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This article was released under the authorization of Professor Liu Youshuo, from the "Department of Geriatrics, Xiangya Second Hospital, Central South University"
.
Life is easy to grow old and hard to grow old.
Chongyang is every year, and now it is Chongyang
.
Wish the elderly in the world: time goes slowly, health first! ——Professor Liu Youshuo from the Department of Geriatrics of the Second Xiangya Hospital of Central South University, a national health science expert, brings you a special edition of Double Ninth Festival
.
Professor Liu Youshuo, Doctor of Medicine; Second-level Professor, First-Class Chief Physician, Doctor and Postdoctoral Supervisor of Department of Geriatrics, Xiangya Second Hospital; Director of Institute of Aging and Geriatric Diseases/Director of Geriatrics Teaching and Research Office of Central South University; Leading Talents of Geriatrics in Hunan Province, Focus Optimization of the diagnosis and treatment plan for the elderly and frail elderly; review experts for the National Postdoctoral Science Foundation, the National Natural Science Foundation and the National Science and Technology Award; the Standing Committee of the Chinese Medical Association Geriatrics Branch, and the leader of the Geriatric Endocrinology Group; The Standing Committee of the Chinese Medical Doctor Association Geriatrics Branch ; Former and appointed chairman of the Geriatrics Branch of Hunan Medical Association; editorial board of journals such as Chinese Journal of Geriatrics and Aging Medicine; presided over 4 National Natural Science Foundation projects, undertook national and Hunan key research and development plans; published many articles on elderly Medical TOP1, Top Journal of Endocrinology and Diabetes, SCI papers; honors such as People’s Good Doctor, Outstanding Graduate Tutor, National Outstanding Scientific and Technological Worker, etc.
Human life expectancy has indeed increased significantly in the past 150 years
.
However, the increase in healthy life expectancy is not ideal, which means that the "unhealthy survival period" is too long and the "longevity and unhealthy" living conditions need to be improved
.
At present, the elderly in China live unhealthy (including disability period) for up to 6.
7 years.
Therefore, people are paying more and more attention to "healthy aging"
.
Investigations have shown that thyroid diseases (including abnormalities in various indicators) are very common in the elderly.
In recent years, the role of thyroid hormones in health and longevity and the impact on debilitating disability have attracted much attention
.
These developments raise many important questions: at the end of the life cycle, how to identify abnormal thyroid function in the elderly? Is it sick or old, or is it a sign of longevity? How to perform hierarchical fine management, and what are the benefits? Could it make life healthier and live longer? This document is for people who are concerned about the health and longevity of the elderly
.
The diagnosis of clinical hypothyroidism in the elderly is mainly based on laboratory tests.
The clinical manifestations of elderly patients with clinical hypothyroidism are often atypical, and because the language expression ability and memory loss of elderly patients with hypothyroidism themselves, the clinical diagnosis is difficult.
Therefore, the clinical diagnosis of elderly hypothyroidism is difficult.
The diagnosis is mainly based on laboratory tests
.
Serum TSH and FT4 are the main indicators for the diagnosis of clinical hypothyroidism in the elderly.
Clinical hypothyroidism is diagnosed based on the increase of serum TSH level and the decrease of FT4
.
When serum TT4 and FT4 are decreased, and TSH is decreased or normal, or even slightly increased, central hypothyroidism needs to be considered.
At this time, pituitary and hypothalamic lesions can be further examined by MRI, and other pituitary hormones can be used to determine the location of the lesion
.
The elderly often take a variety of drugs.
For suspected elderly patients with hypothyroidism, attention should be paid to the possibility of drug-induced hypothyroidism
.
Elderly hypothyroidism needs to be differentiated from old age frailty, cognitive impairment, depression, decreased appetite, constipation and other digestive diseases
.
Elderly clinical hypothyroidism promotes the development of debilitating and disability.
Elderly clinical hypothyroidism is related to debilitating
.
Clinical hypothyroidism in the elderly often has an insidious onset, slow progress, manifested as chills, fatigue, less sweating, swelling of hands and feet, lethargy or insomnia, depression, memory loss, walking imbalance, weight gain, constipation, or joint muscle pain
.
