Department of Geriatric Medicine, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark.
Department of Cardiology, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark.
Arch Gerontol Geriatr. 2023 Jan;104:104806. doi: 10.1016/j.archger.2022.104806. Epub 2022 Sep 7.
Thyroid deficiency may reduce mortality in older adults, but older adults prioritize independence over merely staying alive. We investigated the association between thyroid dysfunction and nursing home admission and all-cause mortality in community-dwelling older adults over 80.
We conducted a retrospective population-based open cohort study using data from laboratory registries covering 75% of Denmark supplemented by national registries. We included all community-dwelling older adults over 80 years with a first TSH measurement between 1996 and 2019. Participants with prior thyroid disorders or medication affecting the thyroid were excluded. Participants were followed from inclusion until nursing home admission, death or loss to follow-up due to emigration.
We included 272,495 participants at baseline. Median follow-time was 3.71 years in analyses of nursing home admissions and 4.00 years for all-cause mortality. Hypothyroidism was associated with lower nursing home admission (TSH 5-10 mIU/l: HR 0.85, 95% CI: 0.80-0.91, P < 0.001); TSH >10 mIU/l HR 0.68, 95% CI: 0.54-0.85, P = 0.001) and with reduced all-cause mortality (TSH >10 mIU/l: HR 0.81, 95% CI: 0.70-0.93, P = 0.002). The association between hyperthyroidism and nursing home admission was of little clinical significance while hyperthyroidism was associated with increased all-cause mortality hazard both for low (HR 1.16, 95% CI 1.13-1.19, P < 0.001) and suppressed (HR 95% CI: 1.14 1.07-1.21, P < 0.001) TSH.
Hypothyroidism is associated with a reduced nursing home admission hazard and to a lesser extent all-cause mortality in community-dwelling adults over 80 years, while hyperthyroidism is associated with increased all-cause mortality but not hazard of nursing home admission.
甲状腺功能减退可能会降低老年人的死亡率，但老年人更看重独立，而不仅仅是活着。我们研究了甲状腺功能障碍与养老院入院和 80 岁以上社区居住老年人全因死亡率之间的关系。
我们进行了一项回顾性基于人群的开放队列研究，使用了涵盖丹麦 75%人口的实验室登记处的数据，并通过国家登记处进行了补充。我们纳入了所有年龄在 80 岁以上、在 1996 年至 2019 年间首次进行 TSH 测量的社区居住老年人。排除了有既往甲状腺疾病或影响甲状腺药物治疗的参与者。参与者从纳入开始随访，直至养老院入院、死亡或因移民而失去随访。
我们在基线时纳入了 272495 名参与者。分析养老院入院情况的中位随访时间为 3.71 年，全因死亡率分析的中位随访时间为 4.00 年。甲状腺功能减退与较低的养老院入院风险相关（TSH 5-10 mIU/l：HR 0.85，95%CI：0.80-0.91，P < 0.001）；TSH >10 mIU/l HR 0.68，95%CI：0.54-0.85，P = 0.001），并且与全因死亡率降低相关（TSH >10 mIU/l：HR 0.81，95%CI：0.70-0.93，P = 0.002）。甲状腺功能亢进与养老院入院的相关性临床意义不大，而甲状腺功能亢进与全因死亡率增加相关，无论是低 TSH（HR 1.16，95%CI 1.13-1.19，P < 0.001）还是抑制 TSH（HR 95%CI：1.14 1.07-1.21，P < 0.001）的患者。
甲状腺功能减退与 80 岁以上社区居住成年人的养老院入院风险降低和全因死亡率降低相关，而甲状腺功能亢进与全因死亡率增加相关，但与养老院入院风险无关。
