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. 2018 Oct;68(675):e718-e726.
doi: 10.3399/bjgp18X698861. Epub 2018 Aug 28.

Stability of Thyroid Function in Older Adults: The Birmingham Elderly Thyroid Study

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Free PMC article

Stability of Thyroid Function in Older Adults: The Birmingham Elderly Thyroid Study

Lesley Roberts et al. Br J Gen Pract. .
Free PMC article

Abstract

Background: Thyroid function tests (TFTs) are among the most requested tests internationally. However, testing practice is inconsistent, and potentially suboptimal and overly costly. The natural history of thyroid function remains poorly understood.

Aim: To establish the stability of thyroid function over time, and identify predictors of development of overt thyroid dysfunction.

Design and setting: Longitudinal follow-up in 19 general practices in the UK.

Method: A total of 2936 participants from the Birmingham Elderly Thyroid Study (BETS 1) with a baseline TFT result indicating euthyroid or subclinical state were re-tested after approximately 5 years. Change in thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid status between baseline and follow-up was determined. Predictors of progression to overt dysfunction were modelled.

Results: Participants contributed 12 919 person-years; 17 cases of overt thyroid dysfunction were identified, 13 having been classified at baseline as euthyroid and four as having subclinical thyroid dysfunction. Individuals with subclinical results at baseline were 10- and 16-fold more likely to develop overt hypothyroidism and hyperthyroidism, respectively, compared with euthyroid individuals. TSH and FT4 demonstrated significant stability over time, with 61% of participants having a repeat TSH concentration within 0.5 mIU/L of their original result. Predictors of overt hypothyroidism included new treatment with amiodarone (odds ratio [OR] 92.1), a new diagnosis of atrial fibrillation (OR 7.4), or renal disease (OR 4.8).

Conclusion: High stability of thyroid function demonstrated over the 5-year interval period should discourage repeat testing, especially when a euthyroid result is in the recent clinical record. Reduced repeat TFTs in older individuals is possible without conferring risk, and could result in significant cost savings.

Keywords: ageing; general practice; primary health care; subclinical thyroid dysfunction; symptoms; thyroid function test.

Figures

Figure 1.
Figure 1.
Consort diagram. BETS 1 = Birmingham Elderly Thyroid Study 1. DOB = date of birth. RCT = randomised controlled trial. TFT = thyroid function tests.
Figure 2.
Figure 2.
Frequency graphs of change in TSH during the period of follow-up (approximately 5 years). TSH = thyroid-stimulating hormone.
Figure 3.
Figure 3.
Frequency graphs of change in free T4 (FT4) during the period of follow-up (approximately 5 years). FT4 = free thyroxine. T4 = thyroxine

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