Low TSH Is Associated With Frailty in an Older Veteran Population Independent of Other Thyroid Function Tests

Low TSH is associated with frailty in the older adult. We studied whether low TSH is an independent marker of frailty or is an indicator of subclinical hyperthyroidism, which in turn predicts frailty. Of outpatient veterans seen between January 2005 and December 2016, we identified 100 patients aged ≥60 years with two low TSH (<0.5 µIU/ml) and one fT3 measurement and 50 matched controls (TSH 0.5–5.0 µIU/ml). We used a deficit accumulation approach to create a frailty index (FI). The higher the FI, the more likely (p<0.001) that patients had expired. Patients with low (0.31 ± 0.11 µIU/mL) versus normal (1.84 ± 0.84 µIU/mL) TSH had higher mean FI compared to controls (0.25 ± 0.12 vs. 0.15 ± 0.07, p < .001). Low TSH was significantly associated with frailty ( p < .001), independent of age. However, lower TSH was not associated with higher fT3 or fT4 levels. There was a nonsignificant inverse association of fT3 levels with FI ( p = .13), which disappeared when adjusted for age. Similar to prior studies, low TSH was associated with frailty. However, neither fT3 nor fT4 predicted low TSH or FI, suggesting that the association of low TSH with frailty is not due to subclinical hyperthyroidism, but perhaps to effects of comorbidities on TSH secretion.

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THE ASSOCIATION OF SUBCLINICAL HYPERTHYROIDISM WITH FRAILTY

Innovation in Aging ◽

10.1093/geroni/igz038.2533 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S687-S687

Author(s):

Nalini S Bhalla ◽

Karyne Vinales ◽

Janet Fawcett ◽

Ming Li ◽

Richa Bhattarai ◽

...

Keyword(s):

Medical Center ◽

Frailty Index ◽

Retrospective Chart Review ◽

The Elderly ◽

Inverse Association ◽

Subclinical Hyperthyroidism ◽

Deficit Accumulation ◽

Free T4 ◽

Free T3 ◽

Tsh Secretion

Abstract The relevance of subclinical hyperthyroidism in the elderly has not been clearly defined. We studied whether the reported association of low TSH with frailty is an indicator of subclinical hyperthyroidism as assessed by free T3 levels. In a retrospective chart review of patients seen between January 2017 and December 2018 at the Phoenix VA Medical Center, we identified 100 patients aged ≥60 years with at least 2 low TSH measurements (<0.5 µIU/ml) and a free T3 measurement within 6 months of the measured TSH and 50 sex- and age-matched controls (TSH 0.5-5.0 µIU/ml). Patients with exogenous or clinical hyperthyroidism were excluded. We used a deficit accumulation approach evaluating 31 factors, to create a frailty index between 0 and 1 for each patient. The higher the FI, the more likely (p<0.001) it was that patients had expired in the interim. Patients with low (0.31±0.11 µIU/mL) vs. normal (1.84±0.84 µIU/mL) TSH had higher mean FI compared to controls (0.25±0.12 vs. 0.15±0.07, p<0.001). TSH significantly predicted frailty score (p<0.0001) independent of age. However, lower TSH was not associated with higher free T3 or free T4 levels. There was a nonsignificant inverse association of free T3 levels with FI (P = 0.09), which disappeared when adjusted for age. Similar to prior studies, low TSH predicted frailty. However, neither free T3 nor free T4 predicted low TSH or frailty index, suggesting that the association of low TSH with frailty is not due to subclinical hyperthyroidism, but perhaps to effects of comorbidities on TSH secretion.

