Hypothyroidism does not always have to be treated

Thyroid hypofunction: controlling values ​​- but not always treating them

At least two percent of women in Germany suffer from hypofunction of the thyroid gland. Men are much less affected. According to experts, the disease does not need to be treated in all cases. However, it is important to check the TSH value. This is indicated by the German Society of Endocrinology (DGE).

Women more often affected than men

According to the Association of German internists (BDI) at least two percent of all women, but only about 0.1 to 0.2 percent of men suffer from hypothyroidism. According to the experts, this is usually discovered between the ages of 40 and 60. "The incidence rate increases with age," the experts write on their website "Internal Medicine on the Net". However, according to the German Society of Endocrinology (DGE), not all those affected need to be treated.

At least two percent of women suffer from hypothyroidism. Men are much less affected. The disease does not always have to be treated. (Image: Gabriel Blaj / fotolia.com)

Effects on the complete metabolism

Symptoms that may indicate that the thyroid gland is no longer controlling hormone production include fatigue, sensitivity to coldness, sleep disorders, hair loss, weight gain, and depressive moods.

However, such symptoms alone are not meaningful. The diagnosis of hypothyroidism is not always easy. Usually, the TSH value in the blood is used for this.

However, over the age of 65, the TSH value, which indicates whether thyroid dysfunction is present, is higher for older people than for younger people.

Higher does not necessarily mean that the subfunction must be treated. There may also be a spontaneous normalization of TSH levels, and the guidelines therefore recommend a very cautious approach.

Experts from the German Society of Endocrinology (DGE) point out this in a communication published by the Information Service Science (idw).

Increased TSH levels are common

In the thyroid gland, the two central hormones, thyroxine (T4) and triiodothyronine (T3) are formed, which affect the metabolism, cardiovascular system and growth.

The organ is regulated by the pituitary gland, whose thyro-stimulating hormone (TSH) stimulates iodine uptake and hormone production in the thyroid gland. For adults, a TSH reference range of approximately 0.4 to 4.0 mU / l applies.

"Increased TSH levels are common. If they are above the defined laboratory reference range, physicians often interpret them automatically as thyroid dysfunction and classify them as latent or subclinical hypothyroidism, "says Professor Dr. med. Dr. med. Dagmar Führer, Member of the Advisory Board of the DGE Section Thyroid.

But not always behind a morbid result: "Especially in older people, in which the TSH value is increased due to the age anyway, in which the symptoms are variable and often also accompanying diseases, the doctor has to interpret the laboratory values Include the age factor, "says Führer, who heads the Department of Endocrinology, Diabetology and Metabolism at Essen University Hospital.

Patients do not benefit from the therapy

Researchers in a large, five-year study, published in the New England Journal of Medicine, examined the impact that age has on the benefits of treating thyroid hormone replacement in the elderly.

The TRUST trial involved a total of 737 over 65 year-olds with TSH between 4.60 and 19.99 mU / L. One half of the group received the active substance levothyroxine for hormone replacement, the other half a placebo.

After one year of therapy, no improvements in quality of life and fatigue were observed.

The authors of the TRUST study concluded that elderly people do not benefit from drug treatment with levothyroxine because nothing changes in the patient's condition.

"Deriving new recommendations from these results would be wrong," explains Führer.

Slightly elevated levels spontaneously normalized

A differentiated analysis of the study showed long-known control systems of thyroid hormones.

"Sixty percent of the study population with TSH elevation - that was 2,647 individuals - had normal thyroid levels at a later follow-up visit," said the expert.

Slightly elevated TSH values ​​of up to 7 mU / l frequently spontaneously normalized. This was also shown by earlier investigations. For the clinical everyday life this means: A low elevated TSH value must first be confirmed.

That means he should be checked after two to three months; only after that a further clarification on a causative thyroid disease is indicated. If the TSH value is> 10 mU / l, there is an increased risk of lipid disorders, cardiovascular events and impaired quality of life.

Diagnostic and therapy recommendations

A pragmatic recommendation would therefore be to start a thyroid hormone substitution on this value for older patients suffering from other diseases such as hypertension, obesity, coronary heart disease or diabetes.

"The value to be achieved should be adjusted to age; So in older patients quite on TSH concentrations of 4 to 6 mU / l, "said Führer.

Incidentally, the participants in the TRUST study had an average of 6.4 mU / l TSH values ​​before the start of therapy. That should explain why no treatment benefit occurred, "adds the expert from Essen.

The TRUST results do not change the current - also guideline - diagnostic and treatment recommendations. You confirm them sooner. (Ad)