Factors affecting the serum free thyroxine levels in hospitalized chronic geriatric patients

I. Szabolcs, C. Ploenes, M. Beyer, W. Bernard, J. Herrmann

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective: Determination of whether nonthyroidal factors affect the diagnostic value of free thyroxine estimation in geriatric patients. Design: Survey. Participants: A convenience sample of 381 non-selected, chronic, hospitalized geriatric patients over 60 years of age (I = relatively good health; II = relatively poor health; III = bad health; subgroups 'sine therapia,' ie, patients receiving no drugs that affect FT4) and 180 20-40 year old healthy persons. Measurements: Thyrotropin-releasing hormone test; thyrotropin (TSH); free thyroxine (FT4, measured in part by two parallel methods) estimation in a screening study; and thyroxine-binding globulin and thyroxine-binding-inhibitor activity measurements. Results: The normal FT4 ranges of the euthyroid geriatric (n = 210) and healthy young groups were similar. In the 'sine therapia' euthyroid patients, FT4 decreased with age but increase with the severity of illness. High FT4 levels with non- suppressed TSH were more frequent in patients in poor and bad health. (I = 6/112; II = 14/140; III = 13/74; P <0.01). The serum thyroxine-binding- inhibitor activity of euthyroid geriatric patients correlated with the severity of their clinical state (I = 6.22 ± 5.65 (13); II = 7.40 ± 4.33 (23); III = 10.04 ± 5.50 (16) μg merthiolate equivalent/μL; ANOVA with log-transformed values: F((2,51)) = 3.50, P <0.05). The mean FT4 was higher in 36 heparin-treated patients (22.81 ± 4.67 pmol/L) than in the 193 'sine therapia' patients (19.03 ± 4.23 pmol/L; - P <0.001). In a convenience subsample of 240 patients, a weak inverse correlation was found between FT4 and the thyroxine-binding globulin (r = -0.14, P <0.02). Only 5/11 patients with low free thyroxine had hypothyroidism, while 11/46 patients with elevated free thyroxine had hyperthyroidism. Conclusions: There is no need to modify the normal free thyroxine range for hospitalized geriatric patients. Clinical condition, drug treatment, and, to a lesser extent, age are factors that significantly affect the diagnostic value of FT4 in hospitalized chronic geriatric patients, decreasing the specificity of the test in diagnosing clinical hyper- and hypothyroidism.

Original languageEnglish
Pages (from-to)742-746
Number of pages5
JournalJournal of the American Geriatrics Society
Volume41
Issue number7
Publication statusPublished - 1993

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Thyroxine
Geriatrics
Serum
Thyroxine-Binding Globulin
Health
Hyperthyroidism
Hypothyroidism
Thimerosal
Thyrotropin-Releasing Hormone
Age Factors
Thyrotropin
Pharmaceutical Preparations
Heparin
Analysis of Variance
Reference Values

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Factors affecting the serum free thyroxine levels in hospitalized chronic geriatric patients. / Szabolcs, I.; Ploenes, C.; Beyer, M.; Bernard, W.; Herrmann, J.

In: Journal of the American Geriatrics Society, Vol. 41, No. 7, 1993, p. 742-746.

