Aging and the thyroid
Abstract
In 84 patients, aged 23 to 84, with primary hypothyroidism, the daily dose of thyroxine needed to lower the serum thyrotropin level into the normal range was significantly less in older patients than in younger ones (p less than 0.01). Most of the difference between middle-aged (40 to 60 years) and older patients (greater than 60 years) was due to a decrease in the required dose in men; there was no difference in the dose needed by women in these age groups. Previous hyperthyroidism did not affect the dose of thyroxine required; it is unlikely that residual autonomous thyroid tissue affected the dose. Although the wide range of doses needed precludes use of these data in calculating a dose of thyroxine for an individual patient, doses of 100 micrograms per day or less were common in patients over age 40, and a few patients over age 60 needed 50 micrograms per day or less. Thus, (1) there is a sound physiologic basis for the common practice of using low doses of thyroxine, e.g., 25 micrograms per day, as initial therapy in older hypothyroid patients and (2) it may be reasonable to reassess the dose of thyroxine after several years in older patients.
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LT4 replacement doses tend to decrease with age when they are titrated based on serum TSH.
“LT4 replacement doses tend to decrease with age when they are titrated based on serum TSH (213,215,216,219,220).”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [220]
Most studies examining factors affecting LT4 dose were retrospective chart reviews, but some were prospective.
“Most studies examining this issue were retrospective chart reviews (47,212-224), but some studies were prospective (38,225-229).”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [220]
Older people often require much lower doses to achieve euthyroidism.
“older people often require much lower doses to achieve euthyroidism, and most recommend a reduced dose of 0.5 µg/kg/day in seniors (age >65 years).1 62”
From Levothyroxine dose and risk of fractures in older adults: nested case-control study (2011) · cites this paper as [62]
Most recommend a reduced dose of 0.5 μg/kg/day in seniors (age >65 years).
“older people often require much lower doses to achieve euthyroidism, and most recommend a reduced dose of 0.5 µg/kg/day in seniors (age >65 years).1 62”
From Levothyroxine dose and risk of fractures in older adults: nested case-control study (2011) · cites this paper as [62]
In individuals established on Levothyroxine, dose requirement falls with age.
“There is also evidence that in individuals established on Levothyroxine, dose requirement falls with age [19, 20].”
From Age-related variation in thyroid function – a narrative review highlighting important implications for research and clinical practice (2023) · cites this paper as [19]
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- Authors
- Sawin, C. T., Herman, T., Molitch, M. E., London, M. H., & Kramer, S. M.
- Corresponding author
- Sawin, Clark T.
- ORCID
- Molitch, Mark E.
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 1983-08
- Volume
- 75
- Issue
- 2
- Pages
- 206-209
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W1579861257
- Cited by
- 139
- References
- 23
- Citations by year
- 2025: 2 · 2024: 3 · 2023: 2 · 2022: 2 · 2021: 3 · 2020: 1 · 2019: 3 · 2018: 2 · 2017: 5 · 2016: 4 · 2015: 2 · 2014: 9 · 2013: 3 · 2012: 6
- FWCI
- 4.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Keywords
- primary hypothyroidism, aging, serum thyrotropin, sex differences, elderly patients
- MeSH terms
- Adult, Aged, Aging, Female, Humans, Hypothyroidism, Male, Middle Aged, Thyrotropin, Thyroxine
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