Among people 60 years of age or older, a low serum thyrotropin concentration is associated with a threefold higher risk that atrial fibrillation will develop in the subsequent decade.

UBCLINICAL OR "MILD" THYROID disease is a common disorder, particularly in middle-aged and elderly individuals. 1 Greater sensitivity of assays and more frequent assessment of serum thyroidstimulating hormone (TSH) levels have resulted in more patients requiring interpretation of abnormal thyroid function test results. However, controversy surrounds the definition, clinical importance, and necessity for prompt diagnosis and treatment of subclinical thyroid disease. Previous review articles 2-6 and position statements 7,8 differ in their conclusions and recommendations, often a consequence of difficulties in interpreting inadequate and conflicting data. In the midst of this uncertainty, clinicians still desire expert guidance for the diagnosis and management of subclinical thyroid disease.

Intense stepped insulin therapy in NIDDM patients who have failed glycemic control on pharmacological therapy is effective in maintaining near-normal glycemic control for > 2 years without excessive severe hypoglycemia, weight gain, hypertension, or dyslipidemia. Cardiovascular event rates are high at this stage of NIDDM. A long-term prospective trial is needed to assess the risk-benefit ratio of intensified treatment of hyperglycemia in NIDDM patients requiring insulin.

In elderly men, hypogonadism related to aging has little influence on bone mineral density, but serum estradiol levels have a strong and positive association with bone mineral density.

No abstract