Thyroid status in elderly sick patients

Demeester-Mirkine, N; Kutnowski, M; Futeral, Bernard; Brauman, Henri; Corvilain, Jacques

doi:10.1007/bf03349412

Cited by 5 publications

(8 citation statements)

References 9 publications

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“…Our data agree with previous reports of a reduced TSH responsiveness with increasing age [2,7,[23][24][25]. Interestingly, the response to TRH was similarly reduced in all elderly subjects, we did not find significant gender differences in basal and TRH-stimulated levels.…”

Section: Discussionsupporting

confidence: 82%

Age-Related Modifications in the Regulation of the Hypothalamic-Pituitary-Thyroid Axis

Monzani¹,

Guerra²,

Caraccio³

et al. 1996

Horm Res

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We studied the hypothalamic-pituitary-thyroid function in two groups of healthy elderly subjects: group A (n = 23, age range 65-80 years), and group B (n = 11 age range 81-92 years), and in 32 controls, aged 20-60. A TRH test for TSH and prolactin was performed in all subjects, while the TSH circadian modulation was evaluated in elderly subjects only. Group B showed significantly lower fT₃ and TSH, and higher fT₄ levels with respect to controls (fT₃: 4.4 ± 0.2 vs. 5.2 ± 0.2 pmol/l, p < 0.05; fT₄: 13.1 ± 0.9 vs. 11.4 ± 0.4 pmol/l, p < 0.05; TSH: 1.07 ± 0.21 vs. 1.46 ± 0.13 mIU/1, p < 0.05). Morning TSH showed an inverse correlation with age (r = -0.42; p < 0.02) among the 34 elderly subjects, but not among controls. Evidence for TSH circadian modulation was found only in group A (nighttime TSH: 1.60 ± 0.17, vs. daytime: 1.25 ± 0.13 mIU/1, p < 0.001). The TRH-stimulated TSH peak was reduced among all elderly subjects with respect to controls (A: 6.26 ± 0.64 mIU/1, p = 0.01; B: 5.02 ± 0.58 mIU/1, p < 0.01). The maximal PRL response was also blunted (A: 25.7 ± 2.6 μg/l, B: 27.7 ± 5.2 μg/l, p < 0.0005). In conclusion, a resetting of the pituitary threshold of the TSH feedback suppression, along with complex alterations in peripheral thyroid hormone levels, may progressively develop in older people, becoming apparent only with extreme senescence. Moreover, the TSH nocturnal surge may be lost with increasing age, thus providing evidence also for hypothalamic dysfunction.

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Section: Discussionsupporting

confidence: 82%

Age-Related Modifications in the Regulation of the Hypothalamic-Pituitary-Thyroid Axis

Monzani¹,

Guerra²,

Caraccio³

et al. 1996

Horm Res

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“…Our data show, parallel to the decreased basal TSH levels, a drastic reduction of the TRH-induced TSH secretion in our elderly group to 38% of the values found in young men, i.e. a decline of even greater magnitude than estimated in previous observations of depressed TSH responsiveness in aging (5,6,13).…”

Section: Discussioncontrasting

confidence: 50%

“…The secretory response of TSH to TRH stimulation in aging men has been variously reported to be decreased (5,6,13), unchanged (4), or increased (3). Our data show, parallel to the decreased basal TSH levels, a drastic reduction of the TRH-induced TSH secretion in our elderly group to 38% of the values found in young men, i.e.…”

Section: Discussionmentioning

confidence: 99%

“…The effect of aging on the TSH response to TRH in men is also the object of some controversy. While most studies have reported that the TSH response to TRH is decreased in the elderly (5,6,13), others found no significant change (4) or even an increased response (3). The T 3 response to TRH appears to be diminished in elderly men, but peak T 4 levels are normal (6).…”

mentioning

confidence: 87%

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Decreased Basal and Stimulated Thyrotropin Secretion in Healthy Elderly Men*

Coevorden

Laurent

Decoster

et al. 1989

The Journal of Clinical Endocrinology & Metabolism

106

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To delineate the effects of aging on basal and stimulated TSH secretion, we studied the 24-h profile of plasma TSH levels and the TSH response to TRH stimulation (200 micrograms TRH, iv) in eight healthy elderly men, aged 67-84 yr, and eight normal young men, aged 20-27 yr. Subjects with thyroid antibodies against microsomal or thyroglobulin antigens were excluded. During the 24-h study, blood was sampled at 15-min intervals. TSH levels were measured by an ultrasensitive immunoradiometric assay. Sleep was polygraphically monitored, and circadian and pulsatile TSH variations were quantified using specifically designed computer algorithms. In older men, the 24-h mean TSH concentration was approximately 50% lower than that in young men (0.78 +/- 0.37 vs. 1.43 +/- 0.41 microU/mL; P less than 0.01), but basal T3 levels were only slightly lower (93 +/- 12 vs. 115 +/- 16 ng/dL; P less than 0.02), while basal T4 levels were normal. The normal diurnal variation of TSH levels, with a nocturnal acrophase and an afternoon nadir, as well as the pulsatile nature of TSH release were preserved in elderly men. When expressed in microunits per mL, the amplitude of these temporal variations was reduced in elderly men compared to that in younger subjects. However, when expressed in relation to the mean TSH levels, the amplitudes of diurnal and pulsatile variations were similar in both groups of subjects. TRH-induced TSH secretion was lower in old than in young men (area under the curve, 15.9 +/- 6.3 microU/mL.10 min in elderly men vs. 42.0 +/- 16.6 microU/mL.10 min in young men; P less than 0.002). However, the TRH-induced elevations of T3 and T4 were of similar magnitude in both groups. These results indicate that in healthy elderly men, the overall 24-h TSH secretion is decreased, and the pituitary is less responsive to stimulation by TRH. However, the chronobiological modulation is preserved. These alterations could reflect an adaptative mechanism to the reduced need for thyroid hormones in old age. The thyroid keeps an intact capacity to respond to acute increases in TSH concentrations.

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“…Basal and TRH-stimulated serum TSH concentrations are frequently depressed in NTI (159,(335)(336)(337). As a rule, thyroid hormone concentrations are increased, although with toxic adenoma and toxic multinodular goiter there may be an increased serum total T 3 and/or FT 3 concentration with normal levels of total T 4 and FT 4 ("T 3 thyrotoxicosis").…”

Section: Laboratory Diagnosismentioning

confidence: 99%