Subclinical thyroid dysfunction symptoms in older adults: cross-sectional study in UK primary care
Open accessAbstract
Background: Subclinical thyroid dysfunction — abnormal serum thyrotrophin (thyroid-stimulating hormone; TSH) concentrations with normal free thyroxine (FT4) is common in older people. It remains unclear whether individuals with subclinical serum status experience an increased symptom profile. Aim: To compare the prevalence of those symptoms typically associated with overt thyroid dysfunction in older individuals with a subclinical and euthyroid serum profile. Design and setting: Cross-sectional study, nested within the Birmingham Elderly Thyroid Study (BETS); from 19 UK general practices. Method: Adults living in a community setting (aged ≥65 years), without overt thyroid dysfunction or associated treatment, self-reported the presence or absence of 18 symptoms (while serum result naïve). Serum concentrations of TSH and FT4 were measured to establish thyroid status. Results: A total of 2870 individuals were screened: 2703 (94%) were categorised as euthyroid (normal), 29 (1%) subclinically hyperthyroid, and 138 (5%) subclinically hypothyroid. Symptoms were common in all groups. No significant differences in the prevalence of individual symptoms were observed between the euthyroid and subclinically hypothyroid groups nor in comparison with the subclinically hyperthyroid group. Multivariate logistic regression analysis failed to reveal an association between individual or multiple symptoms and subclinical status. Conclusion: Findings suggest that subclinical thyroid dysfunction does not confer a symptom burden in older individuals and support adherence to guidelines in the non-treatment of subclinical thyroid dysfunction. GPs may use the findings to reassure older people presenting with symptoms that subclinical thyroid dysfunction is an unlikely explanation. The presence of persistently abnormal TSH concentrations may be linked to long-term risks of cardiovascular disease, especially atrial fibrillation, but whether this should prompt treatment and whether such treatment alters vascular outcomes is unknown.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Symptoms consistent with the presence of hypothyroidism are nonspecific and cannot be reliably used to differentiate those with hypothyroidism from euthyroid people.
“symptoms consistent with the presence of hypothyroidism are nonspecific and cannot be reliably used to differentiate those with hypothyroidism from euthyroid people. 39 -41”
From Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement (2023) · cites this paper as [41]
The Results and the section on symptom expression and subclinical hypothyroidism report that individual and multiple symptoms did not distinguish euthyroid from subclinically hypothyroid older adults. The claim omits those limits: this study does not establish the same conclusion for hypothyroidism generally or for other age groups. Page numbers are not available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
The Colorado Thyroid Disease Prevalence Study
Canaris, G. J., Manowitz, N. R., Mayor, G., & Ridgway, E. C. (2000) · Archives of Internal Medicine · doi:10.1001/archinte.160.4.526 · Cited by 2,824 · see citing works
Cooper, D. S., & Biondi, B. (2012) · The Lancet · doi:10.1016/s0140-6736(11)60276-6 · Cited by 1,039 · see citing works
Subclinical Hypothyroidism: An Update for Primary Care Physicians
Fatourechi, V. (2009) · Mayo Clinic Proceedings · doi:10.4065/84.1.65 · Cited by 376 · see citing works
Biondi, B. (2000) · Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.85.12.4701 · Cited by 356 · see citing works
Biondi, B., Bartalena, L., Cooper, D. S., Hegedüs, L., Laurberg, P., & Kahaly, G. J. (2015) · European Thyroid Journal · doi:10.1159/000438750 · Cited by 323 · see citing works
Evered, D. C., Ormston, B. J., Smith, P., Hall, R., & Bird, T. (1973) · BMJ · doi:10.1136/bmj.1.5854.657 · Cited by 323 · see citing works
Feller, M., Snel, M., Moutzouri, E., Bauer, D. C., de Montmollin, M., Aujesky, D., Ford, I., Gussekloo, J., Kearney, P. M., Mooijaart, S., et al. (2018) · JAMA · doi:10.1001/jama.2018.13770 · Cited by 266 · 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
STATISTICAL METHODS APPLIED TO THE CLINICAL DIAGNOSIS OF THYROTOXICOSIS
Crooks, J., Murray, I. P. C., & Wayne, E. J. (1959) · QJM · doi:10.1093/oxfordjournals.qjmed.a066842 · Cited by 215 · see citing works
Do traditional symptoms of hypothyroidism correlate with biochemical disease?
Canaris, G. J., Steiner, J. F., & Ridgway, E. C. (1997) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.1997.07109.x · Cited by 172 · see citing works
Biondi, B., & Cooper, D. S. (2018) · New England Journal of Medicine · doi:10.1056/nejmcp1709318 · Cited by 135 · 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-citationSymptom Rating Scale for Assessing Hyperthyroidism
Klein, I. L. (1988) · Archives of Internal Medicine · doi:10.1001/archinte.1988.00380020131018 · Cited by 94 · see citing works
Thyroid disease in the elderly. Part 2. Predictability of subclinical hypothyroidism.
