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July 20, 1979, Vol 242, No. 3 >
ARTICLE | July 20, 1979

The Aging Thyroid: Title and subTitle BreakIncreased Prevalence of Elevated Serum Thyrotropin Levels in the Elderly FREE

Clark T. Sawin, MD; Deepak Chopra, MD; Fereidoun Azizi, MD; Jo Ellen Mannix; Pamela Bacharach
[+] Author Affiliations

Reprint requests to Boston Veterans Administration Hospital, 150 S Huntington Ave, Boston, MA 02130 (Dr Sawin).


JAMA. 1979;242(3):247-250. doi:10.1001/jama.1979.03300030019013
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References

Of 344 relatively healthy persons older than 60 years, 22 (5.9%) had a clearly elevated level of serum thyrotropin (TSH) (>10 μU/mL), a finding more common in women than in men. Ten of the 22 had low values for serum thyroxine (T4) and free T4 (FT4) index, but only one had a low value for serum triiodothyronine (T3) or free T3 (FT3) index. A further 14.4% had a slightly elevated level of serum TSH (>5≤10 μU/mL), but none had low values for serum T4 or FT4 index. Age alone has little effect on the measurements of T4; age is associated with slightly lower T3 levels, but only in men 60 years or older or in women 80 years or older. Longitudinal studies should determine if a slightly elevated serum TSH rises further with age and if there is a causal relationship between a high level of serum TSH and cardiovascular disease.

(JAMA 242:247-250, 1979)

