Subclinical thyroid dysfunction symptoms in older adults: cross-sectional study in UK primary care

Deborah McCahon, M Sayeed Haque, James Parle, F D Richard Hobbs, Lesley Roberts

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Background:
Subclinical thyroid dysfunction, characterized by abnormal serum thyrotrophin (thyroid stimulating hormone [TSH]) concentrations with normal free thyroxine (FT4), is common in the elderly. Whether individuals with subclinical serum status experience an increased symptom profile remains unclear.

Aim:
To compare the prevalence of those symptoms typically associated with overt thyroid dysfunction in older individuals with a subclinical and euthyroid serum profile.
Design and setting: Cross-sectional, nested within the Birmingham Elderly Thyroid Study (BETS), 19 general practices, UK.
Method: Community dwelling adults (aged ≥65 years), without overt thyroid dysfunction or associated treatment, self-reported presence or absence of 18 symptoms (whilst serum result naïve). Serum concentrations of TSH and FT4 were measured to establish thyroid status.
Results: 2870 individuals were screened, 2703 (94%) were categorized as euthyroid (normal), 29 (1%) subclinically hyperthyroid and 138 (5%); subclinically hypothyroid. Weight gain was reported by 54% (CI; 45.3-61.7%) and fast thinking by 31% (CI; 17.3-49.2) of individuals with subclinical hypo- and hyperthyroidism respectively. No significant differences in the prevalence of individual symptoms were observed between the euthyroid and subclinical hypothyroid groups nor in comparison with the subclinically hyperthyroid group. Multivariate logistic regression analysis failed to reveal an association between individual or multiple symptoms and subclinical status.

Conclusion:
Findings suggest that subclinical thyroid dysfunction does not confer a symptom burden in older individuals and support adherence to guidelines in the non-treatment of subclinical thyroid dysfunction. GPs may use the findings to reassure older people presenting with symptoms that subclinical thyroid dysfunction is an unlikely explanation. The presence of persistently abnormal TSH concentrations may be linked to long-term risks of cardiovascular disease, especially Atrial Fibrillation, but whether this should prompt treatment and whether such treatment alters vascular outcomes is unknown.
Original languageEnglish
Pages (from-to)e208-e214
Number of pages7
JournalBritish Journal of General Practice
Volume70
Issue number692
Early online date27 Feb 2020
DOIs
Publication statusPublished - 1 Mar 2020

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