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Hypothyroidism in the older population
Open accessAbstract
BACKGROUND: Both overt hypothyroidism as well as minor elevations of serum thyrotropin (TSH) levels associated with thyroid hormones within their respective reference ranges (termed subclinical hypothyroidism) are relatively common in older individuals. There is growing evidence that treatment of subclinical hypothyroidism may not be beneficial, particularly in an older person. These findings are relevant at a time when treatment with thyroid hormones is increasing and more than 10-15% of people aged over 80 years are prescribed levothyroxine replacement therapy. MAIN BODY: The prevalence of hypothyroidism increases with age. However, the reference range for TSH also rises with age, as the population distribution of TSH concentration progressively rises with age. Furthermore, there is evidence to suggest that minor TSH elevations are not associated with important outcomes such as impaired quality of life, symptoms, cognition, cardiovascular events and mortality in older individuals. There is also evidence that treatment of mild subclinical hypothyroidism may not benefit quality of life and/or symptoms in older people. It is unknown whether treatment targets should be reset depending on the age of the patient. It is likely that some older patients with non-specific symptoms and incidental mild subclinical hypothyroidism may be treated with thyroid hormones and could potentially be harmed as a result. This article reviews the current literature pertaining to hypothyroidism with a special emphasis on the older individual and assesses the risk/benefit impact of contemporary management on outcomes in this age group. CONCLUSIONS: Current evidence suggests that threshold for treating mild subclinical hypothyroidism in older people should be high. It is reasonable to aim for a higher TSH target in treated older hypothyroid patients as their thyroid hormone requirements may be lower. In addition, age-appropriate TSH reference ranges should be considered in the diagnostic pathway of identifying individuals at risk of developing hypothyroidism. Appropriately designed and powered randomised controlled trials are required to confirm risk/benefit of treatment of subclinical hypothyroidism in older people. Until the results of such RCTs are available to guide clinical management international guidelines should be followed that advocate a conservative policy in the management of mild subclinical hypothyroidism in older individuals.
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![Fig. 1 Distribution of serum Thyrotropin (TSH) in relation to age. The lower and upper limits of the TSH reference range are calculated from the 2.5th and 97.5th percentile, respectively, and the circle signifies the median value. (adapted from reference [37])](/paper-figures/0a43532638ba484086140c2101252c33/hypothyroidism-in-the-older-population-figure-1.jpg)
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“The prevalence of hypothyroidism increases with age and subclinical hypothyroidism affects up to 15% of adults 65 years of age or older, when non-age-specific TSH reference ranges are used (9, 12–14).”
From Levothyroxine therapy in elderly patients with hypothyroidism (2021) · cites this paper as [14]
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“Therefore for older people it would be necessary to carry out randomized studies to understand the relationship between risk and benefit in the treatment of subclinical hypothyroidism in these patients (58,59).”
Diagnosis and treatment of hypothyroidism in the elderly
Duntas, L. H., & Yen, P. M. (2019) · Endocrine · doi:10.1007/s12020-019-02067-9 · Cited by 65
Levothyroxine therapy in elderly patients with hypothyroidism
Effraimidis, G., Watt, T., & Feldt-Rasmussen, U. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.641560 · Cited by 60
“, has been conducted in patients with overt disease; even well-designed descriptive longitudinal studies exploring the effect of L-T4 treatment on quality of life among elderly are lacking (14).”
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Thyroid Hormones and Functional Ovarian Reserve: Systemic vs. Peripheral Dysfunctions
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“Indeed, in vitro and in vivo studies showed that Dio1 activity rose in the pituitary during ageing in order to maintain the local level of T3 [40,41], necessary to control the increase of circulating level of TSH [42].”
