Prevalence of treated hypothyroidism in the community: Analysis from general practices in North‐East England with implications for the United Kingdom

Ingoe, Lorna; Phipps, Norah; Armstrong, G. P.; Rajagopal, Arvind; Kamali, Farzan; Razvi, Salman

doi:10.1111/cen.13440

Cited by 31 publications

(24 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is despite the fact that the oldest age groups comprise the largest proportion of all hypothyroid. [3] Furthermore, over-treatment with thyroid hormones is common in older women, which is a risk factor for atrial fibrillation and osteoporosis. [86] In the United Kingdom, areas with higher levothyroxine prescribing are independently associated with atrial fibrillation.…”

Section: Main Textmentioning

confidence: 99%

“…[2] In the UK, it is estimated that hypothyroidism treated with levothyroxine may affect nearly 800,000 older individuals aged more than 70 years. [3] The clinical presentation of thyroid dysfunction is non-specific and often variable; therefore, the diagnosis of thyroid dysfunction is based primarily on biochemical abnormalities. The pituitary hormone thyrotropin (TSH) has a complex inverse relationship with the thyroid hormones thyroxine (T4) and tri-iodothyronine (T3).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hypothyroidism in the older population

Leng

Razvi

2019

Thyroid Res

Self Cite

View full text Add to dashboard Cite

BackgroundBoth overt hypothyroidism as well as minor elevations of serum thyrotropin (TSH) levels associated with thyroid hormones within their respective reference ranges (termed subclinical hypothyroidism) are relatively common in older individuals. There is growing evidence that treatment of subclinical hypothyroidism may not be beneficial, particularly in an older person. These findings are relevant at a time when treatment with thyroid hormones is increasing and more than 10–15% of people aged over 80 years are prescribed levothyroxine replacement therapy.Main bodyThe prevalence of hypothyroidism increases with age. However, the reference range for TSH also rises with age, as the population distribution of TSH concentration progressively rises with age. Furthermore, there is evidence to suggest that minor TSH elevations are not associated with important outcomes such as impaired quality of life, symptoms, cognition, cardiovascular events and mortality in older individuals. There is also evidence that treatment of mild subclinical hypothyroidism may not benefit quality of life and/or symptoms in older people. It is unknown whether treatment targets should be reset depending on the age of the patient. It is likely that some older patients with non-specific symptoms and incidental mild subclinical hypothyroidism may be treated with thyroid hormones and could potentially be harmed as a result. This article reviews the current literature pertaining to hypothyroidism with a special emphasis on the older individual and assesses the risk/benefit impact of contemporary management on outcomes in this age group.ConclusionsCurrent evidence suggests that threshold for treating mild subclinical hypothyroidism in older people should be high. It is reasonable to aim for a higher TSH target in treated older hypothyroid patients as their thyroid hormone requirements may be lower. In addition, age-appropriate TSH reference ranges should be considered in the diagnostic pathway of identifying individuals at risk of developing hypothyroidism. Appropriately designed and powered randomised controlled trials are required to confirm risk/benefit of treatment of subclinical hypothyroidism in older people. Until the results of such RCTs are available to guide clinical management international guidelines should be followed that advocate a conservative policy in the management of mild subclinical hypothyroidism in older individuals.

show abstract

Section: Main Textmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hypothyroidism in the older population

Leng

Razvi

2019

Thyroid Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…Furthermore, the global prevalence of undiagnosed thyroid dysfunction, at least in the developed world, is falling, probably due to a combination of iodine supplementation in iodine-deficient areas, widespread and frequent thyroid function assessment, and lower thresholds to commence treatment [3–5]. Approximately, 1–3% of the population has hypothyroidism in iodine-replete areas, with much higher prevalence in older persons and in women [5, 6].…”

Section: Introductionmentioning

confidence: 99%

Challenges in Interpreting Thyroid Stimulating Hormone Results in the Diagnosis of Thyroid Dysfunction

