Hypothyroidism raises mortality risk among older adults
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Older adults with hypothyroidism are 26% more likely to die of any cause when compared with euthyroid older adults, although secondary analyses suggest hypothyroidism is not associated with cardiovascular mortality, according to findings published in The Journal of Clinical Endocrinology & Metabolism.
“Although hypothyroidism is associated with mortality in the general population, it is less clear whether the same relationship exists in the elderly population,” Carol Chiung-Hui Peng, MD, resident physician in the department of internal medicine at the University of Maryland Medical Center Midtown Campus in Baltimore, told Healio. “Our study showed that overt hypothyroidism in individuals aged 60 years or older is related to all-cause mortality, but not cardiovascular mortality. Elderly individuals with subclinical hypothyroidism did not have increased risk of all-cause mortality and cardiovascular mortality.”
Peng and colleagues analyzed data from 15 prospective studies and 12 retrospective studies evaluating the association between hypothyroidism and all-cause and/or CV mortality among adults aged at least 60 years (n = 1,114,638). Researchers used random-effects models to calculate pooled relative risk for CV and all-cause mortality based on thyroid status.
Overall, patients with hypothyroidism experienced a higher risk for all-cause mortality compared with those with euthyroidism (pooled RR = 1.26; 95% CI, 1.15-1.37), with high heterogeneity between studies. There were no between-group differences observed for CV mortality among adults with hypothyroidism and euthyroidism.
In subgroup analyses, researchers found that overt hypothyroidism was associated with increased all-cause mortality (pooled RR = 1.1; 95% CI, 1.01-1.2); however, subclinical hypothyroidism was not. The heterogeneity between studies was partially related to different study designs (prospective and retrospective) and geographic locations (Europe, North America, Asia and Oceania).
“Interestingly, results according to different continents were inconsistent,” the researchers wrote. “In the subgroups from North America and Asia, patients with hypothyroidism were significantly associated with high all-cause mortality risk compared with those with euthyroidism; such significant association was not found in European and Oceania subgroups.”
Across 12 studies evaluating the association between hypothyroidism and CV mortality, researchers found no association with moderate heterogeneity. CV mortality did not increase in either the overt hypothyroidism or subclinical hypothyroidism subgroups.
“This systematic review and meta-analysis showed that hypothyroidism is significantly associated with higher all-cause mortality in the elderly population, but not with cardiovascular mortality,” the researchers wrote. “The subgroup analyses revealed that increased all-cause mortality is merely observed in patients with overt hypothyroidism and not in those with subclinical hypothyroidism. Additionally, the pooled results also vary between studies with different designs and geographic locations. Owing to the between-study heterogeneity, these study results should be interpreted cautiously, and further prospective large-scale high-quality studies are necessary to confirm our findings.” – by Regina Schaffer
For more information:
Carol Chiung-Hui Peng, MD, can be reached at the Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, 827 Linden Ave., Baltimore, MD; email: carolpeng98@gmail.com.
Disclosures: The authors report no relevant financial disclosures.
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Tsai TY, et al. J Clin Endocrinol Metab. 2019;doi:10.1210/clinem/dgz186.
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