1
|
Chatzivasileiou P, Armeni E, Chedraui P, Kontou L, Augoulea A, Palaiologou A, Kaparos G, Panoulis K, Alexandrou A, Vlachos N, Lambrinoudaki I. Postmenopausal women with higher TSH values within the normal range present improved handgrip strength: a pilot study. Gynecol Endocrinol 2024; 40:2333432. [PMID: 38567465 DOI: 10.1080/09513590.2024.2333432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE To evaluate the possible association between thyroid function within the euthyroid range and musculoskeletal parameters as well as body composition in a sample of postmenopausal women. METHODS This cross-sectional study included 96 postmenopausal women with serum thyroid-stimulating hormone (TSH) within the normal laboratory reference range. Fasting venous blood samples were obtained for biochemical/hormonal assessment. Bone status and body composition were measured using Dual Energy X-ray absorptiometry (DXA). Physical activity was quantified using the International Physical Activity Questionnaire (IPAQ) index. RESULTS Serum TSH correlated with handgrip strength (HGS, r-coefficient = 0.233, p = .025), and total body bone mineral density (BMD) T-score values (r-coefficient = 0.321, p = .003). HGS measures were associated with BMD (r-coefficient = 0.415, p < .001), with bone mineral content (BMC, r-coefficient = 0.427, p < .001), and lean mass (r-coefficient = 0.326, p = .003). Women with low muscle strength, defined as HGS < 16 kg, had lower TSH levels than women with normal muscle strength (low vs. normal muscle strength, ANCOVA 1.13 ± 0.49 mU/L vs. 1.60 ± 0.83 mU/L, p = 0.024) independently of age, BMD, percentage of body fat or absolute lean mass. Multivariable linear regression analysis showed that HGS values were associated with TSH measurements (β-coefficient = 0.246, p = .014) and BMD T-score values (β-coefficient = 0.306, p = .002). All models were adjusted for age, body mass index (BMI), vitamin D, low-density lipoprotein cholesterol, current smoking, physical activity, and homeostasis model assessment of insulin resistance. CONCLUSIONS In this sample of postmenopausal women, lower serum TSH values, within normal range, were associated with lower muscle strength compared to higher normal TSH values. Further research is needed to elucidate the significance of our preliminary findings.
Collapse
Affiliation(s)
- Panagiota Chatzivasileiou
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| | - Eleni Armeni
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
- Royal Free Hospital, NHS Foundation Trust, University College London Medical School, London, UK
| | - Peter Chedraui
- Escuela de Posgrado en Salud, Universidad Espíritu Santo, Samborondón, Ecuador
| | - Loraina Kontou
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| | - Areti Augoulea
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| | - Anastasia Palaiologou
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| | - George Kaparos
- Biochemical Laboratory, Aretaieio Hospital, University of Athens, Athens, Greece
| | - Konstantinos Panoulis
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| | - Andreas Alexandrou
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| | - Nikolaos Vlachos
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| |
Collapse
|
2
|
Chen H, Hu J, Yang X, Zhou Q, Hu Y, Tang X, Tang J, Zeng L, Yang J. Low levels of free triiodothyronine are associated with risk of cognitive impairment in older euthyroid adults. Sci Rep 2023; 13:22133. [PMID: 38092827 PMCID: PMC10719249 DOI: 10.1038/s41598-023-49285-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
Accumulated evidence showed that thyroid diseases induced cognitive decline. However, the relationship between thyroid hormones (THs) and cognition in older euthyroid people is still unclear. Our study aimed to estimate the association between THs within the euthyroid range and cognition in community-dwelling older adults in China. Data were extracted from a cohort study on the health status of rural older adults from the Guizhou province in China (HSRO). Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) were measured using the electrochemiluminescence immunoassay. Cognitive function was evaluated by the Mini-Mental State Examination (MMSE). Linear regression and a binary logistic regression model were used to explore the relationship between THs and cognition in euthyroidism (TSH level of 0.27 ~ 4.20mIU/L). A total of 957 euthyroidism individuals were included in this study, with a mean (SD) age of 71.34 (6.35) years. In individuals with euthyroidism, serum TSH and FT3 levels were positively associated with cognition (TSH:β = 0.06, 95% CI 0.01 ~ 0.11, P = 0.03; FT3:β = 0.07, 95% CI 0.01 ~ 0.12, P = 0.01); and serum FT3 and TSH levels were significantly associated with cognitive domains (P < 0.05). Further, euthyroid individuals in the lowest serum FT3(OR = 1.96; 95% CI 1.27 ~ 3.03) quartile had a twofold increased risk of cognitive impairment compared to those in the highest quartile after adjusting for potential confounding factors. These findings suggested that low levels of FT3 could be an independent risk factor for cognitive impairment in older euthyroid adults. Additionally, a positive linear association exists between serum FT3 levels and cognitive domains (such as immediate memory, language, and attention). Further studies are needed to determine the underlying mechanisms and the community significance of these findings.