Razvi

Bhana

Mrabeti

2019

Journal of Thyroid Research

Self Cite

View full text Add to dashboard Cite

The pituitary hormone, thyrotropin (TSH), is regarded as the primary biomarker for evaluating thyroid function and is useful in guiding treatment with levothyroxine for patients with hypothyroidism. The amplified response of TSH to slight changes in thyroid hormone levels provides a large and easily measured signal in the routine care setting. Laboratories provide reference ranges with upper and lower cutoffs for TSH to define normal thyroid function. The upper limit of the range, used to diagnose subclinical (mild) hypothyroidism, is itself a matter for debate, with authoritative guidelines recommending treatment to within the lower half of the range. Concomitant diseases, medications, supplements, age, gender, ethnicity, iodine status, time of day, time of year, autoantibodies, heterophilic antibodies, smoking, and other factors influence the level of TSH, or the performance of current TSH assays. The long-term prognostic implications of small deviations of TSH from the reference range are unclear. Correction of TSH to within the reference range does not always bring thyroid and other biomarkers into range and will not always resolve the patient's symptoms. Overt hypothyroidism requires intervention with levothyroxine. It remains important that physicians managing a patient with symptoms suggestive of thyroid disease consider all of the patient's relevant disease, lifestyle, and other factors before intervening on the basis of a marginally raised TSH level alone. Finally, these limitations of TSH testing mitigate against screening the population for the undoubtedly substantial prevalence of undiagnosed thyroid disease, until appropriately designed randomised trials have quantified the benefits and harms from this approach.

show abstract

“…However, whether these thyroid conditions are associated with autoimmune problems is not known in the current study. Furthermore, elevated rates of hypothyroidism are common in older adults in the general population, with health record reports documenting a 5% prevalence rate at age 50 and older [Ingoe et al, ], while hyperthyroidism is less common with a prevalence rate of 1% [Vanderpump, ]. Among autistic adults, thyroid disease and endocrine conditions more broadly were found to significantly elevated, with a prevalence rates of 7% compared to 3% in non‐autistic controls [Croen et al, ], however, some samples document rates of thyroid disease up to 32% in autistic populations [Hand et al, ].…”

Section: Discussionmentioning

confidence: 99%

The Mental and Physical Health of Older Adults With a Genetic Predisposition for Autism

et al. 2020

View full text Add to dashboard Cite

Autism commonly aggregates in families, with twin studies estimating heritability to be around 80%. Subclinical autism-like characteristics have also been found at elevated rates in relatives of autistic probands. Physical and psychiatric conditions have been reported at elevated rates in autistic children and adults, and also in their relatives. However, to date, there has been no exploration of how aging may affect this pattern. This study examined cross-sectional data from the ongoing online PROTECT study. A total of 20,220 adults aged 50 years and older reported whether they have an autistic first-degree relative. In total, 739 older adults reported having an autistic first-degree relative (AFDR group) and 11,666 were identified as having no family history of any neurodevelopmental disorder (NFD group). The AFDR group demonstrated significantly higher frequencies of self-reported psychiatric diagnoses and a greater total number of co-occurring psychiatric diagnoses than the NFD group. Furthermore, the AFDR group reported elevated current self-report symptoms of depression, anxiety, traumatic experience, and post-traumatic stress than the NFD group. By contrast, few differences between AFDR and NFD groups were observed in physical health conditions, and no differences were observed in the total number of co-occurring physical health diagnoses. These findings suggest that adults who have an AFDR may be at greater risk of poor mental, but not physical, health in later life. Older adults with autistic relatives may benefit from close monitoring to mitigate this susceptibility and to provide timely intervention. Autism Res 2020, 13: 641-654.Lay Summary: Children and adults with an autistic relative have been found to experience more psychiatric difficulties than those with no family links to autism. However, a few studies have explored what happens when these individuals get older. Examining over 20,000 adults age 50+, we found that older adults with an autistic relative experienced elevated rates of most psychiatric conditions but not physical conditions. Older adults with autistic relatives may benefit from close monitoring to mitigate this susceptibility and to provide timely intervention.These two authors are co-principal investigators.

show abstract

Prevalence of treated hypothyroidism in the community: Analysis from general practices in North‐East England with implications for the United Kingdom

Cited by 31 publications

References 29 publications

Hypothyroidism in the older population

Hypothyroidism in the older population

Challenges in Interpreting Thyroid Stimulating Hormone Results in the Diagnosis of Thyroid Dysfunction

The Mental and Physical Health of Older Adults With a Genetic Predisposition for Autism

Contact Info

Product

Resources

About