BackgroundUpdate of hypothyroidism and its management in Unani medicine
Alam, M. A., Quamri, M. A., Sofi, G., & Ansari, S. (2020) · Journal of Basic and Clinical Physiology and Pharmacology · doi:10.1515/jbcpp-2020-0121 · Cited by 31
Risk of Hypothyroidism in Women After Radiation Therapy for Breast Cancer
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“A higher variability in serum TSH has been observed in the older population than in younger age groups, as demonstrated by widening serum TSH range, even in a euthyroid state [117,118].”
BackgroundResultDoes Subclinical Hypothyroidism Add Any Symptoms? Evidence from a Danish Population-Based Study
Carlé, A., Karmisholt, J. S., Knudsen, N., Perrild, H., Thuesen, B. H., Ovesen, L., Rasmussen, L. B., & Pedersen, I. B. (2021) · The American Journal of Medicine · doi:10.1016/j.amjmed.2021.03.009 · Cited by 25
Disease-directed engineering for physiology-driven treatment interventions in neurological disorders
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Immune checkpoint inhibitor induced thyroid dysfunction is a frequent event post-treatment in NSCLC
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“Thyroid dysfunction can be asymptomatic or may be accompanied by a variety of non-specific symptoms including fatigue, weight gain, cold intolerance, constipation.[15].”
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“There is growing evidence suggesting that the treatment of SCH may not be beneficial, particularly in older patients [21].”
BackgroundAdministration and pharmacokinetics of levothyroxine
Lipp, H.-P. (2021) · 70 Years of Levothyroxine · doi:10.1007/978-3-030-63277-9_2 · Cited by 18
Aging and the hypothalamic-pituitary-thyroid axis
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“Hypothyroidism is more common in women and tends to increase with age [2].”
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Clinical Pharmacists in Chronic Care
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“6%, with prevalence being more common in women and in older individuals [187,188].”
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Evaluations of secondary hypertension and laboratory data in the elderly population
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“The prevalence of hypo-thyroidism has been associated with age in general population [24–26] and in pregnant woman as well [21].”
BackgroundAge and Sex Influence Thyroid Hormone Effects in Target Tissues with Organ-Specific Responses
Kerp, H., Gassen, J., & Führer, D. (2020) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/a-1083-6272 · Cited by 7
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Treatment of subclinical hypothyroidism: assessing when treatment is likely to be beneficial
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“increases with the age of the population being studied [15].”
BackgroundAssociation between serum Klotho levels and hypothyroidism in older adults: NHANES 2007–2012
Wang, Y., Hu, B., & Yang, S. (2024) · Scientific Reports · doi:10.1038/s41598-024-62297-4 · Cited by 6
Hypothyroidism is an interdisciplinary problem
", Verbovoy, A. F., S., Dolgikh, Y. A., & Verbovaya, N. I. (2022) · Russian Medical Inquiry · doi:10.32364/2587-6821-2022-6-9-509-515 · Cited by 6
Ionic Levothyroxine Formulations: Synthesis, Bioavailability, and Cytotoxicity Studies
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“It is known that the prevalence increases with age and is higher in females than in males [2].”
BackgroundJessy, A. S., Sandhya, G., Monisha, S., Sundarakumar, J. S., Stezin, A., & Issac, T. G. (2024) · Brain Communications · doi:10.1093/braincomms/fcae391 · Cited by 5
“17 In addition to studies that explore the impact of thyroid dysfunction on cognition, studies have shown that thyroid medication plays an important role in improving cognitive function.”
Fakhroo, A., Elhadary, M. R., Elsayed, B., Alkuwari, A., Aly, R., Mesilhy, R., Bakalaf, A., Al-Maadhadi, M., Al-Dehaimi, A., Chivese, T., et al. (2023) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s428987 · Cited by 5
“22 In fact, the treatment of subclinical hypothyroidism has been a subject of ongoing debate due to several factors, including a natural increase in TSH levels with age, and variability in TSH measurements.”