Elderly clinical hypothyroidism is mainly manifested by increased serum TSH levels and decreased FT4
.
What is the goal of levothyroxine (LT4) in the treatment of clinical hypothyroidism? LT4 has three goals in the treatment of clinical hypothyroidism: (1) improve the symptoms of hypothyroidism; (2) achieve the stratification of serum TSH and thyroid hormone circulating levels; (3) avoid overtreatment, that is, iatrogenic thyrotoxicosis
.
TSH control goals should be individualized based on the results of comprehensive elderly assessments such as age, heart disease and risk factors, osteoporosis and fracture risk
.
➤For elderly patients aged 60 to 70 without heart disease or risk factors for heart disease, the target of serum TSH control is the same as that of adults, and the TSH is controlled to 1/2 of the normal range; ➤Elderly patients over 70 years of age, the target of serum TSH control It should be 4~6mU/L; ➤For elderly patients with high risk of arrhythmia or osteoporotic fractures, the target of serum TSH control should be 6~7mU/L
.
How to choose the treatment drugs and dosage of LT4 for clinical hypothyroidism in the elderly? LT4 is the main alternative treatment for hypothyroidism.
It is not recommended to use LT3 or dry thyroid tablets alone as an alternative treatment for hypothyroidism
.
Dry thyroid tablets are dry animal thyroid preparations.
Because of their unstable thyroid hormone content and a large amount of T3, they are generally not recommended for elderly patients
.
➤The initial dose of LT4 for the treatment of elderly clinical hypothyroidism is about 0.
5~1.
0μg·kg-1·d-1, and the dose is adjusted to 12.
5~25μg each time; ➤The initial dose of elderly patients with ischemic heart disease should be smaller.
Adjust the dose more slowly to prevent angina pectoris or aggravation of myocardial ischemia.
The initial dose is reduced to 12.
5~25μg/d, and the final maintenance dose is generally lower than that of adults.
➤LT4 has a half-life of 7d, just take the medicine once every morning, preferably before breakfast 1h, the interval between taking other drugs and certain foods should be more than 2~4h; ➤Because some drugs and foods affect the absorption and metabolism of T4, the dose of LT4 needs to be adjusted according to the monitoring results.
It is often necessary to take the drug for life, but there are also Hashimoto’s Reports of spontaneous remission of hypothyroidism caused by thyroiditis
.
Diagnosis of subclinical hypothyroidism in the elderly requires repeated measurement of TSH.
The serum TSH level of the elderly is increased, while TT4 and FT4 are normal; repeated measurements within 2 to 3 months still have similar results, and subclinical hypothyroidism in the elderly can be diagnosed to avoid overdiagnosis
.
Mild subclinical hypothyroidism is when TSH is within the upper limit of the normal range to 10mU/L, and severe subclinical hypothyroidism is TSH≥10mU/L
.
When diagnosing subclinical hypothyroidism in the elderly, it is necessary to exclude other reasons for the increase in serum TSH in the elderly, including: ➤anti-TSH autoantibodies lead to a false increase in TSH measurement; ➤recovery period of euthyroid sick syndrome; ➤20% central Patients with hypothyroidism show mild increase in TSH; ➤ Renal insufficiency: 10.
5% of patients with end-stage renal disease have an increase in TSH; ➤ Glucocorticoid deficiency can lead to a mild increase in TSH; ➤Physiological adaptation: exposure to cold for 9 months, serum TSH increased 30% ~ 50%; ➤ subacute thyroiditis functional recovery stage; ➤ drugs: amiodarone and lithium
.
What are the hazards of subclinical hypothyroidism in the elderly to weakness? Whether subclinical hypothyroidism in the elderly causes weakness is controversial
.
Studies have found that elderly patients with subclinical hypothyroidism have an increased risk of cardiovascular events, fractures and death when TSH ≥ 10mU/L
.
The results of a meta-analysis showed that when TSH ≥ 10mU/L, the risk of heart failure events is increased
.
