ArticleDiabetes, metabolic syndrome and obesity : targets and therapy2026
Free and Total Thyroxine Levels are Associated with Cardiovascular-Kidney-Metabolic Syndrome Stages in Elderly Cohorts from China and the United States: A Cross-Sectional Study.
Article in Diabetes, metabolic syndrome and obesity : targets and therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Cardiovascular-kidney-metabolic (CKM) syndrome is an emerging multisystem disorder that predominantly affects older adults. The role of thyroid hormones in its pathogenesis remains underexplored. This study aimed to investigate the associations between thyroid hormone levels and CKM stages in elderly populations. Methods: A total of 3300 participants from the Shanghai Friendship Community Elderly Cohort (SFCEC, enrolled in 2020) and 1153 participants from the US National Health and Nutrition Examination Survey (NHANES 2007-2012) were included. All participants were elderly, defined as aged 60 to 80 years. Thyroid function markers (TSH, FT4, TT4, FT3, TT3) were measured using standardized assays. CKM syndrome was classified into five stages (0-4) according to American Heart Association (AHA) criteria. Multivariable ordinal logistic regression and restricted cubic splines (RCS) were employed to evaluate the associations. Results: The prevalence of CKM (stages 1-4) was strikingly high in both elderly cohorts (98.33% in SFCEC and 98.76% in NHANES). After full adjustment, consistent associations were observed across both cohorts: each 1 ug/dL increase in TT4 was associated with elevated CKM risk (SFCEC: OR=1.064, 95% CI: 1.030-1.100; NHANES: OR=1.145, 95% CI:1.070-1.225). Similarly, each 1 ng/dL increment in FT4 was associated with increased risk (OR=1.538, 95% CI:1.097-2.157 and OR=3.500, 95% CI:1.745-7.020, respectively). Participants in the highest tertile of TT4 exhibited significantly elevated CKM risk compared to the lowest tertile group (SFCEC: OR = 1.304, 95% CI: 1.114-1.528; NHANES: OR = 1.667, 95% CI: 1.219-2.277). A consistent pattern was observed for FT4, with the highest tertile showing increased odds of CKM compared to the lowest (SFCEC: OR = 1.250, 95% CI: 1.066-1.466; NHANES: OR = 1.534, 95% CI: 1.046-2.248). Notably,RCS analyses indicated that both TT4 and FT4 hormone levels were linearly associated with CKM Syndrome. (p- overall <0.05 and p-nonlinear >0.05). However, no significant associations were observed for TSH, FT3, or TT3 in the adjusted models. Conclusion: Elevated levels of TT4 and FT4 are associated with higher CKM stages in elderly populations. These findings suggest that T4 levels may serve as biomarkers for CKM risk stratification. Longitudinal studies are warranted to confirm these associations and to establish causality.
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