Tags

Type your tag names separated by a space and hit enter

Interpreting Elevated TSH in Older Adults.

Abstract

Thyroid function is most often monitored clinically through measurement of the regulatory hormone, thyrotropin (TSH). Subclinical hypothyroidism is generally defined as a TSH level above the reference range while thyroid hormone levels remain within the reference range. Elevated TSH is more common among older adults, leading to high rates of treatment, and over-treatment, in this population. However, the use of levothyroxine in older adults with mild TSH elevations has begun to be called into question by observations that demonstrate a lack of harm from not treating and a lack of benefit from treating. Importantly, these findings suggest that the existing diagnostic algorithm for subclinical hypothyroidism, based on isolated TSH elevation, may be inappropriate for older adults. Age-specific reference ranges have been suggested as a way to avoid inappropriate treatment, but that strategy continues to rely on population norms rather than disease definitions to drive clinical decisions. Recent insight into age-related variability in the underlying pathophysiology that impacts on thyroid function tests demonstrates the need for new clinical tools to allow the targeted use of therapy where it will have benefit.

Authors+Show Affiliations

Johns Hopkins School of Medicine, Department of Medicine, Division of Endocrinology, Diabetes and Metabolism.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31633072

Citation

Mammen, Jennifer S.. "Interpreting Elevated TSH in Older Adults." Current Opinion in Endocrine and Metabolic Research, vol. 5, 2019, pp. 68-73.
Mammen JS. Interpreting Elevated TSH in Older Adults. Curr Opin Endocr Metab Res. 2019;5:68-73.
Mammen, J. S. (2019). Interpreting Elevated TSH in Older Adults. Current Opinion in Endocrine and Metabolic Research, 5, pp. 68-73. doi:10.1016/j.coemr.2019.04.001.
Mammen JS. Interpreting Elevated TSH in Older Adults. Curr Opin Endocr Metab Res. 2019;5:68-73. PubMed PMID: 31633072.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Interpreting Elevated TSH in Older Adults. A1 - Mammen,Jennifer S, Y1 - 2019/04/25/ PY - 2020/03/01/pmc-release PY - 2019/10/22/entrez PY - 2019/10/22/pubmed PY - 2019/10/22/medline SP - 68 EP - 73 JF - Current opinion in endocrine and metabolic research JO - Curr Opin Endocr Metab Res VL - 5 N2 - Thyroid function is most often monitored clinically through measurement of the regulatory hormone, thyrotropin (TSH). Subclinical hypothyroidism is generally defined as a TSH level above the reference range while thyroid hormone levels remain within the reference range. Elevated TSH is more common among older adults, leading to high rates of treatment, and over-treatment, in this population. However, the use of levothyroxine in older adults with mild TSH elevations has begun to be called into question by observations that demonstrate a lack of harm from not treating and a lack of benefit from treating. Importantly, these findings suggest that the existing diagnostic algorithm for subclinical hypothyroidism, based on isolated TSH elevation, may be inappropriate for older adults. Age-specific reference ranges have been suggested as a way to avoid inappropriate treatment, but that strategy continues to rely on population norms rather than disease definitions to drive clinical decisions. Recent insight into age-related variability in the underlying pathophysiology that impacts on thyroid function tests demonstrates the need for new clinical tools to allow the targeted use of therapy where it will have benefit. SN - 2451-9650 UR - https://www.unboundmedicine.com/medline/citation/31633072/Interpreting_Elevated_TSH_in_Older_Adults DB - PRIME DP - Unbound Medicine ER -
Unbound Prime app for iOS iPhone iPadUnbound PubMed app for AndroidAlso Available:
Unbound MEDLINE
Unbound PubMed app for Windows