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Wiener klinische Wochenschrift

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26.11.2019 | review article

Diagnosis and treatment of hypothyroidism in old people

A new old challenge

verfasst von: Antonio Maria Borzì, Antonio Biondi, Francesco Basile, Marco Vacante, PhD

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 5-6/2020

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Summary

Purpose

To review the diagnosis and the treatment of both subclinical and overt hypothyroidism in old people, which could represent a challenge for the clinicians.

Methods

Narrative literature review. An extensive literature search was performed using the databases of Scopus, Medline through PubMed, and Google Scholar from January 1975 to May 2019. The search terms were “hypothyroidism,” “older adults,” “elderly,” and “myxedema.”

Results

Hypothyroidism is more common among older subjects in comparison to the younger counterparts. The hypothalamic-pituitary-thyroid axis and its hormones undergo significant changes due to the physiological aging process. For a correct diagnosis of hypothyroidism in old people clinicians must take such age-related changes into account.

Conclusions

The administration of replacement therapy in older adults should consider frailty, polypharmacy and a high risk to develop overtreatment symptoms. On the other hand, older patients with untreated or undertreated hypothyroidism may develop a state of myxedema coma.

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Mullur R, Liu Y‑Y, Brent GA. Thyroid hormone regulation of metabolism. Physiol Rev. 2014;94:355–82.PubMedPubMedCentral

Welsh KJ, Soldin SJ. How reliable are free thyroid and total T3 hormone assays? Eur J Endocrinol. 2016;175:R255–63.PubMedPubMedCentral

Bargi-Souza P, Goulart-Silva F, Nunes MT. Novel aspects of T3 actions on GH and TSH synthesis and secretion: physiological implications. J Mol Endocrinol. 2017;59:R167–78.PubMed

Magri F, Muzzoni B, Cravello L, Fioravanti M, Busconi L, Camozzi D, et al. Thyroid function in physiological aging and in centenarians: possible relationships with some nutritional markers. Metabolism. 2002;51:105–9.PubMed

Mariotti S, Franceschi C, Cossarizza A, Pinchera A. The aging thyroid. Endocr Rev. 1995;16:686–715.PubMed

Vacante M, Biondi A, Basile F, Ciuni R, Luca S, Di Saverio S, et al. Hypothyroidism as a predictor of surgical outcomes in the elderly. Front Endocrinol. 2019;10:258.

No authors listed. Clinical guideline, part 1. Screening for thyroid disease. American College of Physicians. Ann Intern Med. 1998;129(2):141–3.

Helfand M, Redfern CC. Clinical guideline, part 2. Screening for thyroid disease: an update. American College of Physicians. Ann Intern Med. 1998;129:144–58.PubMed

Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR. Serum TSH and total T4 in the United States population and their association with participant characteristics: national health and nutrition examination survey (NHANES 1999–2002). Thyroid. 2007;17:1211–23.PubMed

10.

Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med. 2000;160:526–34.PubMed

11.

Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American association of clinical endocrinologists and the American thyroid association. Endocr Pract. 2012;18:988–1028.PubMed

12.

Sheehan MT. Biochemical testing of the thyroid: TSH is the best and, oftentimes, only test needed—a review for primary care. Clin Med Res. 2016;14:83–92.PubMedPubMedCentral

13.

Koulouri O, Moran C, Halsall D, Chatterjee K, Gurnell M. Pitfalls in the measurement and interpretation of thyroid function tests. Best Pract Res Clin Endocrinol Metab. 2013;27:745–62.PubMedPubMedCentral

14.

Spencer CA, Hollowell JG, Kazarosyan M, Braverman LE. National health and nutrition examination survey III thyroid-stimulating hormone (TSH)-thyroperoxidase antibody relationships demonstrate that TSH upper reference limits may be skewed by occult thyroid dysfunction. J Clin Endocrinol Metab. 2007;92:4236–40.PubMed

15.

Chakera AJ, Pearce SH, Vaidya B. Treatment for primary hypothyroidism: current approaches and future possibilities. Drug Des Devel Ther. 2011;6:1–11.PubMedPubMedCentral

16.

Burman KD, Wartofsky L. Thyroid function in the intensive care unit setting. Crit Care Clin. 2001;17:43–57.PubMed

17.

Stathatos N, Wartofsky L. The euthyroid sick syndrome: Is there a physiologic rationale for thyroid hormone treatment? J Endocrinol Invest. 2003;26:1174–9.PubMed

18.

