Age-related variation in thyroid function – a narrative review highlighting important implications for research and clinical practice

Taylor, Peter ORCID: https://orcid.org/0000-0002-3436-422X, Lansdown, Andrew, Witczak, Justyna ORCID: https://orcid.org/0000-0002-9530-5194, Khan, Rahim, Rees, Aled ORCID: https://orcid.org/0000-0002-1165-9092, Dayan, Colin ORCID: https://orcid.org/0000-0002-6557-3462 and Okosieme, Onyebuchi 2023. Age-related variation in thyroid function – a narrative review highlighting important implications for research and clinical practice. Thyroid Research 16 , 7. 10.1186/s13044-023-00149-5

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Abstract

Background Thyroid hormones are key determinants of health and well-being. Normal thyroid function is defined according to the standard 95% confidence interval of the disease-free population. Such standard laboratory reference intervals are widely applied in research and clinical practice, irrespective of age. However, thyroid hormones vary with age and current reference intervals may not be appropriate across all age groups. In this review, we summarize the recent literature on age-related variation in thyroid function and discuss important implications of such variation for research and clinical practice. Main text There is now substantial evidence that normal thyroid status changes with age throughout the course of life. Thyroid stimulating hormone (TSH) concentrations are higher at the extremes of life and show a U-shaped longitudinal trend in iodine sufficient Caucasian populations. Free triiodothyronine (FT3) levels fall with age and appear to play a role in pubertal development, during which it shows a strong relationship with fat mass. Furthermore, the aging process exerts differential effects on the health consequences of thyroid hormone variations. Older individuals with declining thyroid function appear to have survival advantages compared to individuals with normal or high-normal thyroid function. In contrast younger or middle-aged individuals with low-normal thyroid function suffer an increased risk of adverse cardiovascular and metabolic outcomes while those with high-normal function have adverse bone outcomes including osteoporosis and fractures. Conclusion Thyroid hormone reference intervals have differential effects across age groups. Current reference ranges could potentially lead to inappropriate treatment in older individuals but on the other hand could result in missed opportunities for risk factor modification in the younger and middle-aged groups. Further studies are now needed to determine the validity of age-appropriate reference intervals and to understand the impact of thyroid hormone variations in younger individuals.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Medicine Neuroscience and Mental Health Research Institute (NMHRI) MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG)
Additional Information:	Correction - Following publication of the original article, the authors identified an error in the Competing interests section. - https://doi.org/10.1186/s13044-023-00149-5
Publisher:	BioMed Central
ISSN:	1756-6614
Date of First Compliant Deposit:	8 February 2023
Date of Acceptance:	5 February 2023
Last Modified:	01 Jun 2023 01:27
URI:	https://orca.cardiff.ac.uk/id/eprint/156571

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