Collapse
Affiliation(s)
- Hao Chen
- Department of Epidemiology and Health Statistics, School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, China
- The Third People's Hospital of Guizhou Province, Guiyang, China
| | - Jin Hu
- Department of Epidemiology and Health Statistics, School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, China
| | - Xing Yang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, China
| | - Quanxiang Zhou
- Department of Clinical Medicine, Qinnan Medical College for Nationalities, Qiannan, China
| | - Yuxin Hu
- Department of Epidemiology and Health Statistics, School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, China
| | - Xiaoyan Tang
- Department of Epidemiology and Health Statistics, School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, China
| | - Ji Tang
- Department of Epidemiology and Health Statistics, School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, China
| | - Li Zeng
- Department of Epidemiology and Health Statistics, School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, China
| | - Jingyuan Yang
- Department of Epidemiology and Health Statistics, School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, China.
| |
Collapse
|
3
|
Garduno Garcia JDJ, Chavez AO, Elías-López D. Editorial: Subclinical thyroid disease: present knowledge and future direction, volume II. Front Endocrinol (Lausanne) 2023; 14:1293910. [PMID: 37876535 PMCID: PMC10593469 DOI: 10.3389/fendo.2023.1293910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 10/26/2023] Open
Affiliation(s)
- Jose De Jesus Garduno Garcia
- Medicine school, Universidad Autónoma del Estado de México, Toluca, Mexico
- General Hospital, Instituto Mexicano del Seguro Social (IMSS), Toluca, Mexico
| | - Alberto O. Chavez
- Texas Diabetes Institute - University Health, UT Health San Antonio, San Antonio, TX, United States
| | - Daniel Elías-López
- Endocrinology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico
| |
Collapse
|
4
|
Song Z, Gurinovich A, Nygaard M, Mengel-From J, Andersen S, Cosentino S, Schupf N, Lee J, Zmuda J, Ukraintseva S, Arbeev K, Christensen K, Perls T, Sebastiani P. Rare genetic variants correlate with better processing speed. Neurobiol Aging 2023; 125:115-122. [PMID: 36813607 PMCID: PMC10038891 DOI: 10.1016/j.neurobiolaging.2022.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/17/2022] [Accepted: 11/23/2022] [Indexed: 01/30/2023]
Abstract
We conducted a genome-wide association study of Digit Symbol Substitution Test scores administered in 4207 family members of the Long Life Family Study (LLFS). Genotype data were imputed to the HRC panel of 64,940 haplotypes resulting in ∼15M genetic variants with a quality score > 0.7. The results were replicated using genetic data imputed to the 1000 Genomes phase 3 reference panel from 2 Danish twin cohorts: the study of Middle Aged Danish Twins and the Longitudinal Study of Aging Danish Twins. The genome-wide association study in LLFS discovered 18 rare genetic variants (minor allele frequency (MAF) < 1.0%) that reached genome-wide significance (p-value < 5 × 10-8). Among these, 17 rare variants in chromosome 3 had large protective effects on the processing speed, including rs7623455, rs9821776, rs9821587, rs78704059, which were replicated in the combined Danish twin cohort. These SNPs are located in/near 2 genes, THRB and RARB, that belonged to the thyroid hormone receptors family that may influence the speed of metabolism and cognitive aging. The gene-level tests in LLFS confirmed that these 2 genes are associated with processing speed.
Collapse
Affiliation(s)
- Zeyuan Song
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
| | - Anastasia Gurinovich
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Marianne Nygaard
- Epidemiology, Biostatistics and Biodemography, The Danish Aging Research Center, and The Danish Twin Registry, Institute of Public Health, University of Southern Denmark, Odense, Denmark; Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Jonas Mengel-From
- Epidemiology, Biostatistics and Biodemography, The Danish Aging Research Center, and The Danish Twin Registry, Institute of Public Health, University of Southern Denmark, Odense, Denmark; Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Stacy Andersen
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Stephanie Cosentino
- Departments of Epidemiology and Neurology, Columbia University Medical Center, New York, NY, USA
| | - Nicole Schupf
- Departments of Epidemiology and Neurology, Columbia University Medical Center, New York, NY, USA
| | - Joseph Lee
- Departments of Epidemiology and Neurology, Columbia University Medical Center, New York, NY, USA
| | - Joseph Zmuda
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Svetlana Ukraintseva
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
| | - Konstantin Arbeev
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
| | - Kaare Christensen
- Epidemiology, Biostatistics and Biodemography, The Danish Aging Research Center, and The Danish Twin Registry, Institute of Public Health, University of Southern Denmark, Odense, Denmark; Department of Clinical Genetics, Odense University Hospital, Odense, Denmark; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Thomas Perls
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Paola Sebastiani
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| |
Collapse
|
5
|
Yang H, Fang B, Wang Z, Chen Y, Dong Y. The Timing Sequence and Mechanism of Aging in Endocrine Organs. Cells 2023; 12:cells12070982. [PMID: 37048056 PMCID: PMC10093290 DOI: 10.3390/cells12070982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/15/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
The world is increasingly aging, and there is an urgent need to find a safe and effective way to delay the aging of the body. It is well known that the endocrine glands are one of the most important organs in the context of aging. Failure of the endocrine glands lead to an abnormal hormonal environment, which in turn leads to many age-related diseases. The aging of endocrine glands is closely linked to oxidative stress, cellular autophagy, genetic damage, and hormone secretion. The first endocrine organ to undergo aging is the pineal gland, at around 6 years old. This is followed in order by the hypothalamus, pituitary gland, adrenal glands, gonads, pancreatic islets, and thyroid gland. This paper summarises the endocrine gland aging-related genes and pathways by bioinformatics analysis. In addition, it systematically summarises the changes in the structure and function of aging endocrine glands as well as the mechanisms of aging. This study will advance research in the field of aging and help in the intervention of age-related diseases.
