Diagnosis and treatment of subclinical hypothyroidism in older adults
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Published:
Jan 5, 2023
Keywords:
Older adults, diagnosis, hypothyroidism, therapeutics.
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Abstract
Introduction. Subclinical hypothyroidism in older adults becomes difficult to diagnose, because thyroid stimulating hormone increases in value as age advances, maintaining normal thyroxine values, which is why the setting and circumstances of the patient will influence the diagnosis and treatment. General objective. To describe the diagnosis and treatment of subclinical hypothyroidism in older adults. Methodology. A non-experimental narrative literature review study was conducted. The initial search yielded 163 articles of which, after reviewing the title, abstract and elimination of duplicates, we worked with 12 articles, according to the type of research. Results. The diagnosis of subclinical hypothyroidism is demonstrated by high thyroid stimulating hormone and normal thyroxine values. In those over 60 years of age thyroid stimulating hormone >10 mIU\L is present. Most physicians administer low doses of levothyroxine or decide to monitor the patient for 3 – 6 before administering levothyroxine. Conclusions. For the diagnosis of subclinical hypothyroidism in older adults, symptomatology, age, their comorbidities and the setting should be assessed, Thyroid hormone replacement therapy can be beneficial or detrimental, so proper assessment of the patient will determine whether medication is required or just watch and wait to avoid overtreatment.
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Tebanta Albán, D. N., Hugo Merino, G. A., Muñoz Arteaga, M. V., & Vázquez López, A. L. (2023). Diagnosis and treatment of subclinical hypothyroidism in older adults. Ciencia Digital, 7(1), 6-19. https://doi.org/10.33262/cienciadigital.v7i1.2415
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References
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Caneo, C., Aedo, I., Riquelme, M. J., & Fardella, C. (2020). Disfunción tiroidea y trastornos del ánimo: Revisión del estado del arte. Revista Médica Clínica Las Condes, 31(2), 122-129. https://doi.org/10.1016/j.rmclc.2020.01.003
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Duntas, L. H., & Yen, P. M. (2019). Diagnosis and treatment of hypothyroidism in the elderly. Endocrine, 66(1), 63-69. https://doi.org/10.1007/s12020-019-02067-9
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Hashimoto, K. (2022). Update on subclinical thyroid dysfunction. Endocrine Journal, 69(7), 725-738. https://doi.org/10.1507/endocrj.EJ22-0182
Lamine, F., De Giorgi, S., Marino, L., Michalaki, M., & Sykiotis, G. P. (2018). Subclinical hypothyroidism: New trials, old caveats. Hormones, 17(2), 231-236. https://doi.org/10.1007/s42000-018-0004-x
Leng, O., & Razvi, S. (2019). Hypothyroidism in the older population. Thyroid Research, 12, 2. https://doi.org/10.1186/s13044-019-0063-3
Leng, O., & Razvi, S. (2021). Treatment of subclinical hypothyroidism: Assessing when treatment is likely to be beneficial. Expert Review of Endocrinology & Metabolism, 16(2), 73-86. https://doi.org/10.1080/17446651.2020.1738924
Macedo Silva, S., Carvalho, A., Lopes- Pereira, M., & Fernandes, V. (2018). Hipotiroidismo Subclínico no Idoso. Acta Médica Portuguesa, 31(12), 766. https://doi.org/10.20344/amp.10991
Magri, F., Chiovato, L., Croce, L., & Rotondi, M. (2019). Thyroid hormone therapy for subclinical hypothyroidism. Endocrine, 66(1), 27-34. https://doi.org/10.1007/s12020-019-02039-z
Pacheco R & Delgado J. (2022). Proceso de elaboración de instrumentos en la gestión administrativa de una universidad peruana. Ciencia Latina Revista Científica Multidisciplinar, 6(4), 770-783. https://doi.org/10.37811/cl_rcm.v6i4.2620
Palacio Rojas, M., Añez, R., Núñez Nava, T., Mejía Fernández, E., Alcivar Banguera, R., Rojas Páez, R., & Maldonado Parra, S. (2017). Disfunción tiroidea subclínica. Med. interna (Caracas), 197-207. http://svmi.web.ve/wh/revista/V33_N4.pdf
Panday, P., Arcia Franchini, A. P., Iskander, B., Anwer, F., Oliveri, F., Kakargias, F., & Hamid, P. (2021). Subclinical Hypothyroidism in Geriatric Population and Its Association With Heart Failure. Cureus. https://doi.org/10.7759/cureus.14296
Paricio PP, García JIL. Asociación Española de Cirujanos. Cirugía AEC. Ed. Médica Panamericana; 2009. 1252 p. (s. f.).