Another prospective study of elderly men found that there was no correlation between elderly subclinical hypothyroidism and weakness.
In the 5-year follow-up study, there was no increase in the incidence of weakness in elderly patients with subclinical hypothyroidism
.
The impact of subclinical hypothyroidism on the cognitive function and quality of life of the elderly, especially the elderly, is controversial, and further research is needed
.
A study of 70-79-year-old elderly patients with subclinical hypothyroidism, 9 years of follow-up did not find that subclinical hypothyroidism was associated with dementia risk and cognitive decline
.
The results of a Meta analysis showed that the correlation between subclinical hypothyroidism and cognitive impairment in the elderly only exists in people younger than 75 years old, and the risk of cognitive impairment is positively correlated with the degree of TSH elevation
.
A cross-sectional study of patients with subclinical hypothyroidism ≥65 years of age found that patients with subclinical hypothyroidism are comparable to those with normal thyroid function in terms of symptoms (fatigue, constipation, weight gain, lack of energy), cognition, neuropsychological function, mood and quality of life No difference
.
Can levothyroxine (LT4) treatment improve the frailty of the elderly with subclinical hypothyroidism? There is no evidence that LT4 treatment can improve the frailty of the elderly with subclinical hypothyroidism
.
A meta-analysis of a randomized controlled trial of non-pregnant adults with subclinical hypothyroidism showed that thyroid hormone therapy is associated with general quality of life, thyroid-related symptoms, depressive symptoms, fatigue/tiredness, cognitive function, muscle strength, blood pressure or weight The benefits of the index are irrelevant
.
For elderly patients with subclinical hypothyroidism, after LT4 treatment, there are almost no differences in general quality of life (QOL), thyroid-related symptoms, depressive symptoms, fatigue, cognitive function, muscle strength, and body mass index (BMI)
.
There is controversy as to whether LT4 therapy can reduce the risk of cardiovascular disease in elderly subclinical patients and improve the cognitive function of elderly subclinical hypothyroidism patients
.
A study on elderly patients with subclinical hypothyroidism showed that there was no significant difference in carotid intima-media thickness and carotid atherosclerosis between the LT4 treatment group and the control group
.
The results of another randomized controlled study showed that supplementation of LT4 to SCH patients between 40 and 70 years old can reduce the risk of cardiovascular events, but it has no effect in patients> 70 years old
.
In addition, 94 patients with subclinical hypothyroidism aged ≥65 years (57 women, 37 men) were followed up for 1 year, and LT4 treatment was not found to improve cognitive function
.
A Meta-analysis of 5 observational studies and 2 randomized controlled trials of 21,055 adults showed that the use of thyroid hormone therapy has no protective effect on the mortality of the elderly with subclinical hypothyroidism
.
What is the goal of levothyroxine (LT4) in the treatment of subclinical hypothyroidism? The goal of LT4 in the treatment of subclinical hypothyroidism in the elderly is to improve the clinical symptoms and signs of patients, while stratifying the patients' serum TSH and thyroid hormone circulating levels to reach the standard
.
Elderly patients with subclinical hypothyroidism should undergo individualized LT4 replacement therapy: ➤Patients with subclinical hypothyroidism over 80 years of age: lack of evidence of benefit from LT4 treatment, conventional LT4 replacement therapy is not recommended, follow-up observation is recommended, every 6 months Monitor thyroid function once
.
➤70-80-year-old elderly patients with subclinical hypothyroidism: ①TSH≥10mU/L: If there are symptoms of hypothyroidism and cardiovascular disease risk factors, consider LT4 treatment; ②TSH<10mU/L: It is recommended to follow-up observation and monitor every 6 months 1 Secondary thyroid function
.
➤Elderly patients with subclinical hypothyroidism between 60 and 70 years old: ①TSH<10mU/L: If there are symptoms of hypothyroidism, TPOAb positive, and cardiovascular disease risk factors, consider LT4 treatment; among them, those who start treatment due to hypothyroidism will be treated after TSH reaches the standard 3 ~4 months later, if the symptoms are not relieved or adverse reactions occur, treatment should be stopped gradually; if there is no such situation, treatment is not recommended, and thyroid function is monitored every 6 months; ②TSH≥10mU/L: LT4 treatment is recommended
.