Collapse
Affiliation(s)
- He Yang
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, Ministry of Education, China Agricultural University, Beijing 100193, China
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Department of Nutrition and Health, China Agricultural University, Beijing 100193, China
| | - Bing Fang
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, Ministry of Education, China Agricultural University, Beijing 100193, China
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Department of Nutrition and Health, China Agricultural University, Beijing 100193, China
| | - Zixu Wang
- College of Veterinary Medicine, China Agricultural University, Beijing 100193, China
| | - Yaoxing Chen
- College of Veterinary Medicine, China Agricultural University, Beijing 100193, China
| | - Yulan Dong
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, Ministry of Education, China Agricultural University, Beijing 100193, China
- College of Veterinary Medicine, China Agricultural University, Beijing 100193, China
| |
Collapse
|
6
|
Apathetic hyperthyroidism in an elderly patient presenting with psychomotor retardation. J Am Assoc Nurse Pract 2022; 34:1098-1102. [PMID: 36083321 DOI: 10.1097/jxx.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/06/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Hyperthyroidism in the elderly population is often associated with atypical, blunted, or nonspecific signs and symptoms, also known as apathetic hyperthyroidism (AH). The absence of the classical hyperkinetic clinical presentation can be confused with the normal aging process, or other diseases, and often leads to misdiagnosis, delayed treatment, and negative outcomes for elderly patients. We provide a case study of an elderly patient to illustrate the atypical presentation of AH. The vignette also highlights a diagnostic and treatment approach based on geriatric medicine fundamentals and evidence-based research. We then review the multiple factors and pathogenetic mechanisms contributing to endocrine disruptors and the paucity of hyperadrenergic signs and symptoms in the elderly with hyperthyroidism. Additionally, the article contrasts the symptomatology and diagnostic profile between primary hyperthyroidism and AH. Finally, we provide an evidence-based, patient-centered approach to manage AH in the elderly population. We recommend that nurse practitioners cultivate illness script inclusive of atypical presentations to guide their clinical decision making. Psychomotor retardation with or without cardiovascular symptoms warrant a high degree of suspicion and the initiation of laboratory studies, including thyroid functions to confirm or rule out hyperthyroidism.
Collapse
|
7
|
Jensen RC, Glintborg D, Timmermann CAG, Nielsen F, Boye H, Madsen JB, Bilenberg N, Grandjean P, Jensen TK, Andersen MS. Higher free thyroxine associated with PFAS exposure in first trimester. The Odense Child Cohort. ENVIRONMENTAL RESEARCH 2022; 212:113492. [PMID: 35597289 DOI: 10.1016/j.envres.2022.113492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/18/2022] [Accepted: 05/14/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Perfluoroalkyl substances (PFAS) are endocrine disrupting chemicals with elimination half-lives ranging from four to eight years. Experimental studies found PFAS able to interfere with thyroid hormone-binding proteins. During the first 20 weeks of gestation (GW), the fetus is reliant on placental transfer of maternal thyroid hormones, mainly free thyroxine (FT4). However, previous studies investigating associations between exposure to PFAS and thyroid hormone status mainly focused on blood samples from late pregnancy or umbilical cord with mixed findings. OBJECTIVES To investigate associations between serum-PFAS concentrations and thyroid hormone status in early pregnancy as reflected by FT4 and thyroid-stimulating hormone (TSH). METHODS In the Odense Child Cohort, a single-center study, we measured maternal pregnancy serum concentrations of five PFAS: perfluorohexane sulfonic acid (PFHxS), perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA); and FT4 and TSH in 1048 pregnant women at median GW 12 (25th, 75th percentile: 10, 15). Multivariate linear regression models were performed to estimate associations between PFAS exposure and thyroid hormone status. RESULTS A doubling in PFOS, PFOA, and PFNA concentrations was associated with an increment in FT4 concentration by 1.85% (95% CI: 0.66%, 3.05%), 1.29% (95% CI: 0.21%, 2.39%), and 1.70% (95% CI: 0.48%, 2.94%), respectively, in adjusted analyses. A statistically significant dose-response relationship was observed across exposure quartiles for PFOS, PFOA, and PFNA in the association with FT4. No association was found between concentrations of PFAS and TSH in adjusted analyses. CONCLUSION Exposure to PFOS, PFOA, and PFNA was associated with higher FT4 concentrations in women during early pregnancy. The potential clinical implications of these findings remain to be clarified.
Collapse
Affiliation(s)
- Richard Christian Jensen
- Department of Endocrinology, Odense University Hospital, Søndre Blvd. 29, 5000, Odense C, Denmark; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, J.B. Winsløws Vej 17A, 5000, Odense C, Denmark.
| | - Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Søndre Blvd. 29, 5000, Odense C, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5000, Odense, Denmark
| | - Clara Amalie Gade Timmermann
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, J.B. Winsløws Vej 17A, 5000, Odense C, Denmark; National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, København K, Denmark
| | - Flemming Nielsen
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, J.B. Winsløws Vej 17A, 5000, Odense C, Denmark
| | - Henriette Boye
- Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000, Odense C, Denmark
| | - Jeppe Buur Madsen
- Department of Biochemistry and Immunology, Lillebaelt Hospital, Kabbeltoft 25, University Hospital of Southern Denmark, 7100, Vejle, Denmark
| | - Niels Bilenberg
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5000, Odense, Denmark; Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000, Odense C, Denmark; Department of Child and Adolescent Mental Health Odense, Mental Health Services in the Region of Southern Denmark, J. B. Winsløws Vej 16, 5000, Odense, Denmark
| | - Philippe Grandjean
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, J.B. Winsløws Vej 17A, 5000, Odense C, Denmark; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, 677 Huntington Avenue Boston, MA, 02115, USA
| | - Tina Kold Jensen
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, J.B. Winsløws Vej 17A, 5000, Odense C, Denmark; Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000, Odense C, Denmark; OPEN, University of Southern Denmark, J. B. Winsløws Vej 9a, 5000, Odense C, Denmark
| | - Marianne S Andersen
- Department of Endocrinology, Odense University Hospital, Søndre Blvd. 29, 5000, Odense C, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5000, Odense, Denmark
| |
Collapse
|
8
|
Hong J, Liu WY, Hu X, Chen WW, Jiang FF, Xu ZR, Shen FX, Zhu H. Free Triiodothyronine and Free Triiodothyronine to Free Thyroxine Ratio Predict All-Cause Mortality in Patients with Diabetic Foot Ulcers. Diabetes Metab Syndr Obes 2022; 15:467-476. [PMID: 35210796 PMCID: PMC8863187 DOI: 10.2147/dmso.s354754] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 01/29/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Free triiodothyronine (FT3) and FT3/free thyroxine (FT4) ratio have been associated with mortality in various diseases. However, no study to date has identified a link between FT3, FT3/FT4 ratio and all-cause mortality in patients with diabetic foot ulcers (DFUs). This study aimed to investigate this relationship. METHODS This retrospective cohort study included 726 patients diagnosed with DFUs in a public hospital from January 2015 to October 2019. Patients were classified by the optimal cut-off values of the FT3 and FT3/FT4 ratio, respectively. The association of FT3 and FT3/FT4 ratio with all-cause mortality was evaluated in a multivariable cox regression model. Directed acyclic graphs were used to assess the minimally sufficient sets of confounding variables. RESULTS Log rank tests indicated that patients with low FT3 and FT3/FT4 ratio had lower overall survival rates (all p < 0.001). The adjusted HRs for all-cause mortality were 0.48 (95% CI: 0.32-0.73, P = 0.001) when comparing high versus low FT3 and 0.47 (95% CI: 0.32-0.70, P < 0.001) when comparing high versus low FT3/FT4 ratio. Subgroup analyses showed that these associations existed only in elderly patients (≥65 years) and women, after adjustment. In men, only high FT3/FT4 ratio was associated with low all-cause mortality, after adjustment. CONCLUSION Routine assessment of FT3 and FT3/FT4 ratio may be a simple and effective way to identify high-risk patients with DFUs, especially in elderly patients and women.
Collapse
Affiliation(s)
- Jing Hong
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Wen-Yue Liu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Xiang Hu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Wen-Wen Chen
- Department of Geriatrics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Fei-Fei Jiang
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Ze-Ru Xu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Fei-Xia Shen
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
| | - Hong Zhu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
- Correspondence: Hong Zhu, Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China, Tel +86 577-55579622, Fax +86 577-55578522, Email
| |
Collapse
|
9
|
Zhang Y, Sun Y, He Z, Xu S, Liu C, Li Y, Shan Z, Teng W. Age-specific thyrotropin references decrease over-diagnosis of hypothyroidism in elderly patients in iodine-excessive areas. Clin Endocrinol (Oxf) 2021. [PMID: 34585413 DOI: 10.1111/cen.14589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Acute or chronic exposure to excess iodine has detrimental effects on thyroid physiology; therefore, this study aimed to determine the prevalence of overt hypothyroidism (OH) and subclinical hypothyroidism (SCH) in an elderly population residing in geographical areas with chronic exposure to excess iodine intake and to analyse contributing risk factors. DESIGN This cross-sectional study was conducted from 2016 to 2017 in areas of Jiangsu Province that have documented chronic exposure to high iodine intake. PATIENTS We enroled 2559 adult participants using a multistage, stratified sampling method. MEASUREMENTS Urinary iodine concentration (UIC), serum thyroid-stimulating hormone (TSH) level and other relevant parameters were measured. Demographic information was recorded using a standardized questionnaire. The age-specific TSH references were determined by the National Academy of Clinical Biochemistry guidelines. Univariate and multivariate logistic regression analyses were performed to identify risk factors for hypothyroidism in the study population. RESULTS The median UIC of participants was 307.3 µg/L (interquartile range: 200.7, 469.8 μg/L). The prevalence of OH in subjects ≥70 years using laboratory reference ranges was 2.37%; however, it decreased to 1.78% with the use of an age-specific reference range. Similarly, the prevalence of SCH also declined drastically from 29.59% to 2.96% with the application of an age-specific reference range. In both univariate and multivariate models, advanced age, female gender and high UIC were identified as risk factors for hypothyroidism. CONCLUSIONS Usage of age-specific TSH reference ranges led to a significantly lower prevalence of OH and SCH in the study population, thus preventing unnecessary over-diagnosis and over-treatment.
Collapse
Affiliation(s)
- Yingchai Zhang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P.R. China
| | - Yu Sun
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P.R. China
- Department of Endocrinology and Metabolism, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu, P.R. China
| | - Zhiwei He
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P.R. China
| | - Shuhang Xu
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P.R. China
| | - Chao Liu
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P.R. China
| | - Yongze Li
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, The First Hospital of China Medical University, Shenyang, Liaoning, P.R. China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, The First Hospital of China Medical University, Shenyang, Liaoning, P.R. China
| | - Weiping Teng
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, The First Hospital of China Medical University, Shenyang, Liaoning, P.R. China
| |
Collapse
|
10
|
Iwen A. [Thyroid dysfunction in old age]. Dtsch Med Wochenschr 2021; 146:1298-1308. [PMID: 34553358 DOI: 10.1055/a-1239-3066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Thyroid dysfunctions are common endocrine disorders. With an increasing number of older persons in European societies, the number of older patients affected will also rise. The physiology of thyroid hormones and their regulation change with increasing age. The age-dependent increase of thyroid stimulating hormone (TSH) is clinically most relevant, but many laboratories do not provide age-specific reference ranges. Older patients also have more comorbidities and thyroid dysfunctions will have a negative impact on many of these, in particular on cardiovascular disorders. While there are clear indications to treat overt hyperthyroidism and hypothyroidism, treatment recommendations for subclinical thyroid dysfunctions differ depending on the patient's age. The European Thyroid Association suggests a TSH level of 0.1 mU/l for patients with subclinical hyperthyroidism older than 65 years as threshold. A TSH level < 0.1 mU/l is a clear indication for treatment while concentrations > 0.1 mU/l are relative treatment indications. Patients older than 65 years with subclinical hypothyroidism and a TSH level > 10 mU/l should also be treated, in particular when cardiovascular comorbidities are present. Levothyroxine treatment has to be monitored on a regular basis, as overdosing is also harmful. For patients with TSH concentrations between 7 and 10 mU/l there is no clear indication to initiate a levothyroxine treatment, as they do not have a clearly elevated mortality and morbidity, also quality of life does not improve.
