Stability of thyroid function in older adults: the Birmingham Elderly Thyroid Study
Open accessAbstract
Background: Thyroid function tests (TFTs) are among the most requested tests internationally. However, testing practice is inconsistent, and potentially suboptimal and overly costly. The natural history of thyroid function remains poorly understood. Aim: To establish the stability of thyroid function over time, and identify predictors of development of overt thyroid dysfunction. Design and setting: Longitudinal follow-up in 19 general practices in the UK. Method: A total of 2936 participants from the Birmingham Elderly Thyroid Study (BETS 1) with a baseline TFT result indicating euthyroid or subclinical state were re-tested after approximately 5 years. Change in thyroid-stimulating hormone (TSH), free thyroxine (FT 4), and thyroid status between baseline and follow-up was determined. Predictors of progression to overt dysfunction were modelled. Results: Participants contributed 12 919 person-years; 17 cases of overt thyroid dysfunction were identified, 13 having been classified at baseline as euthyroid and four as having subclinical thyroid dysfunction. Individuals with subclinical results at baseline were 10- and 16-fold more likely to develop overt hypothyroidism and hyperthyroidism, respectively, compared with euthyroid individuals. TSH and FT 4 demonstrated significant stability over time, with 61% of participants having a repeat TSH concentration within 0.5 mIU/L of their original result. Predictors of overt hypothyroidism included new treatment with amiodarone (odds ratio [OR] 92.1), a new diagnosis of atrial fibrillation (OR 7.4), or renal disease (OR 4.8). Conclusion: High stability of thyroid function demonstrated over the 5-year interval period should discourage repeat testing, especially when a euthyroid result is in the recent clinical record. Reduced repeat TFTs in older individuals is possible without conferring risk, and could result in significant cost savings.
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In the UK Birmingham Elderly Thyroid Study, TSH was stable over time with 96% of euthyroid individuals (TSH < 4.5 mIU/L) remaining euthyroid at follow up.
“In a 5-year follow up study of 2936 participants from the UK Birmingham Elderly Thyroid Study, TSH was shown to be stable over time with 96% of euthyroid individuals (TSH < 4.5 mIU/L) remaining euthyroid at follow up [101].”
From Age-related variation in thyroid function – a narrative review highlighting important implications for research and clinical practice (2023) · cites this paper as [101]
Three other longitudinal studies did not confirm age-related TSH increases.
“Three other longitudinal studies in contrast did not confirm age-related TSH increases [99–101].”
From Age-related variation in thyroid function – a narrative review highlighting important implications for research and clinical practice (2023) · cites this paper as [101]
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The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey
Vanderpump, M. P. J., Tunbrldge, W. M. G., French, J. M., Appleton, D., Bates, D., Clark, F., Evans, J. G., Hasan, D. M., Rodgers, H., Tunbridge, F., et al. (1995) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1995.tb01894.x · Cited by 2,432 · see citing works
Subclinical Thyroid Disease: Scientific Review and Guidelines for Diagnosis and Management
Surks, M. I., Ortiz, E., Daniels, G. H., Sawin, C. T., Col, N. F., Cobin, R. H., Franklyn, J. A., Hershman, J. M., Burman, K. D., Denke, M. A., et al. (2004) · JAMA · doi:10.1001/jama.291.2.228 · Cited by 1,800 · see citing works
The Clinical Significance of Subclinical Thyroid Dysfunction
Biondi, B., & Cooper, D. S. (2008) · Endocrine Reviews · doi:10.1210/er.2006-0043 · Cited by 1,418 · see citing works
Fade, J. V., Franklyn, J. A., Cross, K. W., Jones, S. C., & Sheppard, M. C. (1991) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1991.tb01739.x · Cited by 567 · see citing works
Huber, G., Staub, J.-J., Meier, C., Mitrache, C., Guglielmetti, M., Huber, P., & Braverman, L. E. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.87.7.8678 · Cited by 418 · see citing works
Díez, J. J., & Iglesias, P. (2004) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-032061 · Cited by 281 · see citing works
Prevalence of Subclinical Hypothyroidism in Patients with Chronic Kidney Disease