How to determine the starting dose of LT4 therapy for subclinical hypothyroidism in the elderly? How to adjust the dose? Subclinical hypothyroidism in the elderly should be based on individualized LT4 replacement therapy based on the degree of TSH elevation, the patient's age and life expectancy, potential related risk factors and comorbidities
.
The dosage and adjustment plan of LT4 treatment are the same as that of elderly clinical hypothyroidism
.
The initial dose of LT4 for the treatment of subclinical hypothyroidism in the elderly is about 0.
5~1.
0μg·kg-1·d-1.
The related indexes of thyroid function are measured every 4~6 weeks, and the dose of LT4 is adjusted according to the results, and the dose is adjusted to 12.
5~25μg each time.
, Until the treatment goal is reached
.
What is the interaction between LT4 and other drugs in combination? There are a wide variety of drugs that can alter the absorption of LT4, including calcium carbonate, proton pump inhibitors, bile acid chelators (cholestyramine and colesevelam), phosphate binders, ferrous sulfate, aluminum-containing antacids, and sucralfate
.
LT4 combined with caffeine, calcium carbonate, ferrous sulfate, aluminum hydroxide/magnesium hydroxide, etc.
will reduce the absorption of LT4 and affect the efficacy
.
Co-administration of rifampicin increases the bioavailability of LT4 by 25%, and the co-administration needs to be cautious
.
How to monitor elderly patients who are treated with LT4 intervention for hypothyroidism? The monitoring of LT4 treatment is the same as that of elderly clinical hypothyroidism
.
In the initial stage of LT4 treatment, thyroid function related indicators were measured every 4-6 weeks, and the LT4 dose was adjusted according to the results, each time the dose was adjusted to 12.
5-25μg, until the treatment goal was reached
.
Thyroid function should be reviewed every 6 to 12 months after the treatment reaches the standard
.
.
Life is easy to grow old and hard to grow old.
Chongyang is every year, and now it is Chongyang
.
Wish the elderly in the world: time goes slowly, health first! ——Professor Liu Youshuo from the Department of Geriatrics of the Second Xiangya Hospital of Central South University, a national health science expert, brings you a special edition of Double Ninth Festival
.
Professor Liu Youshuo, Doctor of Medicine; Second-level Professor, First-Class Chief Physician, Doctor and Postdoctoral Supervisor of Department of Geriatrics, Xiangya Second Hospital; Director of Institute of Aging and Geriatric Diseases/Director of Geriatrics Teaching and Research Office of Central South University; Leading Talents of Geriatrics in Hunan Province, Focus Optimization of the diagnosis and treatment plan for the elderly and frail elderly; review experts for the National Postdoctoral Science Foundation, the National Natural Science Foundation and the National Science and Technology Award; the Standing Committee of the Chinese Medical Association Geriatrics Branch, and the leader of the Geriatric Endocrinology Group; The Standing Committee of the Chinese Medical Doctor Association Geriatrics Branch ; Former and appointed chairman of the Geriatrics Branch of Hunan Medical Association; editorial board of journals such as Chinese Journal of Geriatrics and Aging Medicine; presided over 4 National Natural Science Foundation projects, undertook national and Hunan key research and development plans; published many articles on elderly Medical TOP1, Top Journal of Endocrinology and Diabetes, SCI papers; honors such as People’s Good Doctor, Outstanding Graduate Tutor, National Outstanding Scientific and Technological Worker, etc.
Human life expectancy has indeed increased significantly in the past 150 years
.
However, the increase in healthy life expectancy is not ideal, which means that the "unhealthy survival period" is too long and the "longevity and unhealthy" living conditions need to be improved
.
At present, the elderly in China live unhealthy (including disability period) for up to 6.
7 years.
Therefore, people are paying more and more attention to "healthy aging"
.
