Thyroid Function and Mortality in Older Men: A Prospective Study

Waring, Avantika C.; Harrison, Stephanie L.; Samuels, Mary H.; Ensrud, Kristine E.; LeBlanc, Erin S.; Hoffman, Andrew R.; Orwoll, Eric; Fink, Howard A; Barrett‐Connor, Elizabeth; Bauer, Douglas C.

doi:10.1210/jc.2011-2684

Cited by 75 publications

(79 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Originating from a basic understanding of pituitary thyroid feedback, the perspective of the diagnostic role of TSH has shifted in importance and the parameter has been promoted into a separate statistical measure in its own right (5,6,7,8,9,10,11,12,20). Limitations in this approach include analytical issues, genetic variability, uncertainty about the reference range, high ratio of the basic intra-individual to inter-individual variability and considerable natural intra-individual fluctuations (10,11,12,13,21,22,23,24,25,26,27,28,29).…”

Section: Discussionmentioning

confidence: 99%

“…Failure of the thyroid gland or any change in hormone production is sensitively reflected at the pituitary level via a negative feedback within the hypothalamuspituitary-thyroid regulatory loop. As a result, statistically derived TSH reference ranges have shaped definitions of thyroid dysfunctions, introducing subclinical disease entities and thus have been given the various roles of screening tool, therapeutic target and prognostic marker (5,6,7,8,9).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Is pituitary TSH an adequate measure of thyroid hormone-controlled homoeostasis during thyroxine treatment?

Hoermann

Midgley²,

Larisch

et al. 2013

European Journal of Endocrinology

View full text Add to dashboard Cite

Objective: In recognition of its primary role in pituitary-thyroid feedback, TSH determination has become a key parameter for clinical decision-making. This study examines the value of TSH as a measure of thyroid hormone homoeostasis under thyroxine (T 4 ) therapy. Design and methods: We have examined the interrelationships between free triiodothyronine (FT 3 ), free T 4 (FT 4 ) and pituitary TSH by means of i) a retrospective analysis of a large clinical sample comprising 1994 patients either untreated or on varying doses of L-T 4 and ii) independent mathematical simulation applying a model of thyroid homoeostasis, together with a sensitivity analysis. Results: Over a euthyroid to mildly hyperthyroid functional range, we found markedly different correlation slopes of log TSH vs FT 3 and FT 4 between untreated patients and L-T 4 groups. Total deiodinase activity (G D ) was positively correlated with TSH in untreated subjects. However, G D was significantly altered and the correlation was lost under increasing L-T 4 doses. Ninety-five per cent confidence intervals for FT 3 and FT 4 , when assessed in defined TSH concentration bands, differed significantly for L-T 4 -treated compared with untreated patients. Higher doses were often needed to restore FT 3 levels within its reference range. Sensitivity analysis revealed the influence of various structural parameters on pituitary TSH secretion including an important role of pituitary deiodinase type 2. Conclusion: The data reveal disjoints between FT 4 -TSH feedback and T 3 production that persist even when sufficient T 4 apparently restores euthyroidism. T 4 treatment displays a compensatory adaptation but does not completely re-enact normal euthyroid physiology. This invites a study of the clinical consequences of this disparity.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is pituitary TSH an adequate measure of thyroid hormone-controlled homoeostasis during thyroxine treatment?

Hoermann

Midgley²,

Larisch

et al. 2013

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…It has been reported that in elderly individuals (at least 65 year old or older) high levels of TSH were not associated with an increased risk of CAD and its mortality [19][20][21]. Furthermore, in the study by Gussekloo J et al [22], which included 599 subjects who were aged 85 years at enrollment and followed for a mean period of 3.7 years, individuals with higher TSH levels had a longer life span than controls, suggesting a protective effect of SCH in elderly individuals.…”

Section: Discussionmentioning

confidence: 99%

The relationship between thyroid stimulating hormone within the reference range and coronary artery disease: impact of age

et al. 2013

View full text Add to dashboard Cite

“…Small differences in thyroid function between euthyroid subjects have been reported to be associated with specific health-related outcomes including atrial fibrillation, reduced bone mineral density and incident dementia (12,13,14). However, the effect of differences in thyroid function in euthyroid older people on the key outcome of mortality remains unclear, with limited available data and inconsistent findings reported (11,15,16,17). In this study, we tested the hypothesis that thyroid hormone levels within the normal range are an independent predictor of mortality in a large cohort of community-dwelling older men.…”

Section: Introductionmentioning

confidence: 99%

Higher free thyroxine levels are associated with all-cause mortality in euthyroid older men: the Health In Men Study

Yeap

Alfonso

Hankey

et al. 2013

European Journal of Endocrinology

View full text Add to dashboard Cite

Objective: Thyroid dysfunction predicts poorer health outcomes, but the relationship between thyroid hormone levels within the reference range and mortality in older adults remains unclear. In this study, we examined the associations between the concentrations of free thyroxine (FT 4 ) and TSH and allcause mortality in older men without thyroid disease. Subjects and methods: We performed a longitudinal study in community-dwelling men aged 70-89 years. Men with thyroid disease or taking thyroid-related medications were excluded. Baseline FT 4 and TSH levels were assayed. Incident deaths were ascertained using data linkage. Results: There were 3885 men without thyroid disease followed for (meanGS.D.) 6.4G1.5 years, during which time 837 had died (21.5%). Men who had died had higher baseline FT 4 levels (16.2G2.3 vs 15.8G2.1 pmol/l, P!0.001), but comparable TSH levels (2.4G1.5 vs 2.3G1.5 mIU/l, PZ0.250). After accounting for age, smoking, physical factors and medical comorbidities, higher circulating FT 4 levels predicted all-cause mortality (quartile Q4 vs quartiles Q1-Q3: FT 4 levels R17.32 vs !17.32 pmol/l: adjusted hazard ratio (HR)Z1.19, 95% CIZ1.02-1.39, PZ0.025). TSH levels did not predict mortality. After excluding men with subclinical hyperthyroidism or hypothyroidism, there were 3442 men and 737 who had died (21.4%). In these men, higher FT 4 levels remained independently associated with all-cause mortality (quartile Q4 vs quartiles Q1-Q3: adjusted HRZ1.19, 95% CIZ1.02-1.41, PZ0.032). Conclusions: Higher FT 4 levels are associated with all-cause mortality in euthyroid older men, independently of conventional risk factors and medical comorbidities. Additional research is needed to determine whether or not this relationship is causal and to clarify the utility of thyroid function testing to stratify mortality risk in ageing men.

show abstract

Thyroid Function and Mortality in Older Men: A Prospective Study

Abstract: Subclinical thyroid dysfunction is not associated with an increased risk of all-cause or CV mortality in older men.

Cited by 75 publications

References 24 publications

Is pituitary TSH an adequate measure of thyroid hormone-controlled homoeostasis during thyroxine treatment?

Is pituitary TSH an adequate measure of thyroid hormone-controlled homoeostasis during thyroxine treatment?

The relationship between thyroid stimulating hormone within the reference range and coronary artery disease: impact of age

Higher free thyroxine levels are associated with all-cause mortality in euthyroid older men: the Health In Men Study

Contact Info

Product

Resources

About