 
         
         
         Abstract
         
         Thyroid dysfunction affects a considerable portion of the elder population. The aim
            of the present study has been to assess the prevalence of thyroid dysfunction in adult
            healthy subjects over age 60 years from our population. We performed a descriptive,
            cross-sectional study in the setting of a sanitary area in an urban community in Madrid
            (Spain). Serum concentrations of thyrotropin (TSH) and free thyroxine (FT4) were determined
            by an electrochemiluminescency assay in all participants after antecubital venous
            sampling. A second examination, including the measurement of triiodothyronine and
            thyroid autoantibodies, was performed in subjects with abnormal results. A total of
            127 women and 167 men, aged 60 to 84 years, were studied. We identified 6 subjects
            (all women) with hypothyroidism (2.04 %) and 19 (6 women, 13 men) with hyperthyroidism
            (6.46 %, 95 %CI 3.65 - 9.27 %). There were 3 cases (1.02 %) of subclinical and 3 cases
            (1.02 %) of overt hypothyroidism. In the hyperthyroid group only one patient (0.34
            %) showed overt hyperthyroidism. TSH test did not detect erroneously any case of hypothyroidism
            or hyperthyroidism, although one patient with hyperthyroidism was not diagnosed by
            this test. FT4 test detected erroneously two cases of hypothyroidism; however, it
            was the only way to detect the patient with overt hyperthyroidism. In conclusion,
            in our population over age 60 years the prevalence of hypothyroidism was 2.04 % and
            that of hyperthyroidism 6.46 % (95 %CI 3.65 - 9.27 %). The total prevalence of thyroid
            dysfunction was, therefore, 8.50 % (95 %CI 5.31 - 11.69). Our data suggest that TSH
            test is probably enough to screen for thyroid dysfunction in adults over age 60 years.
         
         
         
            
Key words
         
         
            Hypothyroidism - hyperthyroidism - prevalence - aging
          
      
    
   
      
         References
         
         
            - 1 
               Aghini-Lombardi F, Antonangeli L, Martino E, Vitti P, Maccherini D, Leoli F, Rago T,
               Grasso L, Valeriano R, Balestrieri A, Pinchera A. 
               The spectrum of thyroid disorders in an iodine-deficient community: the Pescopagano
               survey. 
               J Clin Endocrinol Metab. 
               1999; 
               84 
               561-566 
               
- 2 
               Bagchi N, Brown T, Parish R F. 
               Thyroid function in older persons. 
               Ann Intern Med. 
               1984; 
               101 
               718-719 
               
- 3 
               Bagchi N, Brown T R, Parish R F. 
               Thyroid dysfunction in adults over age 55 years. A study in an urban US community. 
               Arch Intern Med. 
               1990; 
               150 
               785-787 
               
- 4 
               Bakker S JL, ter Maaten J C, Popp-Snijders C, Slaets J PJ, Heine R J, Gans R OB. 
               The relationship between thyrotropin and low density lipoprotein cholesterol is modified
               by insulin sensitivity in healthy euthyroid subjects. 
               J Clin Endocrinol Metab. 
               2001; 
               86 
               1206-1211 
               
- 5 
               Bemben D A, Winn P, Hamm R M, Morgan L, Davis A, Barton E. 
               Thyroid disease in the elderly. Part 1. Prevalence of undiagnosed hypothyroidism. 
               J Fam Pract. 
               1994; 
               38 
               577-582 
               
- 6 
               Bjøro T, Holmen J, Krüger Ø, Midthjell K, Hunstad K, Schreiner T, Sandnes L, Brochmann H.
               
               Prevalence of thyroid disease, thyroid dysfunction and thyroid peroxidase antibodies
               in a large, unselected population. The Health Study of Nord-Trøndelag (HUNT). 
               Eur J Endocrinol. 
               2000; 
               143 
               639-647 
               
- 7 
               Brochmann H, Bjøro T, Gaarder P I, Hanson F, Frey H M. 
               Prevalence of thyroid dysfunction in elderly subjects: a randomized study in a Norwegian
               rural community (Naerøy). 
               Acta Endocrinol (Copenh). 
               1988; 
               117 
               7-12 
               
- 8 
               Campbell A J, Reinken J, Allan B C. 
               Thyroid disease in the elderly in the community. 
               Age Ageing. 
               1981; 
               10 
               47-52 
               
- 9 
               Chuang C C, Wang S T, Wang P W, Yu M L. 
               Prevalence study of thyroid dysfunction in the elderly of Taiwan. 
               Gerontology. 
               1998; 
               44 
               162-167 
               