Chonchol, M., Lippi, G., Salvagno, G. L., Zoppini, G., Muggeo, M., & Targher, G. (2008) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.00800208 · Cited by 266 · see citing works
Age- and Race-Based Serum Thyrotropin Reference Limits
Surks, M. I., & Boucai, L. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-1845 · Cited by 258 · see citing works
Roberts, L. M., Pattison, H., Roalfe, A., Franklyn, J., Wilson, S., Hobbs, F. D. R., & Parle, J. V. (2006) · Annals of Internal Medicine · doi:10.7326/0003-4819-145-8-200610170-00006 · Cited by 239 · see citing works
Self-citationAssociation Between Serum Free Thyroxine Concentration and Atrial Fibrillation
Gammage, M. D. (2007) · Archives of Internal Medicine · doi:10.1001/archinte.167.9.928 · Cited by 225 · see citing works
The Natural History of Subclinical Hypothyroidism in the Elderly: The Cardiovascular Health Study
Somwaru, L. L., Rariy, C. M., Arnold, A. M., & Cappola, A. R. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-3047 · Cited by 210 · see citing works
Parle, J., Roberts, L., Wilson, S., Pattison, H., Roalfe, A., Haque, M. S., Heath, C., Sheppard, M., Franklyn, J., & Hobbs, F. D. R. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-2571 · Cited by 203 · see citing works
Self-citationLow Serum Thyrotropin (Thyroid-Stimulating Hormone) in Older Persons Without Hyperthyroidism
Sawin, C. T. (1991) · Archives of Internal Medicine · doi:10.1001/archinte.1991.00400010159025 · Cited by 138 · see citing works
Wilson, S., Parle, J., Roberts, L. M., Roalfe, A. K., Hobbs, R. F., Clark, P. M. S., Sheppard, M. C., GAMMAGE, M. D., Pattison, H. M., Franklyn, J. A., et al. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2006-1557 · Cited by 129 · see citing works
Self-citationSpontaneous Normalization of Thyrotropin Concentrations in Patients with Subclinical Hypothyroidism
Díez, J. J., Iglesias, P., & Burman, K. D. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-0375 · Cited by 125 · see citing works
Eggertsen, R., Petersen, K. L., Lundberg, P. A., Nyström, E., & Lindstedt, G. (1988) · BMJ · doi:10.1136/bmj.297.6663.1586 · Cited by 109 · see citing works
Effect of seasonal changes on the transition between subclinical hypothyroid and euthyroid status
Kim, T. H., Kim, K. W., Ahn, H. Y., Choi, H. S., Won, H., Choi, Y., Cho, S. W., Moon, J. H., Yi, K. H., Park, D. J., et al. (2013) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-1607 · Cited by 70 · see citing works
Elevations of Thyroid-Stimulating Hormone During Acute Nonthyroidal Illness
Wong, E. T. (1981) · Archives of Internal Medicine · doi:10.1001/archinte.1981.00340070053012 · Cited by 65 · see citing works
Observations Concerning the Natural History of Subclinical Hyperthyroidism
Woeber, K. A. (2005) · Thyroid · doi:10.1089/thy.2005.15.687 · Cited by 59 · see citing works
First‐line thyroid function tests − TSH alone is not enough
Beckett, G. J., & Toft, A. D. (2003) · Clinical Endocrinology · doi:10.1046/j.1365-2265.2003.01690.x · Cited by 36 · see citing works
Natural history of subclinical hypothyroidism with TSH ≤10 mIU/l: a prospective study
Rosário, P. W., Carvalho, M. U. W. B. D., & Calsolari, M. R. (2015) · Clinical Endocrinology · doi:10.1111/cen.12939 · Cited by 33 · see citing works
Koutras, D. A. (1999) · Thyroid · doi:10.1089/thy.1999.9.311 · Cited by 25 · see citing works
Variability in thyroid function test requests across general practices in south-west England.
Vaidya, B., Ukoumunne, O. C., Shuttleworth, J., Bromley, A., Lewis, A., Hyde, C., Patterson, A., Fleming, S., & Tomlinson, J. (2013) · PubMed · Cited by 20 · see citing works
Why are GPs treating subclinical hypothyroidism? Case note review and GP survey
Allport, J., McCahon, D., Hobbs, R. F., & Roberts, L. M. (2012) · Primary Health Care Research & Development · doi:10.1017/s1463423612000230 · Cited by 16 · see citing works
Self-citationInterpreting elevated TSH in older adults
Mammen, J. S. (2019) · Current Opinion in Endocrine and Metabolic Research · doi:10.1016/j.coemr.2019.04.001 · Cited by 14 · see citing works
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Taylor, P. N., Lansdown, A., Witczak, J., Khan, R., Rees, A., Dayan, C. M., & Okosieme, O. (2023) · Thyroid Research · doi:10.1186/s13044-023-00149-5 · Cited by 72 · see citing works
“Three other longitudinal studies in contrast did not confirm age-related TSH increases [99–101].”