Peng, C. C.-H., Huang, H.-K., Wu, B. B.-C., Chang, R. H.-E., Tu, Y.-K., & Munir, K. M. (2021). Association of Thyroid Hormone Therapy with Mortality in Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis. The Journal of Clinical Endocrinology & Metabolism, 106(1), 292-303. https://doi.org/10.1210/clinem/dgaa777
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Salazar-Vega, J., Ortiz-Prado, E., Solis-Pazmino, P., Gómez-Barreno, L., Simbaña-Rivera, K., Henriquez-Trujillo, A. R., Brito, J. P., Toulkeridis, T., & Coral-Almeida, M. (2019). Thyroid Cancer in Ecuador, a 16 years population-based analysis (2001–2016). BMC Cancer, 19(1), 294. https://doi.org/10.1186/s12885-019-5485-8
Sgarbi, J. A., & Ward, L. S. (2020). A practical contemporary approach to decision-making on subclinical hypothyroidism. Archives of Endocrinology and Metabolism. https://doi.org/10.20945/2359-3997000000317
Stott, D. J., Rodondi, N., Kearney, P. M., Ford, I., Westendorp, R. G. J., Mooijaart, S. P., Sattar, N., Aubert, C. E., Aujesky, D., Bauer, D. C., Baumgartner, C., Blum, M. R., Browne, J. P., Byrne, S., Collet, T.-H., Dekkers, O. M., den Elzen, W. P. J., Du Puy, R. S., Ellis, G., … Gussekloo, J. (2017). Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism. New England Journal of Medicine, 376(26), 2534-2544. https://doi.org/10.1056/NEJMoa1603825
Yoo, W. S., & Chung, H. K. (2021). Subclinical Hypothyroidism: Prevalence, Health Impact, and Treatment Landscape. Endocrinology and Metabolism, 36(3), 500-513. https://doi.org/10.3803/EnM.2021.1066
Zhao, C., Wang, Y., Xiao, L., & Li, L. (2022). Effect of Levothyroxine on Older Patients With Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis. Frontiers in Endocrinology, 13, 913749. https://doi.org/10.3389/fendo.2022.913749
Álvarez Castillo, A., Rodríguez Alfaro, J. M., & Salas Boza, A. (2020). Abordaje del hipotiroidismo subclínico en el adulto. Revista Medica Sinergia, 5(2), e358. https://doi.org/10.31434/rms.v5i2.358
Alzahrani, A. S., Al Mourad, M., Hafez, K., Almaghamsy, A. M., Alamri, F. A., Al Juhani, N. R., Alhazmi, A. S., Saeedi, M. Y., Alsefri, S., Alzahrani, M. D. A., Al Ali, N., Hussein, W. I., Ismail, M., Adel, A., El Bahtimy, H., & Abdelhamid, E. (2020). Diagnosis and Management of Hypothyroidism in Gulf Cooperation Council (GCC) Countries. Advances in Therapy, 37(7), 3097-3111. https://doi.org/10.1007/s12325-020-01382-2
Azim, S., & Nasr, C. (2019). Subclinical hypothyroidism: When to treat. Cleveland Clinic Journal of Medicine, 86(2), 101-110. https://doi.org/10.3949/ccjm.86a.17053
Biondi, B., Cappola, A. R., & Cooper, D. S. (2019). Subclinical Hypothyroidism: A Review. JAMA, 322(2), 153. https://doi.org/10.1001/jama.2019.9052
Blum, M. R., Gencer, B., Adam, L., Feller, M., Collet, T.-H., da Costa, B. R., Moutzouri, E., Dopheide, J., Depairon, M., Sykiotis, G. P., Kearney, P., Gussekloo, J., Westendorp, R., Stott, D. J., Bauer, D. C., & Rodondi, N. (2018). Impact of Thyroid Hormone Therapy on Atherosclerosis in the Elderly With Subclinical Hypothyroidism: A Randomized Trial. The Journal of Clinical Endocrinology & Metabolism, 103(8), 2988-2997. https://doi.org/10.1210/jc.2018-00279
