Endocrine Abstracts

Context: Serum TSH reference range increases with age but target TSH is similar in younger and older hypothyroid patients on treatment. It is unknown if quality of life (QoL), hypothyroid symptoms and cardiovascular (CV) risk factors change in older patients in whom a higher serum TSH is aimed for.

Objective: To assess if a higher target serum TSH of 4.01–8.0 mU/l is feasible in and acceptable to older treated hypothyroid patients.

Design: Single-blind randomised controlled trial.

Participants: Forty eight hypothyroid patients aged ≥80 years on established and stable levothyroxine therapy with serum TSH levels within the reference range (0.4–4.0 mU/l).

Intervention: Usual dose (standard TSH group or ST group) or lower dose (higher TSH group or HT group) levothyroxine for 24 weeks.

Outcome measures: Hypothyroid-specific QoL, symptoms and general health. CV risk factors such as total cholesterol and blood pressure and serum marker of bone resorption were also assessed.

Results: Mean (± S.D.) serum TSH was 1.39 (0.98) and 6.43 (3.15) mU/l at the end of the trial in the ST and HT groups, respectively. Corresponding mean (± S.D.) daily levothyroxine doses were 82.1 (26.4) and 59.2 (23.8) micrograms. There were no significant differences between the two groups with regards to QoL, symptoms or general health status. Furthermore, there were no significant changes in cardiovascular risk factors or marker of bone resorption between the two groups.

Conclusions: A higher target serum TSH in hypothyroid patients on levothyroxine therapy aged ≥80 years is not associated with an adverse impact on patient reported outcomes, CV risk factors or bone resorption marker over 24 weeks. A larger trial assessing hard outcomes in this age group is now required.