TSH, FT4 and FT3 decline in very old age and this is linked to declining cognitive ability

[diogenes]

This new preprint paper shows that all the thyroid parameters decline in very old agre with implications for cognitive ability. I would say that a lower TSH would extend to lowerFT4/3 because the pituitary is not responding as sensitively to the lower levels. However this begs the question as to whether a small dose of T4 should be given to raise FT4/3 a little, even if TSH becomes suppressed. The dreaded Pearce is part of the group

Thyroid

Ahead of Print Free Access

Changes in Serum Thyroid Function Predict Cognitive Decline in the Very Old: Longitudinal Findings from the Newcastle 85+ Study

Earn H. Gan, Carol Jagger, Mohammad E. Yadegarfar, Rachel Duncan, and Simon H. Pearce

Published Online:2 Jul 2021doi.org/10.1089/thy.2020.0596

[Tythrop]

Why is my 98 year old mother-in-law with very very very advanced alzimers still being given t4 (and having bloid tests for it!) She doesnt know she's alive. Its abuse but NHS protocol/pya for indemnity policies.Also why is "dreaded" Pearce dreaded? Im curious.

[Tythrop in reply to Tythrop]

.... And why wont they give it to me with tsh bumping along the very bottom of range for many many years with associated t3 and t4 very very liw6(but in "range" ) levels plus anti tpo antibodies and history of Graves turning inti Hashi? Sorry just had to get of my 64 year old chest.

[Buddy195 Administrator in reply to Tythrop]

He appears to have archaic views about combination therapy, doesn’t advocate testing T3 levels & believes being over weight is not a hypo symptom. Comments about a recent webinar he led can be seen in a recent post by TSH110

[LindaC in reply to Tythrop]

Yes, my aunt at 80 y/o with advanced Alzheimers was also... ludicrous, but £$!

Your last Q...

😅🖤👽

[LindaC]

Thank you for this. Which is why appropriate replacement is required throughout life, rather than 'crippling' those already on the decline? (Just noticed, SP involved! 👽)

[TSH110]

Tried to read it but found it incomprehensible. Any chance you could explain it?

[diogenes Remembering in reply to TSH110]

It is as it has to be, full of statistical calculation. The upshot is that this paper confirms others that thyroid parameters in untreated patients naturally decline with age and this is accompanied by lower brain functioning. One might think that to counteract the fall in TSH FT4 and FT3 might at least stay steady, owing to resetting of the pituitary-thyroid set point. That all factors decline simply corresponds to the last stages of "wearing out" in all departments.

[diogenes Remembering]

The presentation for old people mimics a form of central hypothyroidsm.

[TSH110 in reply to diogenes]

Thanks I did kind of get it then!

[vocalEK]

Since it happens to the majority, the doctors will tell us it is "normal," pretending as always that "normal" means "healthy."

[TSH110 in reply to vocalEK]

That’s what I felt suspicious of as I tried to wade through the stuff - and let’s face it not every old person mentally declines and that ought to be what we aspire to for everyone.

[diogenes Remembering in reply to TSH110]

Well, as a potential member of this group that has been studied in the paper, I certainly hope that I can still hold the dam of decline for a while longer, though reading my academic papers of 50 years ago, I have to keep asking myself "who was this genius".

[TSH110 in reply to diogenes]

Yeah we need you to stay mentally alert for some time yet! I think either you are a genius or you’re not, maybe the flashes of it vary but not the quality itself.

[jgelliss]

Thank you so much for yet another great post. In my opinion. I feel that people over 60 years of age should be on some low dose for starters T4. I think it would be very helpful and very beneficial.

[jimh111]

A lower TSH (with lower fT3, fT4) is described as 'subclinical hyperthyroidism. One loses all hope.

It seems that both the thyroid and pituitary (thyrotrope) can decline with age and one is better off with an under par thyroid than pituitary.

I'm always a bit anxious about studies that use a lot of mathematical analysis to find associations as they usually rely on a large number of assumptions (I worked in computing for 30 years - we lived the 'garbage in garbage out' motto).

We don't know if this association is due to low TSH / thyroid hormone leads to cognitive impairment or mental / cognitive problems lower TSH and thyroid hormone levels. It could be a bit of each, but my money would be on the former.

It would be much better to do an intervention trial, raise thyroid hormone levels for a few months and see if mental / cognitive functions improve. The usual approach would be to give levothyroxine (heaven forbid) but this might lower TSH and reduce T4 to T3 conversion further. Ideally, they would give a low daily dose of TRH, just enough to restore TSH and fT3, fT4 back to normal. I don't see this happening because it would put the cat amongst the pigeons and show that hypothyroidism occurs with a Low TSH.

If this cognitive decline is due to a reduced TSH (I think it is) then it raises the point that if this mild reduction in TSH, fT3, fT4 has measurable effects how much worse it must be for patients who have much lower TSH, fT3. fT4 albeit they remain within their respective reference intervals.

[PaulRobinson]

Or even a small dose of T4/T3 ... or just T3?

[jimh111 in reply to PaulRobinson]

Either would lower TSH further, reducing T4 to T3 conversion - a bit of a vicious circle which I resolve by taking more L-T3. Endocrinologists in general will not appreciate that higher serum fT3 is needed to overcome impaired deiodinase within tissues so correcting TSH might correct fT3, fT4 (if thyroid OK) and make the patient better with normal TSH, fT3, fT4. This will make endocrinologists happy, at least until the penny drops and they realise we can be hypo with normal TSH, fT3, fT4 levels that are just a little lower than usual.

[Tythrop in reply to jimh111]

That's me:very low in range tsh (less than 5%in range) ditto t4 and t3. And antitpo antibidies. Everything level and scraping the range bottom but no trestment from nhs

[jimh111 in reply to Tythrop]

I see it so often on the forum. Endocrinologists treat each hormone as being independent and of course they are not. Basically they don't do science.

[Tythrop]

I wonder what the Queen takes? She's pretty switched on it seems in very old age.