High Thyrotropin Levels and Risk of Mortality in the Elderly With Subclinical Hypothyroidism: A Systematic Review and Meta-analysis

Zhong, Jian; Mu, Danni; Zou, Yutong; Li, Lei; Cheng, Xinqi; Qiu, Ling

doi:10.1016/j.eprac.2022.11.011

Cited by 3 publications

(7 citation statements)

References 37 publications

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“…С другой стороны, в двух метаанализах (26 и 27 исследований), опубликованных в 2020 и 2023 гг., уровень ТТГ более 10 мМЕ/л у лиц старше 60 лет, напротив, был ассоциирован с увеличением риска смерти от всех причин и сердечно-сосудистых заболеваний [4,5]. Однако субклинический гипотиреоз в данных метаанализах не был связан с увеличением как общей, так и сердечно-сосудистой смертности [4,5]. Кроме того, в метаанализе T. Tsai и соавт.…”

Section: Discussionunclassified

“…Неоднозначные результаты исследований влияния уровня ТТГ на смертность в пожилом и старческом возрастах могут быть связаны с дизайном исследований и характеристиками выборки. Большинство исследований, показывающих снижение риска смерти от всех причин в пожилом и старческом возрастах при высоком уровне ТТГ, носят проспективный характер, а демонстрирующие увеличение риска смерти -ретроспективный [4,5]. Кроме того, высокий риск смерти при субклиническом гипотиреозе чаще фиксировали в исследованиях, проведенных в Азии, а снижение риска или его отсутствиев США или Европе [4,5].…”

Section: Discussionunclassified

“…Большинство исследований, показывающих снижение риска смерти от всех причин в пожилом и старческом возрастах при высоком уровне ТТГ, носят проспективный характер, а демонстрирующие увеличение риска смерти -ретроспективный [4,5]. Кроме того, высокий риск смерти при субклиническом гипотиреозе чаще фиксировали в исследованиях, проведенных в Азии, а снижение риска или его отсутствиев США или Европе [4,5]. Это может быть обусловлено региональными различиями в уровне потребления йода, так как его количество в рационе влияет не только на распространенность гипотиреоза и аутоиммунного тиреоидита, но и на смертность.…”

Section: Discussionunclassified

“…[2]. Снижение функции щитовидной железы также коррелирует с более высоким риском развития синдрома старческой астении, сердечно-сосудистой смерти и смерти от всех причин [3][4][5][6]. Однако влияние снижения функции щитовидной железы на смертность и в пожилом, и старческом возрасте не так однозначно, и ряд авторов, наоборот, демонстрируют снижение смертности в этих возрастных группах по мере увеличения уровня ТТГ [7,8].…”

Section: обоснованиеunclassified

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Thyroid paradox in older age

Turusheva,

Popova,

Kinder

2024

Russian Family Doctor

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BACKGROUND: The thyroid gland plays an important role in our body, influencing almost all metabolic processes in the body throughout life. However, literature data on the effect of decreased thyroid function on mortality in older people is contradictory. AIM: To evaluate the impact of thyroid-stimulating hormone levels on 5-year survival in older adults. MATERIALS AND METHODS: This work was carried out on the basis of the second screening of the Crystal study of community-dwelling individuals 65+ (n = 383). Main study parameters: thyroid-stimulating hormone level, blood test, lipid profile, albumin, total protein, comprehensive geriatric assessment, 5 years of follow-up. RESULTS: A thyroid-stimulating hormone level of 3.3–10.0 mIU/L was associated with a 44.6% reduced risk of all-cause mortality (hazard ratio 0.554; 95% confidence interval 0.307–0.999) at 5 years of follow-up, regardless of the presence of non-communicable diseases and geriatric status. A thyroid-stimulating hormone level more 10.0 mIU/L is not associated with an increased risk of mortality. The lower risk of mortality in patients with high thyroid-stimulating hormone levels may be due to a larger thigh muscle circumference. After adjustment for all covariates used and thyroid-stimulating hormone level, a 1 cm increase in thigh muscle circumference was associated with a 4.5% reduction in the risk of all-cause mortality (hazard ratio 0.955; 95% confidence interval 0.932–0.979). CONCLUSIONS: The lowest risk of all cause-mortality mortality in persons aged 65 years and older is observed with a thyroid-stimulating hormone level of 3.3–10.0 mIU/L. Thyroid-stimulating hormone level more 10.0 mIU/L is not associated with an increased risk of all cause-mortality.

