scholarly journals OR18-05 Thyroid Hormone Use and Survival among Older Adults - Longitudinal Analysis of the Baltimore Longitudinal Study of Aging (BLSA)

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Enoch Joseph Abbey ◽  
Eleanor M Simonsick ◽  
John McGready ◽  
Jennifer Sophie Mammen
Keyword(s):  
Older Adults ◽  
Thyroid Hormone ◽  
Thyroid Disease ◽  
Multivariable Analysis ◽  
Hormone Treatment ◽  
Reference Ranges ◽  
Endocrine Society ◽  
Hormone Exposure ◽  
Hormone Use

Abstract Abstract: Introduction: Thyrotropin (TSH) levels on average are higher and vary more widely among older adults.1 Large meta-analyses and treatment trials for isolated elevated TSH in older adults did not demonstrate harm from no treatment or benefit from treatment in this population.2 Isolated, elevated TSH can result from adaptations to aging, rather than primary thyroid disease, suggesting that thyroid hormone treatment could actually cause harm.3 Objective:To determine if there is a survival effect from thyroid hormone treatment in adults aged 65+. Methodology:Thyroid functional status and thyroid hormone exposure were analyzed for 1,258 participants of the BLSA aged 65+ through death or end of follow up. We analyzed exposures by visit and also compared survival between individuals with consistently elevated, euthyroid or low TSH both on and off of therapy.Incident rate ratios (IRR) were calculated using time-dependent Poisson regression models. Covariates included age, sex, race, walking index (measure of physical function), self-rated health (SF-12), body mass index (BMI), smoking and comorbidity score. Results: Average follow-up was 9 years, with 169 deaths over the study period. The cohort comprised 49.5% women, with average age in the study being 78 years (SD ±8.2). Thyroid hormone use trended towards harm analyzed at each visit with an IRR=1.40 (95% CI 0.93–2.12) after adjusting for other covariates. Among ‘treated-to-target’versus euthyroid individuals, thyroid hormone use was associated with a significantly increased mortality rate with an IRR=1.80 (95% CI 1.09–2.96) in multivariable analysis. Conclusion: Thyroid hormone replacement among older adults,even when treated-to-target, is associated with a significantly increased mortality risk compared to euthyroid individuals with no history of thyroid hormone exposure. This suggests that treating isolated elevated TSH when changes are aging adaptations rather than primary thyroid disease could adversely affect health by altering key homeostatic adaptation. We recommend clinicians consider the underlying physiology of aging and employ age specific reference ranges when deciding on treatment for elevated TSH in older adults.4References 1. Surks et al., J Clin Endo. Met. 2007;92(12):4575–4582. 2. Stott et al., NEJM. 2017;376(26):2534–2544. 3. Mammen et al., Thyroid. 2017;27(11):1370–1377. 4. Surks et al., J Clin Endo. Met. 2010:95(2):496-502Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

scholarly journals Risk Factors for Incident Carotid Artery Revascularization among Older Adults: The Cardiovascular Health Study

2016 ◽  
Vol 6 (3) ◽  
pp. 129-139 ◽  
Author(s):  
Parveen K. Garg ◽  
Willam J.H. Koh ◽  
Joseph A. Delaney ◽  
Ethan A. Halm ◽  
Calvin H. Hirsch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Carotid Artery ◽  
Cardiovascular Health ◽  
Multivariable Analysis ◽  
Population Based ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Increased Risk

