N Sforza1, J Rosenfarb1, R Rujelman1, M Rosmarin1, E Blanc1, C Frigerio2, P Fossati2, D Caruso3, C Faingold1, T Meroño4, G Brenta5. 1. Endocrinology Department, Cesar Milstein Hospital, 951 La Rioja St, 1221, Buenos Aires, Argentina. 2. Biochemistry Department, Cesar Milstein Hospital, 951 La Rioja St, 1221, Buenos Aires, Argentina. 3. Internal Medicine Department, Cesar Milstein Hospital, 951 La Rioja St, 1221, Buenos Aires, Argentina. 4. Clinical Biochemistry Department, Pharmacy and Biochemistry School, 954 Junin St, 1113, Buenos Aires, Argentina. 5. Endocrinology Department, Cesar Milstein Hospital, 951 La Rioja St, 1221, Buenos Aires, Argentina. gbrenta@gmail.com.
Abstract
PURPOSE: Overt hypothyroidism has adverse clinical consequences and might worsen prognosis in critically ill elderly patients. However, the difficult interpretation of thyroid function tests (TFT) due to non-thyroidal illness (NTI) has led to discouragement of screening for thyroid dysfunction. Our aim was to determine the prevalence of TFT compatible with hypothyroidism and to study its influence on mortality among hospitalized elderly patients. METHODS: In this prospective study we consecutively included all patients ≥60 years admitted by the Internal Medicine Department to the hospital ward (n = 451) of the Cesar Milstein Hospital in Buenos Aires, Argentina. TFT were done on day 1 and 8. Thyroid function categories were defined as overt and subclinical hypothyroidism, overt and subclinical hyperthyroidism, euthyroidism and NTI. Stage of chronic kidney disease (CKD), Adult Comorbidity Evaluation (ACE)-27, and intra-hospital mortality were recorded. The association between mortality and TFT categories was studied by Cox regression. RESULTS: Out of 451 patients (77.0 ± 7.9 years, 54% females) 76% were categorized as NTI, 4% as overt hypothyroid, 10% as subclinical hypothyroid, 1% as subclinical hyperthyroid and 9% as euthyroid. Overt hypothyroid patients showed significantly higher mortality than the rest of the groups (25%, p < 0.05) while ACE-27 was similar among all of them (p = 0.658). In addition, patients within the overt hypothyroid category showed a higher mortality rate than NTI in a model adjusted by Stage 5-CKD, ACE-27, sex and age [HR 3.1 (1.14-8.41), p < 0.026]. CONCLUSION: Overt hypothyroidism during hospitalization was associated with elevated mortality. Further studies would reveal if TFT alterations compatible with hypothyroidism should be diagnosed/treated in hospitalized elderly patients.
PURPOSE: Overt hypothyroidism has adverse clinical consequences and might worsen prognosis in critically ill elderly patients. However, the difficult interpretation of thyroid function tests (TFT) due to non-thyroidal illness (NTI) has led to discouragement of screening for thyroid dysfunction. Our aim was to determine the prevalence of TFT compatible with hypothyroidism and to study its influence on mortality among hospitalized elderly patients. METHODS: In this prospective study we consecutively included all patients ≥60 years admitted by the Internal Medicine Department to the hospital ward (n = 451) of the Cesar Milstein Hospital in Buenos Aires, Argentina. TFT were done on day 1 and 8. Thyroid function categories were defined as overt and subclinical hypothyroidism, overt and subclinical hyperthyroidism, euthyroidism and NTI. Stage of chronic kidney disease (CKD), Adult Comorbidity Evaluation (ACE)-27, and intra-hospital mortality were recorded. The association between mortality and TFT categories was studied by Cox regression. RESULTS: Out of 451 patients (77.0 ± 7.9 years, 54% females) 76% were categorized as NTI, 4% as overt hypothyroid, 10% as subclinical hypothyroid, 1% as subclinical hyperthyroid and 9% as euthyroid. Overt hypothyroidpatients showed significantly higher mortality than the rest of the groups (25%, p < 0.05) while ACE-27 was similar among all of them (p = 0.658). In addition, patients within the overt hypothyroid category showed a higher mortality rate than NTI in a model adjusted by Stage 5-CKD, ACE-27, sex and age [HR 3.1 (1.14-8.41), p < 0.026]. CONCLUSION: Overt hypothyroidism during hospitalization was associated with elevated mortality. Further studies would reveal if TFT alterations compatible with hypothyroidism should be diagnosed/treated in hospitalized elderly patients.
Entities:
Keywords:
Elderly; Hospitalization; Hypothyroidism; Non-thyroidal disease; Thyroid function tests
Authors: Pedro Iglesias; Elena Ridruejo; Angélica Muñoz; Florentino Prado; María Cruz Macías; María Teresa Guerrero; Pilar Tajada; Carmen García-Arévalo; Juan José Díez Journal: J Clin Endocrinol Metab Date: 2013-10-30 Impact factor: 5.958
Authors: Manuel R Blum; Liselotte W Wijsman; Vanessa S Virgini; Douglas C Bauer; Wendy P J den Elzen; J Wouter Jukema; Brendan M Buckley; Anton J M de Craen; Patricia M Kearney; David J Stott; Jacobjin Gussekloo; Rudi G J Westendorp; Simon P Mooijaart; Nicolas Rodondi Journal: Neuroendocrinology Date: 2015-07-14 Impact factor: 4.914
Authors: J Rosenfarb; N Sforza; R Rujelman; Y Morosan Allo; C Parisi; E Blanc; C Frigerio; P Fossati; D Caruso; C Faingold; T Meroño; G Brenta Journal: J Endocrinol Invest Date: 2018-10-26 Impact factor: 4.256