Bemben, D. A., Hamm, R. M., Morgan, L., Winn, P., Davis, A., & Barton, E. N. (1994) · PubMed · Cited by 78 · see citing works
Ruggeri, R. M., Trimarchi, F., & Biondi, B. (2017) · European Journal of Endocrinology · doi:10.1530/eje-17-0321 · Cited by 53 · see citing works
Perceived Health Status of Women with Overt and Subclinical Hypothyroidism
Vigário, P. D. S., Teixeira, P. D. F. D. S., Reuters, V. S., Almeida, C., Maia, M., Silva, M., & Vaisman, M. (2009) · Medical Principles and Practice · doi:10.1159/000215731 · Cited by 43 · 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
Stability of thyroid function in older adults: the Birmingham Elderly Thyroid Study
Roberts, L., McCahon, D., Johnson, O., Haque, M. S., Parle, J., & Hobbs, F. R. (2018) · British Journal of General Practice · doi:10.3399/bjgp18x698861 · Cited by 30 · see citing works
Self-citationWhy 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-citationParle, J., Franklyn, J. A., Cross, K. W., Jones, S. R., & Sheppard, M. C. (1991) · Europe PMC (PubMed Central) · Cited by 14 · see citing works
Self-citationAvaliação clínica e da função muscular em pacientes com hipotireoidismo subclínico
Reuters, V. S., Buescu, A., Reis, F. A. A., Almeida, C. D. P., Teixeira, P. F. D. S., Costa, A. J. L., Wagman, M. B., Ferreira, M. M., de Castro, C. L. N., & Vaisman, M. (2006) · Arquivos Brasileiros de Endocrinologia & Metabologia · doi:10.1590/s0004-27302006000300016 · Cited by 12 · see citing works
Evans, T. C. (2003) · Primary Care Clinics in Office Practice · doi:10.1016/s0095-4543(03)00087-3 · Cited by 12 · see citing works
Flagged first, then by citations
3 of the 26 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- Reuters VS, Buescu A, Reis FA, et al. Clinical and muscular evaluation in patients with subclinical hypothyroidism. [In Portuguese]. Arq Bras Endocrinol Metabol 2006; 50(3): 523-531.
Cited by
Sorted by citations
Subclinical hypothyroidism in older individuals
Biondi, B., & Cappola, A. R. (2021) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(21)00285-0 · Cited by 80 · see citing works
Ahluwalia, R., Baldeweg, S. E., Boelaert, K., Chatterjee, K., Dayan, C., Okosieme, O., Priestley, J., Taylor, P., Vaidya, B., Zammitt, N., et al. (2023) · Clinical Endocrinology · doi:10.1111/cen.14935 · Cited by 34 · see citing works
“41 For instance, 60% of unselected euthyroid individuals have one or more symptom that may be attributable to hypothyroidism.”
BackgroundAssociation Between Subclinical Thyroid Dysfunction and Fracture Risk
Daya, N. R., Fretz, A., Martin, S. S., Lutsey, P. L., Echouffo-Tcheugui, J. B., Selvin, E., & Juraschek, S. P. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.40823 · Cited by 18 · 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
A practical contemporary approach to decision-making on subclinical hypothyroidism
Sgarbi, J. A., & Ward, L. S. (2020) · Archives of Endocrinology and Metabolism · doi:10.20945/2359-3997000000317 · Cited by 15 · see citing works
The public health burden of diabetes mellitus and thyroid disease: twin epidemics
Razvi, S. (2026) · Nature Reviews Endocrinology · doi:10.1038/s41574-025-01226-5 · Cited by 8 · see citing works
Zhang, T., Pan, W., Huang, K., Qiu, J., Zhang, W., & Yang, J. (2025) · Annals of Medicine · doi:10.1080/07853890.2025.2558122 · Cited by 2 · see citing works
Preliminary observation of thyroid function changes in subclinical thyroid diseases
Wang, H., Gao, W.-Y., Yang, Y., Li, Y., Zhang, Y., Zhang, X., & Li, Y. (2023) · Technology and Health Care · doi:10.3233/thc-220562
- Authors
- McCahon, D., Haque, M. S., Parle, J., Hobbs, F. R., & Roberts, L. M.
- Affiliations
- University of Bristol (GB)
- University of Warwick (GB)
- Venue
- British Journal of General Practice
- Published
- 2020-01-13
- Volume
- 70
- Issue
- 692
- Pages
- e208-e214
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC6960005
- OpenAlex
- W3000435595
- Cited by
- 8
- References
- 26
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 3 · 2022: 1 · 2021: 1 · 2020: 1
- FWCI
- 1.13
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of General Practice (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (publishedVersion, other-oa)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0611-10273)
- 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
- subclinical thyroid dysfunction, subclinical hypothyroidism, subclinical hyperthyroidism, older adults, thyroid symptoms, thyroid-stimulating hormone, free thyroxine, symptom burden, euthyroid status, primary care
- MeSH terms
- Age Factors, Aged, Cross-Sectional Studies, Female, United Kingdom, Humans, Male, Primary Health Care, Surveys and Questionnaires, Thyroid Diseases, Thyroid Function Tests, Thyrotropin, Thyroxine, Prevalence, Symptom Assessment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
