High TSH and low T4 as prognostic markers in older patients

Abstract

th percentile), and mortality assessed during an 18-month follow-up period after their hospital discharge. rESulTS: Out of 2599 older patients admitted to our hospital, 7% had TFT performed for various reasons. The patients who had TFT were mostly women and presented in a more serious clinical condition compared to the rest of the patients. The patients were grouped as per their thyroid values as follows: 61% of them had a non-thyroidal illness, 25% were euthyroid, 7% had overt hyperthyroidism, 5% overt hypothyroidism and 1% had subclinical hyper-or hypothyroidism. The hypothyroid patients had a worse clinical outcome compared to the others. Patients with increased MM exhibited higher TSH and lower TT4 (p<0.005). Short-term MM (Or=2.0,95%cI=1.1-3.6, p<0.01) was associated with the decrease of TT4 adjusted by age, sex, T3 and TSH, while for long-term MM the increase in TSH (Or=1.6,95%cI 1.1-2.3, p<0.05) was also significant. cONcluSION: Among hospitalized older patients who had TFT tests, low TT4 and high TSH were associated with a worse prognosis. We propose that TFT be used as an additional tool in assessing MM in elderly hospitalized patients.

Clinical Conundrums in Management of Hypothyroidism in Critically Ill Geriatric Patients

“…This clinical presentation in hospitalized elderly patients is associated with increased morbidity and mortality rates. The endocrine emergencies exhibit higher morbidity and mortality rates in elderly patients who undergo thyroid surgical procedures (5-8). …”

Are Thyroid Hormone Values Obtained in Hospitalized Elderly Patients Reproducible? - A Cohort Study

“…Thus, reliance on thyroid function tests in hospitalized patients is questionable and treatment decisions are infrequently based on laboratory values performed in hospitalized patients. This is particularly problematic in elderly individuals where normal thyroid function is ill-defined and where the influence of NTIS may be more significant [4][5][6][7]. A metaanalysis and systematic review reported that TSH ▼ It is unclear whether TSH should be obtained in elderly hospitalized patients as several factors associated with hospitalization influence these levels, which may not truly represent the thyroid status of the individual.…”

Función tiroidea y mortalidad en pacientes ancianos hospitalizados

“…Nuestros resultados confirman que la prevalencia de alteraciones en la función tiroidea en ancianos hospitalizados por enfermedad aguda es notablemente alta, alrededor de las tres cuartas partes de los pacientes, principalmente a expensas de SEE, como se ha expuesto anteriormente (39,125,128).…”

“…El síndrome de T3 baja es la alteración más frecuente en las pruebas de función tiroidea encontrada en ancianos hospitalizados por enfermedad aguda, y se detecta entre un 60-66% de los pacientes según los estudios (39,125,128). Sin embargo, hay que considerar que en ocasiones esta alteración es transitoria, normalizándose los niveles séricos de T3 L en aproximadamente un 30% al mes del alta hospitalaria (133).…”

“…han sugerido que la mayor disminución de TSH y T4 L está asociada con un aumento de mortalidad en los ancianos(44; 105-107; 119), mientras que un leve hipotiroidismo subclínico parece estar relacionado con un aumento en la supervivencia en esta población(3,44,107).Este trabajo es uno de los primeros estudios que ha evaluado, prospectivamente, la relación entre las pruebas de función tiroidea en hospitalización por enfermedad aguda y la mortalidad en los pacientes ancianos a largo plazo.Se encontró que las alteraciones en las pruebas de función tiroidea se asociaban con la mortalidad pero, a diferencia de Mingote y cols (128),. se encontró que los pacientes que murieron tenían los niveles séricos de TSH y T3 L significativamente menores que los pacientes que sobrevivieron, sin diferencias en T4 L. Además, los análisis de supervivencia mostraban un tiempo medio de supervivencia significativamente menor para los tertiles más bajos de T3 L, T4 L y TSH.…”