Subclinical Hypothyroidism: is it Really Subclinical with Aging?

No recent study has focused on clinical features of subclinical hypothyroidism (SCH), especially in older patients. TSH measurement has remarkably evolved these last 20 years and thus reconsideration is needed. In our prospective multicenter study (2012-2014) including 807 subjects aged <60 years (<60y) and 531 subjects ≥60 years (≥60y), we have monitored 11 hypothyroidism-related clinical signs (hCS) together with TSH, FT4, FT3 and anti-thyroperoxidase antibodies values. hCS expression has been compared in patients with SCH vs euthyroidism in each age group. The number of hCS above 60y of age were found to be more elevated in the euthyroid population (1.9 vs 1.6, p<0.01) than in the SCH population (2.3 vs 2.6, p=0.41) while increase in hCS is limited to SCH subjects in the <60y group (p<0.01). The percentage of subjects with at least 3 signs increased with SCH in the <60y group (42.6% vs 25.0%, p<0.01) but not ≥60y (34.4% vs 33.9%, p=0.96). In older individuals, only three hCS could be related to both SCH and a decreased T3/T4-ratio (0.26 vs 0.27, p<0.01), suggesting either a reduced activity of TSH, or an adaptive response with aging. While hCS are clearly associated with SCH in patients <60y, they are not so informative in older subjects. TSH measurements carried out on the basis of hCS need to be interpreted with caution in aged patients. A reassessment of the TSH reference range in older patients is clearly needed and should be associated to more appropriate monitoring of thyroid dysfunction.

Pilot study: effectiveness of a training program about autonomy in elderly patients hospitalized after an acute episode.

Patients hospitalized in rehabilitation after an acute episode is at high risk of functional impairment and require active measures to prevent loss of autonomy. Resistance training has been proved beneficial to improve physical performances of aged subjects in the community. However, the feasibility and effects of training programs has never been assessed among hospitalized patients after an acute medical episode. In this pilot study, we aimed to evaluate a personalized training program of adapted physical education teacher combining muscular reinforcement and endurance training among patients over 65 year-old hospitalized in a geriatric rehabilitation care setting. The principal outcome considered was the evolution of the SPPB (short physical performance battery) score from baseline, after the 3-week period of training. Thirty-eight patients (mean age> 80 years) participated to the program. The mean SPPB score at baseline was 6.37 points (standard deviation: 2.17). After the intervention, the SPPB showed a significant improvement of 2.50 points, to reach 8.87 points (standard deviation: ±1.60; p=0.001). These results confirm the feasibility of resistance-training programs among hospitalized elderly. The observed improvements in terms of physic al performances also appear promising with regard to the prevention of loss of autonomy during rehabilitation after acute medical episodes.