Thyroid hormone use, hyperthyroidism and mortality in older women |
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Authors: | Bauer Douglas C Rodondi Nicolas Stone Katie L Hillier Teresa A;Study of Osteoporotic Fractures Research Group: Universities of California Pittsburgh Minnesota ;Kaiser Permanente Center for Health Research Portland |
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Institution: | a Division of General Internal Medicine, University of California, San Francisco b Department of Epidemiology and Biostatistics, University of California, San Francisco c University Outpatient Clinic, Department of Community Medicine and Public Health, University of Lausanne, Switzerland d Department of Endocrinology, Center for Health Research Northwest/Hawaii, Kaiser Permanente Northwest, Portland, Ore. |
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Abstract: | PurposeThyroid dysfunction is common, particularly among older women. The safety of thyroid hormone use and long-term prognosis of hyperthyroidism remain controversial. We performed a prospective cohort study to examine the relationship among thyroid hormone use, previous hyperthyroidism, abnormal thyroid function, and mortality.MethodsWe studied 9449 community-dwelling white women aged ≥65 years followed for 12 years. For analyses of thyroid function, we performed a nested case-cohort in 487 women using a third-generation thyroid-stimulating hormone assay. Causes of death were adjudicated based on death certificates and hospital records.ResultsTwelve percent of the 9449 women took thyroid hormone at baseline, and the mean duration of thyroid hormone use was 15.8 years; 9.4% of participants reported a history of hyperthyroidism. During 12 years of follow-up, 3159 women died (33%). In multivariate analysis, mortality among users of thyroid hormone was similar to that observed for nonusers (relative hazard RH] 1.11, 95% confidence interval CI], 0.98-1.24, P = .09). Previous hyperthyroidism was associated with a higher risk of all-cause mortality (RH 1.20, 95% CI, 1.06-1.36), particularly cardiovascular mortality (RH 1.46, 95% CI, 1.20-1.77). Low (≤0.5 mU/L) or high (>5 mU/L) thyroid-stimulating hormone levels were not associated with excess total or cause-specific mortality, but the power to detect these relationships was limited.ConclusionsAmong older women, thyroid hormone use is not associated significantly with excess mortality, but previous hyperthyroidism may be associated with a small increase in all-cause and cardiovascular mortality. Additional long-term studies of hyperthyroidism and its treatment should further explore these findings. |
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Keywords: | Thyroid diseases Thyroid hormones Thyrotropin Mortality Cardiovascular disease Cohort study |
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