REFERENCES

1 +
Bahemuka M, Hodkinson HM:  Screening for hypothyroidism in elderly inpatients . Br Med J 2:601-603, 1975;.
2 +
Evered DC, Ormston BJ, Smith PA, et al:  Grades of hypothyroidism . Br Med J 1:657-662, 1973;.
3 +
Rubenstein HA, Butler VP Jr, Werner SC:  Progressive decrease in serum triiodothyronine concentrations with human aging: Radioimmunoassay following extraction of serum . J Clin Endocrinol Metab 37:247-253, 1973;.
4 +
Hesch RD, Gatz J, Juppner H, et al:  TBG-dependency of age related variations of thyroxine and triiodothyronine . Horm Metab Res 9:141-146, 1977;.
5 +
Bermudez F, Surks MI, Oppenheimer JH:  High incidence of decreased serum triiodothyronine concentration in patients with nonthyroidal disease . J Clin Endocrinol Metab 41:27-40, 1975;.
6 +
Carter JN, Corcoran JM, Eastman CJ, et al:  Effect of severe, chronic illness on thyroid function . Lancet 2:971-974, 1974;.
7 +
Jefferys PM, Hoffenberg R, Farran HEA, et al:  Thyroid-function tests in the elderly . Lancet 1:924-927, 1972;.
8 +
Chopra IJ:  A radioimmunoassay for measurement of thyroxine in unextracted serum . J Clin Endocrinol Metab 34:938-947, 1972;.
9 +
Mitsuma T, Colucci J, Shenkman L, et al:  Rapid simultaneous radioimmunoassay for triiodothyronine and thyroxine in unextracted serum . Biochem Biophys Res Commun 46:2107-2113, 1972;.
10 +
Nusynowitz ML, Waliszewski J:  Evaluation of a new surface adsorbent triiodothyronine (T,) uptake test . Am J Clin Pathol 56:523-525, 1971;.
11 +
Ingbar SH, Braverman LE, Dawber NA, et al:  A new method for measuring the free thyroid hormone in human serum and an analysis of the factors that influence its concentration . J Clin Invest 44:1679-1689, 1965;.
12 +
Solomon DH, Benotti J, DeGroot LH, et al:  Revised nomenclature for tests of thyroid hormones in serum . J Clin Endocrinol Metab 42:595-598, 1976;.
13 +
Odell WD, Wilber JF, Utiger RD:  Studies of thyrotropin physiology by means of radioimmunoassay . Recent Prog Horm Res 23:47-85, 1967;.
14 +
Gordin A, Saarinen P, Pelkonen R, et al:  Serum thyrotrophin and the response to thyrotrophin releasing hormone in symptomless autoimmune thyroiditis and in borderline and overt hypothyroidism . Acta Endocrinol 75:274-285, 1974;.
15 +
Larsen PR:  Direct immunoassay of triiodothyronine in human serum . J Clin Invest 51:1939-1949, 1972;.
16 +
Gordin A, Lamberg BA:  Natural course of symptomless autoimmune thyroiditis . Lancet 2:1234-1238, 1975;.
17 +
Lloyd WH, Goldberg IJL:  Incidence of hypothyroidism in the elderly . Br Med J 2:1256-1259, 1961;.
18 +
Tunbridge WMG, Evered DC, Hall R, et al:  The spectrum of thyroid disease in a community: The Whickham survey . Clin Endocrinol 7:481-493, 1977;.
19 +
Westgren U, Burger A, Ingemansson S, et al:  Blood levels of 3,5,3′-triiodothyronine and thyroxine . Acta Med Scand 200:493-495, 1976;.
20 +
Herrmann J, Rusche HJ, Kroll HJ, et al:  Free triiodothyronine (T,) and thyroxine (T,) serum levels in old age . Horm Metab Res 6:239-240, 1974;.
21 +
Britton KE, Ellis SM, Miralles JM, et al:  Is "T, toxicosis" a normal biochemical finding in elderly women? Lancet 2:141-142, 1975;
22 +
Brunelle P, Bohuon C:  Baisse de la triiodothyronine serique avec l'age. Clin Chim Acta 42:201-203, 1972;
23 +
Snyder PJ, Utiger RD:  Thyrotropin response to thyrotropin releasing hormone in normal females over 40 . J Clin Endocrinol Metab 34:1096-1098, 1972;.
24 +
Stepanas AV, Mashiter G, Maisey MN:  Serum triiodothyronine: Clinical experience with a new radioimmunoassay kit . Clin Endocrinol 6:171-183, 1977;.
25 +
Kirkegaard C, Friis T, Siersbaek-Nielsen K:  Measurements of serum triiodothyronine by radioimmunoassay . Acta Endocrinol 77:71-81, 1974;.
26 +
McLellan GH, Riley WJ, Davies CP:  T4 toxicosis . Lancet 2:660, 1975;.
27 +
Burrows AW, Shakespear RA, Hesch RD, et al:  Thyroid hormones in the elderly sick: "T, euthyroidism." Br Med J 4:437-439, 1975;.
28 +
Vagenakis AG, Burger A, Portnay GI, et al:  Diversion of peripheral thyroxine metabolism from activating to inactivating pathways during complete fasting . J Clin Endocrinol Metab 41:191-194, 1975;.
29 +
Croxson MS, Ibbertson HK:  Low serum triiodothyronine (T,) and hypothyroidism in anorexia nervosa . J Clin Endocrinol Metab 44:167-174, 1977;.
30 +
Foley TP Jr, Klein AH, Agustin AV:  Adaptation of TSH filter paper method for regionalized screening for congenital hypothyroidism . J Lab Clin Med 90:11-17, 1977;.

