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Changes in thyroid function and evolution of subclinical thyroid disease in older men.

Stephanie Y Tan1, S A Paul Chubb1,2, Leon Flicker1,3

  • 1Medical School, University of Western Australia, Perth, WA, Australia.

Clinical Endocrinology
|December 7, 2023
PubMed
Summary

In older men, thyroid stimulating hormone (TSH) levels increase with age, leading to subclinical hypothyroidism in one-fifth of initially euthyroid individuals. Higher baseline TSH and age predict this progression, suggesting increased surveillance for thyroid dysfunction in this demographic.

Keywords:
ageingfree thyroxinehypothyroidismmensubclinical hyperthyroidismsubclinical hypothyroidismthyroid-stimulating hormone

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Area of Science:

  • Gerontology
  • Endocrinology
  • Internal Medicine

Background:

  • Subclinical thyroid disease prevalence rises with age, yet optimal detection and surveillance strategies for older men are not well-defined.
  • Understanding longitudinal changes in thyroid stimulating hormone (TSH) and free thyroxine (FT4) is crucial for managing thyroid dysfunction in aging populations.

Purpose of the Study:

  • To assess TSH and FT4 concentrations and their longitudinal changes in older men.
  • To determine the prevalence and incidence of subclinical thyroid dysfunction in men aged 70 years and above.

Main Methods:

  • A longitudinal study involving 994 community-dwelling men aged ≥70 years without prior thyroid disease.
  • TSH and FT4 levels were measured at baseline and after an average of 8.7 years, with logistic regression and ROC analyses used to identify predictors of incident dysfunction.

Main Results:

  • At baseline, 8.6% had subclinical hypothyroidism and 1.0% had subclinical hyperthyroidism.
  • Of initially euthyroid men, 20.0% developed subclinical/overt hypothyroidism over the follow-up period.
  • Higher age and baseline TSH (≥2.34 mIU/L) were significant predictors of developing hypothyroidism, with high sensitivity and specificity.

Conclusions:

  • TSH concentrations increase over time in older men, while FT4 remains relatively stable.
  • One-fifth of initially euthyroid older men developed subclinical or overt hypothyroidism, with age and higher baseline TSH being key predictors.
  • Increased surveillance for thyroid dysfunction is warranted in older men, particularly those with high-normal TSH levels.