Overt and Subclinical Hypothyroidism in the Elderly: When to Treat?
Hypothyroidism is characterized by increased thyrotropin (TSH) levels and reduced free thyroid hormone fractions while, subclinical hypothyroidism (sHT) by elevated serum TSH in the face of normal thyroid hormones. The high frequency of hypothyroidism among the general population in Western Countrie...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-03-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fendo.2019.00177/full |
| _version_ | 1818940361512321024 |
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| author | Valeria Calsolaro Valeria Calsolaro Filippo Niccolai Giuseppe Pasqualetti Alessia Maria Calabrese Antonio Polini Chukwuma Okoye Silvia Magno Nadia Caraccio Fabio Monzani |
| author_facet | Valeria Calsolaro Valeria Calsolaro Filippo Niccolai Giuseppe Pasqualetti Alessia Maria Calabrese Antonio Polini Chukwuma Okoye Silvia Magno Nadia Caraccio Fabio Monzani |
| author_sort | Valeria Calsolaro |
| collection | DOAJ |
| description | Hypothyroidism is characterized by increased thyrotropin (TSH) levels and reduced free thyroid hormone fractions while, subclinical hypothyroidism (sHT) by elevated serum TSH in the face of normal thyroid hormones. The high frequency of hypothyroidism among the general population in Western Countries made levothyroxine (LT4) one of the 10 most prescribed drugs. However, circulating TSH has been demonstrated to increase with aging, regardless the existence of an actual thyroid disease. Thus, when confronting an increase in circulating TSH levels in the elderly, especially in the oldest old, it is important to carry an appropriate diagnostic path, comprehensive of clinical picture as well as laboratory and imaging techniques. In the current review, we summarize the recommendations for a correct diagnostic workup and therapeutic approach to older people with elevated TSH value, with special attention to the presence of frailty, comorbidities, and poly-therapy. The treatment of choice for hypothyroid patients is hormone replacement with LT4 but, it is important to consider multiple factors before commencing the therapy, from the age dependent TSH increase to the presence of an actual thyroid disease and comorbidities. When treatment is necessary, a tailored therapy should be chosen, considering poly-pharmacy and frailty. A careful follow-up and treatment re-assessment should be always considered to avoid the risk of over-treatment. It is important to stress the need of educating the patient for a correct administration of LT4, particularly when poly-therapy is in place, and the importance of a tailored therapeutic approach and follow-up, to avoid overtreatment. |
| first_indexed | 2024-12-20T06:38:25Z |
| format | Article |
| id | doaj.art-d0b52e3eac334b4bb2d6a5cc451b893d |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-12-20T06:38:25Z |
| publishDate | 2019-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-d0b52e3eac334b4bb2d6a5cc451b893d2022-12-21T19:49:55ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922019-03-011010.3389/fendo.2019.00177438595Overt and Subclinical Hypothyroidism in the Elderly: When to Treat?Valeria Calsolaro0Valeria Calsolaro1Filippo Niccolai2Giuseppe Pasqualetti3Alessia Maria Calabrese4Antonio Polini5Chukwuma Okoye6Silvia Magno7Nadia Caraccio8Fabio Monzani9Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, ItalyNeurology Imaging Unit, Imperial College, London, United KingdomGeriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, ItalyGeriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, ItalyGeriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, ItalyGeriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, ItalyGeriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, ItalyObesity Center at the Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, ItalyGeriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, ItalyGeriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, ItalyHypothyroidism is characterized by increased thyrotropin (TSH) levels and reduced free thyroid hormone fractions while, subclinical hypothyroidism (sHT) by elevated serum TSH in the face of normal thyroid hormones. The high frequency of hypothyroidism among the general population in Western Countries made levothyroxine (LT4) one of the 10 most prescribed drugs. However, circulating TSH has been demonstrated to increase with aging, regardless the existence of an actual thyroid disease. Thus, when confronting an increase in circulating TSH levels in the elderly, especially in the oldest old, it is important to carry an appropriate diagnostic path, comprehensive of clinical picture as well as laboratory and imaging techniques. In the current review, we summarize the recommendations for a correct diagnostic workup and therapeutic approach to older people with elevated TSH value, with special attention to the presence of frailty, comorbidities, and poly-therapy. The treatment of choice for hypothyroid patients is hormone replacement with LT4 but, it is important to consider multiple factors before commencing the therapy, from the age dependent TSH increase to the presence of an actual thyroid disease and comorbidities. When treatment is necessary, a tailored therapy should be chosen, considering poly-pharmacy and frailty. A careful follow-up and treatment re-assessment should be always considered to avoid the risk of over-treatment. It is important to stress the need of educating the patient for a correct administration of LT4, particularly when poly-therapy is in place, and the importance of a tailored therapeutic approach and follow-up, to avoid overtreatment.https://www.frontiersin.org/article/10.3389/fendo.2019.00177/fullhypothyroidismelderlytreatmentL-thyroxinfrailty |
| spellingShingle | Valeria Calsolaro Valeria Calsolaro Filippo Niccolai Giuseppe Pasqualetti Alessia Maria Calabrese Antonio Polini Chukwuma Okoye Silvia Magno Nadia Caraccio Fabio Monzani Overt and Subclinical Hypothyroidism in the Elderly: When to Treat? Frontiers in Endocrinology hypothyroidism elderly treatment L-thyroxin frailty |
| title | Overt and Subclinical Hypothyroidism in the Elderly: When to Treat? |
| title_full | Overt and Subclinical Hypothyroidism in the Elderly: When to Treat? |
| title_fullStr | Overt and Subclinical Hypothyroidism in the Elderly: When to Treat? |
| title_full_unstemmed | Overt and Subclinical Hypothyroidism in the Elderly: When to Treat? |
| title_short | Overt and Subclinical Hypothyroidism in the Elderly: When to Treat? |
| title_sort | overt and subclinical hypothyroidism in the elderly when to treat |
| topic | hypothyroidism elderly treatment L-thyroxin frailty |
| url | https://www.frontiersin.org/article/10.3389/fendo.2019.00177/full |
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