The aging thyroid

Tabatabaie, Vafa; Surks, Martin I.

doi:10.1097/01.med.0000433055.99570.52

Cited by 36 publications

(30 citation statements)

References 35 publications

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“…Although some studies do not support the routine screening of individuals for thyroid disease, 6 these results suggest that routinely screening patients using TSH as a simple biomarker may be beneficial in identifying subjects with SCH or undiagnosed overt hypothyroidism who are at increased risk of cardiovascular events. This is particularly important as these patients may benefit from TRT to reduce the risk of adverse health outcomes 24 as well as cardiovascular disease.…”

Section: Hypothyroidism and Major Adverse Cardiovascular And Cerebralmentioning

confidence: 70%

“…2 The prevalence of hypothyroidism continues to be debated, 3 and the lack of consistency in results across studies may be due to varying definitions of hypothyroidism. 4 Most studies report a higher prevalence of hypothyroidism in elderly women, 5,6 with estimates as high as 24% in women .60 years of age. Up to 60% of those with hypothyroidism are unaware of their condition, yet the frequency of medical professionals prescribing thyroid medication has increased dramatically over time in the USA, from an estimated 49.8 million prescriptions in 2006 to 70.5 million in 2010.…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes of patients with hypothyroidism undergoing percutaneous coronary intervention

Zhang¹,

Sara²,

Matsuzawa³

et al. 2016

Eur Heart J

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AimsThe aim of this study was to investigate the association between hypothyroidism and major adverse cardiovascular and cerebral events (MACCE) in patients undergoing percutaneous coronary intervention (PCI). Methods and resultsTwo thousand four hundred and thirty patients who underwent PCI were included. Subjects were divided into two groups: hypothyroidism (n ¼ 686) defined either as a history of hypothyroidism or thyroid-stimulating hormone (TSH) ≥5.0 mU/mL, and euthyroidism (n ¼ 1744) defined as no history of hypothyroidism and/or 0.3 mU/mL ≤ TSH , 5.0 mU/mL. Patients with hypothyroidism were further categorized as untreated (n ¼ 193), or those taking thyroid replacement therapy (TRT) with adequate replacement (0.3 mU/mL ≤ TSH , 5.0 mU/mL, n ¼ 175) or inadequate replacement (TSH ≥ 5.0 mU/mL, n ¼ 318). Adjusted hazard ratios (HRs) were calculated using Cox proportional hazards models. Median follow-up was 3.0 years (interquartile range, 0.5 -7.0). After adjustment for covariates, the risk of MACCE and its constituent parts was higher in patients with hypothyroidism compared with those with euthyroidism (MACCE: HR: 1.28, P ¼ 0.0001; myocardial infarction (MI): HR: 1.25, P ¼ 0.037; heart failure: HR: 1.46, P ¼ 0.004; revascularization: HR: 1.26, P ¼ 0.0008; stroke: HR: 1.62, P ¼ 0.04). Compared with untreated patients or those with inadequate replacement, adequately treated hypothyroid patients had a lower risk of MACCE (HR: 0.69, P ¼ 0.005; HR: 0.78, P ¼ 0.045), cardiac death (HR: 0.43, P ¼ 0.008), MI (HR: 0.50, P ¼ 0.0004; HR: 0.60, P ¼ 0.02), and heart failure (HR: 0.50, P ¼ 0.02; HR: 0.52, P ¼ 0.017). ConclusionHypothyroidism is associated with a higher incidence of MACCE compared with euthyroidism in patients undergoing PCI. Maintaining adequate control on TRT is beneficial in preventing MACCE.--

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Section: Hypothyroidism and Major Adverse Cardiovascular And Cerebralmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of patients with hypothyroidism undergoing percutaneous coronary intervention

Zhang¹,

Sara²,

Matsuzawa³

et al. 2016

Eur Heart J

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“…However, detection of thyroid function values outside the assay reference ranges must not necessarily indicate a thyroid disorder. For this reason, there have been heated debates on the so-called ‘normal TSH values' for some years on both national and international stages [4,20,21]. Determination of TSH serum concentrations in clinical chemistry largely depends on the assay(s) used and usually manufacturer-derived reference ranges.…”