Simons RJ, Simon JM, Demers LM, Santen RJ. Thyroid dysfunction in elderly hospitalized patients. Effect of age and severity of illness. Arch Intern Med. 1990;150:1249–53.PubMed

19.

Burrows AW, Shakespear RA, Hesch RD, Cooper E, Aickin CM, Burke CW. Thyroid hormones in the elderly sick: “T4 euthyroidism.”. Br Med J. 1975;4:437–9.PubMedPubMedCentral

20.

Slag MF, Morley JE, Elson MK, Crowson TW, Nuttall FQ, Shafer RB. Hypothyroxinemia in critically ill patients as a predictor of high mortality. JAMA. 1981;245:43–5.PubMed

21.

Hamblin PS, Dyer SA, Mohr VS, Le Grand BA, Lim CF, Tuxen DV, et al. Relationship between thyrotropin and thyroxine changes during recovery from severe hypothyroxinemia of critical illness. J Clin Endocrinol Metab. 1986;62:717–22.PubMed

22.

Wong ET, Bradley SG, Schultz AL. Elevations of thyroid-stimulating hormone during acute nonthyroidal illness. Arch Intern Med. 1981;141:873–5.PubMed

23.

Huber G, Staub J‑J, Meier C, Mitrache C, Guglielmetti M, Huber P, et al. Prospective study of the spontaneous course of subclinical hypothyroidism: prognostic value of thyrotropin, thyroid reserve, and thyroid antibodies. J Clin Endocrinol Metab. 2002;87:3221–6.PubMed

24.

Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev. 2008;29:76–131.PubMed

25.

Sawin CT, Bigos ST, Land S, Bacharach P. The aging thyroid. Relationship between elevated serum thyrotropin level and thyroid antibodies in elderly patients. Am J Med. 1985;79:591–5.PubMed

26.

Drinka PJ, Nolten WE, Voeks S, Langer E. Thyroid stimulating hormone elevation without antithyroid antibody elevation in nursing home patients. J Am Geriatr Soc. 1991;39:1000–1.PubMed

27.

Rosenthal MJ, Hunt WC, Garry PJ, Goodwin JS. Thyroid failure in the elderly. Microsomal antibodies as discriminant for therapy. JAMA. 1987;258:209–13.PubMed

28.

Okuroglu N, Ozdemir A, Sertbas Y, Sancak S. The relationship between thyroid antibody titer and levothyroxine dose in patients with overt primary hypothyroidism. Ann Saudi Med. 2017;37:189–93.PubMedPubMedCentral

29.

Pantalone KM, Hatipoglu BA. Hyponatremia and the thyroid: causality or association? J Clin Med. 2014;4:32–6.PubMedPubMedCentral

30.

Rizos CV, Elisaf MS, Liberopoulos EN. Effects of thyroid dysfunction on lipid profile. Open Cardiovasc Med J. 2011;5:76–84.PubMedPubMedCentral

31.

Ranka R, Mathur R. Serum creatine phosphokinase in thyroid disorders. Indian J Clin Biochem. 2003;18:107–10.PubMedPubMedCentral

32.

Patel RP, Jain A. Study of anemia in primary hypothyroidism. Thyroid Res Pract. 2017;14:22.

33.

Dong X, Yao Z, Hu Y, Yang N, Gao X, Xu Y, et al. Potential harmful correlation between homocysteine and low-density lipoprotein cholesterol in patients with hypothyroidism. Medicine (Baltimore). 2016; https://doi.org/10.1097/MD.0000000000004291.CrossRefPubMedPubMedCentral

34.

Gharib H, Tuttle RM, Baskin HJ, Fish LH, Singer PA, McDermott MT, et al. Consensus statement #1: subclinical thyroid dysfunction: a joint statement on management from the American association of clinical endocrinologists, the American thyroid association, and the endocrine society. Thyroid. 2005;15(1):24–8. response 32–33.PubMed

35.

Baskin HJ, Cobin RH, Duick DS, Gharib H, Guttler RB, Kaplan MM, et al. American association of clinical endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract. 2002;8:457–69.PubMed

36.

Vanderpump MP, Ahlquist JA, Franklyn JA, Clayton RN. Consensus statement for good practice and audit measures in the management of hypothyroidism and hyperthyroidism. The research unit of the royal college of physicians of London, the endocrinology and diabetes committee of the royal college of physicians of London, and the society for endocrinology. BMJ. 1996;313:539–44.PubMedPubMedCentral

37.

