Endogenous subclinical thyroid disorders, physical and cognitive function, depression, and mortality in older individuals

Jongh, Renate T. de; Lips, Paul; Schoor, Natasja M. van; Rijs, K.J.; Deeg, D.J.H.; Comijs, Hannie C.; Kramer, Mark H. H.; Vandenbroucke, Jan P.; Dekkers, Olaf M.

doi:10.1530/eje-11-0430

Cited by 136 publications

(120 citation statements)

References 41 publications

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“…de Jongh et al found in the same population we used that subclinical thyroid disorder does not correspond with disadvantageous effects on the physical and cognitive functions of the elderly. However, the group of subclinical hypo-and hyperthyroid persons was relatively small in comparison with the euthyroid group (37).…”

Section: Discussionmentioning

confidence: 82%

Thyroid function and the metabolic syndrome in older persons: a population-based study

Heima

Eekhoff

Oosterwerff

et al. 2013

European Journal of Endocrinology

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Background: Studies suggest an association between a high TSH and (individual components of) the metabolic syndrome. Only a few studies have been performed in the general older population. Objective: This study investigates the association between serum TSH and the metabolic syndrome in a representative sample of older persons in The Netherlands. Design and patients: Data of the Longitudinal Aging Study Amsterdam were used, which is an ongoing cohort study in a representative sample of Dutch older persons. A total of 1187 subjects (590 men and 597 women) between the ages of 65 and 88 years participated in the study. Measurements: Metabolic syndrome (US National Cholesterol Education Program definition) and its individual components were assessed, as well as serum TSH levels. Results: Among the participants, the prevalence of the metabolic syndrome was 34.2%. The mean serum TSH was 1.9 mU/l. Subjects in the upper quartile with a serum TSH level above 2.28 mU/l (odds ratio (OR)Z1.68; 95% confidence interval (CI) 1.19-2.37) had a significantly increased prevalence of metabolic syndrome compared with subjects in the lowest quartile with a serum TSH below 1.04 mU/l. After adjustment for confounders, age, sex, alcohol use, total physical activity, and smoking, the OR was 1.62 (95% CI 1.15-2.32). Conclusions: Subjects with a serum TSH in the upper quartile have a higher prevalence of metabolic syndrome as compared with subjects with a serum TSH in the lowest quartile.

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Section: Discussionmentioning

confidence: 82%

Thyroid function and the metabolic syndrome in older persons: a population-based study

Heima

Eekhoff

Oosterwerff

et al. 2013

European Journal of Endocrinology

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“…However, data from a cross-sectional study in Australia indicate that subclinical thyroid disease in women (18-75 years) of one community was not associated with decreased well-being or impaired health -related quality of life (127) (A). Furthermore, other large cross-sectional studies have also failed to find any significant effects on cognition, depression and anxiety in SH (38,99,128,129) (D,A,A,B). To add more controversy to this topic, two studies from Brazil exploring neuropsychological function by different techniques arrived at opposite conclusions (130,131) (B,B).…”

Section: Are Clinical Symptoms Depression and Cognitive Dysfunctionmentioning

confidence: 93%

“…There is good evidence suggesting that SH is not related to symptoms or with disorders of cognition and mood in older persons (99,128,129) (A,B,B), and there is strong evidence (133,134) (A,A) against treating elderly patients with SH aiming to improve cognitive function, quality of life and symptoms.…”

Section: Should Elderly Patients Be Considered For Treatment?mentioning

confidence: 99%

Clinical practice guidelines for the management of hypothyroidism

Brenta

Vaisman

Sgarbi

et al. 2013

Arq Bras Endocrinol Metab

124

123

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Introduction: Hypothyroidism has long been known for its effects on different organ systems, leading to hypometabolism. However, subclinical hypothyroidism, its most prevalent form, has been recently related to cardiovascular risk and also to maternal-fetal complications in pregnant women. Objectives: In these clinical practice guidelines, several aspects of this field have been discussed with the clear objectives of helping physicians treat patients with hypothyroidism, and of sharing some of our Latin American-based clinical experience. Materials and methods: The Latin American Thyroid Society commissioned a Task Force on Hypothyroidism to develop evidence-based clinical guidelines on hypothyroidism. A systematic review of the available literature, focused on the primary databases of MedLine/PubMed and Lilacs/SciELO was performed. Filters to assess methodological quality were applied to select the best quality studies. The strength of recommendation on a scale from A-D was based on the Oxford Centre for Evidence--based Medicine, Levels of Evidence 2009, allowing an unbiased opinion devoid of subjective viewpoints. The areas of interest for the studies comprised diagnosis, screening, treatment and a special section for hypothyroidism in pregnancy. Results: Several questions based on diagnosis, screening, treatment of hypothyroidism in adult population and specifically in pregnant women were posed. Twenty six recommendations were created based on the answers to these questions. Despite the fact that evidence in some areas of hypothyroidism, such as therapy, is lacking, out of 279 references, 73% were Grade A and B, 8% Grade C and 19% Grade D. Conclusions: These evidence-based clinical guidelines on hypothyroidism will provide unified criteria for management of hypothyroidism throughout Latin America. Although most of the studies referred to are from all over the world, the point of view of thyroidologists from Latin America is also given. Arq Bras Endocrinol Metab. 2013;57(4):265-99

