[Thyroid function in the aged admitted to a nursing home]

Intrinsic thyroid diseases and so-called sick euthyroid syndrome are frequent among the elderly. Therefore, we set out to assess the usefulness of the measurement of thyroid hormones and TSH on admission to a public nursing home.

A medical history, physical examination, geriatric assessment and a venous sample were taken from 201 elderly subjects on admission to a nursing home. Thyroid hormones and TSH were measured in all cases. All subjects were classified as valid, mentally impaired, or physically impaired, according to the Spanish Red Cross Scales.

Sixty non-disabled and 141 disabled elders were studied. Sixteen (7.9%) cases of primary hypothyroidism were found, of whom 7 (3.5%) were deemed deserving treatment with L-thyroxine, their mean daily dose being 114.3 mcg. Sick euthyroid syndrome was considered to be present in 28 (13.9%) cases, of whom 25 had a normal T4, three had a low T4, and none had a high T4. No cases of hyperthyroidism were detected. Thyroid hormone abnormalities were not statistically associated with age, gender, or physical or mental disability.

On admission to the nursing home, nearly 8% of the elders have hypothyroidism, and an additional 14% have the sick euthyroid syndrome. Routine measurement of T4 and TSH in elders on admission to a nursing home has a favorable cost-utility ratio.