15 Dec Treating Subclinical Thyroid Disease in Elderly May Not Provide Benefits

MedicalResearch.com Interview with:

Dr. Chiung-Hui Peng

Carol Chiung-Hui Peng, MD
Department of Internal Medicine
University of Maryland Medical Center
Baltimore, MD 

MedicalResearch.com: What is the background for this study?

Response: In recently published meta-analyses, focusing on the general population, showed that both overt hypothyroidism and subclinical hypothyroidism were linked to higher all-cause and cardiovascular mortality. However, there is still debate and conflicting evidence on managing overt and subclinical hypothyroidism in the elderly.

This study aimed to evaluate and confirm the association between hypothyroidism and mortality in the elderly population.

MedicalResearch.com: What are the main findings?

Response: In this meta-analysis, consisting of 27 cohort studies targeting patients age 60 or more, we found that hypothyroidism showed a higher risk of all-cause mortality but not cardiovascular mortality than those with euthyroidism. Elderly individuals with subclinical hypothyroidism were not associated with an increased risk of all-cause mortality and cardiovascular mortality.

MedicalResearch.com: What should readers take away from your report?

Response: In accordance with current guidelines, treating subclinical hypothyroidism in the older population may not provide benefits. However, overt hypothyroidism in individuals 60 years or more is related to an increase in all-cause mortality, and treatment should be considered.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Further prospective large-scale studies are necessary to confirm our findings. To determine whether levothyroxine treatment provides benefit in subclinical hypothyroidism would require prospective, randomized controlled trials.

MedicalResearch.com: Is there anything else you would like to add?

Response: Based on the meta-regression, we further found out that the between-study variance was primarily originated from different study designs, namely prospective and retrospective, and primary geographic region of studies.

Study design

In the prospective studies, there was minimal heterogeneity. No difference in all-cause and cardiovascular mortality were found. But in the retrospective study groups, hypothyroidism was significantly associated with increased all-cause and cardiovascular mortality.

Geographic location

Studies from Asia and North America were significantly associated with increased all-cause mortality. This finding may be related to higher than required iodine intake in the U.S. and Asia, although there are still different levels of iodine intake within the country. The hypothesis is supported by a recent large observational study in the U.S. which showed that population with high iodine intake was associated with significantly higher all-cause and cardiovascular mortalities.

We have nothing to disclose. 

Citation:

Association of hypothyroidism and mortality in the elderly population: A systematic review and meta-analysis

Tou-Yuan Tsai, MD, Yu-Kang Tu, DDS, MSc, PhD, Kashif M Munir, MD, Shu-Man Lin, MD, Rachel Huai-En Chang, MD, MPH, MBA …

The Journal of Clinical Endocrinology & Metabolism, dgz186, https://doi.org/10.1210/clinem/dgz186 

Last Modified: [last-modified] 

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Last Updated on December 15, 2019 by Marie Benz MD FAAD