Hypothyroidism in the elderly; routine screening for thyroid diseases

[sisa1975]

I've just read an article from US Clinical Interventions in Aging which based on several studies is suggesting the following:

'In elderly people, low levels of TSH or high levels of FT4 that are still in the normal range are associated with higher mortality, but the same is not clear for high levels of TSH or low levels of FT4.'

I thought that the opposite statement would be more true. What do you think of this and the studies supporting the statement?

Another interesting part of the article:

'Due to the increased prevalence according to age and the impossibility of ruling out the diagnosis without laboratory measurements, several guidelines recommend routinely screening for thyroid diseases after a certain age. The American Thyroid Association recommends screening both women and men at 35 years of age, and every 5 years thereafter.

The American Academy of Family Physicians recommends thyroid screening for patients over 60 years old, independent of gender and the American College of Physicians recommends high-risk strategy for people aged over 50 years with nonspecific complaints.

In contrast, other institutions such as the US Preventive Services Task Force, the Canadian Task Force on the Periodic Health Examination and the British Royal College of Physicians do not recommend routine screening for adults or for the elderly. The Institute of Medicine evaluated evidence for a benefit of screening for thyroid disorders in the Medicare population but decided against screening based on a cost-effectiveness analysis.'

Does that mean that our NHS routinely checks for thyroid function only at birth?

Full article here:

ncbi.nlm.nih.gov/pmc/articl...

[Marz]

As we age we are able to accept the ovaries or testes becoming less effective - however other parts of the endocrine system - the thyroid - seem not to be so.    It makes sense to me that as we age the thyroid is running out of steam and NEEDS support.  So much illness is connected to LOW  thyroid - yet whilst GP's are prisoners of the TSH test - then progress will NOT be made ....

It seems recommendations can be made - but are they followed up ?

[SAMBS]

Does the NHS routinely screen for Thyroid at birth?  

I'm not aware if my 2 were or not but then they were born only 45+ years ago and my eldest grandchild is 23! 

It's interesting to read that someone somewhere may apparently be taking Thyroid Disease seriously though! Not before time either! 

[Clutter in reply to SAMBS]

SAMBS,

It has done so since early/mid 1980s.

[SAMBS in reply to Clutter]

Thanks Clutter. My last was born 1979! But yes they did both have a heel prick test soon after birth?  I of course was never told anything about any results back then. All their health/welfare care came under a midwife initially and then the weekly, later monthly? visits to the local baby clinic, which if I remember correctly went on till they started school, where they both had eyes and teeth checked in a mobile van, much like the mobile 'free mammograph'  vans we have here now.  No doubt UK/NHS systems have long since changed. 

[Hidden]

The cost of checking tsh is already enormous and they will be terrified of raising costs further by checking and treating the old.  They should test before pregnancy. Since the NHS is falling apart, we have to do private tests for our relatives, and spread the word this is possible. 

[Clutter]

Sisa1975,

As far as I'm aware the only universal thyroid testing in the UK is the heel prick test given to newborns.  FT4 decreases and TSH rises in patients >60 according to the study below. In another article I read that TSH 3.0 is apparently normal in the over 70s.

thyroidresearchjournal.biom...

[sisa1975 in reply to Clutter]

It would be good if there was a routine test at 50 but TSH test on it's own is often not enough and with the current guidelines and reference ranges majority of patients would be labeled as 'healthy' or 'normal'.

The situation of patients seems to be remaining rather hopeless.

My mother-in-law who is now 63 and used to work as a finance director is now an Alzheimers sufferer on so much medication and with many vitamin deficiencies but no doctor will treat her thyroid because her TSH is within range.

[Clutter in reply to sisa1975]

Sisa1975,

Sorry about your MIL's early Alzheimers.  Has her B12 been tested?

The BTA guidelines don't consider a hypothyroid diagnosis unless TSH is over range, or FT4 below range.

[sisa1975 in reply to Clutter]

No, it has not as far as I am aware. She was however found deficient in Folic acid and has a prescription for that. My brother-in-law is in charge of her care, I have spoken to him and asked him to look into B12 too but I don't think he had it checked.

I wish I could do more for her but we live quite far from her and I feel that  my hands are tied as her sister and my brother-in-law are keeping an eye on her care and they both believe in the competence of the NHS.

[Clutter in reply to sisa1975]

Sisa1975,

Perhaps you could send your sister and BIL these links google.co.uk/search?q=Low+B...

[sisa1975 in reply to Clutter]

Thank you. I have already done that (a couple of years ago) and recently I have even bought and posted 'Could it be B12' book to her sister. No success so far.

[Clutter in reply to sisa1975]

Sisa1975,

I'm sorry they won't consider trying B12 to see whether it helps.

[sisa1975 in reply to Clutter]

I know, it's very frustrating, I even explained that they can't overdose her with B12.

I myself take B12 injections presribed by my GP (I was nearly mistakenly diagnosed with MS when in reality I was very deficient in B12).

I will try speaking with my MIL's sister again and ask her if they have checked on the thyroid and B12.

[greygoose in reply to Clutter]

Yes, well, given their definition of 'normal', I would be very sceptical about that! I'm 71 and I dread to think how I would feel if my TSH were 3.0! It's usually about 0.01. Just because something often happens, doesn't mean it's right or good. These elderly people with TSH of 3.0 could be suffering any number of low thyroid symptoms, but as doctors have no idea what the symptoms are, they wouldn't know, would they.