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Virgini VS, Rodondi N, Cawthon PM, Harrison SL, Hoffman AR, Orwoll ES, Ensrud KE, Bauer DC. Subclinical Thyroid Dysfunction and Frailty Among Older Men. J Clin Endocrinol Metab 2015; 100:4524-32. [PMID: 26495751 PMCID: PMC4667157 DOI: 10.1210/jc.2015-3191] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
CONTEXT Both subclinical thyroid dysfunction and frailty are common among older individuals, but data on the relationship between these 2 conditions are conflicting. OBJECTIVE The purpose of this study was to assess the cross-sectional and prospective associations between subclinical thyroid dysfunction and frailty and the 5 frailty subdomains (sarcopenia, weakness, slowness, exhaustion, and low activity). SETTING AND DESIGN The Osteoporotic Fractures in Men Study is a prospective cohort study. PARTICIPANTS Men older than 65 years (n = 1455) were classified into 3 groups of thyroid status: subclinical hyperthyroidism (n = 26, 1.8%), subclinical hypothyroidism (n = 102, 7.0%), and euthyroidism (n = 1327, 91.2%). MAIN OUTCOME MEASURES Frailty was defined using a slightly modified Cardiovascular Health Study Index: men with 3 or more criteria were considered frail, men with 1 to 2 criteria were considered intermediately frail, and men with no criteria were considered robust. We assessed the cross-sectional relationship between baseline thyroid function and the 3 categories of frailty status (robust/intermediate/frail) as well as the prospective association between baseline thyroid function and subsequent frailty status and mortality after a 5-year follow-up. RESULTS At baseline, compared with euthyroid participants, men with subclinical hyperthyroidism had an increased likelihood of greater frailty status (adjusted odds ratio, 2.48; 95% confidence interval, 1.15-5.34), particularly among men aged <74 years at baseline (odds ratio for frailty, 3.63; 95% confidence interval, 1.21-10.88). After 5 years of follow-up, baseline subclinical hypothyroidism and hyperthyroidism were not consistently associated with overall frailty status or frailty components. CONCLUSION Among community-dwelling older men, subclinical hyperthyroidism, but not subclinical hypothyroidism, is associated with increased odds of prevalent but not incident frailty.
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Affiliation(s)
- Vanessa S Virgini
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
| | - Nicolas Rodondi
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
| | - Peggy M Cawthon
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
| | - Stephanie Litwack Harrison
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
| | - Andrew R Hoffman
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
| | - Eric S Orwoll
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
| | - Kristine E Ensrud
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
| | - Douglas C Bauer
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
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Virgini VS, Wijsman LW, Rodondi N, Bauer DC, Kearney PM, Gussekloo J, den Elzen WPJ, Jukema JW, Westendorp RG, Ford I, Stott DJ, Mooijaart SP. Subclinical thyroid dysfunction and functional capacity among elderly. Thyroid 2014; 24:208-14. [PMID: 23941540 PMCID: PMC3926182 DOI: 10.1089/thy.2013.0071] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Subclinical thyroid dysfunction is common among older people and has been associated with decreased functional capacity but with conflicting data. The aim of this study was to assess the association between subclinical thyroid dysfunction and functional capacity in an elderly population. METHODS We included 5182 participants with a mean age of 75.2 years from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER). Self-reported functional capacity was assessed using the Barthel Index (BI) and the Instrumental Activities of Daily Living (IADL) scores at baseline and during follow-up. Participants with subclinical hyperthyroidism (n=65) and subclinical hypothyroidism (n=173) were compared to euthyroid participants (n=4944). The association between persistent subclinical thyroid dysfunction and functional capacity and decline was also investigated. RESULTS At baseline, compared to euthyroid participants (BI 19.73±SE 0.06; IADL 13.52±0.02), there was no difference in functional capacity for participants with subclinical hyperthyroidism (BI 19.60±0.09; IADL 13.51±0.12, p>0.05) or subclinical hypothyroidism (BI 19.82±0.06; IADL 13.55±0.08, p>0.05). Over a mean 3.2-year follow-up period, there was no association between thyroid function and annual decline of either BI or IADL (p>0.05). No association was found between persistent subclinical thyroid dysfunction and functional capacity at baseline or during follow-up (p>0.05). Results were similar after excluding participants with a maximum BI and/or IADL score at baseline. CONCLUSION Among well-functioning community-dwelling elderly, we found no evidence that subclinical thyroid dysfunction contributes to decreased functional capacity.
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Affiliation(s)
- Vanessa S. Virgini
- Department of General Internal Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Liselotte W. Wijsman
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- Netherlands Consortium for Healthy Aging, Leiden, The Netherlands
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Douglas C. Bauer
- Department of Internal Medicine, San Francisco University Medical Center, San Francisco, California
| | - Patricia M. Kearney
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Wendy P. J. den Elzen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rudi G.J. Westendorp
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Ian Ford
- Robertson Centre, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - David J. Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Simon P. Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- Netherlands Consortium for Healthy Aging, Leiden, The Netherlands
- Institute for Evidence-Based Medicine in Old Age, Leiden, The Netherlands
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