Subclinical Hypothyroidism on the Elderly

Authors

  • Sofia Macedo Silva Unidade de Saúde Familiar Esposende Norte. Esposende.
  • Alexandra Carvalho Unidade de Saúde Familiar Esposende Norte. Esposende.
  • Maria Lopes- Pereira Serviço de Endocrinologia. Hospital de Braga. Braga.
  • Vera Fernandes Serviço de Endocrinologia. Hospital de Braga. Braga.

DOI:

https://doi.org/10.20344/amp.10991

Keywords:

Aged, Hypothyroidism/diagnosis, Reference Values, Thyroid Function Tests

Abstract

Introduction: Subclinical hypothyroidism, defined as an increase of thyroid stimulating hormone levels with normal levels of thyroid hormones, could have a multiorgan impact. There seem to be differences in the elderly (over 65 years of age) which indicate that there should be a different approach in terms of diagnosis and the treatment.

Material and Methods: Electronic database search and narrative bibliographical review.

Results: Different case studies showing the multiorgan consequences of subclinical hypothyroidism suggest that, in the elderly, there is a minor impact or even a lack of repercussion, especially in those over 80 - 85 years old. Additionally, there is evidence indicating that the levels of thyroid stimulating hormone rise with the age of the patient. The standard treatment, in the beginning, is a low dose of levothyroxine when the levels of thyroid stimulating hormone are over 10.0 mIU/L, when there are noticeable symptoms or positive anti-thyroid antibodies. However, the treatment is not consensual when the levels of thyroid stimulating hormone are between 4.5 and 10.0 mIU/L, in such a way that the TRUST study concluded that no benefits have outcome from treating these patients.

Discussion: The non-definition of the reference range and the age gap are the key factors that contribute the most to biased results. However, there is consensus regarding non-treatment of mild thyroid dysfunctions (4.5 - 7.0 mIU/L) in the elderly, particularly above 80 years of age. Nevertheless, for positive anti-thyroid antibodies, suggestive ultrasound changes or iatrogenic side effects, the reference level should be 4.5 mIU/L.

Conclusion: The general impact of subclinical hypothyroidism is different in elderly people, meaning that an individualized therapeutic approach and long-term monitoring is the appropriate strategy.

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Author Biographies

Sofia Macedo Silva, Unidade de Saúde Familiar Esposende Norte. Esposende.

Interna de Medicina Geral de Familiar da Unidade Saúde Familiar Esposende Norte

Alexandra Carvalho, Unidade de Saúde Familiar Esposende Norte. Esposende.

Interna de Medicina Geral de Familiar da Unidade Saúde Familiar Esposende Norte

Maria Lopes- Pereira, Serviço de Endocrinologia. Hospital de Braga. Braga.

Assistente Hospitalar do Serviço de Endocrinologia do Hospital de Braga

Vera Fernandes, Serviço de Endocrinologia. Hospital de Braga. Braga.

Assistente Hospitalar do Serviço de Endocrinologia do Hospital de Braga

Published

2018-12-28

How to Cite

1.
Macedo Silva S, Carvalho A, Lopes- Pereira M, Fernandes V. Subclinical Hypothyroidism on the Elderly. Acta Med Port [Internet]. 2018 Dec. 28 [cited 2023 Feb. 1];31(12):766-73. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/10991

Issue

Section

Review Articles