Collapse
|
11
|
Guest PC. New Therapeutic Approaches and Biomarkers for Increased Healthspan. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1286:1-13. [PMID: 33725342 DOI: 10.1007/978-3-030-55035-6_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Healthcare costs have increased in developing countries over the last few decades, mostly due to the escalation in average life expectancy and the concomitant increase in age-related disorders. To address this issue, widespread research is now being undertaken across the globe with the aim of finding a way of increasing healthy aging. A number of potential interventions have already shown promise, including lifestyle changes and the use of natural products or pharmaceuticals that may delay the onset of diseases associated with the aging process. In parallel, a number of potential biomarkers have already been identified that can be used for assessing risk of developing age-associated disorders and for monitoring response to therapeutic interventions. This review describes the most recent advances towards the goal of achieving healthier aging with fewer disabilities that may lead to enhanced quality of life and reduced healthcare costs around the world.
Collapse
Affiliation(s)
- Paul C Guest
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil.
| |
Collapse
|
12
|
Duntas LH. Aging and the hypothalamic-pituitary-thyroid axis. VITAMINS AND HORMONES 2021; 115:1-14. [PMID: 33706944 DOI: 10.1016/bs.vh.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The world's population is increasingly aging, this noted particularly in the Western world where there are ever greater numbers of centenarians and those over 85 years. Given the immense importance of the thyroid gland for optimal health and the fact that morphological and functional changes in the hypothalamic-pituitary-thyroid (HPT) axis take place as a natural adaptation to the aging process, a clear distinction must be made in older individuals between these and the onset of disease. However, this is problematic since, frequently, subtle differences exist between them, making diagnosis a challenging task, especially as concerns subclinical disease. The newly emerging interdisciplinary field of geroscience offers the prospect of being used as a platform to investigate the effect of disrupted HPT function on functional capacity and cognitive ability among the aged, as well as the risk or onset of age-associated diseases, thus enhancing healthspan and lifespan. Because optimal functioning of the thyroid gland is a prerequisite for longevity as well as for mental and physical wellbeing, this review summarizes the recent scientific data regarding HPT and aging while discussing alternative and personalized treatment approaches to maintaining a healthy thyroid as a means to ensuring a long, active, and healthy life.
Collapse
Affiliation(s)
- Leonidas H Duntas
- Evgenideion Hospital, Unit of Endocrinology, Diabetes and Metabolism, University of Athens, Athens, Greece.
| |
Collapse
|
13
|
Yuasa R, Ohashi Y, Saito A, Tsuboi K, Shishido S, Sakai K. Prevalence of hypothyroidism in Japanese chronic kidney disease patients. Ren Fail 2020; 42:572-579. [PMID: 32567453 PMCID: PMC7946052 DOI: 10.1080/0886022x.2020.1777162] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Major symptoms of progressive chronic kidney disease (CKD) are similar to those of hypothyroidism. Hidden symptoms of hypothyroidism underlying CKD are often observed in clinical practice. This study aimed to ascertain the frequency of hypothyroidism complicated by CKD, and to analyze factors impacting thyroid function.Methods: During the period from April 2012 through October 2016, 510 CKD patients at our outpatient clinic were measured thyroid and kidney function for diagnosing hypothyroidism (overt hypothyroidism, OH; subclinical hypothyroidism, SH; non-thyroidal illness, NTI) and evaluating the stage of CKD. All patients were over 15 years of age.Results: There were significant differences in age, estimated glomerular filtration rate (eGFR), urinary protein (UP), and serum albumin (Alb) among patients with OH, SH, and NTI compared to the normal group in univariate and multivariate analyses. UP showed the highest odds ratio of OH, SH, and NTI but no differences were recognized in gender in each group. Frequency distribution showed that the prevalence of thyroid dysfunction was greater among more severe stage of CKD with higher amount of UP. OH and SH did not show high positive ratio of anti-thyroglobulin antibody (TgAb) and anti-thyroid peroxidase antibody (TPOAb). NTI and normal subjects showed higher positive ratio as 50.0% and 42.9% of TgAb and TPOAb than OH and SH.Conclusions: Hypothyroidism complicated by CKD exhibited a high prevalence. Age, eGFR, UP, and serum Alb were related to the prevalence of hypothyroidism, whereas gender was not and this was contradicted to the prevalence of hypothyroidism in general population. The prevalence of OH and SH was higher among patients with higher stage of CKD with increased UP. Hypothyroidism complicated by CKD may involve different onset mechanisms unrelated to antithyroid antibodies (ATAb). In CKD patients, assessments of OH and SH, as well as NTI, are needed for proper diagnosis.