BackgroundSubtle Thyroid Dysfunction Is Not Associated with Cognitive Decline: Results from the ELSA-Brasil
Szlejf, C., Suemoto, C. K., Janovsky, C. C. P. S., Bertola, L., Barreto, S. M., Lotufo, P. A., & Benseñor, I. M. (2021) · Journal of Alzheimer s Disease · doi:10.3233/jad-210018 · Cited by 5
“However, in the previous analysis, the first TSH tertile was associated with poorer performance in executive function [22], whereas in the present analysis TSH levels were not associated with cognitive performance at baseline, a possible reflect of the increasing levels of TSH with aging [33].”
Heald, A. H., Premawardhana, L. D. K. E., Taylor, P. N., Bahl, S., Okosieme, O. E., Fryer, A. A., Bianco, A. C., Dayan, C. M., & Stedman, M. (2025) · Clinical Endocrinology · doi:10.1111/cen.70074 · Cited by 4
“Hypothyroidism affects around 3% of the population in Europe [1] and nearly 5% of adult Americans (NIDDK) [2], being more common in females and older adults [3].”
Zugravu, C., Petre, M., & Constantin, C. (2026) · Geriatrics · doi:10.3390/geriatrics11010012 · Cited by 4
Development of oxidative stress in different experimental models of hypothyroidism in immature rats
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“Te confounders identifed and adjusted for were age [21, 22], ethnicity [23, 24], and type 2 DM (T2DM) status [25, 26].”
Kesibi, D., Rotondi, M. A., Edgell, H., & Tamim, H. (2025) · PLoS ONE · doi:10.1371/journal.pone.0324635 · Cited by 3
“Also, typical symptoms of hypothyroidism are less evident in the older population, and their symptoms are sometimes confused for other co-morbid conditions [44] or to aging [45].”
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“Also for hypothyroidism, almost all bodily tissues, at all stages of development, depend on thyroid hormones to function properly (35) .”
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Heald, A. H., Premawardhana, L. D. K. E., Taylor, P. N., Baker, A. R., Chaudhury, N., Fryer, A. A., Okosieme, O. E., Dayan, C. M., & Stedman, M. (2024) · Clinical Endocrinology · doi:10.1111/cen.15185 · Cited by 3
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Relationship Between Loneliness and Hypothyroidism
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“Kruskal Wallis test; **one-way ANOVA test SES: socioeconomic status, TSH: thyroid-stimulating hormone, MCHC: mean corpuscular hemoglobin concentration, MCH: mean corpuscular hemoglobin, MCV: mean corpuscular volume Figure 1 illustrated that only 2.2% of the participants had a high degree of loneliness, while 47.2%, 34…”
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“This elevation in TSH in this cohort may be a physiological adaptation to aging and not necessarily SCH. Experts recommend that this factor should be considered when making a diagnosis of SCH.[12,14]”
InfluentialPhysiological effects of thyroid hormones in the aspect of comorbidity and healthy longevity
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Комплаєнс до лікування левотироксином хворих на гіпотиреоз під час пандемічної ери SARS-CoV-2
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“The incidence of the disease increases with age and is more common in women [4].”
BackgroundBauer, B. S., Azcoaga-Lorenzo, A., Agrawal, U., Fagbamigbe, A. F., & McCowan, C. (2024) · PLoS ONE · doi:10.1371/journal.pone.0298871 · Cited by 2
“It is frequently stated that a higher treatment threshold should be applied for older patients, particularly for mild SCH [18, 49, 50].”
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Maimon, O., & Ben-Yaacov, T. (2025) · Current Psychology · doi:10.1007/s12144-025-08805-9 · Cited by 1
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“[2,20,21] Elderly people have more comorbidities, complicating the correct diagnosis and management of hypothyroidism.”
