Abstract
There is a high prevalence of hypothyroidism in the elderly population, mainly among women. The most important cause is autoimmune thyroiditis, but also iodine deficiency, radioiodine ablation, and surgery may be responsible for hypothyroidism in elderly hospitalized patients. Thyroid-related symptoms are sometimes comparable to physiological manifestations of the aging process, and hypothyroidism may be related with many symptoms which can be present in critical patients, such as cognitive impairment, cardiovascular, gastrointestinal, and hematological alterations, and eventually myxedema coma which is a severe and life-threatening condition in older adults. Adequate thyroid hormone levels are required to achieve optimal outcomes from any kind of surgical intervention. However, only few randomized clinical trials investigated the association between non-thyroidal illness (or low-T3 syndrome), and adverse surgical outcomes, so far. The goal of this review is to discuss the role of thyroid function as a predictor of surgical outcomes in the elderly.
Highlights
Primary hypothyroidism is the most frequent pathological hormone insufficiency; its prevalence is approximately 10 times higher in women compared to men, and its incidence raises with age [1] (Table 1)
Other causes are iodine deficiency, radioiodine ablation, and surgery, that may be responsible for hypothyroidism in elderly hospitalized patients [6]
Hypothyroidism may be related with many symptoms which can be present in critical patients, such as cognitive impairment, cardiovascular, gastrointestinal, and hematological alterations, and eventually myxedema coma which is a severe and life-threatening condition in older adults
Summary
Primary hypothyroidism is the most frequent pathological hormone insufficiency; its prevalence is approximately 10 times higher in women compared to men, and its incidence raises with age [1] (Table 1). The recent Institute for Evidence-Based Medicine in Old Age (IEMO) 80-plus thyroid trial aimed to investigate the effects of levothyroxine for 145 patients over 80 years with subclinical hypothyroidism (TSH ≥4.6 and ≤19.9 mU/L and FT4 within laboratory reference ranges). The results of this randomized clinical trial are expected to shed light on the multimodal effects of levothyroxine treatment in 80-plus subjects, highlighting benefits and potential adverse effects [10]. Secondary (or central) hypothyroidism (SH) is caused by a dysfunction of the pituitary gland or the hypothalamus, and is characterized by both decreased TSH secretion and low levels of thyroid hormones (Figure 1). The aim of this review was to summarize the role of thyroid function as a predictor of surgical outcomes in the elderly
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