This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (101)  • Contact me when this article is cited  Related Content  • Related letters  • Related articles  • Similar articles in JAMA  Topic Collections  • Aging/ Geriatrics  • Otolaryngology/ Head & Neck Surgery  • Endocrine Disease of Head & Neck  • Endocrine Diseases  • Thyroid/ Parathyroid Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Jacobijn Gussekloo, MD, PhD; Eric van Exel, MD, PhD; Anton J. M. de Craen, PhD; Arend E. Meinders, MD, PhD; Marijke Frölich, PhD; Rudi G. J. Westendorp, MD, PhD

JAMA. 2004;292:2591-2599.

Context  Despite the equivocal outcomes of randomized controlled trials, general clinical opinion favors screening and treatment of elderly individuals with subclinical thyroid disorders.

Objectives  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.

Design, Setting, and Participants  A 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 Measures  Complete thyroid status at baseline; disability in daily life, depressive symptoms, cognitive function, and mortality from age 85 years through 89 years.

Results  Plasma 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).

Conclusions  In 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.

Author Affiliations: Section of Gerontology and Geriatrics (Drs Gussekloo, van Exel, de Craen, and Westendorp), Departments of General Internal Medicine (Drs Gussekloo, van Exel, de Craen, Meinders, and Westendorp) and Clinical Chemistry (Dr Frölich), Leiden University Medical Center, Leiden, the Netherlands.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Thyroid Status and Survival in Old Age
Ronald R. Scobbo
JAMA. 2005;293(12):1447.
EXTRACT | FULL TEXT  

Thyroid Status and Survival in Old Age
Juan J. Díez and Pedro Iglesias
JAMA. 2005;293(12):1447.
EXTRACT | FULL TEXT  

Thyroid Status and Survival in Old Age—Reply
Jacobijn Gussekloo, Anton J. M. de Craen, and Rudi G. J. Westendorp
JAMA. 2005;293(12):1447-1448.
EXTRACT | FULL TEXT  

RELATED ARTICLES

Thyroid Neoplasia, Autoimmune Thyroiditis, and Hypothyroidism in Persons Exposed to Iodine 131 From the Hanford Nuclear Site
Scott Davis, Kenneth J. Kopecky, Thomas E. Hamilton, Lynn Onstad, and and the Hanford Thyroid Disease Study Team
JAMA. 2004;292(21):2600-2613.
ABSTRACT | FULL TEXT  

A 64-Year-Old Woman With a Thyroid Nodule
Susan J. Mandel
JAMA. 2004;292(21):2632-2642.
EXTRACT | FULL TEXT  

Thyroid Disease in the Oldest Old: The Exception to the Rule
David S. Cooper
JAMA. 2004;292(21):2651-2654.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Free thyroxine is an independent predictor of subcutaneous fat in euthyroid individuals
Alevizaki et al.
Eur J Endocrinol 2009;161:459-465.
ABSTRACT | FULL TEXT  

Effect of anemia and comorbidity on functional status and mortality in old age: results from the Leiden 85-plus Study
den Elzen et al.
CMAJ 2009;181:151-157.
ABSTRACT | FULL TEXT  

Endothelial-mediated coronary flow reserve in patients with mild thyroid hormone deficiency
Biondi et al.
Eur J Endocrinol 2009;161:323-329.
ABSTRACT | FULL TEXT  

When to consider thyroid dysfunction in the neurology clinic
Mistry et al.
PN 2009;9:145-156.
ABSTRACT | FULL TEXT  

An elderly woman with weight loss and diarrhoea
Mitchell and Pearce
BMJ 2009;338:b1721-b1721.
FULL TEXT  

High Frequency of and Factors Associated with Thyroid Hormone Over-Replacement and Under-Replacement in Men and Women Aged 65 and Over
Somwaru et al.
J. Clin. Endocrinol. Metab. 2009;94:1342-1345.
ABSTRACT | FULL TEXT  

Extreme Longevity Is Associated with Increased Serum Thyrotropin
Atzmon et al.
J. Clin. Endocrinol. Metab. 2009;94:1251-1254.
ABSTRACT | FULL TEXT  

Subclinical Hyperthyroidism: Considerations in Defining the Lower Limit of the Thyrotropin Reference Interval
Goichot et al.
Clin. Chem. 2009;55:420-424.
ABSTRACT | FULL TEXT  