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“…Additional analysis stratified by the degree of serum TSH elevation (4.5-6.9; 7.0-9.9 and 10.0-19.9 mIU/l) confirmed the absence of this association [22]. Accordingly, a cross-sectional study with subgroup analyses by age evidenced an increased CHD risk only in younger sHT participants (<50 years old) [23]. Moreover, a meta-analysis of 5 studies demonstrated that sHT is associated with increased CHD prevalence and events only in young adults (aged <65 years), in which an increased incidence of CHD was present regardless the degree of serum TSH elevation [24].…”

Section: Editorialmentioning

confidence: 65%

Cardiovascular Risk and Mild Thyroid Hormone Deficiency: Are there some Differences in the Elderly?

Pasqualetti¹,

Pagano²,

Monzani

2014

J Hematol Thrombo Dis

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EditorialSubclinical hypothyroidism (sHT) is a clinical condition defined as serum TSH concentration above the upper limit of the reference range in the face of normal free T4 (FT4) and free T3 (FT3) levels. Subclinical hypothyroidism, the prevalence of which increases with age, especially among women, up to almost 20%, encompasses several pathological entities, mainly represented by chronic autoimmune thyroiditis [1,2]. sHT is often associated to symptoms that resembles those of overt hypothyroidism, although to a lesser extent thus, the expression 'mild thyroid impairment' or 'mild thyroid hormone deficiency' would be more appropriate for defining such a condition [1]. Nonetheless, the term sHT is recognized worldwide and will be utilized in the present editorial. Since 90s, a relationship between sHT and increased cardio-vascular (CV) risk (both heart failure and coronary heart disease events) has been reported, although some experiences suggest that the risk may depend on the degree of TSH elevation [1,[3][4][5]. Moreover, several reports from elderly population (>65 years old) showed that this relationship seems no longer evident in such individuals especially in the oldest old (>85 years old) [6][7][8][9].The relationship between thyroid function and ageing has been hypothesized more than almost two decades ago [8]. Several clinical studies confirmed an age-dependent decrease of thyroid function including iodine uptake and thyroid hormone production [9]. However, it should be underlined that direct age-related changes need to be distinguished from the actual alterations induced by thyroid diseases or non-thyroidal illness. In this setting, conflicting results still exist regarding the serum TSH reference range and its modification with ageing between earlier reports (mainly case-control or crosssectional) and recent large naturalistic studies [3,[7][8][10][11][12][13][14]. Given that sHT is essentially recognized as abnormal serum TSH elevation, the definition of a worldwide recognized age-related reference range is clearly warranted.Thyroid hormones (TH) are implicated in maintaining and integrating metabolic homeostasis at multiple levels, and their deficiency can affect CV system by complex mechanisms involving both myocardium and vasculature, favouring hypertension and diastolic heart alteration. Moreover, sHT is associate to atherogenic conditions such as metabolic alterations, characterized by hypercholesterolemia and glucose intolerance as well as impaired coagulation [9]. These findings may explain the reported association between thyroid hormone deficiency and increased risk of CV diseases. However, whereas TH deficiency may contribute to atherogenic CV alterations (e.g. increase coronary heart disease (CHD) risk) in young adults (<65 years old) and moderate old patients (<75 years old), data from both humans and animal models showed a negative correlation between serum TH value and longevity [1,10]. In this setting, conflicting data are still existing on the association between sHT and CHD: some ...

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Endogenous subclinical thyroid disorders, physical and cognitive function, depression, and mortality in older individuals

Cited by 136 publications

References 41 publications

Thyroid function and the metabolic syndrome in older persons: a population-based study

Thyroid function and the metabolic syndrome in older persons: a population-based study

Clinical practice guidelines for the management of hypothyroidism

Cardiovascular Risk and Mild Thyroid Hormone Deficiency: Are there some Differences in the Elderly?

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