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Thyroid Testing in Healthy Elderly- Results from the Senior Labor Study Pedro Medina 1 , Urs Nydegger 1 , Elsbeth Lenggenhager 1,2 , Lorenz Risch 1,3 , Martin Risch 2 1 – Labormedizinisches Zentrum Dr. Risch, CH-Liebefeld Bern 2 – Labormedizinisches Zentrum Dr. Risch, LI-Schaan 3 – Private University Liechtenstein, LI-Triesen 2011 Biochimie Biochemistry Poster 24
Introduction <ul><li>Weakness, cold intolerance, constipation, depression, hoarseness, dry skin & bradycardia point to adherence to the group of the ~5% individuals > 60 years suffering from hypothyroidism. Subclinical forms to turn overt or not may be disclosed using laboratory tests: (i) TSH, FT 3 and FT 4 as well as (ii) serum cholesterol (↑), liver enzymes, creatinine, hyponatremia and anaemia. </li></ul>Poster 24 Biochimie Biochemistry
Probands & Methods <ul><li>1345 healthy elderly >60 years cleared the hurdle of exclusion criteria, including overt thyroid disease, diabetes mellitus, hypertension, kidney disease and carcinoma (see: www.seniorlabor.ch ). Serum samples from fasting state. The ARCHITECT (Abbott, CH-Baar) was used to test levels of thyroid stimulating hormone (TSH), as well as tri-&tetra-iodothyronine FT 3 and FT 4 </li></ul>Biochimie Biochemistry Poster 24
Results <ul><li>Reference intervals (RI) at our institution: TSH: 035 – 4.94 mU/l, FT3 2.6-6.4 pmol/l, FT4: 9.1-23.8 pmol/l. </li></ul><ul><li>Elevated TSH levels were found in 45 (3.35%) of healthy elderly (95% CI 2.51-4.45). Of the 596 males, 24 had elevated TSH levels and 21 of the 749 women. No one had reduced FT 3 and one had a reduced FT 4 level. In the individuals with deviating results from the RI the clinical records could not uncover signs nor symptoms of hypothyroidism. </li></ul>Poster 24 Biochimie Biochemistry Poster 24
Poster 24 Biochimie Biochemistry The orphan nuclear constitutive androstane receptor, CAR, stimulates thyroid follicular cell proliferation thus impinging on the feed back regulation of Thyroid Stimulating Hormone (TSH) and Thyroid Hormone (TH) metabolism The anterior pituitary gland secretes TSH stimulating production and release of TH by the thyroid gland In the elderly, the complex regulatory pathways become susceptible for imbalances, non the least due to xenobiotic and endobiotic stress drawn, in part, from results reported by Qatanani M, Zhang J, Moore D Role of the constitutive androstane receptor in xenobiotic-induced thyroid hormone metabolism. ENDOCRINOLOGY , 146 (3):995 taken from google images Imbalanced Thyroideal Regulatory Pathways to look for in the Elderly
Conclusion <ul><li>A suspicion of sublinical hypothyroidism on some of our elderly probands must be weighed against the possibility, that slightly elevated TSH with normal or slightly depressed FT-levels could be considered to be within normal range for elderly. We can not exclude, that our cohort of 45 probands might present subclinical hypothyreosis however far from a need for hormonal substitution. A follow-up is under way. </li></ul>Poster 24 Biochimie Biochemistry
Similar Work by Others Just Published ! <ul><li>In over thousand (1219) Dutch participants aged >65,TSH, thyroxine and FT 3 levels were measured and subclinical hypothyroidism was found in 64 (5.3%) individuals. This was not associated with increased mortality risk nor with impaired cognitive function nor depression. </li></ul><ul><li>De Jongh RT et al (University Medical Center, Amsterdam, The Netherlands) Endogenous sublinical thyroid disorders, physical and cognitive function, depression, and mortality in older individuals </li></ul><ul><li>EUR J ENDOCRINOL 2011; 165(4):545-554 </li></ul>