Thyroid hormones and frailty in older adults: systematic review and dose–response meta-analysis

[helvella]

We’ve seen several papers in which it is claimed that it is entirely normal for older people to have higher TSH and lower thyroid hormone levels than younger people.

Definition of older (or aged or whatever term they use) varies, but I think we can probably assume most mean at least 65.

While this paper doesn’t entirely reverse that, it does at least identify that higher TSH is associated with higher risk of “frailty”. In my mind, that implies that assumptions of higher TSH could be entirely wrong-headed. If nothing else, the issues appear not to be as settled as might be claimed by some.

Thyroid hormones and frailty in older adults: systematic review and dose–response meta-analysis

Wen-Chun Chia, Yang-Ching Chen, Shuang-ling Xiu & Sen-Te Wang 

BMC Geriatrics volume 25, Article number: 104 (2025)

Abstract

Objective

To investigate (1) whether the association of thyroid hormone with frailty risk is linear or nonlinear and (2) which range of thyroid hormones or thyroid stimulating hormone (TSH) is more associated with a higher risk of frailty in older adults.

Design

Systematic review and dose–response meta-analysis.

Methods

Medical electronic databases were searched for cross-sectional or longitudinal studies, published from database inception to February 2022. We focused on the relationship between TSH and frailty. Data on TSH reference range, TSH exposure categories, sample size of each exposure category, and adjusted odds ratios (ORs) for frailty with 95% confidence interval (CI) were extracted. In the dose–response meta-analysis, we set the OR for frailty as 1 at 0.3 mIU/L TSH.

Results

The systematic review included 10 studies, whereas the meta-analysis included 3 studies (n = 6388). TSH levels ranged from 0.3 to 4.8 mIU/L, and the dose–response meta-analysis revealed a significant J-shaped association (p = 0.0071). Frailty OR (95% CI) increased from 1.30 (1.06–1.59) for 2.7 mIU/L TSH to 2.06 (1.18–3.57) for 4.8 mIU/L TSH.

Conclusions

A significant nonlinear, J-shaped association was noted between TSH level and frailty. TSH levels within the upper half (2.7–4.8mIU/L) of reference range was noted to significantly higher risk of frailty; by contrast, those in the lower half (0.6–1.5 mIU/L) had a lower risk of frailty, though not significantly so.

Trail registration

This systematic review was registered with PROSPERO (registration number: CRD42022299214).

bmcgeriatr.biomedcentral.co...

[Regenallotment Ambassador]

interesting findings… …. Dr Gabrielle Lyon (US geriatric specialist) says frailty is the result of loss in muscle mass.

I can see how being hypo, tired, slow, not motivated to move due to low metabolism and low energy could exacerbate this.

Start doing squats everyone 🏋️‍♂️🏋️🏋️‍♀️

[helvella Administrator in reply to Regenallotment]

Loss of muscle mass is a one of the classic symptoms of hypothyroidism - with, I suspect, many inidividual causative factors converging.

[Hypotennisnut7 in reply to Regenallotment]

Planks are supposed to be even better!

[Regenallotment Ambassador in reply to Hypotennisnut7]

Yes I agree, but really tough! Have you tried taking blood pressure before and after? A 20-30 second plank brings blood pressure down, works on me and hubby. Haven’t tried it on the surgery yet 🤣 that might raise some eyebrows 🙄💪

[Hypotennisnut7 in reply to Regenallotment]

I did not know that! Fantastic! I’m currently able to do 3 planks for 30 seconds each - it feels good - harder than expected but so beneficial; feeling like I can add a 4th next time 🤞🤞🤞🤙🏼

[Regenallotment Ambassador in reply to Hypotennisnut7]

Awesome 🤩

[FallingInReverse]

What a joy to see anyone acknowledge that it’s not just “In range” and that there is a difference between upper range and lower range. Refreshing.

I read something the other day that discussed ferritin results as “being on a continuum.” It’s so glaringly obvious this would be the case for these things yet the world over doctors can’t (or don’t want?) to understand the concept. Absurd.

Also - I did a deep dive on age variations of TSH, both with my daughter and also for my 80 year old mom’s results. My practical takeaway was that yes, there were age related upper and lower limit range shifts, but also that they really were small enough where when you’re watching trends + matching symptoms, it really didn’t matter to my conclusions.

To the studies point, the edges of the ranges are less informative than the trends towards upper or lower in general.

[asiatic]

Being elderly and with low TSH, I am reading articles like this at the moment. Once again, I go round in circles with contradictory reports. Here is one I read recently:-

Age modifies the pituitary TSH response to thyroid failure pubmed.ncbi.nlm.nih.gov/173...

[TSH110]

tattybogle ‘s pinned post has a graph showing how little TSH rises with age so this mantra that it’s normal to have a whopping great TSH after 65 is quite simply complete and utter rubbish.

healthunlocked.com/thyroidu...

the more papers that demolish this unfounded claptrap the better

pinned post has a graph showing how little TSH rises with age so this mantra that it’s normal to have a whopping great TSH after 65 is quite simply complete and utter rubbish.

healthunlocked.com/thyroidu...

the more papers that demolish this unfounded claptrap the better

[SmallBlueThing]

High fT4 associated with muscle loss (sarcopenia): sciencedirect.com/science/a...

There's quite a lot available about a low fT3 to fT4 ratio (what we think of, here, as a high fT4 to fT3 ratio) also being linked or, simply, low in range fT3.