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Thyroid Hormone Therapy and Cognitive Disorders Risk in Older Patients


Core Concepts
Thyroid hormone therapy in older patients may increase the risk of cognitive disorders.
Abstract
Patients aged 65 and older receiving thyroid hormone therapy with low thyrotropin levels face an increased risk of dementia and cognitive issues. The study analyzed over 65,000 patients, highlighting the association between thyrotoxicosis and incident cognitive disorders. Women were more prone to low thyrotropin levels and overtreatment. Primary care physicians are advised to be cautious in prescribing thyroid hormone therapy to older patients to avoid overtreatment and potential cognitive disorders. The study emphasizes the importance of considering the risks versus benefits of thyroid hormone therapy in older adults.
Stats
Patients with thyrotoxicosis had a higher likelihood of incident cognitive disorder (adjusted hazard ratio (aHR), 1.39; 95% CI, 1.18 - 1.64; P < .001). Exogenous thyrotoxicosis was a significant risk factor (aHR, 1.34: 95% CI, 1.10 - 1.63; P = .003). 7.2% of patients received a new cognitive disorder diagnosis during the follow-up period.
Quotes
"There's so much gray zone here." - Jean Chen

Key Insights Distilled From

by Karon Warren at www.medscape.com 11-02-2023

https://www.medscape.com/viewarticle/998036
Thyroid Hormones May Increase Risk for Cognitive Disorders

Deeper Inquiries

How can primary care physicians balance the risks and benefits of thyroid hormone therapy in older patients?

Primary care physicians can balance the risks and benefits of thyroid hormone therapy in older patients by carefully assessing the necessity of treatment, especially considering the potential for overtreatment. It is crucial for physicians to be vigilant about not overtreating older adults with thyroid hormone, as seen in the study's findings linking thyroid hormone therapy to an increased risk of cognitive disorders. Physicians should consider consulting with endocrinologists for a comprehensive evaluation and differential diagnosis before initiating treatment. Understanding the symptoms of hypothyroidism and differentiating them from other conditions is essential to avoid unnecessary treatment and potential harm in older patients.

What are the potential implications of overtreatment with thyroid hormone therapy in the elderly population?

Overtreatment with thyroid hormone therapy in the elderly population can have significant implications, including an increased risk of cognitive disorders such as dementia. The study highlighted that patients receiving thyroid hormone therapy and experiencing low thyrotropin levels were at a higher risk of cognitive problems. Additionally, overtreatment can lead to adverse effects such as atrial fibrillation, fractures, osteoporosis, and arrhythmias. Older patients may present with symptoms that overlap with hypothyroidism, making it crucial for physicians to differentiate and avoid unnecessary treatment. Understanding the risks associated with overtreatment is essential to prevent potential harm and complications in the elderly population.

How can the findings of this study impact the approach to cognitive disorders in older adults?

The findings of this study can impact the approach to cognitive disorders in older adults by emphasizing the importance of cautious prescribing of thyroid hormone therapy. The study's results suggest a correlation between thyroid hormone therapy, low thyrotropin levels, and an increased risk of cognitive disorders, particularly dementia. This underscores the need for primary care physicians to carefully evaluate the necessity of thyroid hormone therapy in older patients and avoid overtreatment. By being aware of the potential risks associated with thyroid hormone therapy, physicians can adopt a more personalized and cautious approach to treatment, considering the individual's age, symptoms, and overall health status. Collaborating with specialists and considering differential diagnoses can help in providing appropriate care for cognitive disorders in older adults.
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