Increased reverse triiodothyronine is associated with shorter survival in independently-living elderly: the Alsanut study
Forestier et al.
Eur J Endocrinol 2009;160:207-214.
ABSTRACT | FULL TEXT  

Subclinical Hypothyroidism: An Update for Primary Care Physicians
Fatourechi
Mayo Clin Proc. 2009;84:65-71.
ABSTRACT | FULL TEXT  

Vitamin B12 and Folate and the Risk of Anemia in Old Age: The Leiden 85-Plus Study
den Elzen et al.
Arch Intern Med 2008;168:2238-2244.
ABSTRACT | FULL TEXT  

Subclinical thyroid dysfunction and mortality: an estimate of relative and absolute excess all-cause mortality based on time-to-event data from cohort studies
Haentjens et al.
Eur J Endocrinol 2008;159:329-341.
ABSTRACT | FULL TEXT  

Should we treat all subjects with subclinical thyroid disease the same way?
Biondi
Eur J Endocrinol 2008;159:343-345.
FULL TEXT  

Mild Hypothyroidism and Ischemic Heart Disease: Is Age the Answer?
Mariotti
J. Clin. Endocrinol. Metab. 2008;93:2969-2971.
FULL TEXT  

The association of thyroid function with carotid artery plaque burden and strokes in a population-based sample from a previously iodine-deficient area
Dorr et al.
Eur J Endocrinol 2008;159:145-152.
ABSTRACT | FULL TEXT  

The Influence of Age on the Relationship between Subclinical Hypothyroidism and Ischemic Heart Disease: A Metaanalysis
Razvi et al.
J. Clin. Endocrinol. Metab. 2008;93:2998-3007.
ABSTRACT | FULL TEXT  

Thyroid Function and the Risk of Alzheimer Disease: The Framingham Study
Tan et al.
Arch Intern Med 2008;168:1514-1520.
ABSTRACT | FULL TEXT  

Management of hypothyroidism in adults
Vaidya and Pearce
BMJ 2008;337:a801-a801.
FULL TEXT  

Meta-analysis: Subclinical Thyroid Dysfunction and the Risk for Coronary Heart Disease and Mortality
Ochs et al.
ANN INTERN MED 2008;148:832-845.
ABSTRACT | FULL TEXT  

Thyrotropin Levels and Risk of Fatal Coronary Heart Disease: The HUNT Study
Asvold et al.
Arch Intern Med 2008;168:855-860.
ABSTRACT | FULL TEXT  

Thyroid Function and Lipid Subparticle Sizes in Patients with Short-Term Hypothyroidism and a Population-Based Cohort
Pearce et al.
J. Clin. Endocrinol. Metab. 2008;93:888-894.
ABSTRACT | FULL TEXT  

The Clinical Significance of Subclinical Thyroid Dysfunction
Biondi and Cooper
Endocr. Rev. 2008;29:76-131.
ABSTRACT | FULL TEXT  

Upper Limit of Normal Serum Thyroid-Stimulating Hormone: A Moving and Now an Aging Target?
Fatourechi
J. Clin. Endocrinol. Metab. 2007;92:4560-4562.
FULL TEXT  

Update in Geriatric Medicine
Reuben
ANN INTERN MED 2007;147:470-477.
FULL TEXT  

Age Affects Outcomes in Chronic Kidney Disease
O'Hare et al.
J. Am. Soc. Nephrol. 2007;18:2758-2765.
ABSTRACT | FULL TEXT  

Altered Platelet Plug Formation in Hyperthyroidism and Hypothyroidism
Homoncik et al.
J. Clin. Endocrinol. Metab. 2007;92:3006-3012.
ABSTRACT | FULL TEXT  

Serum Thyrotropin Measurements in the Community: Five-Year Follow-up in a Large Network of Primary Care Physicians
Meyerovitch et al.
Arch Intern Med 2007;167:1533-1538.
ABSTRACT | FULL TEXT  

The Association of Thyroid Dysfunction with All-Cause and Circulatory Mortality: Is There a Causal Relationship?
Volzke et al.
J. Clin. Endocrinol. Metab. 2007;92:2421-2429.
ABSTRACT | FULL TEXT  

Reply
Gammage et al.
J Am Coll Cardiol 2007;49:2229-2230.
FULL TEXT  

Hyperthyroidism and Mortality
Volzke
J Am Coll Cardiol 2007;49:2228-2229.
FULL TEXT  

Association Between Serum Free Thyroxine Concentration and Atrial Fibrillation
Gammage et al.
Arch Intern Med 2007;167:928-934.
ABSTRACT | FULL TEXT  

