TSH

[Guest guest]

fyi:

JAMA. 2004 Dec 1;292(21):2591-9.

Comment in:

CMAJ. 2005 Mar 1;172(5):633. JAMA. 2004 Dec 1;292(21):2651-4. JAMA. 2005 Mar 23;293(12):1447; author reply 1447-8. JAMA. 2005 Mar 23;293(12):1447; author reply 1447-8. (but they don't seem to be free)

Thyroid status, disability and cognitive function, and survival in old age.Gussekloo J, van Exel E, de Craen AJ, Meinders AE, Frolich M, Westendorp RG.Section of Gerontology and Geriatrics, Department of General Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands. jgussekloo@...CONTEXT: Despite the equivocal outcomes of randomized controlled trials, general clinical opinion favors screening and treatment of elderly individuals with subclinical thyroid disorders. OBJECTIVES: To determine whether subclinical thyroid dysfunction should be treated in old age and the long-term impact of thyroid dysfunction on performance and survival in old age. DESIGN, SETTING, AND PARTICIPANTS: A prospective, observational, population-based follow-up study within the Leiden 85-Plus Study of 87% of a 2-year birth cohort (1912-1914) in the municipality of Leiden, the Netherlands. A total of 599 participants were followed up from age 85 years through age 89 years (mean [sD] follow-up, 3.7 [1.4] years). MAIN OUTCOME MEASURES: Complete thyroid status at baseline; disability in daily life, depressive symptoms, cognitive function, and mortality from age 85 years through 89 years. RESULTS: Plasma levels of thyrotropin and free thyroxine were not associated with disability in daily life, depressive symptoms, and cognitive impairment at baseline or during follow-up. Increasing levels of thyrotropin were associated with a lower mortality rate that remained after adjustments were made for baseline disability and health status. The hazard ratio (HR) for mortality per SD increase of 2.71 mIU/L of thyrotropin was 0.77 (95% confidence interval [CI], 0.63-0.94; P = .009). The HR for mortality per SD increase of 0.21 ng/dL (2.67 pmol/L) of free thyroxine increased 1.16-fold (95% CI, 1.04-1.30; P = .009). CONCLUSIONS: In the general population of the oldest old, elderly individuals with abnormally high levels of thyrotropin do not experience adverse effects and may have a prolonged life span. However, evidence for not treating elderly individuals can only come from a well-designed, randomized placebo-controlled clinical trial.PMID: 15572717

http://www.cmaj.ca/cgi/content/full/172/5/633

Should subclinical hypothyroidism in elderly patients be treated?

"Finally, very old patients (e.g., > 85 years) may be biologically different from moderately older patients (e.g., 60–70 years). For example, octogenarians with higher blood pressure values tend to live longer than those with lower values.4 Consequently, the wisdom of treating hypertension and other abnormalities in very old patients has been called into question. "

regards.

[Guest guest]

Hi JW:

Did they note what it was the lower blood pressure patients who had

died, had died of? If they died predominantly from heart problems

then the lower blood pressure might simply reflect a waning ability

of the heart to pump properly. If so then the conclusion might be to

treat them to improve the lacking heart function, and treat the

others for their high BP.

Rodney.

--- In , " jwwright " <jwwright@e...>

wrote:

For example, octogenarians with higher blood pressure values tend to

live longer than those with lower values. Consequently, the wisdom

of treating hypertension and other abnormalities in very old patients

has been called into question. "

[Guest guest]

Hi JW:

Did they note what it was the lower blood pressure patients who had

died, had died of? If they died predominantly from heart problems

then the lower blood pressure might simply reflect a waning ability

of the heart to pump properly. If so then the conclusion might be to

treat them to improve the lacking heart function, and treat the

others for their high BP.

Rodney.

--- In , " jwwright " <jwwright@e...>

wrote:

For example, octogenarians with higher blood pressure values tend to

live longer than those with lower values. Consequently, the wisdom

of treating hypertension and other abnormalities in very old patients

has been called into question. "

[Guest guest]

Can't get the full text they promised.

[ ] Re: TSH

Hi JW:Did they note what it was the lower blood pressure patients who had died, had died of? If they died predominantly from heart problems then the lower blood pressure might simply reflect a waning ability of the heart to pump properly. If so then the conclusion might be to treat them to improve the lacking heart function, and treat the others for their high BP.Rodney.For example, octogenarians with higher blood pressure values tend to live longer than those with lower values. Consequently, the wisdom of treating hypertension and other abnormalities in very old patients has been called into question. "

[Guest guest]

Can't get the full text they promised.

[ ] Re: TSH

Hi JW:Did they note what it was the lower blood pressure patients who had died, had died of? If they died predominantly from heart problems then the lower blood pressure might simply reflect a waning ability of the heart to pump properly. If so then the conclusion might be to treat them to improve the lacking heart function, and treat the others for their high BP.Rodney.For example, octogenarians with higher blood pressure values tend to live longer than those with lower values. Consequently, the wisdom of treating hypertension and other abnormalities in very old patients has been called into question. "