Health Organization (WHO) recommends using serum samples to measure TSH levels. The use of plasma samples can help to improve laboratory turn around time (TAT) but the difference of measurements results between serum and plasma samples is unknown. The aims of this atudy were to compare TSH levels using serum tubes with clot activator (Tube I), plasma tubes with heparin anticoagulants (Tube II), and plasma tubes with heparin anticoagulant and gel separator (Tube III), and to show an overview of TSH levels according to gender, age, and random blood glucose levels. A cross sectional study was conducted using 89 blood samples from subjects that were selected by consecutive sampling. The median TSH levels in tubes I, II, and III were 1.380 (0.032-7.420) µIU/mL, 1.380 (0.030-7.480) µIU/mL, and 1.360 (0.030-7.460) µIU/mL respectively. There were no statistically significant differences in TSH levels of the three tubes. The median TSH levels differences of tubes II and III compared to tube I were -0.9% (-7.2 - 2.2) and -1.7% (-8.0 - 1.6) respectively. Biases of the measurement results obtained were in accordance with the spesicified desirable bias according to Ricos. The median TSH levels of the male and female groups was 1.500 (0.032-4.250) µIU/mL and 1.345 (0.058-7.420) µIU/mL respectively. Median TSH levels of 31-40 years old age group and >61 years old age group were 1.190 (0.609-3.240) µIU/mL and 1.730 (0.088-5.760) µIU/mL respectively. In the group of blood glucose level <200 mg/dL, the median of blood glucose level according to above, within, and below reference range of TSH were 175 (151-199) mg/dL, 89 (60-190) mg/dL, and 107 (73-117) mg/dL. In conclusion, specimens from the three tubes could be used to examine TSH levels without giving neither statistically nor clinically significant difference. The measurement of TSH levels obtained in the study showed a higher median TSH levelin the male group compared to the female group, higher TSH levels in the older age group, and a higher median glucose level in the TSH group above the reference range of TSH.