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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
.
Respect and filial piety are the traditional virtues of the Chinese nation.
On the occasion of the Chinese Elderly’s Day, let us sincerely 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 arrest for the 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 program process for the elderly and frail elderly; National Postdoctoral Science Foundation, National Natural Science Foundation and National Science and Technology Award Review Experts; Standing Committee Member of the Chinese Medical Association Geriatrics Branch, and leader of the Geriatric Endocrinology Group; 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; honored by People’s Good Doctor, Outstanding Graduate Tutor, National Outstanding Scientific and Technological Worker, etc.
Abnormal thyroid hormone in the elderly is not necessarily a disease.
The hypothalamic-pituitary-thyroid axis changes with age in healthy elderly.
, Manifested in serum total triiodothyronine (TT3), free T3 (FT3) levels decreased, free thyroxine (FT4) levels increased slightly or remained unchanged, FT3/FT4 ratio decreased, thyroid stimulating hormone ( TSH) levels increase
.
According to the results of NHANES-Ⅲ, after the age of 30-39, for every 10 years of age increase, the 97.
5th percentile of serum TSH increases by 0.
3 mU/L; the upper limit of normal range of TSH for people aged 70-80 is higher than that of 60-70.
The year-old increase was 1.
6mU/L, and the population over 80 years old increased to 3.
2mU/L more than the 60-70 year-old population
.
A survey on iodine and thyroid diseases in 31 provinces and cities in China also found that the 97.
5 percentile of TSH increased with age, and the upper limit of serum TSH increased by 0.
534 mU/L for every 10 year-old increase
.
Therefore, age mainly affects the upper limit of the reference range of TSH, but mildly elevated TSH in the elderly does not necessarily require treatment.
It is recommended to consult a geriatrics or endocrinologist
.
Thyroid dysfunction in the elderly is very common.
Thyroid diseases (including abnormalities in various indicators) are very common in the elderly, and more attention should be paid
.
An epidemiological survey of 78470 cases in 31 provinces and cities in China showed that the overall prevalence of thyroid disease was 50.
96%, and the prevalence of thyroid disease in the elderly was higher than that of the general population.
Subclinical hypothyroidism (subclinical hypothyroidism) The most common in the elderly, the prevalence rate is nearly 20%, most of which are mild subclinical hypothyroidism, and only 10% of patients with thyroid stimulating hormone (TSH) ≥ 10mU/L are classified as severe subclinical hypothyroidism
.
A study from China showed that the total prevalence of hypothyroidism and subclinical hypothyroidism in elderly women over 65 years of age was 15.
07%, and that of men of the same age was 9.
22%
.
With increasing age, the prevalence of hypothyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism increases, while the prevalence of hyperthyroidism decreases
.
Compared with the TSH reference range of the kit, if the age-specific reference range of TSH is used, the prevalence of subclinical hypothyroidism in the elderly ≥65 years old will be reduced from 19.
87% to 3.
30%; the prevalence of clinical hypothyroidism will be reduced from 2.
09% It dropped to 1.
60%, and the prevalence of clinical hyperthyroidism remained unchanged
.
Since there is no convincing evidence to prove the impact of changing the TSH reference range in the elderly on health outcomes, the adult TSH reference range is still used clinically as an indicator of thyroid dysfunction
.
Senile hyperthyroidism is a major cause of weakness and disability.
Clinical hyperthyroidism in the elderly is an important cause of weakness
.
The elderly clinical hyperthyroidism is more common with "indifferent hyperthyroidism", which manifests as obvious weight loss, heart palpitations, diarrhea, anorexia, apathy, lethargy and even confusion in severe cases
.
Hyperthyroidism can easily cause attention loss, mood and cognitive changes in the elderly, and increase the risk of osteoporosis and fractures in the elderly
.
Therefore, when the general health status of the elderly changes recently, attention should be paid to screening thyroid function to rule out hyperthyroidism; delays in diagnosis and treatment can easily cause or aggravate elderly weakness and disability
.
Elderly subclinical hyperthyroidism also damages the health of the elderly.