Background: Population-based risk factors for carotid artery revascularization are not known. We investigated the association between demographic and clinical characteristics and incident carotid artery revascularization in a cohort of older adults. Methods: Among Cardiovascular Health Study participants, a population-based cohort of 5,888 adults aged 65 years or older enrolled in two waves (1989-1990 and 1992-1993), 5,107 participants without a prior history of carotid endarterectomy (CEA) or cerebrovascular disease had a carotid ultrasound at baseline and were included in these analyses. Cox proportional hazards multivariable analysis was used to determine independent risk factors for incident carotid artery revascularization. Results: Over a mean follow-up of 13.5 years, 141 participants underwent carotid artery revascularization, 97% were CEA. Baseline degree of stenosis and incident ischemic cerebral events occurring during follow-up were the strongest predictors of incident revascularization. After adjustment for these, factors independently associated with an increased risk of incident revascularization were: hypertension (HR 1.53; 95% CI: 1.05-2.23), peripheral arterial disease (HR 2.57; 95% CI: 1.34-4.93), and low-density lipoprotein cholesterol (HR 1.23 per standard deviation [SD] increment [35.4 mg/dL]; 95% CI: 1.04-1.46). Factors independently associated with a lower risk of incident revascularization were: female gender (HR 0.51; 95% CI: 0.34-0.77) and older age (HR 0.69 per SD increment [5.5 years]; 95% CI: 0.56-0.86). Conclusions: Even after accounting for carotid stenosis and incident cerebral ischemic events, carotid revascularization is related to age, gender, and cardiovascular risk factors. Further study of these demographic disparities and the role of risk factor control is warranted.

scholarly journals Thyroid disease and hepatocellular carcinoma survival. A Danish nationwide cohort study

2021 ◽  
Author(s):  
Linda Skibsted Kornerup ◽  
Frederik Kraglund ◽  
Ulla Feldt-Rasmussen ◽  
Peter Jepsen ◽  
Hendrik Vilstrup
Keyword(s):  
Hepatocellular Carcinoma ◽  
Cohort Study ◽  
Survival Time ◽  
Thyroid Disease ◽  
Animal Studies ◽  
Hormone Treatment ◽  
Mean Survival Time ◽  
Mortality Hazard ◽  
Restricted Mean Survival Time

Introduction Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer mortality worldwide. Recent animal studies suggest that thyroid hormone treatment improves HCC prognosis. The aim of this study was to describe the association between thyroid disease and HCC prognosis in humans. Methods We performed a nationwide cohort study including all persons with an HCC diagnosis from 2000-2018. Patients’ age, sex, HCC treatment, and diagnoses of thyrotoxicosis, nontoxic goitre, and myxoedema, were obtained from Danish national healthcare registries. We used regression models to examine the association between thyroid disease and mortality hazard and restricted mean survival time after HCC diagnosis, adjusting for confounding by sex and age. Results We included 4,812 patients with HCC and 107 patients with thyroid disease. Median follow-up time was 5 months (total 5,985 person-years). The adjusted mortality hazard ratio was 0.68 (95% CI 0.47-0.96) for thyrotoxicosis and 0.60 (95% CI 0.41-0.88) for nontoxic goitre. The restricted mean survival time during the five years following HCC diagnosis was 6.8 months (95% CI 1.1–12.6) longer for HCC patients with thyrotoxicosis than for patients without thyroid disease, and it was 6.9 months (95% CI 0.9–12.9) longer for HCC patients with nontoxic goitre than for patients without thyroid disease. Conclusions In this large nationwide cohort study, thyrotoxicosis and nontoxic goitre were associated with prolonged HCC survival.

Abstract P409: Thyroid Function and Cognitive Decline in Middle-aged and Older Adults: The Elsa-Brasil Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Claudia Szlejf ◽  
Claudia K Suemoto ◽  
Carolina Janovsky ◽  
Paulo A LOTUFO ◽  
Isabela M Bensenor
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Cognitive Performance ◽  
Thyroid Function ◽  
Thyroid Disease ◽  
Word Recall ◽  
Adult Health ◽  
Middle Aged ◽  
Second Wave

