You are here

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

TitleHigh frequency of and factors associated with thyroid hormone over-replacement and under-replacement in men and women aged 65 and over.
Publication TypeJournal Article
Year of Publication2009
AuthorsSomwaru, LL, Arnold, AM, Joshi, N, Fried, LP, Cappola, AR
JournalJ Clin Endocrinol Metab
Volume94
Issue4
Pagination1342-5
Date Published2009 Apr
ISSN1945-7197
KeywordsAged, Body Mass Index, Body Weight, Diabetes Mellitus, Dose-Response Relationship, Drug, Drug Therapy, Combination, Female, Hormone Replacement Therapy, Humans, Male, Multivariate Analysis, Renal Insufficiency, Risk Factors, Thyroid Diseases, Thyroid Hormones, Thyrotropin, Thyroxine, Triiodothyronine
Abstract<p><b>CONTEXT: </b>Thyroid hormone use is common in older populations, but the frequency of over- or under-replacement is debated.</p><p><b>OBJECTIVE: </b>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.</p><p><b>DESIGN: </b>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).</p><p><b>RESULTS: </b>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).</p><p><b>CONCLUSIONS: </b>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.</p>
DOI10.1210/jc.2008-1696
Alternate JournalJ Clin Endocrinol Metab
PubMed ID19126628
PubMed Central IDPMC2682480
Grant ListK23 AG019161 / AG / NIA NIH HHS / United States
K23AG19161 / AG / NIA NIH HHS / United States
N01 HC015103 / HC / NHLBI NIH HHS / United States
N01-HC-85086 / HC / NHLBI NIH HHS / United States
N01HC85086 / HL / NHLBI NIH HHS / United States
N01-HC-85079 / HC / NHLBI NIH HHS / United States
N01HC85079 / HL / NHLBI NIH HHS / United States
N01 HC035129 / HC / NHLBI NIH HHS / United States