Evidence map›Paper›PMID 33418603›Full record

Observational studyJournal of the American Geriatrics Society2021

Thyroid Hormone Supplementation and All-Cause Mortality in Community-Dwelling Older Adults: Results from the Baltimore Longitudinal Study of Aging.

Enoch J Abbey, John McGready, Luigi Ferrucci, Eleanor M Simonsick, Jennifer S R Mammen

Open access · greenAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of the American Geriatrics Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
1.5field-weighted citation impact, top 18% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Article
  4. Review
  5. Article
  6. Towards De-Implementation of low-value thyroid care in older adults.Current opinion in endocrinology, diabetes, and obesity · 2022
    Review
  7. Editorial: Thyroid hormones and cardiac arrhythmia.Frontiers in endocrinology · 2022
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 2 institutions in 1 country.

Enoch J AbbeyDepartment of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.ORCID 0000-0002-3286-0529
John McGreadyDepartment of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Luigi FerrucciNational Institute of Aging, NIH, Baltimore, Maryland, USA.
Eleanor M SimonsickNational Institute of Aging, NIH, Baltimore, Maryland, USA.
Jennifer S R MammenDepartment of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Johns Hopkins University · USNational Institute on Aging · US

Funding

The Baltimore Longitudinal Study Of AgingZIAAG000015 · NIA · NATIONAL INSTITUTE ON AGING · PI SIMONSICK, ELEANOR MARIE · 2009 to 2025
$116.9M
Mechanisms of autoimmune thyroid disease and the role of interferon-alphaK23DK095954 · NIDDK · JOHNS HOPKINS UNIVERSITY · PI MAMMEN, JENNIFER SOPHIE · 2014 to 2018
$913k
Mechanisms of Hypothalamic-Pituitary-Thyroid Axis AgingR01AG064256 · NIA · JOHNS HOPKINS UNIVERSITY · PI MAMMEN, JENNIFER SOPHIE · 2020 to 2021
$684k
Mechanisms of Hypothalamic-Pituitary-Thyroid Axis AgingR56AG064256 · NIA · JOHNS HOPKINS UNIVERSITY · PI MAMMEN, JENNIFER SOPHIE · 2019 to 2019
$422k
Intramural NIH HHS Intramural Research ProgramIntramural NIH HHS Z99 AG999999Intramural NIH HHS ZIA AG000015NIA NIH HHS R01 AG064256NIA NIH HHS R56 AG064256NIA NIH HHS R56AG064256R56NIDDK NIH HHS K23 DK095954NIDDK NIH HHS K23DK095954
6 · The paper itself

Abstract

backgroundAlthough elevated thyrotropin (TSH) is common in older adults, controversy exists over what degree of elevation should be treated with thyroid hormone supplements. Isolated, elevated TSH in this population can be consistent with aging-related adaptations rather than indicative of primary thyroid disease, raising the possibility that thyroid hormone replacement may be harmful.

objectivesDetermine the association between all-cause mortality and levothyroxine use among older adults.

designLongitudinal observational study.

settingBaltimore Longitudinal Study of Aging.

participantsOne thousand two hundred and fifty eight community dwelling adult participants aged 65+ with an average of 9 years of follow up. MEASUREMENTS: Thyroid and pituitary hormone levels and thyroid hormone supplementation were determined at each visit. Incident rate ratios (IRR) for all-cause mortality were calculated using time-dependent Poisson regression models to accommodate the varying start times. To isolate the effects of hormone replacement from its effects on TSH, the association between treatment and all-cause mortality was analyzed in participants with stable thyroid function status throughout follow-up (N = 638).

resultsThyroid hormone supplementation was not associated with a significant increase all-cause mortality in the subsequent year in the fully adjusted model (IRR = 1.40, 95% confidence interval (CI) = 0.93-2.12). In a stratified analysis of euthyroid participants, thyroid hormone use was associated with significantly greater mortality, with an adjusted IRR = 1.81 (95% CI = 1.10-2.98).

conclusionThe increased mortality associated with thyroid hormone use among the subclass of euthyroid community dwelling older adults is consistent with a model in which TSH elevation can result from a variety of underlying pathophysiologic processes, not all of which should be treated with thyroid hormone supplementation. Clinicians should consider overall clinical status when interpreting an isolated elevated TSH in older adults.

Indexed as

AgedAged, 80 and overBaltimoreCause of DeathEuthyroid Sick SyndromesFemaleHormone Replacement TherapyHumansIndependent LivingLongitudinal StudiesMalePoisson DistributionThyroxineThyroxineagingBaltimore longitudinal study of aginglevothyroxinesubclinical hypothyroidism

Identifiers

PMID33418603
PMCPMC8265277
OpenAlexW3120598363

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.