Atzmon G, Barzilai N, Hollowell JG, Surks MI, Gabriely I. Extreme longevity is associated with increased serum thyrotropin. J Clin Endocrinol Metab. 2009;94:1251–4.PubMedPubMedCentral

38.

Vacante M, D’Agata V, Motta M, Malaguarnera G, Biondi A, Basile F, et al. Centenarians and supercentenarians: a black swan. Emerging social, medical and surgical problems. BMC Surgery. 2012;12(1):S36.PubMedPubMedCentral

39.

Gussekloo J, van Exel E, de Craen AJM, Meinders AE, Frölich M, Westendorp RGJ. Thyroid function, activities of daily living and survival in extreme old age: the ‘Leiden 85-plus Study’. Ned Tijdschr Geneeskd. 2006;150:90–6.PubMed

40.

van den Beld AW, Visser TJ, Feelders RA, Grobbee DE, Lamberts SWJ. Thyroid hormone concentrations, disease, physical function, and mortality in elderly men. J Clin Endocrinol Metab. 2005;90:6403–9.PubMed

41.

Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014;24:1670–751.PubMedPubMedCentral

42.

McDermott MT, Haugen BR, Lezotte DC, Seggelke S, Ridgway EC. Management practices among primary care physicians and thyroid specialists in the care of hypothyroid patients. Thyroid. 2001;11:757–64.PubMed

43.

Waring AC, Arnold AM, Newman AB, Bùzková P, Hirsch C, Cappola AR. Longitudinal changes in thyroid function in the oldest old and survival: the cardiovascular health study all-stars study. J Clin Endocrinol Metab. 2012;97:3944–50.PubMedPubMedCentral

44.

Simonsick EM, Newman AB, Ferrucci L, Satterfield S, Harris TB, Rodondi N, et al. Subclinical hypothyroidism and functional mobility in older adults. Arch Intern Med. 2009;169:2011–7.PubMedPubMedCentral

45.

Gussekloo J, van Exel E, de Craen AJM, Meinders AE, Frölich M, Westendorp RGJ. Thyroid status, disability and cognitive function, and survival in old age. JAMA. 2004;292:2591–9.PubMed

46.

Somwaru LL, Arnold AM, Cappola AR. Predictors of thyroid hormone initiation in older adults: results from the cardiovascular health study. J Gerontol A Biol Sci Med Sci. 2011;66:809–14.PubMed

47.

Eligar V, Taylor PN, Okosieme OE, Leese GP, Dayan CM. Thyroxine replacement: a clinical endocrinologist’s viewpoint. Ann Clin Biochem. 2016;53:421–33.PubMed

48.

Stockigt J. Assessment of thyroid function: towards an integrated laboratory—clinical approach. Clin Biochem Rev. 2003;24:109–22.PubMedPubMedCentral

49.

Koch L. Pharmacotherapy: levothyroxine in the elderly-finding the breaking point. Nat Rev Endocrinol. 2011;7:435.PubMed

50.

Saravanan P, Chau W‑F, Roberts N, Vedhara K, Greenwood R, Dayan CM. Psychological well-being in patients on ‘adequate’ doses of l‑thyroxine: results of a large, controlled community-based questionnaire study. Clin Endocrinol (Oxf). 2002;57:577–85.

51.

Brenowitz WD, Han F, Kukull WA, Nelson PT. Treated hypothyroidism is associated with cerebrovascular disease but not Alzheimer’s disease pathology in older adults. Neurobiol Aging. 2018;62:64–71.PubMed

52.

Roberts CG, Ladenson PW. Hypothyroidism. Lancet. 2004;363(9411):793–803.PubMed

53.

Vaidya B, Pearce SHS. Management of hypothyroidism in adults. BMJ. 2008;337:a801.PubMed

54.

Dayan C, Panicker V. Management of hypothyroidism with combination thyroxine (T4) and triiodothyronine (T3) hormone replacement in clinical practice: a review of suggested guidance. Thyroid Res. 2018;11:1.PubMedPubMedCentral

55.

Kong WM, Sheikh MH, Lumb PJ, Naoumova RP, Freedman DB, Crook M, et al. A 6‑month randomized trial of thyroxine treatment in women with mild subclinical hypothyroidism. Am J Med. 2002;112:348–54.PubMed

56.

Jaeschke R, Guyatt G, Gerstein H, Patterson C, Molloy W, Cook D, et al. Does treatment with L‑thyroxine influence health status in middle-aged and older adults with subclinical hypothyroidism? J Gen Intern Med. 1996;11:744–9.PubMed

57.