Introduction: The role of subtle thyroid alterations on cognitive decline is controversial. We aimed to investigate the association of thyrotropin (TSH) and free thyroxine (FT4) with baseline performance on cognitive tests and with cognitive decline in middle-aged and older adults without overt thyroid disease. Methods: This is a longitudinal analysis of the Brazilian Longitudinal Study of Adult Health baseline and second wave, after 4 years of follow-up. We included participants aged ≥ 55 years without over thyroid disease, prevalent stroke and use of drugs that could affect thyroid function and cognition. TSH and FT4 were assessed at baseline. Cognition was evaluated at baseline and at the second wave using delayed word recall test (DWR), semantic verbal fluency test (SVF), and trail making test version B (TMT). Baseline and longitudinal associations of TSH tertiles and FT4 tertiles with cognitive performance were investigated with generalized estimating equations, adjusted for sociodemographic characteristics, lifestyle, cardiovascular risk factors, and depression. Results: The baseline mean age of the 4675 participants was 62.4 ± 5.8 years, 52.3% women (2445 out of 4675). At baseline, TSH levels were not associated with cognitive performance in any test, although the highest FT4 tertile was associated with poorer performance on DWR (β = -0.087, 95% CI = -0.155; -0.019) and SVF (β = -0.076, 95%CI = -0.143; -0.010) after adjustment. Additionally, the lowest FT4 tertile was associated with poorer performance on SVF (β = -0.090, 95%CI = -0.152; -0.028). Cognitive performance did not change after 4 years of follow-up and there was no effect of time on the association of thyroid hormone levels with cognitive performance. Conclusion: At baseline, FT4 levels were associated with worse cognitive performance in a relatively young sample. Neither baseline FT4 nor TSH were associated with cognitive decline after 4 years.

scholarly journals A child with a deletion in the monocarboxylate transporter 8 gene: 7-year follow-up and effects of thyroid hormone treatment

2011 ◽  
Vol 165 (5) ◽  
pp. 823-830 ◽  
Author(s):  
Amnon Zung ◽  
Theo J Visser ◽  
André G Uitterlinden ◽  
Fernando Rivadeneira ◽  
Edith C H Friesema
Keyword(s):  
Thyroid Hormone ◽  
Snp Array ◽  
Hormone Treatment ◽  
Neurological Status ◽  
Psychomotor Retardation ◽  
Monocarboxylate Transporter ◽  
High Dose ◽  
Hormone Administration ◽  
Hormone Analogs

ObjectiveThe monocarboxylate transporter 8 (MCT8; SLC16A2) has a pivotal role in neuronal triiodothyronine (T3) uptake. Mutations of this transporter determine a distinct X-linked psychomotor retardation syndrome (Allan–Herndon–Dudley syndrome (AHDS)) that is attributed to disturbed thyroid hormone levels, especially elevated T3 levels. We describe the genetic analysis of the MCT8 gene in a patient suspected for AHDS and the clinical and endocrine effects of L-thyroxine (LT4) or liothyronine (LT3) treatment intending to overcome the T3 uptake resistance through alternative transporters.MethodsThe six exons of the MCT8 gene were amplified individually by PCR. As multiple exons were missing, the length of the X-chromosomal deletion was determined by a dense SNP array, followed by PCR-based fine mapping to define the exact borders of the deleted segment. The clinical and endocrine data of the patient during 6.5 years of LT4 treatment and two periods (3 months each) of low- and high-dose LT3 were evaluated.ResultsA partial deletion of the MCT8 gene (comprising five of six exons) was detected, confirming the suspected AHDS. MCT8 dysfunction was associated with partial resistance to T3 at the hypothalamus and pituitary level, with normal responsiveness at the peripheral organs (liver and cardiovascular system). Thyroid hormone administration had no beneficial effect on the neurological status of the patient.ConclusionWe identified a 70 kb deletion encompassing exons 2–6 of the MCT8 gene in our AHDS patient. Both LT4 and LT3 administration had no therapeutic effect. Alternatively, treatment of AHDS patients with thyroid hormone analogs should be considered.

