Incidence and determinants of spontaneous normalization of subclinical hypothyroidism in older adults
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Incidence and determinants of spontaneous normalization of subclinical hypothyroidism in older adults. / van der Spoel, Evie; van Vliet, Nicolien A; Poortvliet, Rosalinde K E; Du Puy, Robert S; den Elzen, Wendy P J; Quinn, Terence J; Stott, David J; Sattar, Naveed; Kearney, Patricia M; Blum, Manuel R; Alwan, Heba; Rodondi, Nicolas; Collet, Tinh-Hai; Westendorp, Rudi G J; Ballieux, Bart E; Jukema, J Wouter; Dekkers, Olaf M; Gussekloo, Jacobijn; Mooijaart, Simon P; van Heemst, Diana.
I: The Journal of clinical endocrinology and metabolism, Bind 109, Nr. 3, 2024, s. e1167–e1174.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Incidence and determinants of spontaneous normalization of subclinical hypothyroidism in older adults
AU - van der Spoel, Evie
AU - van Vliet, Nicolien A
AU - Poortvliet, Rosalinde K E
AU - Du Puy, Robert S
AU - den Elzen, Wendy P J
AU - Quinn, Terence J
AU - Stott, David J
AU - Sattar, Naveed
AU - Kearney, Patricia M
AU - Blum, Manuel R
AU - Alwan, Heba
AU - Rodondi, Nicolas
AU - Collet, Tinh-Hai
AU - Westendorp, Rudi G J
AU - Ballieux, Bart E
AU - Jukema, J Wouter
AU - Dekkers, Olaf M
AU - Gussekloo, Jacobijn
AU - Mooijaart, Simon P
AU - van Heemst, Diana
N1 - © The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society.
PY - 2024
Y1 - 2024
N2 - CONTEXT: With age, the prevalence of subclinical hypothyroidism rises. However, incidence and determinants of spontaneous normalization remain largely unknown.OBJECTIVE: To investigate incidence and determinants of spontaneous normalization of thyroid-stimulating hormone (TSH) levels in older adults with subclinical hypothyroidism.DESIGN: Pooled data were used from the (i) pre-trial population, and (ii) in-trial placebo group from two randomized, double-blind, placebo-controlled trials (TRUST and IEMO thyroid 80-plus thyroid trial).SETTING: Community-dwelling 65 + adults with subclinical hypothyroidism from the Netherlands, Switzerland, Ireland, and the United Kingdom.PARTICIPANTS: The pre-trial population (N = 2335) consisted of older adults with biochemical subclinical hypothyroidism, defined as ≥1 elevated TSH measurement (≥4.60 mIU/L) and a free thyroxine (fT4) within the laboratory-specific reference range. Individuals with persistent subclinical hypothyroidism, defined as ≥2 elevated TSH measurements ≥3 months apart, were randomized to levothyroxine/placebo, of which the in-trial placebo group (N = 361) was included.MAIN OUTCOME MEASURES: Incidence of spontaneous normalization of TSH levels and associations between participant characteristics and normalization.RESULTS: In the pre-trial phase, TSH levels normalized in 60.8% of participants in a median follow-up of one year. In the in-trial phase, levels normalized in 39.9% of participants after one year follow-up. Younger age, female sex, lower initial TSH level, higher initial fT4 level, absence of thyroid peroxidase antibodies, and a follow-up measurement in summer were independent determinants for normalization.CONCLUSIONS: Since TSH levels spontaneously normalized in a large proportion of older adults with subclinical hypothyroidism (also after confirmation by repeat measurement), a third measurement may be recommended before considering treatment.
AB - CONTEXT: With age, the prevalence of subclinical hypothyroidism rises. However, incidence and determinants of spontaneous normalization remain largely unknown.OBJECTIVE: To investigate incidence and determinants of spontaneous normalization of thyroid-stimulating hormone (TSH) levels in older adults with subclinical hypothyroidism.DESIGN: Pooled data were used from the (i) pre-trial population, and (ii) in-trial placebo group from two randomized, double-blind, placebo-controlled trials (TRUST and IEMO thyroid 80-plus thyroid trial).SETTING: Community-dwelling 65 + adults with subclinical hypothyroidism from the Netherlands, Switzerland, Ireland, and the United Kingdom.PARTICIPANTS: The pre-trial population (N = 2335) consisted of older adults with biochemical subclinical hypothyroidism, defined as ≥1 elevated TSH measurement (≥4.60 mIU/L) and a free thyroxine (fT4) within the laboratory-specific reference range. Individuals with persistent subclinical hypothyroidism, defined as ≥2 elevated TSH measurements ≥3 months apart, were randomized to levothyroxine/placebo, of which the in-trial placebo group (N = 361) was included.MAIN OUTCOME MEASURES: Incidence of spontaneous normalization of TSH levels and associations between participant characteristics and normalization.RESULTS: In the pre-trial phase, TSH levels normalized in 60.8% of participants in a median follow-up of one year. In the in-trial phase, levels normalized in 39.9% of participants after one year follow-up. Younger age, female sex, lower initial TSH level, higher initial fT4 level, absence of thyroid peroxidase antibodies, and a follow-up measurement in summer were independent determinants for normalization.CONCLUSIONS: Since TSH levels spontaneously normalized in a large proportion of older adults with subclinical hypothyroidism (also after confirmation by repeat measurement), a third measurement may be recommended before considering treatment.
U2 - 10.1210/clinem/dgad623
DO - 10.1210/clinem/dgad623
M3 - Journal article
C2 - 37862463
VL - 109
SP - e1167–e1174
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
SN - 0021-972X
IS - 3
ER -
ID: 374396751