Thyroid function tests and mortality in aged hospitalized patients: a 7-year prospective observational study

J Clin Endocrinol Metab. 2013 Dec;98(12):4683-90. doi: 10.1210/jc.2012-3849. Epub 2013 Oct 30.


Context: Several alterations in thyroid function test (TFT) results have been associated with mortality in elderly patients.

Objective: Our aim was to investigate the relationship between TFT results and all-cause and cardiovascular (CV) mortality in aged hospitalized patients.

Design: A 7-year prospective observational study was conducted. TFTs were performed at hospital admission, and mortality was registered in the follow-up period.

Patients: Participants were 404 patients aged >65 years admitted to the Department of Geriatrics, Hospital General, Segovia, Spain, for any reason during 2005.

Main outcome measures: The study evaluated the association between TFT results and mortality from all causes and CV diseases.

Methods: TSH, free T₄, and free T₃ (FT₃) were measured on the first day of admission. In-hospital and total survival times, number of deaths, and all-cause and CV mortality were registered until the census date on January 1, 2012.

Results: During the study, 323 patients (80%) died. Kaplan-Meier analysis showed that median survival time for all-cause mortality was significantly lower in patients in the first tertile of serum FT₃, in the first tertile of TSH, and in the first tertile of serum free T₄ concentrations. Multivariate adjusted Cox regression analysis showed that the history of cancer (hazard ratio, 1.60; 95% confidence interval, 1.12-2.28; P = .009), age (1.03; 1.01-1.06; P = .003), and FT₃ levels (0.72; 0.63-0.84; P < .001) were significant factors related to all-cause mortality. The cause of death was known in 202 patients. Of this group, 61 patients (30.2%) died of CV disease. Patients in the first tertile of TSH and FT₃ exhibited a significant higher mortality due to CV disease. In the adjusted Cox regression analysis, FT₃ was a significant predictor of CV mortality (0.76; 0.63-0.91; P = .004).

Conclusions: Alterations in TFT results during hospitalization are associated with long-term mortality in elderly patients. In particular, low FT₃ levels are significantly related to all-cause and CV mortality.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aging*
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / physiopathology*
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Hospitals, General
  • Humans
  • Hyperthyroidism / blood
  • Hyperthyroidism / complications
  • Hyperthyroidism / mortality
  • Hyperthyroidism / physiopathology*
  • Hypothyroidism / blood
  • Hypothyroidism / complications
  • Hypothyroidism / mortality
  • Hypothyroidism / physiopathology*
  • Kaplan-Meier Estimate
  • Male
  • Mortality
  • Spain / epidemiology
  • Thyroid Function Tests
  • Thyroid Gland / metabolism
  • Thyroid Gland / physiopathology*
  • Thyrotropin / blood
  • Thyrotropin / metabolism
  • Thyroxine / blood
  • Thyroxine / metabolism
  • Triiodothyronine / blood
  • Triiodothyronine / metabolism


  • Triiodothyronine
  • Thyrotropin
  • Thyroxine