Section: Laboratory Th Assessmentmentioning

confidence: 99%

Understanding the Healthy Thyroid State in 2015

2015

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Thyroid hormones (TH) are of crucial importance for the physiological function of almost all organs. In cases of abnormal TH signaling, pathophysiological consequences may arise. The routine assessment of a healthy or diseased thyroid function state is currently based on the determination of serum concentrations of thyroid-stimulating hormone (TSH), and the TH T₃ and T₄. However, the definition of a ‘normal' TSH range and similarly ‘normal' T₃ and T₄ concentrations remains the subject of debate in different countries worldwide and has important implications on patient treatment in clinics. Not surprisingly, a significant number of patients whose thyroid function tests are biochemically determined to be within the normal range complain of impaired well-being. The reasons for this are so far not fully understood, but it has been recognized that thyroid function status needs to be ‘individualized' and extended beyond simple TSH measurement. Thus, more precise and reliable parameters are required in order to optimally define the healthy thyroid status of an individual, and as a perspective to employ these in clinical routine. With the recent identification of new key players in TH action, a more accurate assessment of a patient's thyroid status may in the future become possible. Recently described distinct TH derivatives and metabolites, TH transporters, nongenomic TH effects (either through membrane-bound or cytosolic signaling), and classical nuclear TH action allow for insights into molecular and cellular preconditions of a healthy thyroid state. This will be a prerequisite to improve management of thyroid dysfunction, and additionally to prevent and target TH-related nonthyroid disease.

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“…Aging results in significant alterations in thyroid hormone synthesis, metabolism, and action, and the biological activity of thyroidstimulating hormone (TSH) has been observed to decrease with aging (7,8). Possible interactions between thyroid hormones and concomitant treatment may induce significant changes in the HPT axis (7).…”

Section: Introductionmentioning

confidence: 99%

Indices of adiposity and thyroid hormones in euthyroid postmenopausal women

Lambrinoudaki

Armeni

Rizos

et al. 2015

European Journal of Endocrinology

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Objective: We aimed to evaluate the association between thyroid hormones and indices of obesity in a sample of euthyroid postmenopausal women. Design: Cross-sectional study. Methods: Serum levels of TSH, free triiodothyronine (FT 3 ), and free thyroxine (FT 4 ) as well as BMI and waist:hip ratio (WHR) were evaluated in 194 healthy euthyroid postmenopausal women. Ultrasonography was used to assess abdominal fat layers (subcutaneous fat (SF), preperitoneal fat (PF), and SF:PF ratio). Indices of adiposity were defined as high vs low depending on the median value of the assessed parameters. Results: After multivariate adjustment for traditional risk factors, lower FT 4 levels and a higher FT 3 :FT 4 ratio predicted higher SF mass (FT 4 , Exp(b)Z0.035, PZ0.020 and FT 3 :FT 4 , Exp(b)Z2.374, PZ0.018), whereas higher FT 3 predicted higher PF mass (Exp(b)Z2.815, PZ0.032). Women with FT 3 :FT 4 above the highest quartile had a significantly higher SF mass as compared to women in the lowest quartile (1.81G0.62 cm vs 1.54G0.46 cm, PZ0.027). BMI had a positive independent association with TSH (Exp(b)Z1.829, PZ0.018). Finally, FT 3 was significantly associated with SF mass among women with higher BMI (FT 3 , bZ0.259, PZ0.040) and women with higher WHR (bZ0.309, PZ0.020) but not among women with lower BMI or WHR values. Conclusion: Thyroid hormone levels, and in particular FT 3 , were independently associated with SF and PF in euthyroid postmenopausal women, and this association was mainly evident in women with higher BMIs. On the other hand, among traditional indices of adiposity, only TSH was positively associated with BMI. Larger prospective studies are needed to evaluate the significance of the present findings.

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The aging thyroid

Abstract: A growing body of literature in the last few years, reviewed here, highlights the importance of employing additional caution before assigning diagnoses of hypothyroidism or hyperthyroidism to elderly patients and initiation of treatment modalities that can have long-lasting effects.

Cited by 36 publications

References 35 publications

Clinical outcomes of patients with hypothyroidism undergoing percutaneous coronary intervention

Clinical outcomes of patients with hypothyroidism undergoing percutaneous coronary intervention

Understanding the Healthy Thyroid State in 2015

Indices of adiposity and thyroid hormones in euthyroid postmenopausal women

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