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This version published online on September 26, 2006
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2006-1557
A more recent version of this article appeared on December 1, 2006
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*Thyroid Diseases

Submitted on July 18, 2006
Accepted on September 18, 2006

Prevalence of subclinical thyroid dysfunction and its relation to socioeconomic deprivation in the elderly: a community based cross-sectional survey

Sue Wilson*, James V Parle, Lesley M Roberts, Andrea K Roalfe, F D Richard Hobbs, Penny Clark, Michael C Sheppard, Michael D Gammage, Helen M Pattison, and Jayne A Franklyn on behalf of the Birmingham Elderly Thyroid Study Team

Department of Primary Care and General Practice, Primary Care Clinical Sciences Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; Department of Medicine, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; The Regional Endocrine Laboratory, University Hospital Birmingham NHS Foundation Trust, B29 6JD, UK; School of Life and Health Sciences, Aston University, Aston Triangle, Birmingham B4 7ET, UK

* To whom correspondence should be addressed. E-mail: s.wilson{at}bham.ac.uk.

Context: Population based screening has been advocated for subclinical thyroid dysfunction in the elderly because the disorder is perceived to be common and health benefits may be accrued by detection and treatment.

Objective: To determine the prevalence of subclinical thyroid dysfunction and unidentified overt thyroid dysfunction in an elderly population.

Design, Setting, Participants: A cross sectional survey of a community sample of participants aged 65 and over registered with 20 family practices in the United Kingdom. Exclusions: current therapy for thyroid disease; thyroid surgery or treatment within 12 months.

Outcome Measure: tests of thyroid function (TSH concentration and free T4 concentration in all, with measurement of free T3 in those with low TSH).

Explanatory variables: All current medical diagnoses and drug therapies, age, gender and socio-economic deprivation (Index of Multiple Deprivation 2004)

Analysis: standardized prevalence rates. Logistic regression modeling used to determine factors associated with the presence of subclinical thyroid dysfunction

Results: 5,960 attended for screening. Using biochemical definitions, 94.2% (95%CI 93.8-94.6%) were euthyroid. Unidentified overt hyper and hypothyroidism were uncommon (0.3%, 0.4% respectively). Subclinical hyperthyroidism and hypothyroidism were identified with similar frequency (2.1% 95%CI 1.8-2.3%; 2.9% 95%CI 2.6-3.1% respectively). Subclinical thyroid dysfunction was more common in females (P < 0.001) and with increasing age (P < 0.001). After allowing for co-morbidities, concurrent drug therapies, age and gender, an association between subclinical hyperthyroidism and a composite measure of socio-economic deprivation remained.

Conclusions: Undiagnosed overt thyroid dysfunction is uncommon. The prevalence of subclinical thyroid dysfunction is 5%. We have, for the first time, identified an independent association between the prevalence of subclinical thyroid dysfunction and deprivation that cannot be explained solely by the greater burden of chronic disease and/or consequent drug therapies in the deprived population.
Key words: sub-clinical thryoid dysfunction • prevalence • deprivation • Thyroid • TSH - Thyrotropin Stimulating Hormone




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