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Section: Discussionunclassified

Section: обоснованиеunclassified

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Thyroid paradox in older age

Turusheva,

Popova,

Kinder

2024

Russian Family Doctor

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“…[37][38][39][40][41] Zhong et al 37 evaluated whether elevated endogenous thyrotropin levels contribute to an increased risk of adverse outcomes, such as all-cause mortality in older adults with SCH. 37 Eight electronic databases were searched for relevant articles from inception until March 23, 2022. Cohort studies assessing the association between thyrotropin levels and the risk of mortality among older adults aged 60 years with SCH were eligible. The outcomes of interest were either all-cause or cardiovascular-related mortality.…”

Section: Outcomes and Prognosismentioning

confidence: 99%

Hypothyroidism in Older Adults: A Concise Review of the Recent Literature

Abouglila,

Mukhtar,

Hajjaji

et al. 2024

Journal of Diabetes and Endocrine Practice

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Introduction Hypothyroidism (HypoT) is a common condition whose prevalence varies according to regional and ethnic factors, dietary iodine, gender, and age. The symptoms of HypoT are generally nonspecific, with considerable overlap with other conditions. These symptoms are not useful for diagnosing HypoT, and a thyroid function test is required for a final diagnosis. Materials and methods We aimed to provide an overview of the recent global literature on HypoT in older adults. A narrative, nonsystematic review of the international literature from a single major medical online database (PubMed) for the past 5 years was performed. The relevant literature was narrated in a concise thematic account. Results Most studies and expert opinions reiterated the benefit of replacement therapy in younger and middle-aged individuals. A good volume of literature also considered the interplay between thyroid hormones and (1) cardiovascular function and risk factors, (2) cognitive function, (3) mental health, and (4) quality of life. Most workers are cognizant of the important difference in normal ranges of thyroid-stimulating hormone (TSH) and the consequent TSH targets in older adults compared to younger age groups. Extra care is recommended for the initiation and titration of thyroid hormone replacement therapy to avoid cardiovascular and skeletal adverse effects of relative overtreatment. Conclusion While clinical benefit is evident in patients under age 65 with overt and subclinical HypoT who are treated with levothyroxine, treatment may be harmful in older adults with subclinical HypoT. The 97th percentile of TSH distribution is 7.5 mIU/L for patients over age 80. Hence, TSH goals should be individualized in older adults to achieve any possible benefit and avoid unnecessary harm.

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Hypothyroidism in Older Adults: A Narrative Review

Fiore,

Barucca,

Barraco

et al. 2024

EMIDDT

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Introduction: The prevalence of hypothyroidism increases along with aging, resulting in one of the most common comorbidities among patients over 75 years. The leading causes of hypothyroidism in older adults are iatrogenic, Hashimoto's thyroiditis, and medications. Aims: The narrative review aimed to discuss the clinical characteristics of hypothyroidism in older adults and the impact of hormonal replacement therapy on survival rates. Results: Thyroid function declines over time due to physiological changes in the thyroid stimulating hormone signaling, iodine absorption and metabolism, thyroid hormone metabolism, and activity at peripheral sites. A serum TSH value over the upper limit of the normal reference range is not necessarily attributable to hypothyroidism. However, an appropriate diagnostic work-up is required to rule out true hypothyroidism and discriminate the etiology (i.e., thyroid autoimmune diseases, iodine deficiency, drug-induced hypothyroidism). Levothyroxine treatment should be considered in cases of overt hypothyroidism. A complete risk-to-benefit assessment, particularly considering the overall health status, life expectancy, cognitive function, mood, and cardiovascular and neurological background, should be considered before treating subclinical hypothyroidism with more potential benefits in patients under 75 years old. Levothyroxine formulations facilitating hormone absorption and increasing compliance to long-term treatment should be preferred. TSH target should usually be set over 3 mIU/ml. Conclusion: Defining optimal diagnostic approaches and targeted therapeutic strategies should be considered in the personalized management of aged patients with hypothyroidism.

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High Thyrotropin Levels and Risk of Mortality in the Elderly With Subclinical Hypothyroidism: A Systematic Review and Meta-analysis

Cited by 3 publications

References 37 publications

Thyroid paradox in older age

Thyroid paradox in older age

Hypothyroidism in Older Adults: A Concise Review of the Recent Literature

Hypothyroidism in Older Adults: A Narrative Review

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