BackgroundResultInfluentialvan der Spoel, E., Roelfsema, F., & van Heemst, D. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.619568 · Cited by 62 · see citing works
The ageing thyroid: implications for longevity and patient care
van Heemst, D. (2024) · Nature Reviews Endocrinology · doi:10.1038/s41574-023-00911-7 · Cited by 43 · see citing works
Du Puy, R. S., Poortvliet, R. K. E., Mooijaart, S. P., den Elzen, W. P. J., Jagger, C., Pearce, S. H. S., Arai, Y., Hirose, N., Teh, R., Menzies, O., et al. (2021) · Thyroid® · doi:10.1089/thy.2020.0567 · Cited by 27 · see citing works
van der Spoel, E., van Vliet, N. A., Poortvliet, R. K. E., Puy, R. S. D., den Elzen, W. P. J., Quinn, T. J., Stott, D. J., Sattar, N. A., Kearney, P. M., Blum, M. R., et al. (2023) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgad623 · Cited by 31 · see citing works
Mammen, J. S. (2023) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2022.10.008 · Cited by 20 · see citing works
Fang, H., Zhao, R., Cui, S., & Wan, W. (2022) · Aging · doi:10.18632/aging.204352 · Cited by 15 · see citing works
Zhang, M., Ni, W., Zhang, L., Fan, K., Sun, Y., Liu, C., & Xu, S. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1216308 · Cited by 14 · see citing works
Management of thyroid dysfunction and thyroid nodules in the ageing patient
Martínez‐Montoro, J. I., Doulatram‐Gamgaram, V. K., Olveira, G., Valdés, S., & Fernández‐García, J. C. (2023) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2023.06.005 · Cited by 13 · see citing works
Interpreting elevated TSH in older adults
Mammen, J. S. (2019) · Current Opinion in Endocrine and Metabolic Research · doi:10.1016/j.coemr.2019.04.001 · Cited by 14 · see citing works
Towards De-Implementation of low-value thyroid care in older adults
Perkins, J. M., & Papaleontiou, M. (2022) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0000000000000758 · Cited by 12 · see citing works
Thyrotropin reference interval in older adults
Zhai, X., Li, Y. J., Teng, X., Teng, W., Shi, X., & Shan, Z. (2024) · Endocrine Connections · doi:10.1530/ec-24-0435 · Cited by 9 · see citing works
Subclinical thyroid dysfunction symptoms in older adults: cross-sectional study in UK primary care
McCahon, D., Haque, M. S., Parle, J., Hobbs, F. R., & Roberts, L. M. (2020) · British Journal of General Practice · doi:10.3399/bjgp20x708065 · Cited by 8 · see citing works
Self-citationThyrovigilance for hypothyroidism in India
Bajaj, S. (2022) · Thyroid Research and Practice · doi:10.4103/trp.trp_16_22 · Cited by 9 · see citing works
Dysthyroidism in Elderly Subjects
Demba, D., Mané, D. I., Gadji, F. K., Sow, D., Assane, N. M., Limane, B. A., Thioye, E. M. M., Mariama, K.-C., Anna, S., & Maimouna, N.-M. (2020) · Open Journal of Internal Medicine · doi:10.4236/ojim.2020.102019 · Cited by 5 · see citing works
2023 Korean Thyroid Association Management Guidelines for Patients with Subclinical Hypothyroidism
Chung, H. K., Ku, E. J., Yoo, W. S., Kang, Y. E., Kim, K. J., Kim, B. H., Kim, T. Y., Park, Y. J., Ahn, C. H., Yoon, J. H., et al. (2023) · International Journal of Thyroidology · doi:10.11106/ijt.2023.16.1.32 · Cited by 6 · see citing works
Xu, Y., Hysaj, O., Qi, X., Feller, M., Pingitore, A., Brown, S. J., Ittermann, T., Iacoviello, M., Trompet, S., Han, J. W., et al. (2026) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(26)00009-4 · Cited by 2 · see citing works
Bagherian, N., Mehran, L., Abdi, H., Masoumi, S., Tohidi, M., Honarvar, M., Amouzegar, A., & Azizi, F. (2026) · Journal of Diabetes & Metabolic Disorders · doi:10.1007/s40200-026-01939-y · Cited by 1 · see citing works
