Eskelinen Seija I, Vahlberg Tero J, Isoaho Raimo E, Löppönen Minna K, Kivelä Sirkka-Liisa, Irjala Kerttu M
The Department of Family Medicine, University of Turku, Turku, Finland.
Endocr Pract. 2007 Sep;13(5):451-7. doi: 10.4158/EP.13.5.451.
To analyze associations between thyroid-stimulating hormone (TSH) and free thyroxine (FT4 concentrations and life satisfaction, symptoms, self-rated health, and common neuropsychiatric diseases (depression or dementia) in a community-dwelling elderly population to provide evidence whether to decrease the upper reference limit for TSH or the optimal TSH target in levothyroxine treatment in older adults.
In this cross-sectional study, we determined TSH and FT4 concentrations in a thyroid disease-free population of 502 men (median age, 71 years) and 584 women (median age, 73 years) and in a patient group of 49 women (median age, 75 years) with primary hypothyroidism who were stable users of thyroxine treatment. Life satisfaction, self-rated health, depression, and dementia were assessed with specific questions and with tools such as the Self-report Depression Scale and the Mini-Mental State Examination. Independent variables were dichotomized, and associations of these variables with TSH and FT4 levels were assessed in the thyroid disease-free population. Levels of TSH and FT4 in thyroid disease-free women and in women treated with thyroxine were also compared.
After age adjustment, there were no associations between TSH levels and self-rated health, life satisfaction, or most symptoms in the thyroid disease-free population. No associations were found between diagnosed depression or Mini-Mental State Examination results and levels of TSH and FT4. Dementia was associated with higher FT4 concentration in men. Although women treated with thyroxine had TSH levels that were higher than thyroid disease-free women, there were no statistically significant differences in independent variables between these 2 groups.
Our results do not support the need to decrease the upper reference limit for TSH or to lower the optimal TSH target in levothyroxine treatment in older adults, as recommended in recent guidelines.
分析社区老年人群中促甲状腺激素（TSH）和游离甲状腺素（FT4）浓度与生活满意度、症状、自评健康状况以及常见神经精神疾病（抑郁症或痴呆症）之间的关联，以提供证据确定是否应降低老年人左甲状腺素治疗中TSH的参考上限或最佳TSH目标。
在这项横断面研究中，我们测定了502名男性（中位年龄71岁）和584名女性（中位年龄73岁）的无甲状腺疾病人群以及49名患有原发性甲状腺功能减退症且左甲状腺素治疗稳定的女性患者（中位年龄75岁）的TSH和FT4浓度。通过特定问题以及如自评抑郁量表和简易精神状态检查表等工具评估生活满意度、自评健康状况、抑郁症和痴呆症。将自变量进行二分法处理，并在无甲状腺疾病人群中评估这些变量与TSH和FT4水平的关联。还比较了无甲状腺疾病女性和接受左甲状腺素治疗女性的TSH和FT4水平。
年龄调整后，无甲状腺疾病人群中TSH水平与自评健康状况、生活满意度或大多数症状之间无关联。未发现诊断出的抑郁症或简易精神状态检查结果与TSH和FT4水平之间存在关联。痴呆症与男性较高的FT4浓度相关。虽然接受左甲状腺素治疗的女性的TSH水平高于无甲状腺疾病的女性，但这两组在自变量方面无统计学显著差异。
我们的结果不支持如近期指南所建议的降低老年人左甲状腺素治疗中TSH的参考上限或降低最佳TSH目标的必要性。
