Thyroid Status, Disability and Cognitive Function, and Survival in Old Age

TLDR

Although randomized controlled trials give equivocal results, clinical opinion supports screening and treating subclinical thyroid disorders in the elderly, yet evidence against treatment requires a well‑designed placebo‑controlled trial. To determine whether subclinical thyroid dysfunction should be treated in old age and the long‑term impact of thyroid dysfunction on performance and survival in old age. The study prospectively followed 599 Leiden residents aged 85–89, assessing baseline thyroid status, disability, depressive symptoms, cognitive function, and mortality over an average of 3.7 years. Plasma thyrotropin levels were not linked to disability, depression, or cognitive impairment, but higher thyrotropin was associated with lower mortality (HR 0.77 per SD), whereas higher free thyroxine was linked to higher mortality (HR 1.16 per SD).

Abstract

ContextDespite the equivocal outcomes of randomized controlled trials, general clinical opinion favors screening and treatment of elderly individuals with subclinical thyroid disorders.ObjectivesTo determine whether subclinical thyroid dysfunction should be treated in old age and the long-term impact of thyroid dysfunction on performance and survival in old age.Design, Setting, and ParticipantsA prospective, observational, population-based follow-up study within the Leiden 85-Plus Study of 87% of a 2-year birth cohort (1912-1914) in the municipality of Leiden, the Netherlands. A total of 599 participants were followed up from age 85 years through age 89 years (mean [SD] follow-up, 3.7 [1.4] years).Main Outcome MeasuresComplete thyroid status at baseline; disability in daily life, depressive symptoms, cognitive function, and mortality from age 85 years through 89 years.ResultsPlasma levels of thyrotropin and free thyroxine were not associated with disability in daily life, depressive symptoms, and cognitive impairment at baseline or during follow-up. Increasing levels of thyrotropin were associated with a lower mortality rate that remained after adjustments were made for baseline disability and health status. The hazard ratio (HR) for mortality per SD increase of 2.71 mIU/L of thyrotropin was 0.77 (95% confidence interval [CI], 0.63-0.94; P = .009). The HR for mortality per SD increase of 0.21 ng/dL (2.67 pmol/L) of free thyroxine increased 1.16-fold (95% CI, 1.04-1.30; P = .009).ConclusionsIn the general population of the oldest old, elderly individuals with abnormally high levels of thyrotropin do not experience adverse effects and may have a prolonged life span. However, evidence for not treating elderly individuals can only come from a well-designed, randomized placebo-controlled clinical trial.