Approach to the Patient with Subclinical Hyperthyroidism
Cooper
J. Clin. Endocrinol. Metab. 2007;92:3-9.
ABSTRACT | FULL TEXT  

Prevalence of Subclinical Thyroid Dysfunction and Its Relation to Socioeconomic Deprivation in the Elderly: A Community-Based Cross-Sectional Survey
Wilson et al.
J. Clin. Endocrinol. Metab. 2006;91:4809-4816.
ABSTRACT | FULL TEXT  

fMRI revealed neural substrate for reversible working memory dysfunction in subclinical hypothyroidism
Zhu et al.
Brain 2006;129:2923-2930.
ABSTRACT | FULL TEXT  

Is subclinical thyroid dysfunction in the elderly associated with depression or cognitive dysfunction?
Roberts et al.
ANN INTERN MED 2006;145:573-581.
ABSTRACT | FULL TEXT  

Management of thyroid disorders.
Premawardhana and Lazarus
Postgrad. Med. J. 2006;82:552-558.
ABSTRACT | FULL TEXT  

Thyroid Status, Cardiovascular Risk, and Mortality in Older Adults
Cappola et al.
JAMA 2006;295:1033-1041.
ABSTRACT | FULL TEXT  

Mortality Risk Stratification in Chronic Kidney Disease: One Size for All Ages?
O'Hare et al.
J. Am. Soc. Nephrol. 2006;17:846-853.
ABSTRACT | FULL TEXT  

Editorial: Thyroid Function and Aging: Do Serum 3,5,3'-Triiodothyronine and Thyroid-Stimulating Hormone Concentrations Give the Janus Response?
Mariotti
J. Clin. Endocrinol. Metab. 2005;90:6735-6737.
FULL TEXT  

Thyroid Hormone Concentrations, Disease, Physical Function, and Mortality in Elderly Men
van den Beld et al.
J. Clin. Endocrinol. Metab. 2005;90:6403-6409.
ABSTRACT | FULL TEXT  

Subclinical Hypothyroidism and Cardiovascular Disease
Crapo
Arch Intern Med 2005;165:2451-2452.
FULL TEXT  

Subclinical Hypothyroidism and the Risk of Heart Failure, Other Cardiovascular Events, and Death
Rodondi et al.
Arch Intern Med 2005;165:2460-2466.
ABSTRACT | FULL TEXT  

Subclinical Thyroid Dysfunction as a Risk Factor for Cardiovascular Disease
Walsh et al.
Arch Intern Med 2005;165:2467-2472.
ABSTRACT | FULL TEXT  

Thyroid Function and Mortality in Patients Treated for Hyperthyroidism
Franklyn et al.
JAMA 2005;294:71-80.
ABSTRACT | FULL TEXT  

Spontaneous Normalization of Thyrotropin Concentrations in Patients with Subclinical Hypothyroidism
Diez et al.
J. Clin. Endocrinol. Metab. 2005;90:4124-4127.
ABSTRACT | FULL TEXT  

Small Differences in Thyroid Function May Be Important for Body Mass Index and the Occurrence of Obesity in the Population
Knudsen et al.
J. Clin. Endocrinol. Metab. 2005;90:4019-4024.
ABSTRACT | FULL TEXT  

Health status in patients with sub-clinical hypothyroidism
Razvi et al.
Eur J Endocrinol 2005;152:713-717.
ABSTRACT | FULL TEXT  

Thyroid Status and Survival in Old Age
Scobbo
JAMA 2005;293:1447-1447.
FULL TEXT  

Thyroid Status and Survival in Old Age
Diez and Iglesias
JAMA 2005;293:1447-1447.
FULL TEXT  

Subclinical Thyroid Disease and Cardiovascular Disease--Reply
Surks
JAMA 2005;293:1060-1060.
FULL TEXT  

Dosed to Death
Davenport
Sci Aging Knowl Environ 2005;2005:nf11-nf11.
ABSTRACT | FULL TEXT  

Endocrinology & Metabolism News, January 2005
J. Clin. Endocrinol. Metab. 2005;90:16a-16a.
FULL TEXT  

Occult Thyroid Dysfunction in Elders
JWatch General 2004;2004:4-4.
FULL TEXT  

Thyroid Disease in the Oldest Old: The Exception to the Rule
Cooper
JAMA 2004;292:2651-2654.
FULL TEXT