Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Department of Internal Medicine, Section General Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Thyroid. 2019 Sep;29(9):1201-1208. doi: 10.1089/thy.2019.0129.
Elevated levels of antithyroperoxidase antibodies (TPOAbs) have been associated with progression of subclinical thyroid dysfunction, extrathyroidal diseases, and decrease in functional status. However, TPOAb as determinant of future thyroid dysfunction and other clinical outcomes has not been studied well for adults aged 85 years and over. This study aimed to assess associations of TPOAb levels with thyroid function, survival, physical function, disability in activities of daily living (ADL), cognitive function, and depressive symptoms in the oldest old. Data from a population-based cohort study (Leiden 85-plus Study) of residents of Leiden, the Netherlands, aged 85 and older were used. Baseline serum TPOAb levels were available for 488 participants (82% of the total cohort). We considered levels ≥35 IU/mL as elevated. Thyroid function (thyrotropin [TSH] and free thyroxine) was assessed at age 85 (baseline), 87, and 88 years. Survival, physical function, disability in ADL, cognitive function, and depressive symptoms were assessed from age 85 through 90 years. At baseline, 64 of the 85-year old participants (13.1%) had elevated TPOAb levels. They were more often female, had higher TSH levels, and a higher prevalence of overt or subclinical hypothyroidism than participants with normal TPOAb levels. Over time, elevated TPOAb levels were independently associated with a lower mortality risk (hazard ratio 0.72, [95% confidence interval 0.53-0.99]), but were not associated with changes in thyroid function, nor with physical function, disability in ADL, cognitive function, or depressive symptoms. In community-dwelling oldest old, elevated TPOAb levels are cross-sectionally associated with higher TSH levels. Over time, elevated TPOAb levels are associated with a survival benefit but are not associated with changes in thyroid function, functional status, or depressive symptoms in old age. The added clinical value of TPOAb tests in oldest old persons with thyroid dysfunction is limited.
抗甲状腺过氧化物酶抗体（TPOAb）水平升高与亚临床甲状腺功能障碍、甲状腺外疾病以及功能状态下降的进展有关。然而，对于 85 岁及以上的成年人，TPOAb 作为未来甲状腺功能障碍和其他临床结局的决定因素尚未得到很好的研究。本研究旨在评估 TPOAb 水平与甲状腺功能、生存、身体功能、日常生活活动（ADL）残疾、认知功能和抑郁症状在最年长人群中的关系。使用了来自荷兰莱顿市一项基于人群的队列研究（莱顿 85 岁以上研究）的数据，该研究的参与者年龄均在 85 岁及以上。共有 488 名参与者（总队列的 82%）基线时有血清 TPOAb 水平。我们将≥35IU/mL 的水平定义为升高。甲状腺功能（促甲状腺激素[TSH]和游离甲状腺素）在 85 岁（基线）、87 岁和 88 岁时进行评估。从 85 岁到 90 岁，生存、身体功能、ADL 残疾、认知功能和抑郁症状进行评估。基线时，85 岁的 64 名参与者（13.1%）TPOAb 水平升高。与 TPOAb 水平正常的参与者相比，他们更常见于女性，TSH 水平更高，且显性或亚临床甲状腺功能减退的患病率更高。随着时间的推移，TPOAb 水平升高与较低的死亡率风险独立相关（风险比 0.72[95%置信区间 0.53-0.99]），但与甲状腺功能变化、身体功能、ADL 残疾、认知功能或抑郁症状无关。在社区居住的最年长人群中，TPOAb 水平升高与 TSH 水平升高有关。随着时间的推移，TPOAb 水平升高与生存获益相关，但与老年时甲状腺功能、功能状态或抑郁症状的变化无关。在甲状腺功能障碍的最年长人群中，TPOAb 检测的临床附加价值有限。
