Standardization of Free Thyroxine Measurements Allows the Adoption of a More Uniform Reference Interval

Clin Chem. 2017 Oct;63(10):1642-1652. doi: 10.1373/clinchem.2017.274407. Epub 2017 Jul 18.


Background: The IFCC Committee for Standardization of Thyroid Function Tests intended to standardize free thyroxine (FT4) immunoassays. We developed a Système International d'Unités traceable conventional reference measurement procedure (RMP) based on equilibrium dialysis and mass spectrometry. We describe here the latest studies intended to recalibrate against the RMP and supply a proof of concept, which should allow continued standardization efforts.

Methods: We used the RMP to target the standardization and reference interval (RI) panels, which were also measured by 13 manufacturers. We validated the suitability of the recalibrated results to meet specifications for bias (3.3%) and total error (8.0%) determined from biological variation. However, because these specifications were stringent, we expanded them to 10% and 13%, respectively. The results for the RI panel were reported as if the assays were recalibrated. We estimated all but 1 RI using parametric statistical procedures and hypothesized that the RI determined by the RMP was suitable for use by the recalibrated assays.

Results: Twelve of 13 recalibrated assays had a bias, meeting the 10% specification with 95% confidence; for 7 assays, this applied even for the 3.3% specification. Only 1 assay met the 13% total error specification. Recalibration reduced the CV of the assay means for the standardization panel from 13% to 5%. The proof-of-concept study confirmed our hypothesis regarding the RI but within constraints.

Conclusions: Recalibration to the RMP significantly reduced the FT4 immunoassays' bias, so that the RI determined by the RMP was suitable for common use within a margin of 12.5%.

Publication types

  • Validation Study

MeSH terms

  • Calibration
  • Chromatography, Liquid / methods
  • Chromatography, Liquid / standards
  • Humans
  • Immunoassay / methods
  • Immunoassay / standards
  • Limit of Detection
  • Reference Values
  • Tandem Mass Spectrometry / methods
  • Tandem Mass Spectrometry / standards
  • Thyroid Function Tests / methods*
  • Thyroid Function Tests / standards*
  • Thyroxine / analysis
  • Thyroxine / blood*


  • Thyroxine