scholarly journals Significance of Anti-TPO as an Early Predictive Marker in Thyroid Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Thushani Siriwardhane ◽  
Karthik Krishna ◽  
Vinodh Ranganathan ◽  
Vasanth Jayaraman ◽  
Tianhao Wang ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Disease ◽  
Thyroid Dysfunction ◽  
Predictive Marker ◽  
Control Group ◽  
Overt Hypothyroidism ◽  
Thyroid Autoantibody ◽  
Significant Difference

Even though most thyroid subjects are undiagnosed due to nonspecific symptoms, universal screening for thyroid disease is not recommended for the general population. In this study, our motive is to showcase the early appearance of thyroid autoantibody, anti-TPO, prior to the onset of thyroid hormone disruption; hence the addition of anti-TPO in conjunction with traditional thyroid markers TSH and FT4 would aid to reduce the long-term morbidity and associated health concerns. Here, a total of 4581 subjects were tested multiple times for TSH, FT4, anti-TPO, and anti-Tg and followed up for 2 years. We streamlined our subjects into two groups, A1 (euthyroid at first visit, but converted to subclinical/overt hypothyroidism in follow-up visits) and A2 (euthyroid at first visit, but converted to hyperthyroidism in follow-up visits). According to our results, 73% of hypothyroid subjects (from group A1) and 68.6% of hyperthyroid subjects (from group A2) had anti-TPO 252 (±33) and 277 (±151) days prior to the onset of the thyroid dysfunction, respectively. Both subclinical/overt hypothyroidism and hyperthyroidism showed a significantly higher percentage of subjects who had anti-TPO prior to the onset of thyroid dysfunction compared to the combined control group. However, there was no significant difference in the subjects who had anti-Tg earlier than the control group. Further assessment showed that only anti-TPO could be used as a standalone marker but not anti-Tg. Our results showcase that anti-TPO appear prior to the onset of thyroid hormone dysfunction; hence testing anti-TPO in conjunction with TSH would greatly aid to identify potentially risk individuals and prevent long-term morbidity.

Neuropsychological Effects of Cybercycling for Older Adults: One-Year Follow-Up

2010 ◽  
Author(s):  
Cay Anderson-Hanley ◽  
Paul Arciero ◽  
Joseph Nimon ◽  
Vadim Yerkohin ◽  
Veronica Hopkins ◽  
...  
Keyword(s):  
Older Adults ◽  
Neuropsychological Effects ◽  
One Year

Linear modulation of serum thyrotrophin by thyroid hormone treatment in hypothyroidism

1980 ◽  
Vol 95 (4) ◽  
pp. 472-478 ◽  
Author(s):  
A. Eugene Pekary ◽  
Jerome M. Hershman ◽  
Clark T. Sawin
Keyword(s):  
Thyroid Hormone ◽  
Hormone Replacement ◽  
Hormone Treatment ◽  
Significant Negative Correlation ◽  
Thyroid Hormone Replacement ◽  
Basal Serum ◽  
Thyroid Hormone Levels ◽  
Peak Versus ◽  
Hypothyroid Patients ◽  
Serum Tsh

Abstract. Basal serum TSH and the peak TSH response to a 500 μg TRH bolus were measured in 57 euthyroid and in 29 hypothyroid subjects either receiving graded thyroid hormone replacement or acutely removed from full replacement therapy. Serum TSH, total T4 and T3 were determined by sensitive radioimmunoassay methods. The peak versus basal TSH data for hypothyroid patients were linear within individuals. The regression slope of the peak versus basal TSH data for all hypothyroid subjects did not differ significantly from the corresponding slope for all euthyroid subjects. Basal and peak TSH versus T3 and T4 data for hypothyroid patients were also linear within each individual. Moreover, the regression of the basal TSH values averaged over the non-replacement to full replacement state against the TSH versus T3 slope had a significant negative correlation. This trend leads to an array of regression lines which average to the familiar hyperbolic relationship between thyrotrophin and thyroid hormone levels in man.

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