Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, 12-136 Translational Research Center, 3400 Civic Center Boulevard, Philadelphia, Pennsylvania 19104-5160, USA.
J Clin Endocrinol Metab. 2012 Nov;97(11):3944-50. doi: 10.1210/jc.2012-2481. Epub 2012 Aug 9.
Data on thyroid function in the oldest old are sparse, and existing studies show conflicting evidence on the relationship between thyroid function and mortality in this age group.
We describe longitudinal changes in thyroid function in a cohort of elderly individuals and determine the relationship between thyroid function and mortality.
DESIGN, SETTING, AND PARTICIPANTS: Eight hundred forty-three participants in the Cardiovascular Health Study All Stars Study who were not taking thyroid medications and had thyroid function testing in 2005-2006 (mean age 85 yr).
Thyroid-stimulating hormone (TSH), free T(4) (FT4), total T(3), and thyroid peroxidase antibody status were measured in 1992-1993 and 2005-2006. Deaths were ascertained through February 2011.
There was a statistically significant 13% increase in TSH, 1.7% increase in FT4, and 13% decrease in total T(3) over the 13-yr period. Two hundred eighty-seven deaths occurred over a median follow-up of 5.1 yr. There was no association between subclinical hypothyroidism[hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.66-1.43], TSH level (HR per milliunits per liter 0.94, 95% CI 0.88-1.01), or persistent thyroid peroxidase antibody positivity (HR 1.09, 95% CI 0.62-1.92), and death. However, FT4 was positively associated with death (HR per nanograms per deciliter 2.57, 95% CI 1.32-5.02).
TSH increased over time in these older individuals. This elevation was not associated with increased or decreased mortality, although higher FT4 levels were associated with death. These findings raise concern for treatment of mild elevations of TSH in advanced age. Further studies are needed to determine the potential benefit of treating age-related changes in thyroid function.
关于高龄人群甲状腺功能的数据很少，现有研究对该年龄段甲状腺功能与死亡率之间的关系提供了相互矛盾的证据。
我们描述了一个老年人群队列中甲状腺功能的纵向变化，并确定了甲状腺功能与死亡率之间的关系。
设计、地点和参与者：未服用甲状腺药物且在 2005-2006 年进行甲状腺功能检测的心血管健康研究全明星研究中的 843 名参与者（平均年龄 85 岁）。
1992-1993 年和 2005-2006 年测定促甲状腺激素（TSH）、游离 T4（FT4）、总 T3 和甲状腺过氧化物酶抗体状态。通过 2011 年 2 月确定死亡情况。
在 13 年期间，TSH 增加了 13%，FT4 增加了 1.7%，总 T3 降低了 13%。中位数随访 5.1 年期间共发生 287 例死亡。亚临床甲状腺功能减退症（危险比 [HR]0.97，95%置信区间 [CI]0.66-1.43）、TSH 水平（每毫单位/升 HR0.94，95% CI 0.88-1.01）或持续甲状腺过氧化物酶抗体阳性（HR1.09，95% CI 0.62-1.92）与死亡均无关联。然而，FT4 与死亡呈正相关（每纳克/分升 HR2.57，95% CI 1.32-5.02）。
在这些老年人中，TSH 随时间推移而增加。这种升高与死亡率的增加或降低无关，尽管 FT4 水平升高与死亡相关。这些发现引起了对治疗高龄人群中 TSH 轻度升高的关注。需要进一步的研究来确定治疗与年龄相关的甲状腺功能变化的潜在益处。