Research output: Contribution to journalArticle

Szabolcs, I. ; Ploenes, C. ; Beyer, M. ; Bernard, W. ; Herrmann, J. / Factors affecting the serum free thyroxine levels in hospitalized chronic geriatric patients. In: Journal of the American Geriatrics Society. 1993 ; Vol. 41, No. 7. pp. 742-746.
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abstract = "Objective: Determination of whether nonthyroidal factors affect the diagnostic value of free thyroxine estimation in geriatric patients. Design: Survey. Participants: A convenience sample of 381 non-selected, chronic, hospitalized geriatric patients over 60 years of age (I = relatively good health; II = relatively poor health; III = bad health; subgroups 'sine therapia,' ie, patients receiving no drugs that affect FT4) and 180 20-40 year old healthy persons. Measurements: Thyrotropin-releasing hormone test; thyrotropin (TSH); free thyroxine (FT4, measured in part by two parallel methods) estimation in a screening study; and thyroxine-binding globulin and thyroxine-binding-inhibitor activity measurements. Results: The normal FT4 ranges of the euthyroid geriatric (n = 210) and healthy young groups were similar. In the 'sine therapia' euthyroid patients, FT4 decreased with age but increase with the severity of illness. High FT4 levels with non- suppressed TSH were more frequent in patients in poor and bad health. (I = 6/112; II = 14/140; III = 13/74; P <0.01). The serum thyroxine-binding- inhibitor activity of euthyroid geriatric patients correlated with the severity of their clinical state (I = 6.22 ± 5.65 (13); II = 7.40 ± 4.33 (23); III = 10.04 ± 5.50 (16) μg merthiolate equivalent/μL; ANOVA with log-transformed values: F((2,51)) = 3.50, P <0.05). The mean FT4 was higher in 36 heparin-treated patients (22.81 ± 4.67 pmol/L) than in the 193 'sine therapia' patients (19.03 ± 4.23 pmol/L; - P <0.001). In a convenience subsample of 240 patients, a weak inverse correlation was found between FT4 and the thyroxine-binding globulin (r = -0.14, P <0.02). Only 5/11 patients with low free thyroxine had hypothyroidism, while 11/46 patients with elevated free thyroxine had hyperthyroidism. Conclusions: There is no need to modify the normal free thyroxine range for hospitalized geriatric patients. Clinical condition, drug treatment, and, to a lesser extent, age are factors that significantly affect the diagnostic value of FT4 in hospitalized chronic geriatric patients, decreasing the specificity of the test in diagnosing clinical hyper- and hypothyroidism.",
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AU - Ploenes, C.

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AU - Bernard, W.

AU - Herrmann, J.

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N2 - Objective: Determination of whether nonthyroidal factors affect the diagnostic value of free thyroxine estimation in geriatric patients. Design: Survey. Participants: A convenience sample of 381 non-selected, chronic, hospitalized geriatric patients over 60 years of age (I = relatively good health; II = relatively poor health; III = bad health; subgroups 'sine therapia,' ie, patients receiving no drugs that affect FT4) and 180 20-40 year old healthy persons. Measurements: Thyrotropin-releasing hormone test; thyrotropin (TSH); free thyroxine (FT4, measured in part by two parallel methods) estimation in a screening study; and thyroxine-binding globulin and thyroxine-binding-inhibitor activity measurements. Results: The normal FT4 ranges of the euthyroid geriatric (n = 210) and healthy young groups were similar. In the 'sine therapia' euthyroid patients, FT4 decreased with age but increase with the severity of illness. High FT4 levels with non- suppressed TSH were more frequent in patients in poor and bad health. (I = 6/112; II = 14/140; III = 13/74; P <0.01). The serum thyroxine-binding- inhibitor activity of euthyroid geriatric patients correlated with the severity of their clinical state (I = 6.22 ± 5.65 (13); II = 7.40 ± 4.33 (23); III = 10.04 ± 5.50 (16) μg merthiolate equivalent/μL; ANOVA with log-transformed values: F((2,51)) = 3.50, P <0.05). The mean FT4 was higher in 36 heparin-treated patients (22.81 ± 4.67 pmol/L) than in the 193 'sine therapia' patients (19.03 ± 4.23 pmol/L; - P <0.001). In a convenience subsample of 240 patients, a weak inverse correlation was found between FT4 and the thyroxine-binding globulin (r = -0.14, P <0.02). Only 5/11 patients with low free thyroxine had hypothyroidism, while 11/46 patients with elevated free thyroxine had hyperthyroidism. Conclusions: There is no need to modify the normal free thyroxine range for hospitalized geriatric patients. Clinical condition, drug treatment, and, to a lesser extent, age are factors that significantly affect the diagnostic value of FT4 in hospitalized chronic geriatric patients, decreasing the specificity of the test in diagnosing clinical hyper- and hypothyroidism.

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