Subclinical hyperthyroidism (SH) in the elderly: symptoms, depression and quality of life (QoL) and relationship with TSH concentration in a prospective cohort of 110 patients
B. Goichot1, S. Vinzio1, J. Kuhn2, N. Meyer1, J. Wémeau4, P. Caron3, F. Luca1 & J. Orgiazzi5
SH is defined by a decrease of TSH with normal thyroid hormone (TH) concentrations. The clinical picture is not clear, whether these patients may have symptoms or alterations of QoL. It is well known that in overt hyperthyroidism, symptoms may be absent in old patients. In SH, one study in young patients has reported an increased symptom score and a slight decrease of QoL but these results have not been confirmed in middle-aged subjects. We report the initial data of the Pirathes study, an ongoing randomized study comparing radioiodine treatment vs monitoring in SH. We particularly analyzed the results regarding the grade of SCH as some authors have proposed to distinguish patients with TSH below 0.1 and patients with 0.1≤TSH<0.4 mU/l.
Inclusion criteria were: age >50, durably TSH<0.4 mU/l, normal TH, signs of thyroid autonomy on a thyroid scan and sinusal heart rhythm. After randomization, patients are seen every 4 months. At each visit, they fill 3 questionaries: one on thyroid related symptoms, one on anxiety and depression (HADS) and one on health-related QoL (SF36). We report here the data at inclusion of the first 110 patients included.
Patients (M27, F83) had a mean age of 64.6±8.8, and a TSH 0.09±0.09 mU/l. 72.6% had a TSH<0.1, 26.4% between 0.1 and 0.4 mU/l. 28.8% could considered as symptomatic, mainly with symptoms of hyperthyroidism but 11% of the whole population had rather symptoms of hypothyroidism. HADS anxiety score was 8.6±3.6 and HADS depression score 4.5±3.7. SF36 was comparable to that of the general population (PCS 47.0±8.1, MCS 45.5±11.9). There were no differences between grade 1 and grade 2 patients for BMI, heart rate or blood pressure. Patients with TSH<0.1 had a tendancy to be more anxious and more depressive (−0.7 and −1.0 respectively) and to have a decrease of QoL but the differences were significant only for PF and RP components of the SF36. Symptoms were also more pronounced in these patients. HADS, QoL and symptoms scores were highly correlated.
Our study shows that elderly patients with SH have few symptoms and no clear alteration of QoL. However, patients with TSH<0.1 have a tendancy to be more anxious and depressed and to have slight alterations in Qol and this could bring a clinical basis to the recent concept of grading SH.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This work was supported, however funding details unavailable.