Collapse
Affiliation(s)
- Rena Yuasa
- Department of Nephrology, Toho University School of Medicine, Tokyo, Japan
| | - Yasushi Ohashi
- Department of Nephrology, Toho University School of Medicine, Tokyo, Japan
| | - Akinobu Saito
- Department of Nephrology, Toho University School of Medicine, Tokyo, Japan
| | - Kumiko Tsuboi
- Department of Internal Medicine, Division of Diabetes Metabolism and Endocrinology, Toho University School of Medicine, Tokyo, Japan
| | - Seiichiro Shishido
- Department of Nephrology, Toho University School of Medicine, Tokyo, Japan
| | - Ken Sakai
- Department of Nephrology, Toho University School of Medicine, Tokyo, Japan
| |
Collapse
|
14
|
Mariani G, Tonacchera M, Grosso M, Orsolini F, Vitti P, Strauss HW. The Role of Nuclear Medicine in the Clinical Management of Benign Thyroid Disorders, Part 1: Hyperthyroidism. J Nucl Med 2020; 62:304-312. [PMID: 33008929 DOI: 10.2967/jnumed.120.243170] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/02/2020] [Indexed: 12/15/2022] Open
Abstract
Benign thyroid disorders, especially hyper- and hypothyroidism, are the most prevalent endocrine disorders. The most common etiologies of hyperthyroidism are autoimmune hyperthyroidism (Graves disease, GD), toxic multinodular goiter (TMNG), and toxic thyroid adenoma (TA). Less common etiologies include destructive thyroiditis (e.g., amiodarone-induced thyroid dysfunction) and factitious hyperthyroidism. GD is caused by autoantibodies against the thyroid-stimulating hormone (TSH) receptor. TMNG and TA are caused by a somatic activating gain-of-function mutation. Typical laboratory findings in patients with hyperthyroidism are low TSH, elevated free-thyroxine and free-triiodothyronine levels, and TSH-receptor autoantibodies in patients with GD. Ultrasound imaging is used to determine the size and vascularity of the thyroid gland and the location, size, number, and characteristics of thyroid nodules. Combined with lab tests, these features constitute the first-line diagnostic approach to distinguishing different forms of hyperthyroidism. Thyroid scintigraphy with either radioiodine or 99mTc-pertechnetate is useful to characterize different forms of hyperthyroidism and provides information for planning radioiodine therapy. There are specific scintigraphic patterns for GD, TMNG, TA, and destructive thyroiditis. Scintigraphy with 99mTc-sestamibi allows differentiation of type 1 from type 2 amiodarone-induced hyperthyroidism. The radioiodine uptake test provides information for planning radioiodine therapy of hyperthyroidism. Hyperthyroidism can be treated with oral antithyroid drugs, surgical thyroidectomy, or 131I-iodide. Radioiodine therapy is generally considered after failure of treatment with antithyroid drugs, or when surgery is contraindicated or refused by the patient. In patients with TA or TMNG, the goal of radioiodine therapy is to achieve euthyroid status. In GD, the goal of radioiodine therapy is to induce hypothyroidism, a status that is readily treatable with oral thyroid hormone replacement therapy. Dosimetric estimates based on the thyroid volume to be treated and on radioiodine uptake should guide selection of the 131I-activity to be administered. Early side effects of radioiodine therapy (typically mild pain in the thyroid) can be handled by nonsteroidal antiinflammatory drugs. Delayed side effects after radioiodine therapy for hyperthyroidism are hypothyroidism and a minimal risk of radiation-induced malignancies.
Collapse
Affiliation(s)
- Giuliano Mariani
- Department of Translational Research and Advanced Technologies in Medicine and Surgery, Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy
| | - Massimo Tonacchera
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mariano Grosso
- Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy; and
| | - Francesca Orsolini
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paolo Vitti
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - H William Strauss
- Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
15
|
Goichot B, Raverot V, Klein M, Vija Racaru L, Abeillon-Du Payrat J, Lairez O, Leroy R, Cailleux A, Wolff P, Groussin L, Kaltenbach G, Caron P. Management of thyroid dysfunctions in the elderly. French Endocrine Society consensus statement 2019. Long version. ANNALES D'ENDOCRINOLOGIE 2020; 81:89-100. [PMID: 32416938 DOI: 10.1016/j.ando.2020.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Bernard Goichot
- Service de médecine interne, endocrinologie et nutrition, hôpital de Hautepierre, hôpitaux universitaires, 67098 Strasbourg cedex, France.
| | - Véronique Raverot
- Hospices civils de Lyon, groupement hospitalier Est, LBMMS, laboratoire d'hormonologie, 69677 Bron cedex, France.
| | - Marc Klein
- Service EDN, CHU de Nancy, 54500 Vandœuvre-Lès-Nancy, France.
| | - Lavinia Vija Racaru
- Service de médecine nucléaire, institut universitaire de cancérologie de Toulouse Oncopole, 31059 Toulouse, France.
| | | | - Olivier Lairez
- Fédération des services de cardiologie, centre d'imagerie cardiaque, CHU Rangueil, CHU de Toulouse, Toulouse, France.
| | - Rémy Leroy
- Cabinet d'endocrinologie et diabétologie, 71, rue de La Louvière, 59000 Lille, France.
| | - Anne Cailleux
- Clinique Mathilde, 7, boulevard de l'Europe, 76100 Rouen, France.
| | - Pierre Wolff
- Espace santé, 8, rue de Lattre de Tassigny, 69350 La Mulatière, France.
| | - Lionel Groussin
- Université de Paris, Inserm U1016, CNRS UMR8104, institut Cochin, service d'endocrinologie, AP-HP, hôpital Cochin, 75014 Paris, France.
| | - Georges Kaltenbach
- Pôle de gériatrie, hôpital de la Robertsau, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France.