- 10 
               Cooper D S. 
               Subclinical hypothyroidism. 
               N Engl J Med. 
               2001; 
               345 
               260-265 
               
- 11 
               Eggertsen R, Petersen K, Lundberg P A, Nyström E, Lindstedt G. 
               Thyroid disease in a primary care unit: established cases and undiagnosed cases as
               identified in a screening of 2000 adult patients with a thyroid stimulating hormone
               assay with low detection limit. 
               Br Med J. 
               1988; 
               297 
               1586-1593 
               
- 12 
               Falkenberg M, Kagedal B, Norr A. 
               Screening of an elderly female population for hypo- and hyperthyroidism by use of
               a thyroidal hormone panel. 
               Acta Med Scand. 
               1983; 
               214 
               261-265 
               
- 13 
               Flatau E, Trougouboff P, Kaufman N, Reichman N, Luboshitzky R. 
               Prevalence of hypothyroidism and diabetes mellitus in elderly kibbutz members. 
               Eur J Epidemiol. 
               2000; 
               16 
               43-46 
               
- 14 
               Hak A E, Pols H AP, Visser T J, Drexhage H A, Hofman A, Witteman J CM. 
               Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial
               infarction in elderly women: the Rotterdam Study. 
               Ann Intern Med. 
               2000; 
               132 
               270-278 
               
- 15 
               Heikoff K, Luxenberg J, Feigenbaum L. 
               Low yield of screening for hypothyroidism in healthy elderly. 
               J Am Geriatr Soc. 
               1984; 
               32 
               616-617 
               
- 16 
               Helfand M, Redfern C C. 
               Screening for thyroid disease: an update. 
               Ann Intern Med. 
               1998; 
               129 
               144-158 
               
- 17 
               Hershman J M, Pekary A E, Berg L, Solomon D H, Sawin C T. 
               Serum thyrotropin and thyroid hormone levels in elderly and middle-aged euthyroid
               persons. 
               J Am Geriatr Soc. 
               1993; 
               41 
               832-838 
               
- 18 
               Huber G, Staub J J, Meier C, Mitrache C, Guglielmetti M, Huber P, Braverman L E. 
               Prospective study of the spontaneous course of subclinical hypothyroidism: prognostic
               value of thyrotropin, thyroid reserve, and thyroid antibodies. 
               J Clin Endocrinol Metab. 
               2002; 
               87 
               3221-3226 
               
- 19 
               Kung A W, Janus E D. 
               Thyroid dysfunction in ambulatory elderly Chinese subjects in an area of borderline
               iodine intake. 
               Thyroid. 
               1996; 
               6 
               111-114 
               
- 20 
               Levy E G. 
               Thyroid disease in the elderly. 
               Med Clin North Am. 
               1991; 
               75 
               151-167 
               
- 21 
               Luboshitzky R, Oberman A S, Kaufman N, Reichman N, Flatau E. 
               Prevalence of cognitive dysfunction and hypothyroidism in an elderly community population. 
               Isr J Med Sci. 
               1996; 
               32 
               60-65 
               
- 22 
               Manciet G, Dartigues J F, Decamps A, Barberger-Gateau P, Letenneur L, Latapie M J,
               Latapie J L. 
               The PAQUID survey and correlates of subclinical hypothyroidism in elderly community
               residents in the South-West of France. 
               Age Ageing. 
               1995; 
               24 
               235-241 
               
- 23 
               Meyers B, Gionet M, Abreau C, Robuschi G, Pino S, Braverman L, Roti E. 
               Iodine intake probably affects the incidence of hypothyroidism and Hashimoto thyroiditis
               in elderly women. 
               J Nucl Med. 
               1986; 
               27 
               909 
               
- 24 Morreale de Escobar G, Escobar del Rey F. 
               Consequences of iodine deficiency for brain development. De Vilder J, Morreale de Escobar G, Butz S, Hostalek V Thyroid and Brain. Stuttgart;
               Schattauer Verlag 2003: 33-56 
- 25 
               Nissinen A, Kivelä S L, Pekkanen J, Pitkänen L, Punsar S, Kaarsalo E, Puska P. 
               Thyroid function tests in elderly Finnish Men. 
               Acta Med Scand. 
               1986; 
               220 
               63-69 
               
- 26 
               Nyström E, Bengtsson C, Lindstedt G, Lundberg P A. 
               Screening for thyroid disease. 
               Lancet. 
               1981; 
               1 
               927-928 
               
- 27 
               Okamura K, Ueda K, Sone H, Ikenoue H, Hasuo Y, Sato K, Yoshinari M, Fujishima M. 
               A sensitive thyroid stimulating hormone assay for screening of thyroid functional
               disorder in elderly Japanese. 
               J Am Geriatr Soc. 
               1989; 
               33 
               317-322 
               
