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Thyroid status, disability and cognitive function, and survival in old age
Jacobijn Gussekloo1, Eric van Exel, Anton J M de Craen
1Section of Gerontology and Geriatrics, Department of General Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands. jgussekloo@lumc.nl
JAMA
|December 2, 2004
Summary
In the oldest old, high thyrotropin levels were not linked to adverse outcomes and may prolong life. However, randomized trials are needed to confirm if treating subclinical thyroid dysfunction benefits the elderly.
Area of Science:
- Gerontology
- Endocrinology
- Epidemiology
Background:
- Clinical opinion often favors treating subclinical thyroid disorders in the elderly, despite mixed trial results.
- The long-term impact of untreated thyroid dysfunction in advanced age remains unclear.
Purpose of the Study:
- To investigate the impact of subclinical thyroid dysfunction on performance and survival in the oldest old.
- To determine if treating subclinical thyroid dysfunction is warranted in elderly individuals.
Main Methods:
- A prospective, population-based follow-up study of 599 individuals aged 85 years and older.
- Thyroid status, daily life disability, depressive symptoms, cognitive function, and mortality were assessed over a mean follow-up of 3.7 years.
Main Results:
- Thyrotropin and free thyroxine levels were not associated with disability, depression, or cognitive impairment.
- Higher thyrotropin levels correlated with a lower mortality rate (HR, 0.77 per SD increase).
- Higher free thyroxine levels correlated with increased mortality (HR, 1.16 per SD increase).
Conclusions:
- In the oldest old, elevated thyrotropin levels do not appear to cause adverse effects and may be associated with a longer lifespan.
- Further evidence from randomized controlled trials is necessary to guide treatment decisions for subclinical thyroid dysfunction in the elderly.
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