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Related Experiment Videos

Low serum thyrotropin (thyroid-stimulating hormone) in older persons without hyperthyroidism.

C T Sawin1, A Geller, M M Kaplan

  • 1Medical Services, Boston (Mass) Veterans Affairs Medical Center.

Archives of Internal Medicine
|January 1, 1991
PubMed
Summary

In older adults, a low thyroid-stimulating hormone (TSH) level is common but often not indicative of hyperthyroidism. Measuring TSH first is recommended for screening, with thyroxine levels aiding diagnosis when needed.

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Area of Science:

  • Endocrinology
  • Geriatrics
  • Clinical Chemistry

Background:

  • Subtle thyroid dysfunction is common in older adults.
  • A low serum thyroid-stimulating hormone (TSH) level, suggestive of hyperthyroidism in younger individuals, may have different implications in the elderly.

Purpose of the Study:

  • To determine the prevalence of low serum TSH levels in ambulatory individuals over 60 years old.
  • To assess the diagnostic value of low TSH and thyroxine levels for identifying hyperthyroidism in this population.

Main Methods:

  • A sensitive assay was used to measure serum TSH in 2575 unselected individuals aged over 60.
  • Follow-up of up to 4 years was conducted for individuals with low TSH levels.
  • Serum thyroxine (T4) levels were measured to differentiate between euthyroidism and hyperthyroidism.

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Main Results:

  • 3.9% of the population studied had low serum TSH levels.
  • Of those with low TSH, about half were on thyroid hormone replacement.
  • Only 6% of individuals with low TSH were actually hyperthyroid; most remained euthyroid, with low TSH values often associated with normal or borderline normal thyroxine levels.

Conclusions:

  • A low serum TSH level is more common than hyperthyroidism in older adults.
  • Measuring serum TSH is a sensitive initial screening test for hyperthyroidism in the elderly.
  • Adding a serum thyroxine measurement to a low TSH result significantly improves the positive predictive value for diagnosing hyperthyroidism.