What Happens If Tsh Is Over 50

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What Happens If Tsh Is Over 50 – Treatment of overt hypothyroidism with levothyroxine (L-T4) may be more difficult in older patients than in younger patients. The aging population is increasing, and the incidence and prevalence of hypothyroidism is increasing worldwide. Older adults have more comorbidities than younger patients, making accurate diagnosis and management of hypothyroidism difficult. Importantly, cardiovascular disease compromises the normal initial dose and elevation of L-T4 due to the high risk of ischemic heart failure and dysfunction. Therefore, it requires more effort and care from the doctor, and the maintenance dose should be lower to avoid heart disease. On the other hand, L-T4 has a positive effect on the work of the heart by increasing its efficiency. Clinical severity should not prevent treatment with L-T4 if the patient has, for example, cardiac ischemia. The endocrinologist is obliged to cooperate with the cardiologist on measures to prevent the heart through invasive heart surgery or medical treatment against ischemic heart angina. This usually allows for successful subsequent treatment. Controlling mild (subclinical) hypothyroidism is even more difficult. Common diseases in the elderly make accurate diagnosis difficult, as many co-morbidities may mimic mild hypothyroidism and cause nonthyroidal disorders. Diagnosis is further complicated by the fact that the methods used to measure thyroid function (thyrotropin and thyroxine) vary depending on the procedure and the population. It is therefore important to confirm the correct diagnosis of the etiology (eg autoimmunity) before deciding on treatment. However, there is controversy about whether treating these subtypes of hypothyroidism in the elderly improves mortality, morbidity, and quality of life. This should be studied in a larger group of patients in long-term placebo-controlled studies with clinically relevant results. Other conditions of hypothyroidism, such as medications, iodine overload, or hypothalamic-pituitary-hypothyroidism, each have unique challenges in managing hypothyroidism; These conditions are also common in elderly people. Finally, adherence to treatment is often difficult. This is also the case for elderly patients, who may need to have their thyroid hormones measured at altered intervals, which is important to avoid overdosing with an increased risk of heart disease and death, osteoporosis, cognitive dysfunction and muscle failure.

According to World Population Prospects 2019 (United Nations, 2019), the share of people aged 65 and over increased from 6% in 1990 to 9% in 2019 and is expected to increase to 16% in 2050 (1 ). Life expectancy experienced the fastest increase between 2000 and 2016 since the 1960s (2), and the over-65 age group is improving worldwide, as between 2015 and 2020 a 65-year-old can expect living 17 more years on average. . Ironically, this population change is accompanied by an increase in the prevalence of many chronic diseases, an increase (more) in morbidity and disability, leading to polypharmacy at a greater risk of drug interactions and side effects (3).

What Happens If Tsh Is Over 50

What Happens If Tsh Is Over 50

Hypothyroidism is a common disease caused by a lack of thyroid hormone. In general, the pathology occurs in the thyroid gland, so it is called primary hypothyroidism, which is characterized biochemically by an increase in thyroid-stimulating hormone (TSH) in the blood plasma. Depending on the concentration of circulating free thyroxine (fT4), it is divided into overt hypothyroidism when fT4 is below the population reference range and subclinical hypothyroidism when fT4 is within the population reference range (4). The latter, in turn, is divided into grade 1 (mild) subclinical hypothyroidism when TSH is within 10 mU/L of the upper limit, and grade 2 (severe) subclinical hypothyroidism when TSH ≥10 mU/L (5).

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The prevalence of overt hypothyroidism in the general population is 0.1 to 2% (6-9), while the prevalence of subclinical hypothyroidism is much higher, 4-10% (6, 8, 10, 11). The prevalence of hypothyroidism increases with age, and subclinical hypothyroidism affects up to 15% of adults older than 65 years when unadjusted TSH reference values ​​are used (9, 12-14). Spontaneous hypothyroidism is about 10 times more common in women than in men (15). The proportion of women with elevated serum TSH concentrations in each decade was higher than men in the Colorado Thyroid Disease Prevalence Study (9).

Symptoms of hypothyroidism are not specific and vary between patients, especially in subclinical hypothyroidism. Similar symptoms are seen in euthyroid individuals and often overlap with symptoms seen in hypothyroid patients (9). Symptoms associated with hypothyroidism can indicate and diagnose hypothyroidism in many young patients, but this is rare in the elderly (16). However, true hypothyroidism that leads to fatigue, sleep disorders, depression, lack of concentration and memory loss in the elderly may be overlooked because these symptoms can be interpreted by both doctors and patients as normal age-related changes.

