Chia Wen-Chun, Chen Yang-Ching, Xiu Shuang-Ling, Wang Sen-Te
Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
Department of Family Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, 116, Taiwan.
BMC Geriatr. 2025 Feb 17;25(1):104. doi: 10.1186/s12877-025-05748-5.
To investigate (1) whether the association of thyroid hormone with frailty risk is linear or nonlinear and (2) which range of thyroid hormones or thyroid stimulating hormone (TSH) is more associated with a higher risk of frailty in older adults.
Systematic review and dose-response meta-analysis.
Medical electronic databases were searched for cross-sectional or longitudinal studies, published from database inception to February 2022. We focused on the relationship between TSH and frailty. Data on TSH reference range, TSH exposure categories, sample size of each exposure category, and adjusted odds ratios (ORs) for frailty with 95% confidence interval (CI) were extracted. In the dose-response meta-analysis, we set the OR for frailty as 1 at 0.3 mIU/L TSH.
The systematic review included 10 studies, whereas the meta-analysis included 3 studies (n = 6388). TSH levels ranged from 0.3 to 4.8 mIU/L, and the dose-response meta-analysis revealed a significant J-shaped association (p = 0.0071). Frailty OR (95% CI) increased from 1.30 (1.06-1.59) for 2.7 mIU/L TSH to 2.06 (1.18-3.57) for 4.8 mIU/L TSH.
A significant nonlinear, J-shaped association was noted between TSH level and frailty. TSH levels within the upper half (2.7-4.8mIU/L) of reference range was noted to significantly higher risk of frailty; by contrast, those in the lower half (0.6-1.5 mIU/L) had a lower risk of frailty, though not significantly so.
This systematic review was registered with PROSPERO (registration number: CRD42022299214).
探讨（1）甲状腺激素与衰弱风险之间的关联是线性还是非线性的；（2）甲状腺激素或促甲状腺激素（TSH）的哪个范围与老年人更高的衰弱风险更相关。
系统评价和剂量反应荟萃分析。
检索医学电子数据库中从数据库建立至2022年2月发表的横断面或纵向研究。我们重点关注TSH与衰弱之间的关系。提取TSH参考范围、TSH暴露类别、每个暴露类别的样本量以及衰弱的调整比值比（OR）及其95%置信区间（CI）的数据。在剂量反应荟萃分析中，我们将TSH为0.3 mIU/L时衰弱的OR设定为1。
系统评价纳入10项研究，荟萃分析纳入3项研究（n = 6388）。TSH水平范围为0.3至4.8 mIU/L，剂量反应荟萃分析显示出显著的J形关联（p = 0.0071）。衰弱OR（95%CI）从TSH为2.7 mIU/L时的1.30（1.06 - 1.59）增加到TSH为4.8 mIU/L时的2.06（1.18 - 3.57）。
TSH水平与衰弱之间存在显著的非线性J形关联。参考范围上半部分（2.7 - 4.8 mIU/L）的TSH水平与显著更高的衰弱风险相关；相比之下，下半部分（0.6 - 1.5 mIU/L）的TSH水平衰弱风险较低，但差异不显著。
本系统评价在国际前瞻性系统评价注册库（PROSPERO）注册（注册号：CRD42022299214）。
