Abstract
Thyroid function in individuals from a representative population of 81-year olds was evaluated clinically and from assay of serum thyrotropin (TSH) and serum free thyroxine (free T4). Among the 144 men, 2 had markedly abnormal values; L-thyroxine treatment had been prescribed for both, one because of primary hypothyroidism (concentrations at screening were high for TSH and low for free T4) and one because of panhypopituitarism (low free T4 at screening). Among the 250 women, 10 had TSH concentrations > 10 mU/L; L-thyroxine therapy had been prescribed for 3 of them. Only 1 non-L-thyroxine treated woman had a high free T4 concentration. She had few clinical signs and symptoms of hyperthyroidism (mainly weight loss), and multinodular goiter. Total and free 3,5,3′-triiodothyronine concentrations were normal but her total and free T4 concentrations were high at ages 70, 75 and 79 years, indicating that “T4-toxicosis” had been present for at least 11 years without evidence of progression of her hyperthyroidism. The results indicate that clinical signs and symptoms of thyroid disease in the elderly may be too subtle for diagnosis. (Aging 3; 31-37,1991)
Similar content being viewed by others
References
Edén S., Sundbeck G., Lindstedt G., Lundberg P.A., Jagenburg R., Landahl S., Svanborg A.: Screening for thyroid disease in the elderly. Serum concentrations of thyrotropin and 3,5,3′-triiodothyronine in a representative population of 79-year-old women and men. Compr. Gerontol 2: 40–45, 1988.
Caldwell G., Gow S.M., Sweeting V.M., Kellet H.A., Beckett G.J., Seth J., Toft A.D.: A new strategy for thyroid function testing. Lancet I: 1117–1119, 1985.
Lindstedt G., Tisell L-E., Nyström E., Petersen K., Jagenburg R., Lundberg P-A.: Thyroid function evaluation in the mid’80s. Scand. J. Clin. Lab. Invest. 44: 465–470, 1984.
Lindstedt G., Edén S., Jagenburg R., Lundberg P-A., Mellström D., Odén A., Svanborg A.: Factors influencing serum free T4 in 70-year-old men. Implications for reference intervals in the elderly. Scand. J. Clin. Lab. Invest. 43: 410–413, 1983.
Edén S., Jagenburg R., Lindstedt G., Lundberg P-A., Mellström D.: Interrelationships among body mass, thyrotropin, thyroid hormones and thyroid-hormone binding proteins in healthy 70-year-old men. Clin. Chem. 30: 681–686, 1984.
Rinder L., Roupe S., Steen B., Svanborg A.: Seventy-year-old people in Gothenburg. A population study in an industrialized Swedish city. I. General presentation of the study. Acta Med. Scand. 198: 397–407, 1975.
Svanborg A.: Seventy-year-old people in Göteborg. A population study in an industrialized Swedish city. II. General presentation of social and medical conditions. Acta Med. Scand. (suppl. 611): 5-37, 1977.
Bergström G., Aniansson A., Bjelle A., Grimly G., Lundgren-Lindquist B., Svanborg A.: Functional consequences of joint impairment at age 79. Scand. J. Rehabil. Med. 17: 183–190, 1985.
Scandinavian Committée on ECG classification. The Minnesota code or ECG classification. Actaptation to CR leads and modification of the code for ECG recording during and after exercise. Acta Med. Scand. (suppl. 481), 1967.
Landahl S., Jagenburg R., Svanborg A.: Blood components in a 70-year-old population. Clin. Chim. Acta 112:301–304,1981.
Edén S., Jagenburg R., Lundberg P-A., Mellström D., Svanborg A.: Thyroregulatory changes associated with smoking in healthy 70-year-old men. Clin. Endocrinol. 21: 605–610, 1984.
Diem K., Lenter C.: Scientific tables. Ciba Geigy Ltd, Basel, Switzerland, 1970.
Bradley J.V.: Distribution-free statistical test. Prentice Hall, London, 1968.
Solberg H.: The theory of reference values. J. Clin. Chem. Clin. Biochem. 21: 749–760, 1983.
Svanborg A., Berg S., Mellström D., Nilsson L., Persson G.: Possibilities of preserving physical and mental fitness and autonomy in old age. In: Häfner H., Moschel G., Satorius N. (Eds.), Mental Health in the Elderly. A review of the present state of research. Springer Verlag, Heidelberg, 1986, pp. 195–202.
