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Thyroid Hormone Concentrations, Disease, Physical Function, and Mortality in Elderly Men

Department of Internal Medicine (A.W.v.d.B., T.J.V., R.A.F., S.W.J.L.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Julius Center for Patient Oriented Research (D.E.G.), University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands

Address all correspondence and requests for reprints to: A. W. van den Beld, M.D., Ph.D., Department of Internal Medicine, Room Bd230, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail: a.vandenbeld{at}erasmusmc.nl.

Context: Physiological changes in thyroid hormone concentrations might be related to changes in the overall physical function in the elderly.

Objective: We determined to what extent thyroid hormone concentrations are related to physical function and mortality in elderly men.

Design: A longitudinal population study (the Zoetermeer study) was conducted. Mortality was registered in the subsequent 4 yr.

Participants: Four hundred three independently and ambulatory living men (aged 73–94 yr) participated.

Main Outcome Measures: The study examined the association between serum thyroid hormones and parameters of physical function as well as the association with mortality.

Methods: TSH, free T₄ (FT4) total T₄, T₃, rT₃, and T₄-binding globulin were measured. Physical function was estimated by the number of problems in activities of daily living, a measure of physical performance score (PPS), leg extensor strength and grip strength, bone density, and body composition.

Results: Serum rT₃ increased significantly with age and the presence of disease. Sixty-three men met the biochemical criteria for the low T₃ syndrome (decreased serum T₃ and increased serum rT₃). This was associated with a lower PPS, independent of disease. Furthermore, higher serum FT4 (within the normal range of healthy adults) and rT₃ (above the normal range of healthy adults) were related with a lower grip strength and PPS, independent of age and disease. Isolated low T₃ was associated with a better PPS and a higher lean body mass. Low FT4 was related to a decreased risk of 4-yr mortality.

Conclusions: In a population of independently living elderly men, higher FT4 and rT₃ concentrations are associated with a lower physical function. High serum rT₃ may result from a decreased peripheral metabolism of thyroid hormones due to the aging process itself and/or disease and may reflect a catabolic state. Low serum FT4 is associated with a better 4-yr survival; this may reflect an adaptive mechanism to prevent excessive catabolism.

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