Thyroid Status and 6‐Year Mortality in Elderly People Living in a Mildly Iodine‐Deficient Area: The Aging in the Chianti Area Study
Open accessAbstract
Objectives: To test the hypothesis that, in older adults, living in a mildly iodine‐deficient area, thyroid dysfunction may be associated with mortality independent of potential confounders. Design: Longitudinal. Setting: Community‐based. Participants: Nine hundred fifty‐one individuals aged 65 and older. Measurements: Plasma thyrotropin, free thyroxine, and free triiodothyronine concentrations and demographic features were evaluated in participants of the Invecchiare in Chianti Study aged 65 and older. Participants were classified according to thyroid function test. Kaplan‐Meier survival and Cox proportional hazards models adjusted for confounders were used in the analysis. Results: Eight hundred nineteen participants were euthyroid, 83 had subclinical hyperthyroidism ( SH yper), and 29 had subclinical hypothyroidism ( SH ypo). Overt hypo‐ and hyperthyroidism were found in five and 15 subjects, respectively. During a median of 6 years of follow‐up, 210 deaths occurred (22.1%), 98 (46.6%) of which were from cardiovascular causes. Kaplan‐Meier analysis revealed higher overall mortality for SH yper ( P = .04) than euthyroid subjects. After adjusting for multiple confounders, participants with SH yper (hazard ratio ( HR ) = 1.65, 95% confidence interval ( CI ) = 1.02–2.69) had significantly higher all‐cause mortality than those with normal thyroid function. No significant association was found between SH yper and cardiovascular mortality. In euthyroid subjects, thyrotropin was found to be predictive of lower risk of all‐cause mortality ( HR = 0.76, 95% CI = 0.57–0.99). Conclusion: SH yper is an independent risk factor for all‐cause mortality in older adults. Low to normal circulating thyrotropin should be carefully monitored in elderly euthyroid individuals.
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Some studies report increased overall mortality rates in SH subjects, especially older subjects, while others indicate no relation.
“Some studies report increased overall mortality rates in SH subjects (374,379-383), especially older subjects, while others indicate no relation (384)(385)(386)(387).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [380]
Some other, smaller studies have reached similar conclusions, although other smaller studies have failed to find a correlation.
“Some other, smaller studies have reached similar conclusions (374,383), although other smaller studies have failed to find a correlation (380,381,384,386).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [380]
Subclinical hyperthyroidism with low but detectable TSH is associated with increased overall mortality in older subjects.
“Some of these studies re-ported increased risks of overall mortality in older subjects (380,429), cardiovascular events (391), heart failure (381), and atrial fibrillation in all subjects (401) or in older subjects (384), and vertebral fractures in older women (408).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [380]
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“Some of these studies reported increased risks of overall mortality in older subjects (380,429), cardiovascular events (391), heart failure (381), and atrial fibrillation in all subjects (401) or in older subjects (384), and vertebral fractures in older women (408).”
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- Authors
- Ceresini, G., Ceda, G. P., Lauretani, F., Maggio, M., Usberti, E., Marina, M., Bandinelli, S., Guralnik, J. M., Valenti, G., & Ferrucci, L.
- Affiliations
- Ospedale di Parma (IT)
- Geriatric Unit University Hospital of Parma Parma Italy
- Azienda Sanitaria di Firenze (IT)
- National Institute on Aging (US)
- Corresponding author
- Ceresini, Graziano
- ORCID
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2013-05-06
- Volume
- 61
- Issue
- 6
- Pages
- 868-874
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC3686888
- OpenAlex
- W2009150636
- Cited by
- 67
- References
- 48
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 5 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 8 · 2019: 6 · 2018: 4 · 2017: 10 · 2016: 8 · 2015: 4 · 2014: 9 · 2013: 4
- FWCI
- 6.55
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Johnson and Johnson
- National Institute on Aging
- 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 › Thyroid Cancer Diagnosis and Treatment
- Keywords
- subclinical hyperthyroidism, subclinical hypothyroidism, thyroid dysfunction, all-cause mortality, older adults, iodine deficiency, thyroid-stimulating hormone, free thyroxine, free triiodothyronine, cardiovascular mortality
- MeSH terms
- Aged, Aged, 80 and over, Aging, Cause of Death, Female, Follow-Up Studies, Goiter, Endemic, Humans, Iodine, Italy, Male, Retrospective Studies, Risk Factors, Thyroid Function Tests, Thyroid Gland, Time Factors, Survival Rate, Confidence Intervals, Proportional Hazards Models, Kaplan-Meier Estimate
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