Prevalence and follow‐up of abnormal thyrotrophin (TSH) concentrations in the elderly in the United Kingdom

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Abstract
Increasing use of assays for TSH with improved sensitivity as a first-line test of thyroid function has raised questions regarding prevalence and clinical significance of abnormal results, especially values below normal. We have assessed the thyroid status of 1210 patients aged over 60 registered with a single general practice by measurement of serum TSH using a sensitive assay. High TSH values were more common in females (11.6|X%) than males (2.9|X%). TSH values below normal were present in 6.3|X% of females and 5.5|X% of males, with values below the limit of detection of the assay present in 1.5|X% of females and 1.4|X% of males. Anti-thyroid antibodies were found in 60|X% of those with high TSH but only 5.6|X% of those with subnormal TSH. Eighteen patients were hypothyroid (high TSH, low free thyroxine) and one thyrotoxic (low TSH, raised free thyroxine) at initial testing. Seventy-three patients with elevated TSH but normal free T4 were followed for 12 months; 13 (17.8|X%) developed low free T4 levels and commenced thyroxine, TSH returned to normal in four (5.5|X%) and 56 (76.7|X%) continued to have high TSH values. Sixty-six patients with TSH results below normal were followed. Of the 50 subjects with low but detectable TSH at initial testing, 38 (76|X%) returned to normal at 12 months; of those 16 with undetectable TSH followed, 14 (87.5|X%) remained low at 12 months. Only one subject (who had an undetectable TSH) developed thyrotoxicosis. In view of the marked prevalence of thyroid dysfunction in the elderly, we suggest that screening of all patients over 60 should be considered. It is important that those with high TSH are followed in view of the risk of progression to overt hypothyroidism, but the risk of thyrotoxicosis in those with TSH values below normal appears small.