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[Thyroid hormone therapy in old age].
1Medizinische Klinik I, Experimentelle und Klinische Endokrinologie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland. alexander.iwen@uksh.de.
Der Internist
|April 26, 2020
Summary
Thyroid hormone therapy does not improve outcomes for subclinical hypothyroidism when thyroid-stimulating hormone (TSH) is below 10 mIU/l. Treatment is generally not recommended for elderly patients with TSH levels below this threshold due to potential side effects.
Area of Science:
- Endocrinology
- Geriatrics
- Internal Medicine
Background:
- Overt hyperthyroidism treatment reduces mortality and morbidity.
- Evidence for treating subclinical hypothyroidism, especially in the elderly, is unclear.
- Elderly individuals have altered hypothalamo-pituitary regulation and hormone response.
Purpose of the Study:
- To review evidence on treating hypothyroidism in the elderly.
- To determine appropriate initiation thresholds and therapeutic goals for thyroid hormone therapy in older adults.
Main Methods:
- Review of original data and meta-analyses.
- Analysis of evidence regarding morbidity and mortality in subclinical hypothyroidism.
- Examination of treatment guidelines and prescription trends.
Main Results:
- Thyroid hormone therapy does not alter morbidity or mortality in subclinical hypothyroidism with TSH < 7-10 mIU/l.
- Data support a TSH threshold of 10 mIU/l for intervention, particularly in the elderly.
- Thyroxine prescriptions have increased significantly, with TSH levels decreasing.
Conclusions:
- Thyroid hormone substitution should generally not be initiated at TSH levels < 10 mIU/l for subclinical hypothyroidism.
- Elderly patients are more susceptible to side effects of thyroid hormone therapy.
- Symptoms and quality of life are not improved by thyroxine replacement in this population.
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