Thyroid Status, Disability and Cognitive Function, and Survival in Old Age
CONTEXT Despite the equivocal outcomes of randomized controlled trials, general clinical opinion favors screening and treatment of elderly individuals with subclinical thyroid disorders. OBJECTIVES To determine whether subclinical thyroid dysfunction should be treated in old age and the long-term im...
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Published in | JAMA : the journal of the American Medical Association Vol. 292; no. 21; pp. 2591 - 2599 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Chicago, IL
American Medical Association
01.12.2004
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Subjects | |
Online Access | Get full text |
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Summary: | CONTEXT Despite the equivocal outcomes of randomized controlled trials, general
clinical opinion favors screening and treatment of elderly individuals with
subclinical thyroid disorders. OBJECTIVES To determine whether subclinical thyroid dysfunction should be treated
in old age and the long-term impact of thyroid dysfunction on performance
and survival in old age. DESIGN, SETTING, AND PARTICIPANTS A prospective, observational, population-based follow-up study within
the Leiden 85-Plus Study of 87% of a 2-year birth cohort (1912-1914) in the
municipality of Leiden, the Netherlands. A total of 599 participants were
followed up from age 85 years through age 89 years (mean [SD] follow-up, 3.7
[1.4] years). MAIN OUTCOME MEASURES Complete thyroid status at baseline; disability in daily life, depressive
symptoms, cognitive function, and mortality from age 85 years through 89 years. RESULTS Plasma levels of thyrotropin and free thyroxine were not associated
with disability in daily life, depressive symptoms, and cognitive impairment
at baseline or during follow-up. Increasing levels of thyrotropin were associated
with a lower mortality rate that remained after adjustments were made for
baseline disability and health status. The hazard ratio (HR) for mortality
per SD increase of 2.71 mIU/L of thyrotropin was 0.77 (95% confidence interval
[CI], 0.63-0.94; P = .009). The HR for
mortality per SD increase of 0.21 ng/dL (2.67 pmol/L) of free thyroxine increased
1.16-fold (95% CI, 1.04-1.30; P = .009). CONCLUSIONS In the general population of the oldest old, elderly individuals with
abnormally high levels of thyrotropin do not experience adverse effects and
may have a prolonged life span. However, evidence for not treating elderly
individuals can only come from a well-designed, randomized placebo-controlled
clinical trial. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0098-7484 1538-3598 |
DOI: | 10.1001/jama.292.21.2591 |