Investigations have shown that thyroid diseases (including abnormalities in various indicators) are very common in the elderly.
In recent years, the role of thyroid hormones in health and longevity and the impact on debilitating disability have attracted much attention
.
These developments raise many important questions: at the end of the life cycle, how to identify abnormal thyroid function in the elderly? Is it sick or old, or is it a sign of longevity? How to perform hierarchical fine management, and what are the benefits? Could it make life healthier and live longer? This document is for people who are concerned about the health and longevity of the elderly
.
The diagnosis of clinical hypothyroidism in the elderly is mainly based on laboratory tests.
The clinical manifestations of elderly patients with clinical hypothyroidism are often atypical, and because the language expression ability and memory loss of elderly patients with hypothyroidism themselves, the clinical diagnosis is difficult.
Therefore, the clinical diagnosis of elderly hypothyroidism is difficult.
The diagnosis is mainly based on laboratory tests
.
Serum TSH and FT4 are the main indicators for the diagnosis of clinical hypothyroidism in the elderly.
Clinical hypothyroidism is diagnosed based on the increase of serum TSH level and the decrease of FT4
.
When serum TT4 and FT4 are decreased, and TSH is decreased or normal, or even slightly increased, central hypothyroidism needs to be considered.
At this time, pituitary and hypothalamic lesions can be further examined by MRI, and other pituitary hormones can be used to determine the location of the lesion
.
The elderly often take a variety of drugs.
For suspected elderly patients with hypothyroidism, attention should be paid to the possibility of drug-induced hypothyroidism
.
Elderly hypothyroidism needs to be differentiated from old age frailty, cognitive impairment, depression, decreased appetite, constipation and other digestive diseases
.
Elderly clinical hypothyroidism promotes the development of debilitating and disability.
Elderly clinical hypothyroidism is related to debilitating
.
Clinical hypothyroidism in the elderly often has an insidious onset, slow progress, manifested as chills, fatigue, less sweating, swelling of hands and feet, lethargy or insomnia, depression, memory loss, walking imbalance, weight gain, constipation, or joint muscle pain
.
Elderly clinical hypothyroidism is mainly manifested by increased serum TSH levels and decreased FT4
.
What is the goal of levothyroxine (LT4) in the treatment of clinical hypothyroidism? LT4 has three goals in the treatment of clinical hypothyroidism: (1) improve the symptoms of hypothyroidism; (2) achieve the stratification of serum TSH and thyroid hormone circulating levels; (3) avoid overtreatment, that is, iatrogenic thyrotoxicosis
.
TSH control goals should be individualized based on the results of comprehensive elderly assessments such as age, heart disease and risk factors, osteoporosis and fracture risk
.
➤For elderly patients aged 60 to 70 without heart disease or risk factors for heart disease, the target of serum TSH control is the same as that of adults, and the TSH is controlled to 1/2 of the normal range; ➤Elderly patients over 70 years of age, the target of serum TSH control It should be 4~6mU/L; ➤For elderly patients with high risk of arrhythmia or osteoporotic fractures, the target of serum TSH control should be 6~7mU/L
.
How to choose the treatment drugs and dosage of LT4 for clinical hypothyroidism in the elderly? LT4 is the main alternative treatment for hypothyroidism.
It is not recommended to use LT3 or dry thyroid tablets alone as an alternative treatment for hypothyroidism
.
Dry thyroid tablets are dry animal thyroid preparations.
Because of their unstable thyroid hormone content and a large amount of T3, they are generally not recommended for elderly patients
.
➤The initial dose of LT4 for the treatment of elderly clinical hypothyroidism is about 0.
5~1.
0μg·kg-1·d-1, and the dose is adjusted to 12.
5~25μg each time; ➤The initial dose of elderly patients with ischemic heart disease should be smaller.
Adjust the dose more slowly to prevent angina pectoris or aggravation of myocardial ischemia.
The initial dose is reduced to 12.
5~25μg/d, and the final maintenance dose is generally lower than that of adults.
