Prevalence of thyroid dysfunction in different geriatric subpopulations from a moderately iodine-deficient Hungarian region. Comparative clinical and hormonal screening

Abstract

The aim of this study was to investigate the prevalence of thyroid dysfunction in different geriatric subpopulations from a moderately iodine-deficient Hungarian region and to compare the efficacy of clinical versus hormonal screening. A screening study was done on 279 chronically ill geriatric patients (Group I) and 256 consecutive hospital admissions over 60 years of age (Group II). The method of clinical screening was different from those used so far: the object was not to search for symptoms of hypo- or hyperthyroidism but to find any sign justifying a further thyrotrophin-based biochemical evaluation, i.e. history of thyroid disease or goitre or any clinical sign of hormonal dysfunction. The rates of overt hypothyroidism, overt hyperthyroidism, subclinical hypothyroidism and subclinical hyperthyroidism discovered by the hormonal screening were 2.9, 1.1, 3.6 and 5.7% in Group I and 3.5, 2.3, 3.9 and 2.0% in Group II. The sensitivities of the clinical screening to suspect overt or overt+subclinical dysfunctions were, respectively, 0.82 and 0.64 in Group I and 1.0 and 0.7 in Group II (or 0.67 and 0.4 if the clinical investigation was done not by an endocrinologist but by the medical attendants). A primarily clinical investigation-based screening would have spared 171/279 thyrotrophin estimation in Group I and 161/256 in Group II, but would have missed 2/11 overt and 11/26 subclinical dysfunctions in Group I. In Group II, no overt but 9/15 subclinical dysfunctions would have been lost in this way. Our approach of a clinical investigation-based screening was rather efficient in suspicion of overt thyroid dysfunction but failed to detect many cases with subclinical dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative screening for thyroid disorders in old age in areas of iodine deficiency, long‐term iodine prophylaxis and abundant iodine intake

“…In old age, especially in iodine-depleted geographical areas, there is an increased prevalence of goitre and thyroid nodules, and hyperthyroidism of non-autoimmune origin seems to be more frequent (Herrmann, 1981;Hegedüs et al, 1983;Olbricht et al, 1983;Oberhofer et al, 1989;Szabolcs et al, 1990Szabolcs et al, , 1995bHintze et al, 1991;Gönczi et al, 1994). On the other hand, in regions with good iodine supply hypothyroidism occurs more frequently (Sawin et al, 1985;Robuschi et al, 1987;Rosenthal et al, 1987;Brochmann et al, 1988;Okamura et al, 1989;Parle et al, 1991;Sundbeck et al, 1991).…”

Follow up of thyroid hormone parameters in chronically ill geriatric patients: screening for thyroid disorders at hospital admission justified

“…In previous studies we reported on the high prevalence of clinical and subclinical thyroid dysfunctions in chronically ill hospitalized geriatric patients living in moderately iodine deficient areas (14.4% in Germany or 13.3% in Hungary) (Szabolcs et al, 1990(Szabolcs et al, , 1995(Szabolcs et al, , 1997. Besides of this high prevalence, there are other good reasons to recommend thyroid screening of this elderly subpopulation as well:…”

“…When should chronically ill hospitalized geriatric patients be screened for thyroid dysfunctions? The general view is that thyroid screening is not indicated upon acute hospital admission because nonthyroidal illnesses may influence the thyroid parameters (Small et al, 1990;Szabolcs et al, 1995). Chronically ill geriatric patient do have nonthyroidal illnesses but these are ªper seº non-acute disorders.…”

The Blood Spot Thyrotropin Method is Not Adequate to Screen for Hypothyroidism in the Elderly Living in Abundant-Iodine Intake Areas: Comparison to Sensitive Thyrotropin Measurements

“…In some countries, such as Hungary, a well-estab¬ lished network of blood spot TSH screening for congenital has been recognized that the clinical detection of thyhypothyroidism exists, which could be used for screening in roid dysfunction in the elderly is difficult to distinguish the elderly as well, from the signs and symptoms of aging (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Thus, there is In two previous studies, the efficiency of the blood spot good reason to recommend biochemical screening of the elversus sensitive serum TSH screening was investigated in el¬ derly, at least in areas of abundant iodine intake, where the derly subjects.…”