Association of Hypothyroidism and Mortality in the Elderly Population: A Systematic Review and Meta-Analysis

Tsai, Tou-Yuan; Tu, Yu–Kang; Munir, Kashif M.; Lin, Shu‐Man; Chang, Rachel Huai‐En; Kao, Sheng-Lun; Loh, Ching‐Hui; Peng, Chung Kang; Huang, Huei‐Kai

doi:10.1210/clinem/dgz186

Cited by 21 publications

(28 citation statements)

References 67 publications

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“…Many previous studies have investigated the link between hypothyroidism and mortality risk, but their results have been inconsistent (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(28)(29)(30)(31)(32)(33)(34). Possible reasons for such discrepancies include considerable variations in the definition and severity of hypothyroidism, characteristics of study populations, and adjustments for comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…Regardless of cause, hypothyroidism is associated with a number of well-characterized metabolic changes, such as hyperlipidemia, hypertension, and coagulopathy, as well as endothelial dysfunction and cardiovascular disorders (6)(7)(8)(9)(10), all of which could theoretically lead to increased mortality. However, studies of hypothyroidism have yielded considerable variation in mortality data (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Some studies have found an increased risk of mortality in hypothyroid patients (12-14, 16, 17, 19, 21-24), but others have not (11,15,18,20).…”

Section: Introductionmentioning

confidence: 99%

“…To date, a number of cohort studies and meta-analyses have investigated the relationship between hypothyroidism and mortality (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). However, most have been restricted to subjects with subclinical hypothyroidism (17,20,21,28,29,33,34,38) and some studies have defined hypothyroidism based on only one TSH level measurement (13,15,22,28,30,37).…”

Section: Introductionmentioning

confidence: 99%

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Risk of All-Cause Mortality in Levothyroxine-Treated Hypothyroid Patients: A Nationwide Korean Cohort Study

2021

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BackgroundAlthough hypothyroidism is associated with various comorbidities, its relationship with increased all-cause mortality remains controversial. The aim of this nationwide retrospective cohort study was to investigate whether hypothyroid patients treated with levothyroxine had increased mortality compared to controls.MethodsHypothyroid subjects were identified through the Korean National Health Insurance Service Claims database between 2008 and 2017. Hypothyroidism in this study was defined as overt hypothyroidism treated with long-term prescription of levothyroxine (>6 months). After 1:3 age-, sex- and index year-matching, 501,882 patients with newly diagnosed hypothyroidism and 1,505,646 controls without hypothyroidism were included.ResultsDuring a mean follow-up of 6 years, 25,954 (5.2%) hypothyroid patients and 59,105 (3.9%) controls died. Hypothyroidism was significantly associated with increased all-cause mortality (adjusted hazard ratio [HR], 1.14; 95% confidence interval [CI] 1.12–1.16) even with levothyroxine treatment. When stratified by age, sex, and cardiovascular disease risk, independent associations between hypothyroidism and mortality remained significant in all subgroups. The risk of mortality was higher in the < 65 age group (HR: 1.25, 95% CI: 1.22–1.29), men (HR: 1.28, 95% CI: 1.25–1.31), and the high cardiovascular disease risk group (HR: 1.31, 95% CI: 1.29–1.34). The mortality rate of hypothyroid patients was highest within 1 year of treatment and decreased with time.ConclusionThis nationwide, population-based cohort study showed that all-cause mortality was significantly higher in levothyroxine-treated hypothyroid patients than in non-hypothyroid controls. This association remained significant regardless of age, sex, and cardiovascular disease risk.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk of All-Cause Mortality in Levothyroxine-Treated Hypothyroid Patients: A Nationwide Korean Cohort Study

2021

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“…Bei der Hashimoto-Thyreoiditis sollte zudem auch bedacht werden, dass diese zu ca. 25 [26,27]. Ob und wie weit es sich dabei um kausale Zusammenhänge handelt, ist noch unklar, wobei diesbezüglich angemerkt werden sollte, dass z.…”