Ryabukha, O. (2021) · The Medical and Ecological Problems · doi:10.31718/mep.2021.25.1-2.08 · Cited by 1
“Age fluctuations in the levels of the thyrotropic pituitary hormone, free and total thyroxine, and triiodothyronine have also been established in publications [16,17,19], which indicate age-related changes in the “hypothalamic-”
BackgroundHypothyroidism: find and neutralize
Verbovoy, A. F., Dolgikh, Y. A., Katorzhanskaya, T. Y., & Katorzhanskiy, V. K. (2021) · Meditsinskiy sovet = Medical Council · doi:10.21518/2079-701x-2021-12-266-274 · Cited by 1
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“Primary and explicit hypothyroidism is identified through elevated levels of TSH (4,3).”
BackgroundResultExamining the relationship between non-alcoholic fatty liver disease and hypothyroidism
Teimouri, K., Pakravan, S., & Azadbakht, K. (2022) · Journal of Parathyroid Disease · doi:10.34172/jpd.2022.9148 · Cited by 1
Hussien, G. G., & Ali, O. H. (2023) · The Egyptian Journal of Hospital Medicine · doi:10.21608/ejhm.2023.293475 · Cited by 1
Foda, D. S., & Nour, S. A. (2023) · Beni-Suef University Journal of Basic and Applied Sciences · doi:10.1186/s43088-023-00413-5 · Cited by 1
“Hypothyrodism risk case is firstly preceded with a case of subclinical hypothyroidism that is characterized by significant increase in serum TSH with a normal levels of T4 and T3 [53, 54] which was not observed in our study.”
BackgroundKwon, S., Lee, Y., Seo, E., Kim, D., Lee, J., Jeong, Y., Kim, J., Jeong, J., & Lee, W. (2023) · Annals of Occupational and Environmental Medicine · doi:10.35371/aoem.2023.35.e41 · Cited by 2
“31,32 This is related to alterations in thyroid function and the increasing incidence and prevalence of autoimmune thyroiditis with aging.”
BackgroundQuintanilla, K., Joo, K. M., Torre, H. L. L., Neyra-Rivera, C., Gutiérrez, E. L., Parodi, J. F., & Runzer-Colmenares, F. M. (2024) · Current Gerontology and Geriatrics Research · doi:10.1155/2024/2156630 · Cited by 1
“In studies restricted to older persons, the reported prevalence of overt hypothyroidism has ranged between 0.2–5.7% and subclinical hypothyroidism between 1.5% and 12.5% of patients, making it the most prevalent endocrine disease among the aged, with a mayor prevalence in the female population [5].”
BackgroundInfluentialPrakash, S., & Kumbamoorthy, S. S. (2024) · Nutrición clínica y dietética hospitalaria · doi:10.12873/442prakash · Cited by 1
“With aging, triiodothyronine level increases and TSH level remains normal but in some circumstances it has a tendency to increase 10,11 .”
Abraham, L., & Varghese, S. (2020) · International Journal of Advances in Medicine · doi:10.18203/2349-3933.ijam20201039 · Cited by 1
“The biochemical parameters of thyroid function(namely serum TSH, free T4 and T3 levels) also vary according to age and gender, especially in the older population.(3) The present study has included a substantial number of patients who present ABSTRACT”
BackgroundPERSONALIZED THYROID HYPOFUNCTION THERAPY STRATEGY
Кравчун, Н. А., Дунаєва, І., & Kozakov, O. (2021) · PROBLEMS OF ENDOCRINE PATHOLOGY · doi:10.21856/j-pep.2021.3.17 · Cited by 1
Factors Associated with Goiter Incidence in Farmers in Kismantoro Sub-District, Wonogiri Regency
Ramadhaningtiyas, A., Dewi, Y. L. R., & Sugihardjo, S. (2022) · Amerta Nutrition · doi:10.20473/amnt.v6i2.2022.148-154 · Cited by 1
Kapfhammer, H. (2022) · Springer eBooks · doi:10.1007/978-3-662-65873-4_9 · Cited by 1
Diagnóstico y tratamiento del hipotiroidismo subclínico en adultos mayores
Albán, D. N. T., Merino, G. A. H., Arteaga, M. V. M., & López, A. L. V. (2023) · Ciencia Digital · doi:10.33262/cienciadigital.v7i1.2415 · Cited by 1
Fallahi, P., Ferrari, S. M., & Antonelli, A. (2019) · Springer eBooks · doi:10.1007/978-3-319-69892-2_63-1 · Cited by 1
Naeem, M., Ahmed, S., Haidary, A. M., Saadaat, R., Gowani, A., & Abdul‐Ghafar, J. (2021) · Research Square · doi:10.21203/rs.3.rs-311322/v1 · Cited by 1
“Other causes of hypothyroidism might be failure or resection of the thyroid gland itself or de ciency of TSH secretion from pituitary gland (5).”
