Is Subclinical Thyroid Dysfunction in the Elderly Associated with Depression or Cognitive Dysfunction?

Roberts, Lesley; Pattison, Helen; Roalfe, Andrea; Franklyn, Jayne A.; Wilson, Sue; Hobbs, F. D. R.; Parle, James

doi:10.7326/0003-4819-145-8-200610170-00006

Cited by 222 publications

(190 citation statements)

References 24 publications

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“…Although it is still controversial whether subclinical hypothyroidism is associated with depression or cognitive dysfunction [24,25], it seems possible that disability and/or depressed mood due to endocrinological dysfunction could decrease the physical activity of daily life, which may result in the reduction of mechanical load on heel. On the contrary, loss of physical activity and hypothyroidism might increase body weight, which would be positively associated with bone mass, though there was no association between BMI and heel QUS in this study.…”

Section: Discussionmentioning

confidence: 99%

Subclinical Hypothyroidism is Related to Lower Heel QUS in Postmenopausal Women

et al. 2007

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Abstract. Recent findings suggest that thyroid stimulating hormone (TSH) is a negative regulator of skeletal remodeling by reducing both differentiation of osteoblasts and formation of osteoclasts. In addition, increased fracture risk in untreated hypothyroid patients has been reported to begin up to 8 years before diagnosis. The aim of the present study was to evaluate the effect of subclinical hypothyroidism on bone structure by using the heel QUS. Subjects were outpatients without any past or present history of thyroid disease. Among 210 postmenopausal women, 22 of 33 patients (Hypo), who had elevated serum TSH concentration (TSHõ4 µU/ml) with normal serum free thyroxine (FT 4 ) concentration, agreed to join to this study. We also randomly selected 24 control subjects (Cont) from 176 postmenopausal women with normal thyroid status. Calcaneus osteo sono assessment indices (OSI) of right feet were measured using the ultrasound bone densitometry AOS-100. Serum TSH concentrations in Hypo patients (5.31 ± 1.3 µU/ml) were higher than those in Cont patients (2.05 ± 1.1 µU/ml), and there was significant difference of FT 4 concentrations (Cont 1.33 ± 0.15 ng/dl; Hypo 1.19 ± 0.17 ng/dl). OSI and its Z-score in Hypo subjects (OSI, 2.138 ± 0.152; Z-Score -0.322 ± 0.504 SD, Mean ± SD) were significantly lower than those in Cont subjects (OSI, 2.347 ± 0.243; Z-Score 0.322 ± 0.91 SD, Mean ± SD). Simple regression statistical analysis showed that OSI decreased according to the increase of serum TSH concentration (n = 47, P<0.037). In addition, multiple regression analysis showed that the elevation of serum TSH concentration was associated with the decrease of OSI. These results suggest that the elevation of serum TSH concentration in subclinical hypothyroidism affects not bone turnover but bone structure as assessed by QUS.

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Section: Discussionmentioning

confidence: 99%

Subclinical Hypothyroidism is Related to Lower Heel QUS in Postmenopausal Women

et al. 2007

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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: 99%

“…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

117

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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“…Many recent studies have not shown improvement in mood, anxiety, and cognition in older persons. [48][49][50] In a previous scientific review in 2004, 3 available data were considered insufficient to support a benefit for levothyroxine therapy in patients with SCH, in particular for the group with TSH less than 10 mIU/L, and a similar conclusion can again be drawn in 2008. Management of SCH differs depending on whether the serum TSH concentration is 3 to 5 mIU/L, 5.1 to 10 mIU/L, or higher than 10 mIU/L.…”

Section: Management Of Schmentioning

confidence: 53%

“…33 Treatment failure for depression has been more commonly observed in patients with subclinical hypothyroidism. 34 Evidence of the association between cognitive dysfunction and subclinical hypothyroidism is conflicting, 35,36 and the most recent population-based cross-sectional study examining 2,050 participants including 141 individuals with subclinical hypothyroidism did not show an association with mild cognitive impairment, which represents the earliest detectable clinical stage of cognitive impairment.…”

Section: E Psychiatric and Cognitive Dysfunctionmentioning

confidence: 99%

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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Is Subclinical Thyroid Dysfunction in the Elderly Associated with Depression or Cognitive Dysfunction?

Abstract: After the confounding effects of comorbid conditions and use of medication were controlled for, subclinical thyroid dysfunction was not associated with depression, anxiety, or cognition.

Cited by 222 publications

References 24 publications

Subclinical Hypothyroidism is Related to Lower Heel QUS in Postmenopausal Women

Subclinical Hypothyroidism is Related to Lower Heel QUS in Postmenopausal Women

Clinical practice guidelines for the management of hypothyroidism

Subclinical Hypothyroidism: A Review on Clinical Consequences and Management Strategies

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