➤LT4 has a half-life of 7d, just take the medicine once every morning, preferably before breakfast 1h, the interval between taking other drugs and certain foods should be more than 2~4h; ➤Because some drugs and foods affect the absorption and metabolism of T4, the dose of LT4 needs to be adjusted according to the monitoring results.
It is often necessary to take the drug for life, but there are also Hashimoto’s Reports of spontaneous remission of hypothyroidism caused by thyroiditis
.
Diagnosis of subclinical hypothyroidism in the elderly requires repeated measurement of TSH.
The serum TSH level of the elderly is increased, while TT4 and FT4 are normal; repeated measurements within 2 to 3 months still have similar results, and subclinical hypothyroidism in the elderly can be diagnosed to avoid overdiagnosis
.
Mild subclinical hypothyroidism is when TSH is within the upper limit of the normal range to 10mU/L, and severe subclinical hypothyroidism is TSH≥10mU/L
.
When diagnosing subclinical hypothyroidism in the elderly, it is necessary to exclude other reasons for the increase in serum TSH in the elderly, including: ➤anti-TSH autoantibodies lead to a false increase in TSH measurement; ➤recovery period of euthyroid sick syndrome; ➤20% central Patients with hypothyroidism show mild increase in TSH; ➤ Renal insufficiency: 10.
5% of patients with end-stage renal disease have an increase in TSH; ➤ Glucocorticoid deficiency can lead to a mild increase in TSH; ➤Physiological adaptation: exposure to cold for 9 months, serum TSH increased 30% ~ 50%; ➤ subacute thyroiditis functional recovery stage; ➤ drugs: amiodarone and lithium
.
What are the hazards of subclinical hypothyroidism in the elderly to weakness? Whether subclinical hypothyroidism in the elderly causes weakness is controversial
.
Studies have found that elderly patients with subclinical hypothyroidism have an increased risk of cardiovascular events, fractures and death when TSH ≥ 10mU/L
.
The results of a meta-analysis showed that when TSH ≥ 10mU/L, the risk of heart failure events is increased
.
Another prospective study of elderly men found that there was no correlation between elderly subclinical hypothyroidism and weakness.
In the 5-year follow-up study, there was no increase in the incidence of weakness in elderly patients with subclinical hypothyroidism
.
The impact of subclinical hypothyroidism on the cognitive function and quality of life of the elderly, especially the elderly, is controversial, and further research is needed
.
A study of 70-79-year-old elderly patients with subclinical hypothyroidism, 9 years of follow-up did not find that subclinical hypothyroidism was associated with dementia risk and cognitive decline
.
The results of a Meta analysis showed that the correlation between subclinical hypothyroidism and cognitive impairment in the elderly only exists in people younger than 75 years old, and the risk of cognitive impairment is positively correlated with the degree of TSH elevation
.
A cross-sectional study of patients with subclinical hypothyroidism ≥65 years of age found that patients with subclinical hypothyroidism are comparable to those with normal thyroid function in terms of symptoms (fatigue, constipation, weight gain, lack of energy), cognition, neuropsychological function, mood and quality of life No difference
.
Can levothyroxine (LT4) treatment improve the frailty of the elderly with subclinical hypothyroidism? There is no evidence that LT4 treatment can improve the frailty of the elderly with subclinical hypothyroidism
.
A meta-analysis of a randomized controlled trial of non-pregnant adults with subclinical hypothyroidism showed that thyroid hormone therapy is associated with general quality of life, thyroid-related symptoms, depressive symptoms, fatigue/tiredness, cognitive function, muscle strength, blood pressure or weight The benefits of the index are irrelevant
.
For elderly patients with subclinical hypothyroidism, after LT4 treatment, there are almost no differences in general quality of life (QOL), thyroid-related symptoms, depressive symptoms, fatigue, cognitive function, muscle strength, and body mass index (BMI)
.
There is controversy as to whether LT4 therapy can reduce the risk of cardiovascular disease in elderly subclinical patients and improve the cognitive function of elderly subclinical hypothyroidism patients
.
