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Seniors on the Edge

Study Claims Mild Thyroid Problems in Elderly Require No Treatment

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Updated December 21, 2006

Seniors on the Edge
A study published in October 2006 in the Annals of Internal Medicine looked at whether people over 65 with borderline thyroid conditions are more likely to suffer depression, anxiety, and problems with memory or thinking than people with normal thyroid function.

The researchers concluded that the seniors with borderline thyroid conditions were not more likely to suffer these symptoms, and there was no justification for widespread screening programs based on these criteria.

This issue of screening -- and treatment -- for borderline thyroid conditions is a controversial one. Some experts, such as the U.S. Preventive Services Task Force, believe that there is not enough evidence either pro or con to make a recommendation regarding routine thyroid screening for adults. The American Thyroid Association, however, recommends thyroid screening every five years for all adults, starting at age 35.

What is happening, however, is that because thyroid blood tests are increasingly considered a basic diagnostic test by physicians, more thyroid testing is being performed. As a result, more borderline and low-level thyroid problems are being detected.

Some of the borderline patients progress on to overt and symptomatic thyroid dysfunction that requires treatment, and some do not. Some studies find benefits to treatment, others claim that many patients are overtreated and that it might pose a risk.

The controversy is even more significant for seniors, who have a higher rate of heart disease, which puts them at greater risk from thyroid treatment. Thyroid treatment must be carefully approached -- and overtreatment avoided -- in patients with underlying heart conditions, as thyroid medication can aggravate these conditions.

At this point, the study primarily points out the need for further research. In the American Medical News, Dr. Martin Surks, endocrinology program chair at Montefiore Medical Center and Albert Einstein College of Medicine in the Bronx, New York, said "We need a formal study. Does treatment result in any benefits that outweigh the risks?"

Note from Mary Shomon: Concerns and Questions

Keep in mind that this study is not definitive, and further research is needed. This was a small study, and the study authors themselves said that "because of the low participation rate, low prevalence of subclinical thyroid dysfunction, and other unidentified recruitment biases, participants may not be representative of the elderly population."

My concern is that a headline like "Study: No ill effects from mild thyroid disease" in the American Medical News and website may oversimplify the findings, and lead some physicians to consider less thyroid testing, especially in the elderly. This study should not be interpreted to mean that doctors should avoid thyroid testing in seniors with depression, anxiety, and problems with memory or thinking. Given that some researchers estimate that we have as many as 59 million Americans with thyroid conditions -- and only 13 million of them diagnosed -- we need doctors to be more aware of the prevalence of undiagnosed thyroid disease, and the importance of testing. From a patient perspective, I feel that The American Thyroid Association's recommendations for screening at the age of 35, and every five years thereafter, is a sound one, and perhaps the best policy for patients.

Finally, a key question arising out of this study is whether thyroid treatment for those seniors who have borderline thyroid conditions will improve symptoms such as depression, anxiety, and problems with memory or thinking. In my opinion, we clearly need further study for a definitive answer.

Sources

U.S. Preventive Services Task Force on screening for thyroid disease, January 2004 (http://www.ahrq.gov/clinic/uspstf/uspsthyr.htm)

"Is Subclinical Thyroid Dysfunction in the Elderly Associated with Depression or Cognitive Dysfunction?," abstract, Annals of Internal Medicine, Oct. 17 (http://www.annals.org/cgi/content/abstract/145/8/573)

"Study: No ill effects from mild thyroid disease," December 2006, AMNews, (http://www.ama-assn.org/amednews/2006/12/25/hlsc1225.htm)

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