Is subclinical hypothyroidism a cardiovascular risk factor in the elderly?
Abstract
CONTEXT: The negative impact of subclinical hypothyroidism (sHT) on cardiovascular risk, widely recognized in young adults (aged <55-60 y), is still debated in the elderly (>65 y), especially in the oldest olds (>80 y). EVIDENCE ACQUISITION: We searched Medline for reports published with the following search terms: "hypothyroidism," "subclinical hypothyroidism," "ageing," "elderly," "L-thyroxin," "thyroid," "guidelines," "treatment," "quality of life," "cardiovascular risk," "heart failure," "coronary heart disease" (CHD), "atherosclerosis," and "endothelial dysfunction." We limited our search to reports in English published after 1980, although we incorporated some reports published before 1980. We supplemented the search with records from personal files, textbooks, and relevant articles. Analyzed parameters included the epidemiology of thyroid failure, the effect of thyroid hormone on the aging process, cardiovascular function, and CHD risk factors. We also included the potential benefits of L-T4 therapy on the quality of life, cardiovascular events, and survival. EVIDENCE SYNTHESIS: TSH levels increase with age, even in older people without thyroid disease. Most longitudinal studies show an increased risk for CHD events and mortality in sHT participants. This increase is less evident in the elderly, mainly in cases of serum TSH values above 10 mIU/L. Lower mortality rate in a cohort of the oldest olds (>85 y) has been reported. CONCLUSIONS: sHT in older people should be not regarded as a unique condition, and moderately old patients (aged <70-75 y) could be considered clinically similar to the adult population, albeit with a higher optimal TSH target value. Conversely, the oldest old subjects should be carefully followed with a wait-and-see strategy, generally avoiding hormonal treatment. The decision to treat elderly people is still an unresolved clinical challenge--first, due to a lack of appropriately powered randomized controlled trials of L-T4 in sHT patients, examining cardiovascular hard endpoints in various classes of age; and second, because of the negative effects of possible overtreatment.
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There may be age-related differences in the vascular risk associated with a raised serum TSH, with higher risks in younger individuals that attenuate with advancing age.
“This led us and others to suggest that there may be age-related differences in the vascular risk associated with a raised serum TSH, with higher risks found in younger individuals that attenuated with advancing age (27, 39, 40).”
From Serum Thyroid Function, Mortality and Disability in Advanced Old Age: The Newcastle 85+ Study (2016) · cites this paper as [40]
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Cardiovascular Risk and Mild 䀆rod Hormoneeficenc Are there some 怆erences in the Elderly
Pasqualetti, G., Pagano, G., & Monzani, F. (2014)
Self-citationGuan, F., Zhao, H., Jiao, B., Liu, S., Sa, R., Hou, S., Lin, Q., Wang, Q., & Lin, C. (2015) · Annals of Nuclear Medicine · doi:10.1007/s12149-015-1046-7
Male Hypothyroidism-Clinical Relevance Including Role in Reproduction
Kaur, K. (2015) · Journal of Diabetes Metabolic Disorders & Control · doi:10.15406/jdmdc.2015.02.00029
Pasqualetti, G., Calsolaro, V., & Monzani, F. (2016) · Journal of Thoracic Disease · doi:10.21037/jtd.2016.04.11
Self-citationEndocrine disorders in the elderly
Yalamanchi, S., Tabatabai, L. S., & Moseley, K. F. (2016) · Cambridge University Press eBooks · doi:10.1017/cbo9781107294967.029
Cardiovascular Risk in Subclinical Hypothyroidism
Dobrescu, M., Păun, D. L., Grigorie, D., & Poiană, C. (2018) · Internal Medicine · doi:10.2478/inmed-2018-0022 · Cited by 1 · see citing works
Ipotiroidismo nel paziente anziano: quando e come trattare?
Niccolai, F., Calabrese, A. M., Pasqualetti, G., Polini, A., Tognini, S., Caraccio, N., & Monzani, F. (2019) · L Endocrinologo · doi:10.1007/s40619-019-00517-0
Self-citationDoes subclinical hypothyroidism confer an increased risk of coronary heart disease in the elderly?
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Approach to geriatric patients with subclinical thyroid disorders
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Thyroid Dysfunctions and the Vascular System
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Association between Thyroid Hormones and Renal Function in Patients with Chronic Kidney Disease
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- Authors
- Pasqualetti, G., Tognini, S., Polini, A., Caraccio, N., & Monzani, F.
- Affiliations
- University of Pisa (IT)
- Corresponding author
- Monzani, Fabio
- ORCID
- Monzani, Fabio
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2013-06-01
- Volume
- 98
- Issue
- 6
- Pages
- 2256-2266
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W1985671574
- Cited by
- 79
- References
- 114
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 1 · 2023: 5 · 2022: 3 · 2021: 4 · 2020: 7 · 2019: 6 · 2018: 8 · 2017: 5 · 2016: 6 · 2015: 11 · 2014: 13 · 2013: 5
- FWCI
- 1.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- Funders
- Università di Pisa
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- subclinical hypothyroidism, cardiovascular risk, older adults, oldest old, thyroxine therapy, coronary artery disease, mortality, overtreatment, wait-and-see strategy, aging, quality of life
- MeSH terms
- Aged, Aged, 80 and over, Cardiovascular Diseases, Coronary Disease, Female, Heart Failure, Humans, Hypothyroidism, Male, Risk Factors, Sex Characteristics, Thyrotropin
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