Re: subclininal hypo in elderly

[Guest guest]

I ran across this article about it being better not to treat subclinial hypo

in elderly (high TSH, no symptoms).

I think this answers my question about why SO many older females I know are

taking .25 mcg of Synthroid and think they have the same thing i do. HAHAHA

But I think the point is ...is that it is NORMAL for TSH to rise in the

elderly and doesn't necessarily mean a person has an underactive thyroid.

Remember

these folks are being treated based on the TSH, not the Free T4 and Free T3

levels.

Next time one of them says to me " oh - I have that " ....I'm gonna correct

them and tell them they have subclinical hypo and a recent study indicates they

probably should not be treated.

Cindi

Health

Elderly Better Off With Underactive Thyroid

var byline = 'By Gardner

HealthDay Reporter,'; if (byline != null) {

document.write(byline.replace(/,[\s]*$/, ''));

} By Gardner

HealthDay Reporter <b>By Gardner</b><br><i>HealthDay Reporter</i>,

TUESDAY, Nov. 30 (HealthDayNews) -- Very old people with underactive thyroid

glands do not experience adverse effects and may even live longer than people

of the same age with normally functioning thyroids, Dutch researchers

say.These surprising results, which appear in the Dec. 1 issue of the Journal of

the

American Medical Association, add fuel to an ongoing debate about whether to

screen and treat the oldest for mild thyroid disease. " Contrary to general

expectation, the clinical implications of subclinical thyroid dysfunction are

not as

grave, " said study author Dr. ijn Gussekloo, an associate professor of

gerontology and geriatrics at Leiden University Medical Center. " This

definitely diminishes the 'need' for screening and treatment. " Subclinical

hypothyroidism, meaning an underactive thyroid gland that does not result in

symptoms, is

extremely common, possibly affecting up to 20 percent of women over the age of

60. " Whether this is just an abnormality that you find on blood tests that has

no implication for the persons -- or whether it's something that needs to be

diagnosed and treated aggressively -- is one of the most contentious issues in

endocrinology because it's so common, " said Dr. S. , author of an

accompanying editorial, director of the division of endocrinology at Sinai

Hospital of Baltimore and a professor of medicine at s Hopkins University

School of Medicine.While some experts, including those at the Institute of

Medicine, have advised against screening, professional groups have recommended

it,

added.The dilemma plays down to the doctor-patient level. On the one

hand, said, " what's the point of finding something if treating it makes

you do worse? " On the other hand, he added, " as a doctor who sees patients every

day, it's hard to resist treating patients like this, especially if they have

more severe degrees. " Studies so far have shown conflicting evidence, but none

have looked at " hard " endpoints, such as dying.For this study, researchers

followed 599 people from the time they were 85 years old until they were 89.

This constituted the majority of all people living in the Dutch city of Leiden

who were born between 1912 and 1914. Each participant had his or her thyroid

status measured at the beginning of the study. As the study progressed, the

authors looked at disability in daily life, depression, cognitive function and

mortality.Most of the study participants with abnormal thyroid function were

underactive, although some had mildly overactive thyroids. None were treated.As

it

turned out, the overactive cohort had a slightly worse mortality than normal

people, although that had been shown before. Those with underactive hormones

had even better survival, which was the new finding. " It appeared, at least in

this study, that not treating somebody was to their benefit. That's really

peculiar, " said.Previous studies had found the same thing in

animals. " It's

rather unexpected for us medics, but in line with experimental mice models, "

Gussekloo said.No one really knows why this may be the case, but it's possible

that the effects might be related to a dampened-down metabolic rate,

said. Older animals also respond differently to thyroid hormone than do younger

animals.The dilemma of to treat or not to treat probably can be solved only

with a randomized, double-blind clinical trial, but these are extremely

expensive

to undertake.Certainly, the findings are food for thought. " Let's rethink the

whole idea of screening for subclinical hypothyroidism in very old people, as

this appears to have little consequence, " Gussekloo said. " Let's rethink the

therapeutic strategies. Should they be at lower intensity, or even

withdrawn? " " I say it's still reasonable to treat, but not be more aggressive in

treatment, " said. " To be not so aggressive makes sense. "