Relevance of TSH evaluation in elderly in-patients with non-thyroidal illness
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Non-thyroidal illness (NTI) is frequent in hospitalized patients. Its recovery is characterized by a raise in TSH levels. However, the clinical significance of high TSH levels at admission in hospitalized elderly patients with NTI remains uncertain.
To explore the relevance of baseline TSH evaluation in hospitalized elderly patients with NTI.
We examined the participants with NTI (n = 123) from our previous study (Sforza, 2017). NTI was defined as: low T3 (< 80 ng/dL) and normal or low total T4 in the presence of TSH values between 0.1 and 6.0 mU/L. Thyroid function tests were performed on day 1 and day 8 of the hospital stay. Positive TSH changes (+ ΔTSH) were considered when the day-8 TSH value increased more than the reference change value for TSH (+ 78%). Multiple logistic regression was used to evaluate the independent association of baseline TSH, sex, clinical comorbidities (by ACE-27) and medications with + ΔTSH.
Out of 123 patients (77 ± 8 years, 52% female), 34 showed a + ΔTSH. These patients had a lower TSH at admission (p < 0.001) and intra-hospital mortality (p = 0.003) than the others. In multiple logistic regression, TSH > 2.11 mU/L at baseline was associated with reduced odds to show + ΔTSH [odds ratio (95 CI) 0.29 (0.11–0.75); p = 0.011] in a model adjusted by age, sex and ACE-27.
Inappropriately higher TSH levels at admission in hospitalized elderly patients were associated with a reduced ability to raise their TSH levels later on. The present results confront the idea that TSH levels at admission are irrelevant in this clinical context.
KeywordsThyroid function Non-thyroidal illness Elderly patients Mortality Critical illness TSH
The authors would like to acknowledge all the medical and non-medical staff from the Internal Medicine and Laboratory Departments from the “Dr. César Milstein” Hospital for their cooperation with this study. Noelia Sforza has received additional support from a scholarship granted by the Comisión Nacional Salud Investiga, Ministerio de Salud de la República Argentina.
DC, CF, TM and GB designed the study and prepared the presentation to the Ethics Review Board of the “Dr. César Milstein” Hospital for approval. JR, NS, RR, AM, CP, and EB were in charge of the recruitment of the patients, performed the clinical evaluations, and registered the medications, the hospital stay and the causes of admission of all the subjects included. DC, CF and GB supervised the protocol development. CF and PF performed the biochemical measurements and filled the study database. TM performed the statistical analyses. JR and NS wrote the manuscript draft. CF, TM and GB reviewed and corrected the manuscript for submission. All the authors approved the final version of the manuscript.
Compliance with ethical standards
Conflict of interest
The author reports no conflicts of interest in this work.
The study protocol was approved by the Ethics Committee from the Cesar Milstein Hospital. The study was conducted in compliance with the ethical principles for medical research involving human subjects (Declaration of Helsinki).
All the patients, or their relatives, signed the informed consent to participate in the study.
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