| | - Philippe Caron
- Service d'endocrinologie et maladies métaboliques, CHU Larrey, 31059 Toulouse, France.
| |
Collapse
|
16
|
Li ZZ, Yu BZ, Wang JL, Yang Q, Ming J, Tang YR. Reference intervals for thyroid-stimulating hormone and thyroid hormones using the access TSH 3rd IS method in China. J Clin Lab Anal 2020; 34:e23197. [PMID: 31912542 PMCID: PMC7246370 DOI: 10.1002/jcla.23197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 11/09/2022] Open
Abstract
Background To calculate the reference intervals for thyroid‐stimulating hormone (TSH) and thyroid hormones using the Access TSH 3rd IS method and evaluate the differences between age and genders in Chinese populations. Methods This study collected 349 serum samples of healthy subjects were from Shengli Oilfield Central Hospital in China. Subjects who tested positive for thyroid peroxidase antibody or thyroglobulin antibody were excluded. Accordingly, 313 subjects were included for establishing reference intervals for the thyroid hormones. The serum concentrations of TSH, total and free thyroxine (TT4 and FT4), and total and free triiodothyronine (TT3 and FT3) were measured using the Access TSH 3rd IS method. The 2.5th and 97.5th percentiles or mean with standard deviation were calculated as the reference interval as appropriate. Results The reference intervals for TSH, FT4, FT3, TT4, and TT3 calculated in present study were 0.61‐4.16 mIU/L, 0.67‐1.11 ng/dL, 2.63‐4.33 pg/mL, 5.56‐11.33 μg/dL, and 0.72‐1.32 ng/mL, respectively. The FT3, TT4, and TT3 levels in males were significantly higher than in females (P < .05), while TSH levels in males were significantly lower than in females (P < .05). The levels of FT3 in subjects with the age of less than 30 years were significantly higher than other groups (P < .05). Conclusion The present study provided a valid basis for the reference intervals for TSH, FT4, FT3, TT4, and TT3 in Chinese populations. In addition, this present study indicated that age and gender should be considered in diagnostic evaluation of thyroid diseases.
Collapse
Affiliation(s)
- Zhen-Zhen Li
- Department of Clinical Laboratory, Shengli Oilfield Central Hospital, Dongying, China
| | - Ben-Zhang Yu
- Department of Clinical Laboratory, Shengli Oilfield Central Hospital, Dongying, China
| | - Ji-Liang Wang
- Department of Clinical Laboratory, Shengli Oilfield Central Hospital, Dongying, China
| | - Qin Yang
- Department of Clinical Laboratory, Shengli Oilfield Central Hospital, Dongying, China
| | - Jia Ming
- Department of Clinical Laboratory, Shengli Oilfield Central Hospital, Dongying, China
| | - Yu-Rong Tang
- Department of Clinical Laboratory, Shengli Oilfield Central Hospital, Dongying, China
| |
Collapse
|
17
|
Thayakaran R, Adderley NJ, Sainsbury C, Torlinska B, Boelaert K, Šumilo D, Price M, Thomas GN, Toulis KA, Nirantharakumar K. Thyroid replacement therapy, thyroid stimulating hormone concentrations, and long term health outcomes in patients with hypothyroidism: longitudinal study. BMJ 2019; 366:l4892. [PMID: 31481394 PMCID: PMC6719286 DOI: 10.1136/bmj.l4892] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To explore whether thyroid stimulating hormone (TSH) concentration in patients with a diagnosis of hypothyroidism is associated with increased all cause mortality and a higher risk of cardiovascular disease and fractures. DESIGN Retrospective cohort study. SETTING The Health Improvement Network (THIN), a database of electronic patient records from UK primary care. PARTICIPANTS Adult patients with incident hypothyroidism from 1 January 1995 to 31 December 2017. EXPOSURE TSH concentration in patients with hypothyroidism. MAIN OUTCOME MEASURES Ischaemic heart disease, heart failure, stroke/transient ischaemic attack, atrial fibrillation, any fractures, fragility fractures, and mortality. Longitudinal TSH measurements from diagnosis to outcomes, study end, or loss to follow-up were collected. An extended Cox proportional hazards model with TSH considered as a time varying covariate was fitted for each outcome. RESULTS 162 369 patients with hypothyroidism and 863 072 TSH measurements were included in the analysis. Compared with the reference TSH category (2-2.5 mIU/L), risk of ischaemic heart disease and heart failure increased at high TSH concentrations (>10 mIU/L) (hazard ratio 1.18 (95% confidence interval 1.02 to 1.38; P=0.03) and 1.42 (1.21 to 1.67; P<0.001), respectively). A protective effect for heart failure was seen at low TSH concentrations (hazard ratio 0.79 (0.64 to 0.99; P=0.04) for TSH <0.1 mIU/L and 0.76 (0.62 to 0.92; P=0.006) for 0.1-0.4 mIU/L). Increased mortality was observed in both the lowest and highest TSH categories (hazard ratio 1.18 (1.08 to 1.28; P<0.001), 1.29 (1.22 to 1.36; P<0.001), and 2.21 (2.07 to 2.36; P<0.001) for TSH <0.1 mIU/L, 4-10 mIU/L, and >10 mIU/L. An increase in the risk of fragility fractures was observed in patients in the highest TSH category (>10 mIU/L) (hazard ratio 1.15 (1.01 to 1.31; P=0.03)). CONCLUSIONS In patients with a diagnosis of hypothyroidism, no evidence was found to suggest a clinically meaningful difference in the pattern of long term health outcomes (all cause mortality, atrial fibrillation, ischaemic heart disease, heart failure, stroke/transient ischaemic attack, fractures) when TSH concentrations were within recommended normal limits. Evidence was found for adverse health outcomes when TSH concentration is outside this range, particularly above the upper reference value.
