Low FT3: a possible marker of frailty in the elderly

Abstract

IntroductionFrailty is associated with a functional decline of multiple physiological systems, of which they may be a cause or consequence. The objective of the study was to evaluate the prevalence of thyroid hormone modifications in elderly frail subjects and its relationship with frailty.Study population and methodsAn observational study was carried out at the University Hospital “Tor Vergata” in Rome among ambulatory and hospitalized patients. The study population consisted of 112 elderly subjects: 62 were hospitalized following hip fracture and 50 control subjects were outpatients. Participating patients received a multidimensional geriatric evaluation. The Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI) was used to assess the degree of frailty. Thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were measured to evaluate thyroid status.ResultsFT3, but not FT4, was significantly correlated with Frailty score, both in patients with hip fracture and in patients from the control group. In the entire study population, FT3 under normal limits is effective in discriminating frail/prefrail subjects from nonfrail subjects.DiscussionThe reduction in serum concentrations of FT3 is a clear manifestation of stress associated with fractures. Numerous preexisting factors, such as the fracture patients’ nutritional status, sarcopenia, disability and comorbidities, which characterize the condition of frailty and influence its pathogenesis, are strongly correlated with FT3 values, suggesting the existence of latent nonthyroidal illness syndrome (NTIS).ConclusionWe conclude that measuring FT3 can be a useful laboratory parameter in clinical assessment, which can play an important role in identifying vulnerable elderly subjects and in quantifying the condition of frailty.

Osteoprotegerin in diabetic osteopathy

“…Data presented in this paper derive from the extension of an observational study previously described in Bertoli et al [19], conducted at Tor Vergata University Hospital in Rome on an elderly population and the main aims of which were to evaluate the major markers of frailty and to establish their relationship with changes of the endocrine system observed with ageing [19].…”

“…All patients participating to the study protocol underwent clinical examination, anthropometric parameters (weight and height) were recorded and body mass index (BMI) was calculated. All participants received a multidimensional geriatric evaluation, as previously described [19], and underwent blood sampling for blood cell count, plasma concentrations of glucose, glycosylated haemoglobin (HbA1c), blood urea nitrogen (BUN), creatinine, sodium, potassium, calcium, phosphorus and magnesium, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, albumin, parathyroid hormone (PTH), 25-hydoxyvitamin D (25OHD), osteoprotegerin (OPG), bone alkaline phosphatase (BAP), osteocalcin (OC), Cterminal cross-linked telopeptide of type I collagen (CTX), thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), adrenocorticotropic hormone (ACTH), cortisol, dehydroepiandrosterone sulphate (DHEAS), testosterone, estradiol, sex hormone binding globulin (SHBG), growth hormone (GH), insulinlike growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), interleukin-6 (IL-6), tumor necrosis factor-a (TNF-a), high sensitivity C reactive protein (hs-CRP).…”

“…As described in Bertoli et al [19], comorbidities were assessed using Charlson Comorbidity Index (CCI), the degree of frailty was calculated in 160 subjects using the Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI) [20], and disability was evaluated using the Activities of Daily Living (ADL) scale and the Instrumental Activities of Daily Living (IADL) scale.…”

“…Subjects participating to the study protocol and able to collaborate underwent DXA scans to evaluate lumbar spine and femoral neck bone mineral density (BMD) and T-score, as previously reported [19]. DXA scans were performed and analysed according to the manufacture's guidelines using either dual-energy x-ray absorptiometry Lunar (Lunar Corp., Madison, WI, USA) for subjects enrolled at the Orthopaedic Department or dual-energy x-ray absorptiometry Hologic (Hologic, Inc, Waltham, MA, USA) for subjects enrolled at the Department of Medicine, as described in Valentini et al [22].…”

Frailty and the endocrine system

“…The importance of DHEAS in the pathogenesis of frailty may be most relevant as part of a generalised endocrine dysfunction (79). A 2017 study reported a significant inverse correlation between FT3 and frailty score in elderly subjects (n=112, 62 inpatients with hip fracture and 50 outpatient controls) (113). The study used the 'Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI) to generate the frailty score with an r of -0.436 and P<0.001 when correlated with FT3.…”