Borzì, A. M., Biondi, A., Basile, F., & Vacante, M. (2020). Diagnosis and treatment of hypothyroidism in old people: A new old challenge. Wiener Klinische Wochenschrift, 132(5-6), 161-167. https://doi.org/10.1007/s00508-019-01579-8
Calissendorff, J., & Falhammar, H. (2020). To Treat or Not to Treat Subclinical Hypothyroidism, What Is the Evidence? Medicina, 56(1), 40. https://doi.org/10.3390/medicina56010040
Calsolaro, V., Niccolai, F., Pasqualetti, G., Tognini, S., Magno, S., Riccioni, T., Bottari, M., Caraccio, N., & Monzani, F. (2019). Hypothyroidism in the Elderly: Who Should Be Treated and How? Journal of the Endocrine Society, 3(1), 146-158. https://doi.org/10.1210/js.2018-00207
Caneo, C., Aedo, I., Riquelme, M. J., & Fardella, C. (2020). Disfunción tiroidea y trastornos del ánimo: Revisión del estado del arte. Revista Médica Clínica Las Condes, 31(2), 122-129. https://doi.org/10.1016/j.rmclc.2020.01.003
Chrysant, S. G. (2020). The current debate over treatment of subclinical hypothyroidism to prevent cardiovascular complications. International Journal of Clinical Practice, 74(7). https://doi.org/10.1111/ijcp.13499
Duntas, L. H., & Yen, P. M. (2019). Diagnosis and treatment of hypothyroidism in the elderly. Endocrine, 66(1), 63-69. https://doi.org/10.1007/s12020-019-02067-9
Effraimidis, G., Watt, T., & Feldt-Rasmussen, U. (2021). Levothyroxine Therapy in Elderly Patients With Hypothyroidism. Frontiers in Endocrinology, 12, 641560. https://doi.org/10.3389/fendo.2021.641560
Esquivel Salgado, M. M., Olivares Luna, A. M., & Pedraza Avilés, A. G. (2018). Prevalencia de hipotiroidismo subclínico, deterioro cognitivo y su posible asociación en adultos mayores de una clínica de la Ciudad de México 2016. Revista Médicas UIS, 31(3). https://doi.org/10.18273/revmed.v31n3-2018002
Gavoto, L. (2022). ¿El tratamiento del hipotiroidismo subclínico tiene efecto sobre la morbimortalidad cardiovascular? Evidencia, actualizacion en la práctica ambulatoria, 25(1), e002087. https://doi.org/10.51987/evidencia.v25i2.7008
Hashimoto, K. (2022). Update on subclinical thyroid dysfunction. Endocrine Journal, 69(7), 725-738. https://doi.org/10.1507/endocrj.EJ22-0182
Lamine, F., De Giorgi, S., Marino, L., Michalaki, M., & Sykiotis, G. P. (2018). Subclinical hypothyroidism: New trials, old caveats. Hormones, 17(2), 231-236. https://doi.org/10.1007/s42000-018-0004-x
Leng, O., & Razvi, S. (2019). Hypothyroidism in the older population. Thyroid Research, 12, 2. https://doi.org/10.1186/s13044-019-0063-3
Leng, O., & Razvi, S. (2021). Treatment of subclinical hypothyroidism: Assessing when treatment is likely to be beneficial. Expert Review of Endocrinology & Metabolism, 16(2), 73-86. https://doi.org/10.1080/17446651.2020.1738924
Macedo Silva, S., Carvalho, A., Lopes- Pereira, M., & Fernandes, V. (2018). Hipotiroidismo Subclínico no Idoso. Acta Médica Portuguesa, 31(12), 766. https://doi.org/10.20344/amp.10991