Optimizing TSH Testing: Minimizing Overdiagnosis and Unnecessary Interventions
Bayona, K. L. P. (2024) · IntechOpen eBooks · doi:10.5772/intechopen.1005108 · Cited by 2 · see citing works
Repeat thyroid function tests for healthy older people are not needed
Cook, R., Fortescue-Webb, D., & Taft, R. (2019) · BMJ · doi:10.1136/bmj.l805 · Cited by 1 · see citing works
Wahid, R. A., Naseem, M., Kakar, A., Zafarullah, Khan, N., & Masood, M. I. (2020) · Scholars International Journal of Traditional and Complementary Medicine · doi:10.36348/sijtcm.2020.v03i03.003 · Cited by 1 · see citing works
Thyroid Function in Patients with Acute Ischemic Stroke
Broczek, K. M. (2021) · Journal of Endocrinology and Thyroid Research · doi:10.19080/jetr.2021.06.555680 · Cited by 1 · see citing works
Repeated thyroid function testing is unnecessary in previously euthyroid over 65s, study finds
Murphy, D. C. (2018) · BMJ · doi:10.1136/bmj.k3664
Regelmäßige Schilddrüsen-Kontrolle im Alter meist unnötig
Medizin, S. (2019) · CME · doi:10.1007/s11298-019-7007-z
Tugendsam, C., & Kurtaran, A. (2020) · Wiener Medizinische Wochenschrift · doi:10.1007/s10354-020-00761-2
Thyroid dysfunction in the ageing patient
Bilookyi, O. V., Vasiuk, V. L., & Shupik, O. A. (2024) · INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine) · doi:10.22141/2224-0721.20.2.2024.1376
Egidi, G., Schübel, J., & Voigt, K. (2024) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.m2024.0013
Clinical management of thyroid dysfunction in the aging population
Gao, B., Yang, T., & Li, G. (2025) · Aging Research · doi:10.26599/agr.2025.9340048
Changes in serum TSH across the adult lifespan: 22-year follow-up of the HUNT Study
Åsvold, B. O., Denos, M., Taylor, P. N., Razvi, S., Bjøro, T., Brumpton, B. M., & Haug, E. B. (2026) · European Journal of Endocrinology · doi:10.1093/ejendo/lvag097
- Authors
- Roberts, L., McCahon, D., Johnson, O., Haque, M. S., Parle, J., & Hobbs, F. R.
- Affiliations
- University of Warwick (GB)
- University of Bristol (GB)
- Countess of Chester Hospital (GB)
- Venue
- British Journal of General Practice
- Published
- 2018-08-28
- Volume
- 68
- Issue
- 675
- Pages
- e718-e726
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC6145980
- OpenAlex
- W2888823779
- Cited by
- 30
- References
- 25
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 4 · 2023: 7 · 2022: 3 · 2021: 2 · 2020: 5 · 2019: 4 · 2018: 1
- FWCI
- 2.39
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of General Practice (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Explore Bristol Research (publishedVersion, other-oa)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
- Bristol Research (University of Bristol) (acceptedVersion, other-oa)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- Funders
- National Institute for Health and Care Research (NF-SI-0611-10273, IS-SPC-0514-10043)
- NIHR Oxford Biomedical Research Centre
- NIHR School for Primary Care Research
- 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 › Thyroid Cancer Diagnosis and Treatment
- Keywords
- thyroid function, older adults, thyroid-stimulating hormone, free thyroxine, subclinical thyroid dysfunction, overt hypothyroidism, overt hyperthyroidism, natural history (disease), amiodarone, atrial fibrillation, kidney disease, cost reduction
- MeSH terms
- Aged, Cost-Benefit Analysis, Female, Follow-Up Studies, United Kingdom, Humans, Hypothyroidism, Longitudinal Studies, Male, Predictive Value of Tests, Risk Factors, Thyroid Function Tests, Thyroid Gland, Risk Assessment
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