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- Title
Incidence and Determinants of Spontaneous Normalization of Subclinical Hypothyroidism in Older Adults.
- Authors
van der Spoel, Evie; van Vliet, Nicolien A.; Poortvliet, Rosalinde K. E.; Du Puy, Robert S.; den Elzen, Wendy P. J.; Quinn, Terence J.; Stott, David J.; Sattar, Naveed; Kearney, Patricia M.; Blum, Manuel R.; Alwan, Heba; Rodondi, Nicolas; Collet, Tinh-Hai; Westendorp, Rudi G. J.; Ballieux, Bart E.; Jukema, J. Wouter; Dekkers, Olaf M.; Gussekloo, Jacobijn; Mooijaart, Simon P.; van Heemst, Diana
- Abstract
Context: With age, the prevalence of subclinical hypothyroidism rises. However, incidence and determinants of spontaneous normalization remain largely unknown. Objective: To investigate incidence and determinants of spontaneous normalization of TSH levels in older adults with subclinical hypothyroidism. Design: Pooled data were used from the (1) pretrial population and (2) in-trial placebo group from 2 randomized, double-blind, placebo-controlled trials (Thyroid Hormone Replacement for Untreated Older Adults With Subclinical Hypothyroidism Trial and Institute for Evidence-Based Medicine in Old Age thyroid 80-plus thyroid trial). Setting: Community-dwelling 65+ adults with subclinical hypothyroidism from the Netherlands, Switzerland, Ireland, and the United Kingdom. Participants: The pretrial population (N = 2335) consisted of older adults with biochemical subclinical hypothyroidism, defined as ≥1 elevated TSH measurement (≥4.60 mIU/L) and a free T4 within the laboratory-specific reference range. Individuals with persistent subclinical hypothyroidism, defined as ≥2 elevated TSH measurements ≥3 months apart, were randomized to levothyroxine/placebo, of which the intrial placebo group (N = 361) was included. Main Outcome Measures: Incidence of spontaneous normalization of TSH levels and associations between participant characteristics and normalization. Results: In the pretrial phase, TSH levels normalized in 60.8% of participants in a median follow-up of 1 year. In the in-trial phase, levels normalized in 39.9% of participants after 1 year of follow-up. Younger age, female sex, lower initial TSH level, higher initial free T4 level, absence of thyroid peroxidase antibodies, and a follow-up measurement in summer were independent determinants for normalization. Conclusion: Because TSH levels spontaneously normalized in a large proportion of older adults with subclinical hypothyroidism (also after confirmation by repeat measurement), a third measurement may be recommended before considering treatment.
- Subjects
HYPOTHYROIDISM; DISEASE incidence; HEALTH of older people
- Publication
Journal of Clinical Endocrinology & Metabolism, 2024, Vol 109, Issue 3, pe1167
- ISSN
0021-972X
- Publication type
Article
- DOI
10.1210/clinem/dgad623