Elderly subclinical hyperthyroidism is generally asymptomatic or has only mild symptoms, but clinical studies have shown that it significantly increases the risk of senile debility
.
Prospective observations based on the population and Meta analysis showed that the risks of atrial fibrillation, arrhythmia, heart failure, major cardiovascular adverse events, cardiovascular death and all-cause death in patients with severe subclinical hyperthyroidism were significantly increased
.
Subclinical hyperthyroidism in the elderly leads to an increased risk of osteoporosis and dementia, as well as symptoms such as changes in mood, decline in cognitive function, and decreased physical fitness, leading to increased weakness
.
Since subclinical hyperthyroidism in the elderly is detrimental to the overall health of the elderly, and the comprehensive manifestation is debilitating, it is generally recommended to give anti-hyperthyroidism treatment, but at least two thyroid function test results (2 months apart) should support the diagnosis of subclinical hyperthyroidism before starting treatment.
To avoid over-treatment
.
How to recognize and deal with thyroid dysfunction in the elderly early? Serum TSH is the first choice for screening of abnormal thyroid function in the elderly
.
It is recommended that the elderly be screened for hypothyroidism when they are admitted to nursing homes, hospitalizations, and routine health examinations, especially elderly women
.
Active screening is needed for the following situations: history of external cervical radiation or 131I treatment, history of thyroid surgery and abnormal thyroid function, family history of autoimmune thyroid disease, other autoimmune diseases, anemia, dyslipidemia, hypertension, diabetes Other metabolic diseases, mental and cognitive abnormalities, cardiovascular diseases, pulmonary hypertension, digestive system diseases, osteoporosis, sarcopenia, and the use of amiodarone, ketoconazole, lithium, interferon-α, and interleukin -2, a tyrosine kinase inhibitor, immunosuppressive drugs are inhibitors of the checkpoint
.
After being diagnosed by a specialist in geriatrics and endocrinologists, refined diagnosis and treatment should be carried out in accordance with the eight-character policy of "hierarchical management and safety compliance"
.
.
Life is easy to grow old and hard to grow old.
Chongyang is every year, and now it is Chongyang
.
Respect and filial piety are the traditional virtues of the Chinese nation.
On the occasion of the Chinese Elderly’s Day, let us sincerely 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 arrest for the 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 program process for the elderly and frail elderly; National Postdoctoral Science Foundation, National Natural Science Foundation and National Science and Technology Award Review Experts; Standing Committee Member of the Chinese Medical Association Geriatrics Branch, and leader of the Geriatric Endocrinology Group; 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; honored by People’s Good Doctor, Outstanding Graduate Tutor, National Outstanding Scientific and Technological Worker, etc.
Abnormal thyroid hormone in the elderly is not necessarily a disease.
The hypothalamic-pituitary-thyroid axis changes with age in healthy elderly.
, Manifested in serum total triiodothyronine (TT3), free T3 (FT3) levels decreased, free thyroxine (FT4) levels increased slightly or remained unchanged, FT3/FT4 ratio decreased, thyroid stimulating hormone ( TSH) levels increase
.
According to the results of NHANES-Ⅲ, after the age of 30-39, for every 10 years of age increase, the 97.
5th percentile of serum TSH increases by 0.
3 mU/L; the upper limit of normal range of TSH for people aged 70-80 is higher than that of 60-70.
The year-old increase was 1.
6mU/L, and the population over 80 years old increased to 3.
2mU/L more than the 60-70 year-old population
.
A survey on iodine and thyroid diseases in 31 provinces and cities in China also found that the 97.
5 percentile of TSH increased with age, and the upper limit of serum TSH increased by 0.
534 mU/L for every 10 year-old increase
.
Therefore, age mainly affects the upper limit of the reference range of TSH, but mildly elevated TSH in the elderly does not necessarily require treatment.
It is recommended to consult a geriatrics or endocrinologist
.
Thyroid dysfunction in the elderly is very common.
Thyroid diseases (including abnormalities in various indicators) are very common in the elderly, and more attention should be paid
.
An epidemiological survey of 78470 cases in 31 provinces and cities in China showed that the overall prevalence of thyroid disease was 50.
