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Free thyroxine but not TSH levels are associated with decline in functional status in a cohort of geriatric outpatients

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Key summary points

AbstractSection Aim

What is the association between serum TSH and FT4 levels with functional decline in a group of older euthyroid patients at risk of frailty?

AbstractSection Findings

For each 0.1 ng/dL increase in baseline and mean FT4 follow-up levels, the risks of functional decline increased by 14.1% and 7.7%, respectively. The risk of functional decline was almost 9 times higher in patients with a baseline level of FT4 in the fourth and fifth quintiles and 50% lower in those with a baseline level of FT4 in the first quintile. No association between TSH and the outcome was found.

AbstractSection Message

Higher and lower FT4 levels are, respectively, a risk and a protective factor for functional decline in these individuals.

Abstract

Purpose

To assess the associations between TSH and free thyroxine (FT4) levels and decline in functional status in euthyroid older patients at risk of frailty.

Design

Longitudinal prospective study.

Methods

Participants from the geriatric outpatient clinic of a university hospital, who fulfilled the criteria for frailty or were at risk of frailty, were recruited. Only those euthyroid, defined by age-specific reference range of TSH, were included. Serum was collected during enrollment and at the third and sixth years of follow-up to assess the mean value of all follow-up levels of serum TSH and FT4. Functional status assessing activities of daily living (ADL) and instrumental ADL were evaluated using the Katz Index and the Health Assessment Questionnaire, respectively. Functional decline was defined by a positive variation in any of the applied scales in the absence of disagreement between the scales or if the patient was institutionalized.

Results

Of the 273 participants (72.5% females) enrolled (mean age 80 years old), 48 died and 102 presented functional decline at the end of follow-up (mean 3.6 ± 1.7 years). Each 0.1 ng/dL increase in baseline and mean follow-up serum FT4 levels increased the risk of functional decline by 14.1% and 7.7%, respectively. The risk of functional decline was 9 times greater with baseline FT4 levels in the fourth and fifth quintiles (p = 0.049) and 50% lower with baseline FT4 levels in the first quintile (p = 0.046). No association between TSH and the outcome was found.

Conclusions

Higher and lower FT4 levels were, respectively, a risk and a protective factor for the decline in functional status in a cohort of euthyroid older adults at risk of frailty.

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Funding

Teixeira PFS received financial support from The Brazilian National Council for Scientific and Technological Development (CNPQ; 311964/2019-2).

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Authors and Affiliations

  1. Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho, 373. Edifício do Centro de Ciências da Saúde, Bloco K, Cidade Universitária, Rio de Janeiro, RJ, 21941-902, Brazil

    Aline S. da S. Correia, Michele L. F. Nascimento, Letícia B. B. de M. Teixeira, Silvana O. e Silva, Mário Vaisman & Patricia F. S. Teixeira

  2. Hospital Antônio Pedro, Universidade Federal Fluminense, Rio de Janeiro, Brazil

    Michele L. F. Nascimento

Authors
  1. Aline S. da S. Correia
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  2. Michele L. F. Nascimento
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  3. Letícia B. B. de M. Teixeira
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  4. Silvana O. e Silva
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  5. Mário Vaisman
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  6. Patricia F. S. Teixeira
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Contributions

NMLF, TLBBM, SSO, and CASS executed the project, evaluated all the patients, collected the data, and maintained the database. CASS performed the analysis and interpreted the collected data along with TPFS. CASS and TPFS wrote the manuscript, which was reviewed by all the authors. VM and TPFS designed the study and supervised the execution of the project from enrollment to the end of the study. TPFS and VM added final considerations and remarks to the manuscript before submission.

Corresponding author

Correspondence to Aline S. da S. Correia.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

This study was conducted according to the guidelines for human research and ethical standards of the World Medical Association Declaration of Helsinki. The Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro’s research ethics committee approved the protocol of the study (protocol number 193/09).

Informed consent

All patients or their caregivers provided written informed consent.

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Correia, A.S.S., Nascimento, M.L.F., Teixeira, L.B.B.M. et al. Free thyroxine but not TSH levels are associated with decline in functional status in a cohort of geriatric outpatients. Eur Geriatr Med 13, 147–154 (2022). https://doi.org/10.1007/s41999-021-00589-y

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  • DOI: https://doi.org/10.1007/s41999-021-00589-y

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