Impact of thyroid status and age on comprehensive geriatric assessment

Abstract

This study aimed to evaluate the prevalence of thyroid dysfunction in elderly subjects attending an outpatient clinic at a tertiary hospital and to assess whether subclinical hypothyroidism (SCH) or aging affected activities of daily living (ADLs), instrumental activities of daily living (IADLs), cognitive status, or depressive symptoms. This crosssectional study included 411 patients recruited in the outpatient geriatric setting. 48 subjects reported levothyroxine use and were evaluated separately. After excluding subjects with diseases or drugs which could influence thyroid status, the 284 subjects remaining were classified as having euthyroidism (n = 235, 82.8 %), subclinical hypothyroidism (n = 43, 15.1 %), subclinical hyperthyroidism (n = 4, 1.4 %), or overt hyperthyroidism (n = 2, 0.7 %). ADLs and IADLs were assessed using the Katz Index (ranging from 0 [independence] to 6 [dependence in all activities]) and Health Assessment Questionnaire (ranging from 0 to 3 [severely disabled]), respectively. Cognition was assessed using the mini mental state depressive symptoms that were assessed using the Geriatric depression scale or cornell scale for depression in dementia. SCH did not reduce performance in ADLs or IADLs in elderly subjects as a whole, but was an independent protective factor against dependence in ADLs (OR = 0.196 [0.045–0.853]; p = 0.003) and IADLs (OR = 0.060 [0.010–0.361]; p = 0.002) in subjects aged ≥85 years. Very old subjects with SCH showed better performance in ADLs than did those with euthyroidism (Katz Index: 0.9 ± 1.6 [median: 0.5] vs. 1.7 ± 1.7 [1.0], p = 0.024; HAQ: 1.2 ± 0.8 [0.9] vs. 1.8 ± 1.0 [1.9], p = 0.015). This putative protective effect of SCH was not found in subjects aged <85 years. The number of falls, number of medications used, depressive symptoms, and cognitive impairment did not differ among thyroid status groups, regardless of age. In conclusion, SCH does not have impact functional performance in the elderly population as a whole, but was associated with better functional status in subjects aged ≥85 years.

Approach to geriatric patients with subclinical thyroid disorders

“…For example, in a recent report, Virgini et al [4] reported no substantial differences in functional capacity between either SHypo or subclinical hyperthyroidism (SHyper) and euthyroidism in elderly subjects, although in their study the age of the subjects was lower than that reported in the study by e Silva et al However, the critical evaluation of the results reported by e Silva et al [3] must take into account that the number of subjects in this study was quite low (i.e., 43 SHypo subjects were compared with 235 euthyroid subjects), although this is a characteristic shared by many studies which have dealt with aging and thyroid dysfunctions. Another point to be underlined is represented by the fact that in the study by e Silva et al circulating TSH levels which defined Shypo were modestly elevated (i.e., 5.5 ± 1.2 [Mean ± SD] mIU/L).…”

“…In this issue of Endocrine, e Silva et al [3] evaluated the prevalence of thyroid dysfunction in elderly subjects attending an outpatient clinic and assessed whether subclinical hypothyroidism (SHypo) affected functional status, which was evaluated by the well-known scores for activities of daily living (ADLs) and instrumental activities of daily living (IADLs), cognitive performance or depressive symptoms. Cognitive impairment or depressive symptoms did not differ among thyroid status groups, regardless of age.…”

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

“…As mentioned, elderly individuals with elevated TSH levels have shown better outcomes, especially regarding functionality, than have those with serum TSH levels in the "normal" range (8)(9)(10). In a study including 2,290 elderly subjects, Simonsick and cols.…”

“…High serum TSH levels seem to be associated with better survival and mobility in individuals aged > 85 years comparing to those at the same age but with serum TSH in the reference range (8)(9)(10). Furthermore, recently, an association between lower levels of serum TSH, even in the normal range, and negative outcomes has been proposed, as demonstrated in population-based studies which evaluated depressive symptoms (11), cognitive impairment (12) and hip fractures (13).…”

Should Nursing Home Residents be Screened for Thyroid Function?

“…About 5% of nodules are malignant, although this percentage tends to increase over the recent decades (14,15). Several studies have showed that nursing home residents should be screened for thyroid functions due to the presence of several risk factors, including older age, comorbidities and increased usage of drugs (16,17). In this study; our aim was to investigate whether nursing home residents constitute a priority group for the evaluation of thyroid function.…”