- 28 
               Özbakir O, Dogukan A, Kelestimur F. 
               The prevalence of thyroid dysfunction among elderly subjects in an endemic goiter
               area of Central Anatolia. 
               Endocr J. 
               1995; 
               42 
               713-716 
               
- 29 
               Parle J V, Franklyn J A, Cross K W, Jones S C, Sheppard M C. 
               Prevalence and follow-up of abnormal thyrotrophin (TSH) concentrations in the elderly
               in the United Kingdom. 
               Clin Endocrinol (Oxf). 
               1991; 
               34 
               77-83 
               
- 30 
               Parle J V, Maisonneuve P, Sheppard M C, Boyle P, Franklyn J A. 
               Prediction of all-cause and cardiovascular mortality in elderly people from one low
               serum thyrotropin result: a 10-year cohort study. 
               Lancet. 
               2001; 
               358 
               861-865 
               
- 31 
               Petersen K, Lindstedt G, Lundberg P A, Bengtsson C, Lapidus L, Nyström E. 
               Thyroid disease in middle-aged and elderly Swedish women: thyroid-related hormones,
               thyroid dysfunction and goitre in relation to age and smoking. 
               J Intern Med. 
               1991; 
               229 
               407-414 
               
- 32 
               Sawin C T, Castelli W P, Hershman J M, McNamara P, Bacharach P. 
               The aging thyroid: thyroid deficiency in the Framingham study. 
               Arch Intern Med. 
               1985; 
               145 
               1386-1388 
               
- 33 
               Sawin C T, Chopra D, Azizi F, Mannix J E, Bacharach P. 
               The aging thyroid: increased prevalence of elevated serum thyrotropin levels in the
               elderly. 
               JAMA. 
               1979; 
               242 
               247-250 
               
- 34 
               Seck T, Scheidt-Nave C, Ziegler R, Pfeilschifter J. 
               Prevalence of thyroid gland dysfunction in 50- to 80-year-old patients. An epidemiological
               cross-sectional study in a southwestern community. 
               Med Klin. 
               1997; 
               92 
               642-646 
               
- 35 
               Shetty K R, Duthie Jr E H. 
               Thyroid disease and associated illness in the elderly. 
               Clin Geriatr Med. 
               1995; 
               11 
               311-325 
               
- 36 
               Simons R J, Simon J M, Demers L M, Santen R J. 
               Thyroid dysfunction in elderly hospitalized patients: effect of age and severity of
               illness. 
               Arch Intern Med. 
               1990; 
               150 
               1249-1253 
               
- 37 
               Sundbeck G, Lundberg P A, Lindstedt G, Jagenburg R, Edén S. 
               Incidence and prevalence of thyroid disease in elderly women: results from the longitudinal
               population study of elderly people in Gothenburg, Sweden. 
               Age Ageing. 
               1991; 
               20 
               291-298 
               
- 38 
               Szabolcs I, Ploenes C, Bernard W, Herrmann J. 
               Screening of geriatric patients of thyroid dysfunction with thyrotropin-releasing
               hormone test, sensitive thyrotropin and free thyroxine stimulation. 
               Horm Metab Res. 
               1990; 
               22 
               298-302 
               
- 39 
               Toft A D. 
               Subclinical hyperthyroidism. 
               N Engl J Med. 
               2001; 
               345 
               512-516 
               
- 40 
               Tunbridge W MG, Brewis M, French J M, Appleton D, Bird T, Clark F, Evered D C, Grimley-Evans J,
               Hall R, Smith P A, Stephenson J, Young E. 
               Natural history of autoimmune thyroiditis. 
               Br Med J. 
               1981; 
               282 
               258-262 
               
- 41 
               Tunbridge W MG, Evered D, Hall R, Appleton D, Brewis M, Clark F, Grimley Evans J,
               Young E, Bird T, Smith P A. 
               The spectrum of thyroid disease in a community: the Wickham survey. 
               Clin Endocrinol (Oxf). 
               1977; 
               7 
               481-493 
               
- 42 
               Winder A F, Jagger C, Garrick D P, Vallance D T, Butowski P F, Anderson J, Clarke M.
               
               Lipid screening in an elderly population: difficulty in interpretation and in detection
               of occult metabolic disease. 
               J Clin Pathol. 
               1996; 
               49 
               278-283 
               
Juan J. Díez
            Travesía Téllez 8, 4R
            
            28007 Madrid
            
            Spain
            
            Phone: + 34915017284
            
            Email: mibarsd@infomed.es