BackgroundA Clinical Study of Hypothyroidism Associated With Type – 2 Diabetes Mellitus
Ajmera, P., Sailaja, P., & Ramulu, P. R. (2020) · Academia Journal of Medicine · doi:10.47008/ajm.2020.3.2.3
Şahiner, S., & Sarı, O. (2021) · Life and Medical Sciences · doi:10.54584/lms.2022.8
Dominguez, L. J., & Barbagallo, M. (2022) · Wiley eBooks · doi:10.1002/9781119484288.ch83
Alam, M. A., Quamri, M. A., & Sofi, G. (2021) · SSRN Electronic Journal · doi:10.2139/ssrn.3994446
Aftab, M. I., Ali, M. B., Ali, B. A., Habib, B., Haq, I., & Shah, S. I. A. (2021) · The Annals of Clinical and Analytical Medicine · doi:10.4328/acam.20448
“More recently, no association has been demonstrated between unrecognized SCH and cardiovascular events or mortality [21].”
BackgroundLakanwall, M. N., Ahmed, S. A., Azizi, S., Jalal, J. E., Haidary, A. M., Hanifi, A. N., & Gowani, A. (2020) · Research Square · doi:10.21203/rs.3.rs-112181/v1
“Other causes of hypothyroidism might be failure or resection of the thyroid gland itself or de ciency of TSH secretion from pituitary gland (5).”
BackgroundHypothyroidism and Levothyroxine, Review Article
Akhtar, W., Moghal, F. A., Ishaq, M., Naseem, A., Rana, A. H., Nadeem, H., Huda, M. N. U., Barki, K. M. E., Naseem, S., & Shaikh, M. Z. (2022) · Pakistan Journal of Medical and Health Sciences · doi:10.53350/pjmhs22164630
Yanko, R. V., & Levashov, M. I. (2022) · Morphology · doi:10.17816/morph.110838
“Принимая существующие сведения о том, что ЩЖ в различные возрастные периоды жизни организма по-разному реагирует на одни и те же воздействия [10], для сравнения возрастных морфологических особенностей железы после введения метионина в эксперимент мы взяли крыс разного возраста.”
Lower prevalence of subclinical hypothyroidism in vegetarian men compared with omnivores
Navarro, J. C. A., Antoniazzi, L., Dias, L. F., Ferreira, E. P., de Oliveira, M., & Acosta-Cardenas, P. (2023) · Revista Portuguesa de Endocrinologia Diabetes e Metabolismo · doi:10.26497/ao210023
A Pilot study on thyroid status, lipid profile creatine kinase in human cardiac patients
Pancholi, B., & Gautam, M. (2023) · Journal of Drug Delivery and Therapeutics · doi:10.22270/jddt.v13i2.5950
Assessment Of The Effect Of Menopause On Thyroid Function In South East,Nigeria
Duru, O. A., Onyenemezu, K. R., Okeke, C. D., Ubah, J. C., Royal Wolverhampton NHS Trust, W., & Ubah, N. R. (2023) · INTERNATIONAL JOURNAL OF HEALTH & MEDICAL RESEARCH · doi:10.58806/ijhmr.2023.v2i8n05
HUBUNGAN ANTARA KEJADIAN CARPAL TUNNEL SYNDROME DENGAN HIPOTIROIDISME
Hamda, I., Yohanes, G., Putra, A. W., Rahmatullah, M. I., & Biyanti, N. (2023) · Jurnal Kesehatan Tambusai · doi:10.31004/jkt.v4i4.19217
“Hubungan antara TSH dan hormon tiroid dipengaruhi oleh sejumlah faktor termasuk usia, merokok, dan status antibodi tiroid peroksidase (Leng & Razvi, 2019).”