Conclusive evidence in recent decades has shown that the age-dependent distribution of TSH shifts to higher concentrations with increasing age. In NHANES III, the mean concentration of TSH increased gradually with age and was highest in the 97.5th percentile of the reference population over 70 years without thyroid antibodies (97.5th percentile TSH in the reference population: value 4.1 mU/L; 70 – 79 years old 5.9 mIU/l, > 80 years old 7.5 mIU/l) (11). Similar results were obtained in other populations, such as Scottish (31-40 years, 80-90 years and >90 years 97.5th percentile TSH 4.0, 5.5 and 5.9 mU/L), Ashkenazi Jews (4.6 and 7.2) are available. mU/L mean age 72 and 98 years, Americans (5.2 and 6.8 mU/L for 20-29 years and > 80 years respectively) and Chinese (<65 years 6.6 and 8.9 mU/L ) years, respectively ≥ 65 years ) (17–20). Iodine intake and thyroid autoimmunity are important factors to consider when considering the epidemiology of hypothyroidism in different age groups and populations (21-23). Even careful iodine supplementation in humans can significantly alter the incidence of disease (21, 24, 25). Autoimmune hypothyroidism is the most common cause of hypothyroidism at all ages, and the prevalence of thyroid autoimmunity increases with aging (23, 26, 27).

However, the high prevalence of thyroid autoimmunity in the elderly may partially explain the elevated TSH concentrations with increasing age. Therefore, in the NHANES III study, an age-dependent increase in TSH concentration was observed among thyroid antibody-negative subjects, and longitudinal data suggest that TSH generally increases with time and age in the same individual, especially in the elderly (28), 29). Individually, age-dependent TSH elevation was not associated with fT4 decline or increased mortality, suggesting that TSH elevation may reflect age-related changes in TSH set point and/or reduced TSH bioactivity and/or sensitivity. TSH than occult thyroid disease (30). When using the age reference categories in the NHANES III study, 70% of the 80-year-old group was reclassified as having a normal TSH for their age rather than a high TSH based on the normal population range (>4.5 mU/L). ) (31). Furthermore, no correlation was observed between thyroid function and quality of life, mood, and cognition when variable TSH reference measurements were used and community-dwelling elderly men were followed for 5-8 years (32).

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Longevity is associated with higher concentrations of TSH in the Ashkenazi population (19) and confirmed by two Dutch studies (the Leiden 85-Plus study and the Leiden Longevity Study) (33-35). 85-year-old men and women with abnormally high TSH and abnormally low fT4 concentrations according to the standard reference list for young adults had significantly lower mortality during 3.7 years of follow-up (33). Analysis of pooled data from the Leiden 85-Plus Study of Longevity Families and the Leiden 85-Plus Study from the general population showed an association between mortality risk and low fT4, high free thyronine (fT3), and high fT3/ . The mean fT4 but not TSH is high (36). A low basal metabolic rate due to low fT4 activity has been suggested as a possible explanation for the association between TSH and longevity (35).

A drug test should always be done before a diagnosis of hypothyroidism is made. This is especially important for the elderly, as they often have (multiple) illnesses and over-prescribed medications. Many drugs can affect the test of thyroid function not only by interfering with TSH and thyroid hormone synthesis, transport, and metabolism, but also by interfering with the test of immunoassays of thyroid function (30, 37-40) (Table 1) .

Comorbidities, which are more common in older adults, can cause changes in thyroid function as part of the euthyroid disease syndrome. Although euthyroid pain syndrome is seen in critically ill patients (41, 42), it can also develop in common chronic conditions such as heart, kidney, liver disease, diabetes, severe stress, and low-calorie diet (43). ). Biochemical marker of euthyroid disease syndrome is normal or slightly decreased TSH (Figure 1) (Table 2) (41, 42) with very low T3 and therefore T3 measurement should be done when euthyroid syndrome is suspected . . Low T4 is also often seen in progression and TSH is often elevated in the recovery phase (41, 42). So far, treatment with L-T4 has not been shown in this setting, except for patients

What Happens If Tsh Is Over 50

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