Stott DJ, Rodondi N, Bauer DC, TRUST Study Group. Thyroid hormone therapy for older adults with subclinical hypothyroidism. N Engl J Med. 2017;377:e20.PubMed

58.

Razvi S, Weaver JU, Butler TJ, Pearce SHS. Levothyroxine treatment of subclinical hypothyroidism, fatal and nonfatal cardiovascular events, and mortality. Arch Intern Med. 2012;172:811–7.PubMed

59.

Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham survey. Clin Endocrinol (Oxf). 1995;43:55–68.

60.

Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA. 2004;291:228–38.PubMed

61.

Beastall G, Beckett G, Franklyn J, et al. UK guidelines for the use of thyroid function tests: the Association for Clinical Biochemistry, British Thyroid Association, British Thyroid Foundation, ACB and BTA, London. 2006.

62.

Nyström E, Bengtsson C, Lindquist O, Noppa H, Lindstedt G, Lundberg PA. Thyroid disease and high concentration of serum thyrotrophin in a population sample of women. A 4‑year follow-up. Acta Med Scand. 1981;210:39–46.PubMed

63.

Tunbridge WM, Evered DC, Hall R, Appleton D, Brewis M, Clark F, et al. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol (Oxf). 1977;7:481–93.

64.

Hennessey JV, Espaillat R. Diagnosis and management of subclinical hypothyroidism in elderly adults: a review of the literature. J Am Geriatr Soc. 2015;63:1663–73.PubMed

65.

Sawin CT, Geller A, Wolf PA, Belanger AJ, Baker E, Bacharach P, et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med. 1994;331:1249–52.PubMed

66.

Biondi B, Fazio S, Carella C, Amato G, Cittadini A, Lupoli G, et al. Cardiac effects of long term thyrotropin-suppressive therapy with levothyroxine. J Clin Endocrinol Metab. 1993;77:334–8.PubMed

67.

Nyström E, Caidahl K, Fager G, Wikkelsö C, Lundberg PA, Lindstedt G. A double-blind cross-over 12-month study of L‑thyroxine treatment of women with “subclinical” hypothyroidism. Clin Endocrinol (Oxf). 1988;29:63–75.

68.

Müller B, Zulewski H, Huber P, Ratcliffe JG, Staub JJ. Impaired action of thyroid hormone associated with smoking in women with hypothyroidism. N Engl J Med. 1995;333:964–9.PubMed

69.

Chu JW, Crapo LM. The treatment of subclinical hypothyroidism is seldom necessary. J Clin Endocrinol Metab. 2001;86:4591–9.PubMed

70.

Pearce SHS, Brabant G, Duntas LH, Monzani F, Peeters RP, Razvi S, et al. 2013 ETA guideline: management of subclinical hypothyroidism. Eur Thyroid J. 2013;2:215–28.PubMedPubMedCentral

71.

Mathew V, Misgar RA, Ghosh S, Mukhopadhyay P, Roychowdhury P, Pandit K, et al. Myxedema coma: a new look into an old crisis. J Thyroid Res. 2011;2011:493462.PubMedPubMedCentral

72.

Ueda K, Kiyota A, Tsuchida M, Okazaki M, Ozaki N. Successful treatment of myxedema coma with a combination of levothyroxine and liothyronine. Endocr J. 2019;66:469–74.PubMed

73.

Olsen CG. Myxedema coma in the elderly. J Am Board Fam Pract. 1995;8:376–83.PubMed

74.

Rosenbaum RL, Barzel US. Levothyroxine replacement dose for primary hypothyroidism decreases with age. Ann Intern Med. 1982;96:53–5.PubMed

75.

Sawin CT, Herman T, Molitch ME, London MH, Kramer SM. Aging and the thyroid. Decreased requirement for thyroid hormone in older hypothyroid patients. Am J Med. 1983;75:206–9.PubMed

76.

Wartofsky L. Myxedema coma. Endocrinol Metab Clin North Am. 2006;35(4):687–98.PubMed

Titel: Diagnosis and treatment of hypothyroidism in old people
A new old challenge
verfasst von: Antonio Maria Borzì
Antonio Biondi
Francesco Basile
Marco Vacante, PhD
Publikationsdatum: 26.11.2019
Verlag: Springer Vienna
Erschienen in: Wiener klinische Wochenschrift / Ausgabe 5-6/2020
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI: https://doi.org/10.1007/s00508-019-01579-8

Springer Medizin Österreich

Summary

Purpose

Methods

Results

Conclusions

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