BackgroundStijgend gebruik van levothyroxine in België
Boets, L., den Bruel, A. V., haecht, C. V., Cornelis, K., Debbaut, B., Ntahonganyira, R.-M., Flamaing, J., Stokx, J., & Decallonne, B. (2024) · Tijdschrift voor Geneeskunde · doi:10.47671/tvg.79.23.122
Spectrum of thyroid dysfunction at a tertiary care hospital: A retrospective studyPreprint
Aidoo, E. D., Ababio, G. K., Arko‐Boham, B., Tagoe, E. A., & Aryee, N. A. (2024) · Research Square · doi:10.21203/rs.3.rs-3898841/v1
Dysthyroidism in patients with psychiatric disorders in Morocco
Stati, S., Kharbach, A., Baba, M. A., Rhaouti, A. K., Khallouk, A., Obtel, M., Laboudi, F., & Ouanass, A. (2024) · The Annals of Clinical and Analytical Medicine · doi:10.4328/acam.21353
“It is also it is consistent with another previous study that age was a risk factor for hypothyroidism [14].”
Zhang, X., & Lee, V. C. S. (2024) · IntechOpen eBooks · doi:10.5772/intechopen.1004546
Laboratory Studies, Neuroimaging, and Neuropsychological Testing
Seritan, A. L., Bruns, E. B., Bledsoe, I. O., & Racine, C. A. (2024) · Springer eBooks · doi:10.1007/978-3-031-53976-3_4
Bochyński, K., Dacka, M., Giżewska, K., Białogłowski, K., Dąbrowska, P., Żuber, M., Ciuba, K., Molenda, K., Borodziuk, F., & Borodziuk, B. (2024) · Quality in Sport · doi:10.12775/qs.2024.18.53211
Protocolo diagnóstico y tratamiento de la patología tiroidea en el anciano
Tapia-Sanchiz, M. S., Jiménez-Blanco, S., Navas-Moreno, V., & Enríquez, A. J. (2024) · Medicine - Programa de Formación Médica Continuada Acreditado · doi:10.1016/j.med.2024.07.007
Ípsilon invertida. Retratos romanos con motivo en forma de Y en el flequillo
Ojeda, D. (2024) · Archivo Español de Arqueología · doi:10.3989/aespa.097.024.686
Metadata
- Authors
- Leng, O., & Razvi, S.
- Affiliations
- Newcastle upon Tyne Hospitals NHS Foundation Trust (GB)
- Gateshead Health NHS Foundation Trust (GB)
- Corresponding author
- Razvi, Salman
- ORCID
- Razvi, Salman
- Venue
- Thyroid Research
- Published
- 2019-02-08
- Volume
- 12
- Issue
- 1
- Pages
- 2-2
- ISSN
- 1756-6614 (ISSN-L)
- PMC
- PMC6367787
- OpenAlex
- W2921761178
- Cited by
- 112
- References
- 96
- Citations by year
- 2026: 6 · 2025: 14 · 2024: 21 · 2023: 16 · 2022: 12 · 2021: 22 · 2020: 15 · 2019: 6
- FWCI
- 2.12
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Thyroid Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Newcastle University ePrints (Newcastle Univesity) (cc-by)
- 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
- subclinical hypothyroidism, hypothyroidism, older adults, levothyroxine, TSH reference range, overt hypothyroidism, treatment thresholds, quality of life, cognitive outcomes, cardiovascular outcomes, mortality
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