A study on elderly patients with subclinical hypothyroidism showed that there was no significant difference in carotid intima-media thickness and carotid atherosclerosis between the LT4 treatment group and the control group
.
The results of another randomized controlled study showed that supplementation of LT4 to SCH patients between 40 and 70 years old can reduce the risk of cardiovascular events, but it has no effect in patients> 70 years old
.
In addition, 94 patients with subclinical hypothyroidism aged ≥65 years (57 women, 37 men) were followed up for 1 year, and LT4 treatment was not found to improve cognitive function
.
A Meta-analysis of 5 observational studies and 2 randomized controlled trials of 21,055 adults showed that the use of thyroid hormone therapy has no protective effect on the mortality of the elderly with subclinical hypothyroidism
.
What is the goal of levothyroxine (LT4) in the treatment of subclinical hypothyroidism? The goal of LT4 in the treatment of subclinical hypothyroidism in the elderly is to improve the clinical symptoms and signs of patients, while stratifying the patients' serum TSH and thyroid hormone circulating levels to reach the standard
.
Elderly patients with subclinical hypothyroidism should undergo individualized LT4 replacement therapy: ➤Patients with subclinical hypothyroidism over 80 years of age: lack of evidence of benefit from LT4 treatment, conventional LT4 replacement therapy is not recommended, follow-up observation is recommended, every 6 months Monitor thyroid function once
.
➤70-80-year-old elderly patients with subclinical hypothyroidism: ①TSH≥10mU/L: If there are symptoms of hypothyroidism and cardiovascular disease risk factors, consider LT4 treatment; ②TSH<10mU/L: It is recommended to follow-up observation and monitor every 6 months 1 Secondary thyroid function
.
➤Elderly patients with subclinical hypothyroidism between 60 and 70 years old: ①TSH<10mU/L: If there are symptoms of hypothyroidism, TPOAb positive, and cardiovascular disease risk factors, consider LT4 treatment; among them, those who start treatment due to hypothyroidism will be treated after TSH reaches the standard 3 ~4 months later, if the symptoms are not relieved or adverse reactions occur, treatment should be stopped gradually; if there is no such situation, treatment is not recommended, and thyroid function is monitored every 6 months; ②TSH≥10mU/L: LT4 treatment is recommended
.
How to determine the starting dose of LT4 therapy for subclinical hypothyroidism in the elderly? How to adjust the dose? Subclinical hypothyroidism in the elderly should be based on individualized LT4 replacement therapy based on the degree of TSH elevation, the patient's age and life expectancy, potential related risk factors and comorbidities
.
The dosage and adjustment plan of LT4 treatment are the same as that of elderly clinical hypothyroidism
.
The initial dose of LT4 for the treatment of subclinical hypothyroidism in the elderly is about 0.
5~1.
0μg·kg-1·d-1.
The related indexes of thyroid function are measured every 4~6 weeks, and the dose of LT4 is adjusted according to the results, and the dose is adjusted to 12.
5~25μg each time.
, Until the treatment goal is reached
.
What is the interaction between LT4 and other drugs in combination? There are a wide variety of drugs that can alter the absorption of LT4, including calcium carbonate, proton pump inhibitors, bile acid chelators (cholestyramine and colesevelam), phosphate binders, ferrous sulfate, aluminum-containing antacids, and sucralfate
.
LT4 combined with caffeine, calcium carbonate, ferrous sulfate, aluminum hydroxide/magnesium hydroxide, etc.
will reduce the absorption of LT4 and affect the efficacy
.
Co-administration of rifampicin increases the bioavailability of LT4 by 25%, and the co-administration needs to be cautious
.
How to monitor elderly patients who are treated with LT4 intervention for hypothyroidism? The monitoring of LT4 treatment is the same as that of elderly clinical hypothyroidism
.
In the initial stage of LT4 treatment, thyroid function related indicators were measured every 4-6 weeks, and the LT4 dose was adjusted according to the results, each time the dose was adjusted to 12.
5-25μg, until the treatment goal was reached
.
Thyroid function should be reviewed every 6 to 12 months after the treatment reaches the standard
.