Section: Ursachen Der Hypothyreoseunclassified

Hypothyreose: Guidelines, neue Erkenntnisse und klinische Praxis

Pilz

Theiler‐Schwetz

Malle

et al. 2020

J. Klin. Endokrinol. Stoffw.

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Zusammenfassung Eine Hypothyreose (Schilddrüsenunterfunktion) findet sich bei ca. 5 % der Bevölkerung, wobei man bei der primären Hypothyreose eine manifeste Hypothyreose mit erhöhtem Thyreoidea-stimulierendem Hormon (TSH) und reduziertem freiem Thyroxin (fT4) von einer latenten (subklinischen) Hypothyreose mit zwar erhöhtem TSH, aber im Normbereich gelegenem fT4 unterscheidet. Die Indikationen für eine TSH-Testung sind nicht klar festgelegt, wobei aber von den meisten Fachgesellschaften kein generelles Screening empfohlen wird, es jedoch in der klinischen Routine häufig eine Überdiagnostik gibt. Während eine manifeste Hypothyreose eine klare Therapieindikation für eine Schilddrüsenhormonsubstitution darstellt, wird die Therapieindikation bei der latenten Hypothyreose zunehmend infrage gestellt, da sich häufig mit Hypothyreose in Verbindung gebrachte Beschwerden wie reduzierte Lebensqualität, Müdigkeit oder Übergewicht durch eine Therapie der latenten Hypothyreose nicht verbessern. Andererseits legen neue Erkenntnisse zur Homöostase und Allostase nahe, dass eine differenzierte Betrachtung der Schilddrüsenfunktion inklusive Berücksichtigung individueller Setpoints und adaptiver Mechanismen die Diagnostik und Therapie der Hypothyreose verbessert und die lineare, TSH-zentrierte Vorgehensweise verdrängen könnte. In diesem kurzen Übersichtsartikel gehen wir auf die aktuellen Richtlinien in Bezug auf Diagnostik und Therapie der Hypothyreose ein, wobei wir diese im Hinblick auf rezente Erkenntnisse auf diesem Gebiet beleuchten und großen Wert auf praktische Handlungsempfehlungen für die tägliche Routine legen.

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“…Cardiovascular disease still remains a major cause of morbidity and mortality worldwide and accounts for over 15 million deaths/year 3 . Although the cause of CVD is multifactorial, one of its causes has been recently recognised as being attributed to SCH, which incidence increases with advancement of age 4,5 . The thyroid hormones exert their effects through their receptors α and β located in the myocardial and vascular endothelial tissues and modulate their cardiovascular function 6‐8 .…”

Section: Introductionmentioning

confidence: 99%

The current debate over treatment of subclinical hypothyroidism to prevent cardiovascular complications

Chrysant

2020

Int J Clin Pract

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Background Subclinical hypothyroidism (SCH) is an asymptomatic condition associated with increased thyroid‐stimulating hormone (TSH) >4 mIU/L with normal thyroxine (T4) and triidothyronine (T3) levels. It is more common in older subjects and especially in women with an overall incidence of 10%. Objective Because the normal TSH levels increase with age up to 7.5 mIU/L in older people, several studies have reported either no benefits whereas others have reported the benefits of treatment. These studies have caused a great debate over the treatment of SCH, especially in older subjects. Therefore, the objective of this study was to review the current evidence over this debate by reviewing the recent literature on the subject to discern whether treatment of SCH is necessary and under what circumstances. Methods To get a better perspective on the current debate over treatment of SCH, a focused Medline search of the English language literature was conducted from 2012 to 2019 using the terms, hypothyroidism, subclinical, dyslipidaemia, cardiovascular disease, heart failure and 38 papers with pertinent information were selected. Results The analysis of results from these papers indicated that the normal levels of TSH are increasing with the advancement of age from 4 mIU/L up to 7.5 mIU/L for patients ≥75 years of age. Also, several of reviewed studies have shown no benefits of treatment whereas, others have shown definite benefits of treatment with levothyroxine supplementation on the clinical and metabolic effects of SBH with reductions in CVD, HF and mortality. The treatment is more effective in younger persons and less so in older persons. Conclusions Based on the overall evidence, treatment of SCH is indicated in younger persons with a TSH level >4.0 mIU/L. In older subjects, treatment should be individualised and based on the presence of symptoms, the level of TSH, and initiated at TSH levels ≥10 mIU/L and at low doses to avoid adverse cardiovascular effects from overtreatment.

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Association of Hypothyroidism and Mortality in the Elderly Population: A Systematic Review and Meta-Analysis

Cited by 21 publications

References 67 publications

Risk of All-Cause Mortality in Levothyroxine-Treated Hypothyroid Patients: A Nationwide Korean Cohort Study

Risk of All-Cause Mortality in Levothyroxine-Treated Hypothyroid Patients: A Nationwide Korean Cohort Study

Hypothyreose: Guidelines, neue Erkenntnisse und klinische Praxis

The current debate over treatment of subclinical hypothyroidism to prevent cardiovascular complications

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