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Cited by 112Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryHormonal and reproductive studies

The DOI matches its Crossref record; 95 of the 96 references it cites were found in a registry or an index.

Hypothyroidism in the older population

Open access
Leng, Owain, Razvi, Salman·2019·Thyroid Research
DOI 10.1186/s13044-019-0063-3PMC PMC6367787
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Abstract

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])
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])CC BY · PubMed Central

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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
Publisher
Springer Science and Business Media LLC
Published
2019-02-08
Volume
12
Issue
1
Pages
2-2
ISSN
1756-6614 (ISSN-L)
DOI
10.1186/s13044-019-0063-3
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
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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