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Cited by 24Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryHormonal and reproductive studies

Elevated TSH in adults treated for hypothyroidism is associated with increased mortality

Akirov, Amit, Gimbel, Hannah, Grossman, Alon, Shochat, Tzipora, Shimon, Ilan·2017·European Journal of Endocrinology
DOI 10.1530/eje-16-0708
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Abstract

Context: Numerous studies investigated the link between hypothyroidism and mortality, but a definite conclusion is hard to reach as these were limited by a number of factors, including age of participants, comorbidities and single measurement of thyroid function. Objective: To evaluate the association between TSH and fT4 levels and mortality in patients with levothyroxine-treated hypothyroidism. Design and setting: Observational data of hospitalized patients (2011–2014). TSH and fT4 levels obtained between at least 30 days after discharge and until death or end of follow-up were collected. Median TSH and fT4 levels were stratified into categories. Patients: In total, 611 patients with treated hypothyroidism, aged 60–80 years (72% females, mean age 71 ± 6 years) were included in the study. Main outcome measure: All-cause mortality up to 66 months after discharge, by TSH and fT4 categories. Results: During follow-up, the average numbers of TSH and fT4 measurements were 5.5 ± 3.8 and 2.5 ± 4.2 per patient respectively. Mortality rates were 28%, 29% and 54% with median TSH of 0.5–2.5, 2.5–5.0 and 5.0–10.0 IU/L respectively. Adjusted hazard ratios for mortality with median TSH between 5.0 and 10.0 IU/L were 2.3 (95% CI: 1.6–3.4) and 2.2 (95% CI: 1.6–3.2) compared with patients with TSH between 0.5–2.5 IU/L and 2.5–5 IU/L respectively. There was no difference in mortality between patients with median fT4 10–15 or 15–20 pmol/L. Conclusion: In treated hypothyroid adult patients and serial measurements of thyroid function tests, median TSH levels of 5–10 IU/L are associated with increased mortality with no effect of fT4 levels. Treatment should aim at achieving euthyroidism to improve survival.

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Crossref · 10.1530/eje-16-0708

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  • Excessive levothyroxine treatment in patients of high age is associated with increased mortality.

    “Excessive LT4 treatment in patients of high age is associated with an increased mortality.”

    From Risks of suboptimal and excessive thyroid hormone replacement across ages (2023) · cites this paper as [42]

  • Several studies showed insufficiently treated overt and/or subclinical hypothyroidism as well as excessively replaced hypothyroid patients are associated with increased early mortality risk in older patients.

    “However, several studies showed insufficiently treated overt and/or subclinical hypothyroidism as well as excessively replaced hypothyroid patients associated with increased early mortality risk in older patients [41–44].”

    From Risks of suboptimal and excessive thyroid hormone replacement across ages (2023) · cites this paper as [42]

  • In treated hypothyroid patients, median TSH levels of 5-10 IU/L are associated with increased mortality.

    “in treated hypothyroid patients, median TSH levels of 5–10 IU/L associated with increased mortality”

    From L-T4 therapy in the presence of pharmacological interferents (2020) · cites this paper as [105]

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Authors
Akirov, A., Gimbel, H., Grossman, A., Shochat, T., & Shimon, I.
Affiliations
  • Tel Aviv University (IL)
  • Rabin Medical Center (IL)
Corresponding author
Akirov, Amit
ORCID
Venue
European Journal of Endocrinology
Publisher
Oxford University Press (OUP)
Published
2017-01
Volume
176
Issue
1
Pages
57-66
ISSN
  • 0804-4643 (ISSN-L)
  • 1479-683X
DOI
10.1530/eje-16-0708
OpenAlex
W2533368511
Cited by
24
References
30
Citations by year
2025: 1 · 2023: 3 · 2022: 3 · 2021: 2 · 2020: 2 · 2019: 4 · 2018: 2 · 2017: 7
FWCI
4.34
Type
journal article
Language
en
Open access
closed
Locations
  • European Journal of Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
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
hypothyroidism, thyroid-stimulating hormone, free thyroxine, mortality, levothyroxine, euthyroidism, thyroid function tests, hospitalized patients, older adults
MeSH terms
Aged, Female, Hormones, Humans, Hypothyroidism, Male, Thyroid Function Tests, Thyroid Gland, Thyrotropin, Thyroxine, Triiodothyronine

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