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THYROID FUNCTION TESTS: A REVIEW

10.36106/ijsr/2502260 ◽

2021 ◽

pp. 73-76

Author(s):

Vasudev Sankhla ◽

Aman Deep

Keyword(s):

Thyroid Function ◽

Thyroid Dysfunction ◽

Radioactive Iodine ◽

Thyroid Stimulating Hormone ◽

Thyroid Function Tests ◽

Function Tests ◽

Tsh Secretion ◽

Line Test ◽

Radioactive Iodine Uptake

Thyroid function tests are one of the most common endocrine panels in general practice because a good understanding of when to order them, indications for treatment are important for the optimal treatment of thyroid dysfunction. Thyroid-stimulating hormone (TSH) should be the rst test to be performed on any patient with suspected thyroid dysfunction and in follow-up of individuals on treatment. It is useful as a rst-line test because even small changes in thyroid function are sufcient to cause a signicant increase in TSH secretion. Thyroxine levels may be assessed in a patient with hyperthyroidism, to determine the severity of hyperthyroxinemia. Antithyroid peroxidase measurements should be considered while evaluating patients with subclinical hypothyroidism and can facilitate the identication of autoimmune thyroiditis during the evaluation of nodular thyroid disease. The measurement of TSH receptor antibody must be considered when conrmation of Graves’ disease is needed and radioactive iodine uptake cannot be done.

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The spectrum of thyroid function tests during hospitalization for SARS COV-2 infection

Acta Endocrinologica ◽

10.1530/eje-20-1391 ◽

2021 ◽

Vol 184 (5) ◽

pp. 699-709

Author(s):

Irene Campi ◽

Ilaria Bulgarelli ◽

Antonella Dubini ◽

Giovanni Battista Perego ◽

Elena Tortorici ◽

...

Keyword(s):

Thyroid Function ◽

Thyroid Function Tests ◽

Cytokine Storm ◽

Single Center ◽

Predictors Of Mortality ◽

Function Tests ◽

Tsh Secretion ◽

Thyroid Dysfunctions ◽

Tsh Levels

Objective Alterations in thyroid function tests (TFTs) have been recorded during SARS-CoV-2 infection as associated to either a destructive thyroiditis or a non-thyroidal illness. Methods We studied 144 consecutive COVID-19 patients admitted to a single center in intensive or subintensive care units. Those with previous thyroid dysfunctions or taking interfering drugs were excluded. Differently from previous reports, TSH, FT3, FT4, thyroglobulin (Tg), anti-Tg autoantibodies (TgAb) were measured at baseline and every 3–7 days. C-reacting protein (CRP), cortisol and IL-6 were also assayed. Results The majority of patients had a normal TSH at admission, usually with normal FT4 and FT3. Low TSH levels were found either at admission or during hospitalization in 39% of patients, associated with low FT3 in half of the cases. FT4 and Tg levels were normal, and TgAb-negative. TSH and FT3 were invariably restored at the time of discharge in survivors, whereas were permanently low in most deceased cases, but only FT3 levels were predictors of mortality. Cortisol, CRP and IL-6 levels were higher in patients with low TSH and FT3 levels. Conclusions Almost half of our COVID-19 patients without interfering drugs had normal TFTs both at admission and during follow-up. In this series, the transient finding of low TSH with normal FT4 and low FT3 levels, inversely correlated with CRP, cortisol and IL-6 and associated with normal Tg levels, is likely due to the cytokine storm induced by SARS-Cov-2 with a direct or mediated impact on TSH secretion and deiodinase activity, and likely not to a destructive thyroiditis.

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Undetectable TSH could be a TSH variant; case of a young asymptomatic Nepalese male

Journal of Diabetes and Endocrine Association of Nepal ◽

10.3126/jdean.v3i1.24071 ◽

2019 ◽

Vol 3 (1) ◽

pp. 34-37

Author(s):

Santosh Pradhan ◽

Vivek Pant ◽

Keyoor Gautam ◽

Devish Pyakurel ◽

Abha Shrestha

Keyword(s):

Thyroid Hormone ◽

Thyroid Function ◽

Unusual Case ◽

Assay System ◽

Thyroid Function Tests ◽

Subclinical Hyperthyroidism ◽

Negative Interference ◽

Diagnosis And Management ◽

Function Tests ◽

Hormone Assay

Thyroid function tests are frequently ordered test. Infrequently, the automated thyroid hormone assay system is subjected to interference which may yield false results, thus leading to inappropriate diagnosis and management. We report an unusual case of clinically misdiagnosed subclinical hyperthyroidism with undetectable TSH due to negative interference in particular TSH assay platforms in a young Nepalese male.

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