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Prevalence of Thyroid Disease and Abnormal Thyroid Tests in Older Hospitalized and Ambulatory Persons
Author(s) -
Livingston Edward H.,
Hershman Jerome M.,
Sawin Clark T.,
Yoshikawa Thomas T.
Publication year - 1987
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1987.tb01338.x
Subject(s) - medicine , subclinical infection , ambulatory , triiodothyronine , thyroid , thyroid disease , hormone , thyroid stimulating hormone , endocrinology , pediatrics
To determine the utility of laboratory tests for diagnosing thyroid disease in the hospitalized elderly, we measured serum thyroid‐stimulating hormone (TSH), thyroxine (T 4 ), free thyroxine index (FT 4 I), triiodothyronine (T 3 ), and free triiodothyronine index (FT 3 I) in 125 geriatric inpatients, mostly men, and compared the results to those in elderly ambulatory patients. Hypothyroidism (TSH > 10 μU/mL with a low T 4 and FT 4 I or clinical findings) was present in 7.8% (nine of 116) of male inpatients compared to only 0.7% of male ambulatory controls (P < 0.01). Only a few women were studied but 17% (two of 12) were hypothyroid compared to 2.4% of ambulatory elderly women. Three of the hypothyroid inpatients had no clinical clue to their hypothyroidism. Further, decreased thyroid reserve or subclinical hypothyroidism (TSH > 10 μU/mL with a normal T 4 and FT 4 I and no overt clinical findings), a condition which may lead to overt hypothyroidism, was more common in male inpatients (4.3%) than in male ambulatory controls (1.8% [ P < 0.01]). Thus, a clearly elevated serum TSH (> 10 μU/mL) was more common in inpatient (12.1%) than in ambulatory (2.4%) elderly men ( P < 0.01). Four inpatients and nine ambulatory controls had an elevated T 4 and FT 4 I, but in only one (0.8%) inpatient and one (0.6%) control was a final diagnosis of hyperthyroidism made; the others had no clinical findings and a normal or low T 3 and FT 3 I. A low T 3 and FT 3 I or T 4 and FT 4 I occurred with equal prevalence in inpatient (19%) as in ambulatory older men (14.9%); three of 12 women inpatients also had a low T 3 and FT 3 I. This finding did not aid in diagnosing thyroid dysfunction. Because of the high prevalence of thyroid disease, predominantly hypothyroidism, in the inpatients (9.4%, or 14.1% if decreased thyroid reserve is included) and the difficulty in detecting thyroid disease on clinical grounds (27% of inpatients with thyroid disease had no specific clinical manifestation), we recommend that geriatric patients, including men, be screened for thyroid dysfunction by measurements of serum TSH and T 4 (or FT 4 I) upon hospital admission.