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1 +
Bahemuka M, Hodkinson HM:  Screening for hypothyroidism in elderly inpatients . Br Med J 2:601-603, 1975;.
2 +
Evered DC, Ormston BJ, Smith PA, et al:  Grades of hypothyroidism . Br Med J 1:657-662, 1973;.
3 +
Rubenstein HA, Butler VP Jr, Werner SC:  Progressive decrease in serum triiodothyronine concentrations with human aging: Radioimmunoassay following extraction of serum . J Clin Endocrinol Metab 37:247-253, 1973;.
4 +
Hesch RD, Gatz J, Juppner H, et al:  TBG-dependency of age related variations of thyroxine and triiodothyronine . Horm Metab Res 9:141-146, 1977;.
5 +
Bermudez F, Surks MI, Oppenheimer JH:  High incidence of decreased serum triiodothyronine concentration in patients with nonthyroidal disease . J Clin Endocrinol Metab 41:27-40, 1975;.
6 +
Carter JN, Corcoran JM, Eastman CJ, et al:  Effect of severe, chronic illness on thyroid function . Lancet 2:971-974, 1974;.
7 +
Jefferys PM, Hoffenberg R, Farran HEA, et al:  Thyroid-function tests in the elderly . Lancet 1:924-927, 1972;.
8 +
Chopra IJ:  A radioimmunoassay for measurement of thyroxine in unextracted serum . J Clin Endocrinol Metab 34:938-947, 1972;.
9 +
Mitsuma T, Colucci J, Shenkman L, et al:  Rapid simultaneous radioimmunoassay for triiodothyronine and thyroxine in unextracted serum . Biochem Biophys Res Commun 46:2107-2113, 1972;.
10 +
Nusynowitz ML, Waliszewski J:  Evaluation of a new surface adsorbent triiodothyronine (T,) uptake test . Am J Clin Pathol 56:523-525, 1971;.
11 +
Ingbar SH, Braverman LE, Dawber NA, et al:  A new method for measuring the free thyroid hormone in human serum and an analysis of the factors that influence its concentration . J Clin Invest 44:1679-1689, 1965;.
12 +
Solomon DH, Benotti J, DeGroot LH, et al:  Revised nomenclature for tests of thyroid hormones in serum . J Clin Endocrinol Metab 42:595-598, 1976;.
13 +
Odell WD, Wilber JF, Utiger RD:  Studies of thyrotropin physiology by means of radioimmunoassay . Recent Prog Horm Res 23:47-85, 1967;.
14 +
Gordin A, Saarinen P, Pelkonen R, et al:  Serum thyrotrophin and the response to thyrotrophin releasing hormone in symptomless autoimmune thyroiditis and in borderline and overt hypothyroidism . Acta Endocrinol 75:274-285, 1974;.
15 +
Larsen PR:  Direct immunoassay of triiodothyronine in human serum . J Clin Invest 51:1939-1949, 1972;.
16 +
Gordin A, Lamberg BA:  Natural course of symptomless autoimmune thyroiditis . Lancet 2:1234-1238, 1975;.
17 +
Lloyd WH, Goldberg IJL:  Incidence of hypothyroidism in the elderly . Br Med J 2:1256-1259, 1961;.
18 +
Tunbridge WMG, Evered DC, Hall R, et al:  The spectrum of thyroid disease in a community: The Whickham survey . Clin Endocrinol 7:481-493, 1977;.
19 +
Westgren U, Burger A, Ingemansson S, et al:  Blood levels of 3,5,3′-triiodothyronine and thyroxine . Acta Med Scand 200:493-495, 1976;.
20 +
Herrmann J, Rusche HJ, Kroll HJ, et al:  Free triiodothyronine (T,) and thyroxine (T,) serum levels in old age . Horm Metab Res 6:239-240, 1974;.
21 +
Britton KE, Ellis SM, Miralles JM, et al:  Is "T, toxicosis" a normal biochemical finding in elderly women? Lancet 2:141-142, 1975;
22 +
Brunelle P, Bohuon C:  Baisse de la triiodothyronine serique avec l'age. Clin Chim Acta 42:201-203, 1972;
23 +
Snyder PJ, Utiger RD:  Thyrotropin response to thyrotropin releasing hormone in normal females over 40 . J Clin Endocrinol Metab 34:1096-1098, 1972;.
24 +
Stepanas AV, Mashiter G, Maisey MN:  Serum triiodothyronine: Clinical experience with a new radioimmunoassay kit . Clin Endocrinol 6:171-183, 1977;.
25 +
Kirkegaard C, Friis T, Siersbaek-Nielsen K:  Measurements of serum triiodothyronine by radioimmunoassay . Acta Endocrinol 77:71-81, 1974;.
26 +
McLellan GH, Riley WJ, Davies CP:  T4 toxicosis . Lancet 2:660, 1975;.
27 +
Burrows AW, Shakespear RA, Hesch RD, et al:  Thyroid hormones in the elderly sick: "T, euthyroidism." Br Med J 4:437-439, 1975;.
28 +
Vagenakis AG, Burger A, Portnay GI, et al:  Diversion of peripheral thyroxine metabolism from activating to inactivating pathways during complete fasting . J Clin Endocrinol Metab 41:191-194, 1975;.
29 +
Croxson MS, Ibbertson HK:  Low serum triiodothyronine (T,) and hypothyroidism in anorexia nervosa . J Clin Endocrinol Metab 44:167-174, 1977;.
30 +
Foley TP Jr, Klein AH, Agustin AV:  Adaptation of TSH filter paper method for regionalized screening for congenital hypothyroidism . J Lab Clin Med 90:11-17, 1977;.

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