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. 2009 Apr;94(4):1342-5.
doi: 10.1210/jc.2008-1696. Epub 2009 Jan 6.

High frequency of and factors associated with thyroid hormone over-replacement and under-replacement in men and women aged 65 and over

Lily L Somwaru  1 , Alice M Arnold, Neha Joshi, Linda P Fried, Anne R Cappola
Affiliations

High frequency of and factors associated with thyroid hormone over-replacement and under-replacement in men and women aged 65 and over

Lily L Somwaru et al. J Clin Endocrinol Metab. 2009 Apr.

Abstract

Context: Thyroid hormone use is common in older populations, but the frequency of over- or under-replacement is debated.

Objective: We sought to describe the frequency of and factors associated with thyroid hormone over- or under-replacement in a population of older men and women.

Design: Participants were 3678 U.S. community dwelling individuals aged 65 yr or older enrolled in the Cardiovascular Health Study who had thyroid function tests in 1989-1990. Thyroid hormone users (n = 339) were identified and classified into low TSH (<0.45 mU/liter), euthyroid (0.45-4.5 mU/liter), and high TSH (>4.5 mU/liter).

Results: Of the 339 thyroid hormone users, 41% had a low TSH, 16% had a high TSH, and 43% were in the euthyroid range. In multivariable analyses, lower weight (P < 0.001) was independently associated with low TSH status. For every 10 kg lower weight, the likelihood of having low TSH increased by 65% [odd ratio (OR) 1.65; 95% confidence interval (CI) 1.31-2.07]. Those with renal insufficiency were less likely to have low TSH levels (P = 0.02). The presence of diabetes was independently associated with having low (OR 3.35; 95% CI 1.46-7.65) and high TSH levels (OR 2.66; 95% CI 1.14-6.21).

Conclusions: There is a very high prevalence of thyroid function testing abnormalities in older people taking thyroid hormone preparations, particularly in those of low weight or with diabetes. Because of potential adverse cardiovascular and skeletal effects from over-replacement, older people represent a key population for increased TSH monitoring on therapy.

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Figures

Figure 1
Figure 1
Thyroid function tests among participants taking all types of thyroid hormone preparations (A), only T4 preparations (B), and only T4 plus T3 preparations (C).
See this image and copyright information in PMC

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