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Thyroid function tests in elderly patients with and without an acute illness.

P Finucane1, T Rudra, H Church

  • 1University of Wales College of Medicine, Heath Park, Cardiff.

Age and Ageing
|November 1, 1989
PubMed
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In acutely ill elderly patients, thyroid function tests often show abnormal thyrotropin (TSH) levels, suggesting impaired pituitary TSH secretion. Standard TSH assays may be unreliable in this population.

Area of Science:

  • Gerontology
  • Endocrinology
  • Clinical Chemistry

Background:

  • Thyroid dysfunction is common in the elderly.
  • Acute illness can affect thyroid hormone levels and pituitary function.
  • Accurate assessment of thyroid function is crucial for elderly patients.

Purpose of the Study:

  • To evaluate thyroid function in acutely ill elderly patients compared to healthy controls.
  • To investigate the reliability of standard thyroid function tests, particularly thyrotropin (TSH), in this demographic.

Main Methods:

  • Measurement of free thyroid hormones and TSH in 78 acutely ill elderly patients and a control group.
  • Comparison of test results between the acutely ill and control groups.
  • Assessment of TSH response to thyrotropin-releasing hormone (TRH) in a subset of patients.

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Main Results:

  • Acutely ill elderly patients showed significantly more abnormal thyroid function tests than controls.
  • Abnormal TSH levels were found in 40% of the acutely ill group versus 8% of controls (p < 0.001).
  • Seven acutely ill patients had very low TSH levels and a blunted TRH response, not attributable to thyroid disease.

Conclusions:

  • Pituitary TSH secretion may be impaired in elderly patients with acute illness, even when thyroid hormone levels are normal (euthyroid sick).
  • High-sensitivity TSH assays might be inappropriate as initial screening tests for thyroid function in acutely ill elderly individuals.
  • Further research is needed to establish appropriate thyroid function testing strategies for this vulnerable population.