Добавлю, что у пожилых людей уровень ТТГ для разделения эутироидного и субклинического гипотироидного состояния может отличаться от молодых или среднего возраста, например в прекрасной публикации, что доступна в полной версии:
Hypothyroidism in the elderly: diagnosis and management
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имеется такая табличка частоты выявления субклинического и явного гипотироза у пожилых:
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только в одном исследовании среди людей старше 40 (средний 46.7 лет) децизионный уровень ТТГ был > 4.0 как лаб. показатель субклинического гипотироза, в остальных исследованиях у людей старше 65лет ТТГ принимался или >4.5 или >4.8 или >5.0 ... 5.5.
Связано это с тем, что пожилые люди живут дольше, если у них уровень ТТГ высоко-нормален или Т4 низконормален, тогда как более низкие цифры ТТГ и высоконормальный Т4 ассоциируется с более высокой смертностью:
In elderly people, low levels of TSH or high levels of FT4 that are still in the normal range are associated with higher mortality, but the same is not clear for high levels of TSH or low levels of FT4. Gussekloo et al evaluated a general population of people who were 85 years of age at the beginning of the study; after a follow-up of 4 years, they concluded that elderly individuals with high TSH levels have a prolonged life span. The hazard ratio for mortality was 0.77 (95% CI, 0.63 to 0.94) for a standard deviation increase of 2.71 mIU/L of thyrotropin. Likewise, van den Beld et al showed that low serum FT4 levels are associated with a longer 4-year survival, reflecting a possible adaptive mechanism to prevent excessive catabolism in the elderly.
подобные выводы сделаны и в недавней - смертность у людей с ТТГ 3.1-6 не увеличивается, исход пожилых (старше 65) может отличаться от тех, кому до 65:
Thyroid. 2011 Aug;21(8):837-43.
Hypothyroidism and moderate subclinical hypothyroidism are associated with increased all-cause mortality independent of coronary heart disease risk factors: a PreCIS database study.
McQuade C, Skugor M, Brennan DM, Hoar B, Stevenson C, Hoogwerf BJ.
Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, Ohio 44195, USA.
BACKGROUND: Thyroid hormones have profound effect on the heart and peripheral vasculature. Hypothyroidism is associated with an increase in a number of coronary heart disease (CHD) risk factors including dyslipidemia, hypertension, and elevated levels of homocysteine. Our objective was to assess the effects of hypothyroidism (thyroid-stimulating hormone [TSH]: >10 μ U/mL), moderate subclinical hypothyroidism (SCH; TSH: 6.1-10 μ U/mL), and mild SCH (TSH: 3.1-6.0 μ U/mL) on cardiovascular risk factors, CHD prevalence, and all-cause mortality in patients at high risk for CHD seen in a preventive cardiology clinic.
METHODS: All patients seen in the Cleveland Clinic Preventive Cardiology clinic have demographic and laboratory tests including TSH and multiple CHD risk factors obtained at the baseline visit. All data are entered into a database (called PreCIS). The social security death index is queried monthly to determine all-cause mortality.
RESULTS: Several CHD risk factors including age, male gender, systolic blood pressure, triglycerides, and fibrinogen were more common in hypothyroid patients. Prevalence of CHD was more common in hypothyroid and moderate SCH patients. All-cause mortality was higher in hypothyroid and moderate SCH patients, but not in mild SCH patients. Higher mortality in these groups was observed in both genders, patients under 65 years of age, and patients not on thyroid replacement therapy, but was not observed in patients over 65 years of age.
CONCLUSIONS: Hypothyroidism and moderate, but not mild, SCH are associated with increased CHD prevalence and all-cause mortality. These observations suggest patients with moderate, but not mild, SCH and patients at high risk for CHD should be treated with thyroid replacement therapy.
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