Ruggeri R M, Trimarchi F, Biondi B
Department of Clinical and Experimental Medicine, UOC Endocrinology, University of Messina, Italy.
Accademia Peloritana dei Pericolanti, University of Messina, Messina, Italy.
Eur J Endocrinol. 2017 Oct;177(4):R199-R217. doi: 10.1530/EJE-17-0321. Epub 2017 May 31.
The number of elderly people, mostly aged over 85 years (the 'oldest old'), is increasing worldwide. As a consequence, accompanying morbidity and disability have been increasing, and frailty, defined as an age-related condition of decline of physiological reserves and vulnerability, represents an emerging problem. Caring for older frail people may represent a challenge, since the elderly differ significantly from younger adults in terms of comorbidity, polypharmacy, pharmacokinetics and greater vulnerability to adverse drug reactions. Specific criteria of therapeutic appropriateness and modified goals of care are needed in such patients, also in endocrine care settings. Indeed, thyroid dysfunctions are among the most common conditions in older, multimorbid populations. The prevalence of overt and subclinical hypothyroidism is as high as 20% and thyroid hormone prescription is common in the elderly, with a trend toward levothyroxine treatment of more marginal degrees of hypothyroidism. In addition, older patients have the highest rate of overtreatment during replacement therapy and are more susceptible to developing adverse effects from thyroid hormone excess. Recently, results of a multicentric randomized controlled trial, the TRUST-IEMO collaboration trial, added further insights to the debated question of whether and when levothyroxine treatment is required and if it is beneficial in the elderly. With this in mind, we revised the relevant literature on the impact of thyroid dysfunction and replacement therapy among older people, with the aim to better define indications, benefits and risks of l-T4 replacement therapy in the frail elderly.
全球范围内，老年人数量不断增加，其中大多数年龄超过85岁（“最年长的老人”）。因此，随之而来的发病率和残疾率也在上升，而衰弱，即一种与年龄相关的生理储备下降和易损性状况，已成为一个新出现的问题。照顾体弱的老年人可能是一项挑战，因为老年人在合并症、多种药物治疗、药代动力学以及对药物不良反应的更高易感性方面与年轻人有显著差异。在这类患者中，在内分泌护理环境中也需要有治疗适宜性的具体标准和调整后的护理目标。事实上，甲状腺功能障碍是老年多病患者中最常见的病症之一。显性和亚临床甲状腺功能减退的患病率高达20%，甲状腺激素处方在老年人中很常见，而且有对程度较轻的甲状腺功能减退采用左甲状腺素治疗的趋势。此外，老年患者在替代治疗期间过度治疗的发生率最高，且更容易因甲状腺激素过量而出现不良反应。最近，一项多中心随机对照试验——TRUST - IEMO合作试验的结果，为左甲状腺素治疗是否必要以及何时必要以及对老年人是否有益这一备受争议的问题提供了进一步的见解。考虑到这一点，我们对有关甲状腺功能障碍和替代治疗对老年人影响的相关文献进行了修订，旨在更好地界定左甲状腺素替代治疗在体弱老年人中的适应症、益处和风险。
