Subclinical Thyroid Dysfunction and Functional Capacity Among Elderly

Virgini, Vanessa; Wijsman, Liselotte W.; Rodondi, Nicolas; Bauer, Douglas C.; Kearney, Patricia M.; Gussekloo, Jacobijn; Elzen, Wendy P. J. den; Jukema, J. Wouter; Westendorp, Rudi G.J.; Ford, Ian; Stott, David J.; Mooijaart, Simon P.

doi:10.1089/thy.2013.0071

Cited by 36 publications

(38 citation statements)

References 41 publications

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“…It is a common limitation concerning studies evaluating exercise performance (38), specially including elderly subjects. These factors are also justified by the involvement of a selected group of elderly patients who had also to repeat exercise performance and by the difficult of having so health old people with TSH in this low-normal reference range, without thyroid disease, to receive investigational intervention with methimazole, since only just less than 11% of elderly over 70 years old has TSH between 0.5 -1.0 mIU/L (39).…”

Section: Discussionmentioning

confidence: 99%

Does low serum TSH within the normal range have negative impact on physical exercise capacity and quality of life of healthy elderly people?

Chachamovitz

Vigário

Carvalho

et al. 2016

Arch. Endocrinol. Metab.

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Objective: Investigate the differences in cardiopulmonary (CP) capacity and Quality of Life (QOL) between healthy elderly (≥ 65 years) with different TSH levels (< 1.0 and ≥ 1.0 μIU/mL) both within the normal range. Also, evaluate the effects of TSH elevation on CP test and QOL, by administering methimazole to subjects with initial lower-normal TSH, in order to elevate it to superior-normal limit. Materials and methods: Initially, a cross-sectional study was performed to compare CP capacity at peak exercise and QOL (using WHOQOL-OLD questionnaire) between healthy seniors (age ≥ 65 years) with TSH < 1.0 μIU/mL vs. TSH ≥1.0 μIU/mL. In the second phase, participants with TSH < 1.0 μIU/mL were included in a non-controlled-prospective-interventional study to investigate the effect of TSH elevation, using methimazole, on QOL and CP capacity at peak exercise. Results: From 89 elderly evaluated, 75 had TSH ≥ 1 μIU/mL and 14 TSH < 1 μIU/mL. The two groups had similar basal clinical characteristics. No difference in WHOQOL-OLD scores was observed between groups and they did not differ in terms of CP function at peak exercise. QOL and CP variables were not correlated with TSH levels. Twelve of 14 participants with TSH < 1.0 μIU/mL entered in the prospective study. After one year, no significant differences in clinical caracteristics, QOL, and CP variables were detected in paired analysis before and after methimazole intervention. Conclusions: We found no differences in CP capacity and QOL between health elderly with different TSH levels within normal range and no impact after one year of methimazole treatment. More prospective-controlled-randomized studies are necessary to confirm or not the possible harm effect in normal low TSH. Arch Endocrinol Metab. 2016;60(3):236-45

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Section: Discussionmentioning

confidence: 99%

Does low serum TSH within the normal range have negative impact on physical exercise capacity and quality of life of healthy elderly people?

Chachamovitz

Vigário

Carvalho

et al. 2016

Arch. Endocrinol. Metab.

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“…(80) However, two prospective cohort studies, by Simonsick et al and Virgini et al, showed no associations between SCH and musculoskeletal symptoms. (8,81) Furthermore, physical function appeared to be better in elderly subjects with SCH. (9) There were conflicting reports on fracture rates from prospective cohort studies by Lee et al and Svare et al (82,83) Brennan et al (80) showed improvement in strength measurements, while Mainenti et al (84) showed improvement in cardiopulmonary performance with treatment.…”

Section: Musculoskeletal Symptomsmentioning

confidence: 93%

The debate on treating subclinical hypothyroidism

Tng¹

2016

smedj

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Subclinical hypothyroidism (SCH) represents a mild or compensated form of primary hypothyroidism. The diagnosis of SCH is controversial, as its symptoms are non-specific and its biochemical diagnosis is arbitrary. The treatment of SCH was examined among non-pregnant adults, pregnant adults and children. In non-pregnant adults, treatment of SCH may prevent its progression to overt hypothyroidism, reduce the occurrence of coronary heart disease, and improve neuropsychiatric and musculoskeletal symptoms associated with hypothyroidism. These benefits are counteracted by cardiovascular, neuropsychiatric and musculoskeletal side effects. SCH is associated with adverse maternal and fetal outcomes that may improve with treatment. Treating SCH in children is safe and may improve growth. Importantly, the evidence in this field is largely from retrospective and prospective studies with design limitations, which precludes a conclusive recommendation for the treatment of SCH.

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“…A possible mechanism for the lower exercise capacity could be higher oxygen requirements during exercise in people with subclinical hypothyroidism 25 as well as a possible association with anaemia. 26 On the other hand, large cohort studies did not find a reduction in functional mobility or functional capacity assessed in elderly individuals with subclinical hypothyroidism 27,28 and persons with only mild elevations of TSH even revealed a slightly better mobility than euthyroid controls. 27 High TSH levels as seen in hypothyroidism have been shown to directly affect bone metabolism through inhibition of osteoclast formation and survival, osteoblast differentiation and expression of collagen type 1.…”

Section: B Lipid Abnormalities and Other Cardiac Risk Factorsmentioning

confidence: 96%

Subclinical Hypothyroidism: A Review on Clinical Consequences and Management Strategies

2017

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Abstract Abstract AbstractSubclinical hypothyroidism (SCH) is defined as an elevated serum thyroid-stimulating hormone (TSH) level with normal free thyroid hormone values. The prevalence of subclinical hypothyroidism is 3 to 8 percent in the general population, and up to 15 to 18 percent in women who are older than 60 years. It is more common in women than men, and its prevalence increases with age. Of patients with SCH, 80% have a serum TSH of less than 10 mIU/L. Management strategies including screening and treatment of subclinical hypothyroidism are still controversial. The strongest arguments for levothyroxine therapy are the high risk of progression to overt hypothyroidism. Initiating levothyroxine replacement therapy is recommended for all patients with a TSH greater than 10 mIU/L, even if the free thyroxine concentration is within normal laboratory range. However, treatment of patients with a serum TSH level between 5 and 10 mIU/L remains controversial. There was insufficient evidence for a clinically significant relationship between subclinical hypothyroidism and adverse cardiac events or cardiac dysfunction. Conflicting results have been found on the association between subclinical hypothyroidism and cognitive impairment, depression and the risk of fractures. This narrative review aims to assess current evidence on the clinical aspects, as well as screening and treatment recommendations in adults with subclinical hypothyroidism.

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Subclinical Thyroid Dysfunction and Functional Capacity Among Elderly

Cited by 36 publications

References 41 publications

Does low serum TSH within the normal range have negative impact on physical exercise capacity and quality of life of healthy elderly people?

Does low serum TSH within the normal range have negative impact on physical exercise capacity and quality of life of healthy elderly people?

The debate on treating subclinical hypothyroidism

Subclinical Hypothyroidism: A Review on Clinical Consequences and Management Strategies

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