The world's population is aging. Therefore, one of the main health problems is likely to be the spread of diseases associated with aging, such as dementia, type 2 diabetes and cardiovascular diseases.
As well as obvious hypothyroidism, a slight increase in the level of thyrotropin (thyroid-stimulating hormone − TSH) in the blood serum is often noted in older people.
Find out in the article on estet-portal.com how thyroid hormone levels are related to aging processes.
Peculiarities of therapy for hypothyroidism in older patients
The prevalence of thyroid hormone treatment is increasing and more than 10-15% of people over the age of 80 are currently taking levothyroxine replacement therapy.
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The dose of levothyroxine, which normalizes serum TSH levels, is lower in older patients with age-related decrease in adipose tissue mass. Other factors such as reduced absorption, concomitant drug use, and other comorbidities may also affect thyroid hormone metabolism.
Older people are more sensitive to the negative effects of excess thyroid hormones.
Thus, careful dose adjustments of levothyroxine at regular intervals are necessary to prevent iatrogenic hyperthyroidism in this group of patients. In the study − 12 months of treatment with levothyroxine for subclinical hypothyroidism in the elderly, the experts concluded that there was no benefit from the treatment and no effect on quality of life.
Thus, it is reasonable to raise serum TSH targets in individuals over 70-80 years of age, especially if they are at risk of developing cardiac arrhythmias or osteoporosis.
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Life expectancy and thyroid hormones
As the number of older people around the world is growing rapidly, the factors associated with healthy aging have become the subject of intense research. Experimental data effectively demonstrate the correlation between thyroid hormones and life expectancy.
Researchers indicate that age-related mild hypothyroidism is beneficial in terms of longevity.
Numerous population-based studies have shown either benefit or no adverse effects of reduced thyroid function on the elderly. Because thyroid hormones have a direct effect on metabolic rate, it may be that thyroid hormone replacement in older people with hypothyroidism should be different than in younger patients.
However, TSH and thyroid target levels are uniform for all age groups, and age ranges are not used. This is despite the fact that older age groups make up the largest proportion of all patients with hypothyroidism. In addition, overtreatment with thyroid hormones in older women is a risk factor for atrial fibrillation and osteoporosis.
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The effect of thyroid hormones on bone density
The Newcastle 85+ study found evidence that lower TSH levels are associated with an increased proportion of non-thyroid disease and disability in the elderly. It has been confirmed that QoL scores do not differ between euthyroid and subclinical hypothyroid groups in the older population.
A US study that followed 3,567 people over the age of 65 for an average of 13 years found that subclinical hypothyroidism was significantly associated with an increased risk of hip fracture in men, but not in women. There is currently little evidence in the literature that clearly links overt hypothyroidism with decreased mobility or increased bone fragility.
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Age correction of thyroid hormones
Recent evidence suggests that the threshold for treatment of mild subclinical hypothyroidism in older people should be high. In addition, appropriate TSH age ranges should be considered when diagnosing hypothyroidism in this category. Thus, a slight increase in TSH may be a normal consequence of aging.
In addition, thyroid hormone requirements change with age, and patients on replacement therapy are more vulnerable to excessive thyroid hormone exposure. Therefore, when interpreting the results of thyroid function tests, as well as in the treatment of thyroid diseases in the older population, it is necessary to carefully evaluate the results.
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More research is needed to fully understand why thyroid function changes in the elderly and whether thyroid hormone modulation is beneficial for healthy longevity. Until the results of randomized trials are available, it is necessary to adhere to international recommendations that promote conservative methods in the treatment of mild subclinical hypothyroidism.
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