Robuschi G., Safran M., Braverman L.E., Gnudi A., Roti E.: Hypothyroidism in the Elderly. Endocr. Rev. 8: 142–151, 1987.
Helfand M., Crapo L.M.: Screening for thyroid disease. Ann. Intern. Med. 112: 840–849, 1990.
Palmer K.T.: A prospective study into thyroid disease in a geriatric unit. N.Z. Med. J. 86: 323–324, 1977.
Tibaldi J.M., Barzel U.S., Albin J., Surks M.: Thyrotoxicosis in the very old. Am. J. Med. 81: 619–622, 1986.
Falkenberg M., Kåedal B., Norr A.: Screening of an elderly population for hypo- and hyperthyroidism. Acta Med. Scand. 214: 361–365, 1983.
Havard C.W.H.: The thyroid and ageing. J. Clin. Endocrinol. Metab. 10: 163–178, 1981.
Tunbridge W.M.G., Evered D.C., Hall R., Appleton D., Brewis M., Clark F., Grimley Evans J., Young E., Bird T., Smith P.A.: The spectrum of thyroid disease in a community: The Whickham survey. Clin. Endocrinol. 7: 481–493, 1977.
Nyström E., Bengtsson C., Lindquist O., Lindberg S., Lindstedt G., Lundberg P.A.: Serum triiodothyronine and hyperthyroidism in a population sample of women. Clin. Endocrinol. 20: 31–42, 1984.
Nyström E., Lindstedt G., Lundberg P-A., Lundholm K., Smith U.: Recognizing hyperthyroidism in the elderly. Clin. Chem. 33: 429–431, 1987.
Nyström E., Petersen L., Lindstedt G., Lundberg P-A.: Screening for thyroid disease in women ≥ 50 years of age seeking hospital care: Influence of common nonthyroidal illness on serum free thyroxin as determined by analog radioimmunoassay. Clin. Chem. 32: 461–464, 1986.
Basset F., Eastman G.M., Maberly G.F., Smith D.C.: Diagnostic value of thyrotropin concentrations as measured by sensitive immunoradiometric assay. Clin. Chem. 32: 603–608, 1986.
Howanitz P.J., Howanitz J.H., Lamberson H.V., Ennis K.M.: Incidence and mechanism of spurious increases in serum thyrotropin. Clin. Chem. 28: 427–431, 1982.
Paterson N., Briggart E.M., Chapman R.S., Beastall G.H.: Evaluation of time resolved immunofluorometric assay for serum thyroid stimulating hormone. Ann. Clin. Biochem. 22: 606–611, 1985.
Eggertsen R., Petersen K., Lundberg P-A., Nyström E., Lindstedt G.: Screening for thyroid disease in a primary care unit with a thyroid stimulating hormone assay with a low detection limit. Br. Med. J. 297:1586–1592, 1988.
Robbins J., Rail J.E., Rawson R.W.: An unusual instance of thyroxine-binding human serum by serum gammaglobulin. J. Clin. Endocrinol. Metab. 16: 573–579, 1956.
Karlsson FA, Wibell L., Wide L.:Hypothyroidism. due to thyroid-hormone-binding antibodies. N. Engl. J. Med. 296: 1146–1148, 1977.
Allan D.Y., Murphy F., Needham C.A., Barron N., Wilkins TA, Midgley J.E.M.: Sensitive test for thyroid hormone auto-antibodies in serum (Letter). Lancet II: 824, 1982.
Byfield P.G.H., Lalloz M.R.A., Pearce C.J., Himworth R.L.: Free thyroid-hormone concentrations in subjects with various abnormalities of binding-proteins. Experience with Amerlex free T3 and free T4. Clin. Endocrinol. 19: 277–283, 1983.
Lindstedt G., Lundberg P-A., Jagenburg R., Nyström E.: Effect of heparin in vivo on the in vitro assay of free thyroxine. Scand. J. Clin. Lab. Invest. 43: 643–646, 1983.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Sundbeck, G., Lundberg, P.A., Lindstedt, G. et al. Screening for thyroid disease in the elderly. Serum free thyroxine and thyrotropin concentrations in a representative population of 81-year-old women and men. Aging Clin Exp Res 3, 31–37 (1991). https://doi.org/10.1007/BF03323975
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03323975