96%, and the prevalence of thyroid disease in the elderly was higher than that of the general population.
Subclinical hypothyroidism (subclinical hypothyroidism) The most common in the elderly, the prevalence rate is nearly 20%, most of which are mild subclinical hypothyroidism, and only 10% of patients with thyroid stimulating hormone (TSH) ≥ 10mU/L are classified as severe subclinical hypothyroidism
.
A study from China showed that the total prevalence of hypothyroidism and subclinical hypothyroidism in elderly women over 65 years of age was 15.
07%, and that of men of the same age was 9.
22%
.
With increasing age, the prevalence of hypothyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism increases, while the prevalence of hyperthyroidism decreases
.
Compared with the TSH reference range of the kit, if the age-specific reference range of TSH is used, the prevalence of subclinical hypothyroidism in the elderly ≥65 years old will be reduced from 19.
87% to 3.
30%; the prevalence of clinical hypothyroidism will be reduced from 2.
09% It dropped to 1.
60%, and the prevalence of clinical hyperthyroidism remained unchanged
.
Since there is no convincing evidence to prove the impact of changing the TSH reference range in the elderly on health outcomes, the adult TSH reference range is still used clinically as an indicator of thyroid dysfunction
.
Senile hyperthyroidism is a major cause of weakness and disability.
Clinical hyperthyroidism in the elderly is an important cause of weakness
.
The elderly clinical hyperthyroidism is more common with "indifferent hyperthyroidism", which manifests as obvious weight loss, heart palpitations, diarrhea, anorexia, apathy, lethargy and even confusion in severe cases
.
Hyperthyroidism can easily cause attention loss, mood and cognitive changes in the elderly, and increase the risk of osteoporosis and fractures in the elderly
.
Therefore, when the general health status of the elderly changes recently, attention should be paid to screening thyroid function to rule out hyperthyroidism; delays in diagnosis and treatment can easily cause or aggravate elderly weakness and disability
.
Elderly subclinical hyperthyroidism also damages the health of the elderly.
Elderly subclinical hyperthyroidism is generally asymptomatic or has only mild symptoms, but clinical studies have shown that it significantly increases the risk of senile debility
.
Prospective observations based on the population and Meta analysis showed that the risks of atrial fibrillation, arrhythmia, heart failure, major cardiovascular adverse events, cardiovascular death and all-cause death in patients with severe subclinical hyperthyroidism were significantly increased
.
Subclinical hyperthyroidism in the elderly leads to an increased risk of osteoporosis and dementia, as well as symptoms such as changes in mood, decline in cognitive function, and decreased physical fitness, leading to increased weakness
.
Since subclinical hyperthyroidism in the elderly is detrimental to the overall health of the elderly, and the comprehensive manifestation is debilitating, it is generally recommended to give anti-hyperthyroidism treatment, but at least two thyroid function test results (2 months apart) should support the diagnosis of subclinical hyperthyroidism before starting treatment.
To avoid over-treatment
.
How to recognize and deal with thyroid dysfunction in the elderly early? Serum TSH is the first choice for screening of abnormal thyroid function in the elderly
.
It is recommended that the elderly be screened for hypothyroidism when they are admitted to nursing homes, hospitalizations, and routine health examinations, especially elderly women
.
Active screening is needed for the following situations: history of external cervical radiation or 131I treatment, history of thyroid surgery and abnormal thyroid function, family history of autoimmune thyroid disease, other autoimmune diseases, anemia, dyslipidemia, hypertension, diabetes Other metabolic diseases, mental and cognitive abnormalities, cardiovascular diseases, pulmonary hypertension, digestive system diseases, osteoporosis, sarcopenia, and the use of amiodarone, ketoconazole, lithium, interferon-α, and interleukin -2, a tyrosine kinase inhibitor, immunosuppressive drugs are inhibitors of the checkpoint
.
After being diagnosed by a specialist in geriatrics and endocrinologists, refined diagnosis and treatment should be carried out in accordance with the eight-character policy of "hierarchical management and safety compliance"
.
