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Submitted on April 21, 2005
Accepted on September 8, 2005
Department Internal Medicine, Erasmus MC, Rotterdam, The Netherlands (A.W. van den Beld, and T.J. Visser, R.A. Feelders, and S.W.J. Lamberts); Julius Center for Patient Oriented Research, University Medical Center Utrecht, The Netherlands (D.E. Grobbee)
* To whom correspondence should be addressed. 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 four years.
Participants 403 independently and ambulatory living men (aged 73 to 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 and total T4, T3, rT3, and TBG were measured. Physical function was estimated by the number of problems in activities of daily living (ADL), a measure of physical performance (PPS), leg extensor strength and grip strength, bone density and body composition.
Results Serum rT3 increased significantly with age and with the presence of disease. 63 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. Further, 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-year 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 to disease, and may reflect a catabolic state. Low serum FT4 is associated with a better 4-year survival; this may reflect an adaptive mechanism to prevent excessive catabolism.
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