Collapse
Affiliation(s)
- Rasiah Thayakaran
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
- Joint first authors
| | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
- Joint first authors
| | - Christopher Sainsbury
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Barbara Torlinska
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Kristien Boelaert
- Institute of Metabolism and Systems Research, Edgbaston, Birmingham B15 2TT, UK
- Institute of Translational Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
- Centre for Endocrinology, Diabetes and Metabolism, Edgbaston, Birmingham B15 2TT, UK
| | - Dana Šumilo
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Malcolm Price
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Konstantinos A Toulis
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
- Department of Endocrinology, 424 General Army Training Hospital, Thessaloniki, Greece
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
- Centre for Endocrinology, Diabetes and Metabolism, Edgbaston, Birmingham B15 2TT, UK
- Health Data Research UK Midlands, Institute of Translational Medicine, Edgbaston, Birmingham B15 2TH, UK
| |
Collapse
|
18
|
Affiliation(s)
- Matthew T Drake
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN.
| |
Collapse
|
19
|
Clerico A, Trenti T, Aloe R, Dittadi R, Rizzardi S, Migliardi M, Musa R, Dipalo M, Prontera C, Masotti S, Musetti V, Tozzoli R, Padoan A, Bagnasco M. A multicenter study for the evaluation of the reference interval for TSH in Italy (ELAS TSH Italian Study). ACTA ACUST UNITED AC 2018; 57:259-267. [DOI: 10.1515/cclm-2018-0541] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/18/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Background
The aims of this study were: (1) to calculate reliable thyroid stimulating hormone (TSH) reference intervals using laboratory databases; (2) to evaluate the relationship between TSH, sex and age values in different large Italian populations.
Methods
The TSH values stored in the laboratory information system of clinical laboratories of four Italian city hospitals, including 146,801 TSH measurements (with the respective age and sex data of individuals) were taken in consideration. Assuming a log-normal distribution, to log-transformed TSH values were applied the Dixon’s iterative principle in order to exclude the outliers. At the end of this iterative process 142,821 log-transformed TSH results remained. The four clinical laboratories measured serum TSH concentrations using the same TSH immunoassay method (Access TSH 3rd IS, using UniCel DxI platform).
Results
The TSH reference interval calculated in the present study (0.362–5.280 mIU/L) is similar to that suggested by the manufacturer for the Access TSH 3rd IS assay (0.45–5.33 mIU/L). TSH values in females were significantly higher than in males (females: mean=2.06 mIU/L; standard deviation [SD]=1.26 mIU/L; n=101,243; males: mean=1.92 mIU/L; SD=1.19 mIU/L; n=41,578; p<0.0001). Moreover, a negative linear relationship was observed between TSH throughout all interval age values (from 0 to 105 years).
Conclusions
The results of the present multicenter study confirm that data mining techniques can be used to calculate clinically useful reference intervals for TSH. From a pathophysiological point of view, our results suggest that some Northern populations of Italy might still suffer some harmful effects on the thyroid gland due to mild to moderate iodine intake deficiency. Specific clinical trials are needed to confirm these results.
Collapse
Affiliation(s)
- Aldo Clerico
- Laboratory of Cardiovascular Endocrinology and Cell Biology, Department of Laboratory Medicine , Fondazione CNR-Regione Toscana Gabriele Monasterio, Scuola Superiore Sant’Anna , Via Trieste 41 , 56126 Pisa , Italy
| | - Tommaso Trenti
- Laboratorio di Patologia Clinica, Ospedale Pavullo nel Frignano , Modena , Italy
| | - Rosalia Aloe
- Dipartimento di Biochimica ad Elevata Automazione, Dipartimento Diagnostico , Azienda Ospedaliero-Universitaria di Parma , Parma , Italy
| | - Ruggero Dittadi
- U.O.C. Laboratorio Analisi, Ospedale dell’Angelo, AULSS3 Serenissima , Mestre, Venezia , Italy
| | - Sara Rizzardi
- Laboratorio Analisi Aziendale (SC), Azienda Socio-Sanitaria Territoriale di Cremona, Istituti Ospitalieri , Cremona , Italy
| | - Marco Migliardi
- S.C. Laboratorio Analisi, A.O. Ordine Mauriziano di Torino , Turin , Italy
| | - Roberta Musa
- Dipartimento di Biochimica ad Elevata Automazione, Dipartimento Diagnostico , Azienda Ospedaliero-Universitaria di Parma , Parma , Italy
| | - Mariella Dipalo
- Dipartimento di Biochimica ad Elevata Automazione, Dipartimento Diagnostico , Azienda Ospedaliero-Universitaria di Parma , Parma , Italy
| | - Concetta Prontera
- Fondazione CNR-Regione Toscana Gabriele Monasterio, Scuola Superiore Sant’Anna , Pisa , Italy
| | - Silvia Masotti
- Fondazione CNR-Regione Toscana Gabriele Monasterio, Scuola Superiore Sant’Anna , Pisa , Italy
| | - Veronica Musetti
- Fondazione CNR-Regione Toscana Gabriele Monasterio, Scuola Superiore Sant’Anna , Pisa , Italy
| | - Renato Tozzoli
- Clinical Pathology Laboratory, Department of Laboratory Medicine , Azienda per l’Assistenza Sanitaria n.5, Pordenone Hospital , Pordenone , Italy
| | - Andrea Padoan
- Department of Laboratory Medicine , University-Hospital , Padova , Italy
| | | |
Collapse
|