Magri, F., Chiovato, L., Croce, L., & Rotondi, M. (2019). Thyroid hormone therapy for subclinical hypothyroidism. Endocrine, 66(1), 27-34. https://doi.org/10.1007/s12020-019-02039-z
Pacheco R & Delgado J. (2022). Proceso de elaboración de instrumentos en la gestión administrativa de una universidad peruana. Ciencia Latina Revista Científica Multidisciplinar, 6(4), 770-783. https://doi.org/10.37811/cl_rcm.v6i4.2620
Palacio Rojas, M., Añez, R., Núñez Nava, T., Mejía Fernández, E., Alcivar Banguera, R., Rojas Páez, R., & Maldonado Parra, S. (2017). Disfunción tiroidea subclínica. Med. interna (Caracas), 197-207. http://svmi.web.ve/wh/revista/V33_N4.pdf
Panday, P., Arcia Franchini, A. P., Iskander, B., Anwer, F., Oliveri, F., Kakargias, F., & Hamid, P. (2021). Subclinical Hypothyroidism in Geriatric Population and Its Association With Heart Failure. Cureus. https://doi.org/10.7759/cureus.14296
Paricio PP, García JIL. Asociación Española de Cirujanos. Cirugía AEC. Ed. Médica Panamericana; 2009. 1252 p. (s. f.).
Peng, C. C.-H., Huang, H.-K., Wu, B. B.-C., Chang, R. H.-E., Tu, Y.-K., & Munir, K. M. (2021). Association of Thyroid Hormone Therapy with Mortality in Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis. The Journal of Clinical Endocrinology & Metabolism, 106(1), 292-303. https://doi.org/10.1210/clinem/dgaa777
Ponce Loor, A. (2021). Hipotiroidismo en pacientes del Centro de Especialidades Médicas; IESS-La Libertad. Revista Vive, 4(11), 229-241. https://doi.org/10.33996/revistavive.v4i11.90
Salazar-Vega, J., Ortiz-Prado, E., Solis-Pazmino, P., Gómez-Barreno, L., Simbaña-Rivera, K., Henriquez-Trujillo, A. R., Brito, J. P., Toulkeridis, T., & Coral-Almeida, M. (2019). Thyroid Cancer in Ecuador, a 16 years population-based analysis (2001–2016). BMC Cancer, 19(1), 294. https://doi.org/10.1186/s12885-019-5485-8
Sgarbi, J. A., & Ward, L. S. (2020). A practical contemporary approach to decision-making on subclinical hypothyroidism. Archives of Endocrinology and Metabolism. https://doi.org/10.20945/2359-3997000000317
Stott, D. J., Rodondi, N., Kearney, P. M., Ford, I., Westendorp, R. G. J., Mooijaart, S. P., Sattar, N., Aubert, C. E., Aujesky, D., Bauer, D. C., Baumgartner, C., Blum, M. R., Browne, J. P., Byrne, S., Collet, T.-H., Dekkers, O. M., den Elzen, W. P. J., Du Puy, R. S., Ellis, G., … Gussekloo, J. (2017). Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism. New England Journal of Medicine, 376(26), 2534-2544. https://doi.org/10.1056/NEJMoa1603825
Yoo, W. S., & Chung, H. K. (2021). Subclinical Hypothyroidism: Prevalence, Health Impact, and Treatment Landscape. Endocrinology and Metabolism, 36(3), 500-513. https://doi.org/10.3803/EnM.2021.1066
Zhao, C., Wang, Y., Xiao, L., & Li, L. (2022). Effect of Levothyroxine on Older Patients With Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis. Frontiers in Endocrinology, 13, 913749. https://doi.org/10.3389/fendo.2022.913749