Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom
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Department of Endocrinology, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
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Department of Endocrinology, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
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States [ 3 ]. Hypothyroidism has a prevalence of up to 16% in elderly females and the number of individuals diagnosed with it is expected to rise due to increased life expectancy [ 4 - 7 ]. Currently, all individuals with hypothyroidism are
Department of Surgery, County Hospital Ryhov, Jönköping, Sweden
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referral) were diagnosed with thyroid cancer during the follow-up period. Three of them were elderly women who developed anaplastic carcinomas in longstanding multinodular goitres. The carcinomas were diagnosed 8 months, 3 and 12 years after inclusion in
Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
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University Hospital Heidelberg, Heidelberg, Germany
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[ 54 ]. Indeed, mean L-T4 daily doses of 1.2–1.6 μg/kg bw/day were judged sufficient in the large majority of adult CeH patients, with the main aim of achieving a more appropriate metabolic profile [ 24 , 25 , 55 ]. In the elderly or in patients with
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obscured in elderly patients and hence diagnosis may be missed [ 1 ]. Hyperthyroidism is associated with significant morbidity and mortality, mainly from cardiovascular and cerebrovascular disease, which are conditions that are particularly relevant to an
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Objective: Subclinical hyperthyroidism (SCH) is common and associated with atrial fibrillation (AF) risk in the elderly. Current guidelines rely on a low level of evidence.
Methods: Randomized clinical trial including patients 50 years and older, with TSH <0.4 mU/L and normal thyroid hormone concentrations. All patients showed autonomy on thyroid scan. They were randomized either to receive radioiodine (I131) or to be monitored and treated only if they underwent AF or evolved towards overt hyperthyroidism. Primary outcome was the onset of new AF. Secondary outcomes were treatment-induced hypothyroidism rate and health-related quality of life.
Results: 144 patients (mean age 65.3±8.9y, 76% female) were randomized, 74 to surveillance and 70 to treatment. Four patients in the surveillance group and one in the treatment group developed AF (p=0.238). However, the patient who developed AF in the treatment group maintained TSH <0.4 mU/L at AF onset. A post-hoc analysis was carried out and showed that when normalization of TSH was considered, the risk of AF was significantly reduced (p=0.0003). In the surveillance group, several patients showed no classical characteristics associated with AF risk, including age>65y or TSH<0.1mU/L. Of 94 patients treated using radioiodine, 25% developed hypothyroidism during follow-up.
Conclusions: Due to recruitment difficulties this study failed to demonstrate that SCH treatment can reduce significantly the incidence of AF in patients older than 50 years with thyroid autonomy even if all the patients who developed AF maintained TSH <0.4 mU/L. This result must be balanced with the increased risk of radioiodine-induced hypothyroidism.
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useful background and guidance, we suggest that the approach recommended there carries potential risks, with the likely outcome of an increase in the proportion of ‘younger' elderly patients treated for SCH and the withholding of thyroxine treatment in
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concentrations [ 19 ]. In addition, a change in serum TSH levels may be observed in elderly patients due to potential changes in the hypothalamic-pituitary-thyroid axis with aging [ 20 , 21 ]. Iodine intake and the frequent alterations secondary to non
Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Queen Elizabeth Hospital, Gateshead, UK
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significant non-thyroidal illness and during treatment with various drugs (e.g. lithium, amiodarone) [ 17 ]. Furthermore, there is a widening of the reference range for serum TSH with increasing age, such that a mild TSH elevation (4.0-7.0 mU/l) in the elderly
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it can persist causing hypothyroidism. A pathologic response to the exogenous iodine load may lead to iodine-induced hyperthyroidism (IIH), known as the Jod-Basedow phenomenon. IIH is infrequent, but elderly patients and individuals with autonomously
DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
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DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
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DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
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DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
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30 elderly women with PAD in comparison to a control group without PAD [ 8 ]. In contrast, a population-based study detected no significant association between subclinical hypothyroidism and PAD-related hospitalization or procedures among 2
