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Cited by 31Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryHormonal and reproductive studies

Associations between thyroid function and mortality: the influence of age

Open access
van de Ven, Annenienke C, Netea-Maier, Romana T, de Vegt, Femmie, Ross, H Alec, Sweep, Fred C G J, Kiemeney, Lambertus A, Smit, Johannes W, Hermus, Ad R +1 more·2014·European Journal of Endocrinology
DOI 10.1530/eje-13-1070
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Abstract

Objective: The aim of this study was to investigate the influence of age on the association between thyroid function and mortality. Design: The Nijmegen Biomedical Study is a population-based study, comprising 5816 randomly selected adults of all age groups without previously known thyroid disease. Methods: TSH, free thyroxine (FT 4) and peroxidase antibodies were measured in 2002–2003. The number of deaths were established in 2012 (median follow-up time 9.4 years). Results: Subclinical thyrotoxicosis was associated with mortality in subjects aged <65 years (hazard ratio (HR) 2.5, 95% CI 1.1–5.7), but not in subjects aged >65 years. As for thyroid function within the normal range: in the 493 participants aged 80 years or older, an FT 4 level in the high-normal range (18.5–22 pmol/l) was associated with a higher mortality in comparison with FT 4 levels in the middle range (11.5–15.0 pmol/l): HR 1.7 (95% CI 1.0–2.9). In these elderly, TSH levels within the high-normal range (3.0–4.0 mIU/l) were also associated with a higher mortality in comparison with TSH levels within the middle range (1.0–2.0 mIU/l): HR 1.8 (95% CI 1.0–3.1). Conclusions: The relationship between thyroid function and mortality differs according to age. This finding might (partially) explain the discrepant results of previous studies examining the relationship between thyroid function and mortality in different age groups.

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  • SHyper was associated with increased mortality in a population-based study of 5,816 randomly selected adults not included in the meta-analysis by Collet et al.

    “SHyper was associated with increased mortality in a population-based study [87] of 5,816 randomly selected adults not included in the meta-analysis by Collet et al. [71] .”

    From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [87]

    The Study participants and Results sections describe a population-based study that invited randomly selected adults and analyzed 5,816 participants. But Table 2 and the conclusion report an association between subclinical thyrotoxicosis and mortality only among participants younger than 65, not in the study population overall. The statement about inclusion in Collet et al.’s meta-analysis is attached to a separate citation and is not assessed here. (LLM, conf=0.90)

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  • Cardiovascular morbidity and mortality are particularly increased in men, in elderly patients with high-normal FT4 levels and in patients with underlying heart disease.

    “Cardiovascular morbidity and mortality are particularly increased in men, in elderly patients with high-normal FT 4 levels and in patients with underlying heart disease [71-73, 76, 77, 87, 91, 92, 94] .”

    From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [87]

    The Results (Table 3; page unavailable) report higher mortality among participants aged 80 or older with high-normal FT4 than among those with mid-range FT4. The paper does not establish that this is cardiovascular mortality or morbidity, or that the increase is particularly seen in men or patients with underlying heart disease; it states that cause-of-death data were unavailable. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Mortality was higher in 493 participants aged 80 years or older with FT4 levels in the high-normal range than in those with FT4 levels in the middle range (HR = 1.7).

    “Mortality was higher in 493 participants aged 80 years or older with FT 4 levels in the high-normal range than in those with FT 4 levels in the middle range (HR = 1.7) [87] .”

    From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [87]

  • 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 [382]

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Authors
van de Ven, A. C., Netea-Maier, R. T., de Vegt, F., Ross, H. A., Sweep, F. C. G. J., Kiemeney, L. A., Smit, J. W., Hermus, A. R., & den Heijer, M.
Affiliations
Radboud University Nijmegen (NL)
ORCID
Venue
European Journal of Endocrinology
Publisher
Oxford University Press (OUP)
Published
2014-08
Volume
171
Issue
2
Pages
183-191
ISSN
  • 0804-4643 (ISSN-L)
  • 1479-683X
DOI
10.1530/eje-13-1070
OpenAlex
W2154150970
Cited by
31
References
41
Citations by year
2026: 1 · 2025: 1 · 2024: 4 · 2023: 3 · 2022: 4 · 2021: 1 · 2020: 2 · 2019: 3 · 2018: 3 · 2017: 1 · 2016: 5 · 2015: 3
FWCI
2.41
Type
journal article
Language
en
Open access
Locations
  • European Journal of Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
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
thyroid function, mortality, age differences, subclinical thyrotoxicosis, thyroid-stimulating hormone, free thyroxine, older adults
MeSH terms
Age Factors, Aged, Aged, 80 and over, Humans, Middle Aged, Netherlands, Thyroid Function Tests, Thyroid Gland, Thyrotoxicosis, Thyrotropin, Thyroxine, Kaplan-Meier Estimate

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