Search

Context: Prevalence estimates and evidence informing treatment targets for thyroid dysfunction largely come from studies of middle-aged adults. There are limited data on the prevalence of thyroid dysfunction in older populations. Objective: To determine the prevalence of thyroid dysfunction and risk factors for abnormal thyroid tests in older adults. Methods: We conducted a cross-sectional analysis of data from participants aged 65 or older in the Atherosclerosis Risk in Communities (ARIC) study who attended visit 5 in 2011-2013. We measured serum concentrations of triiodothyronine (T3), free thyroxine (FT4), thyroid peroxidase antibody (Anti-TPO), and thyroid stimulating hormone (TSH) in 5,392 participants. We used multivariable linear and logistic regression to assess associations of demographic and clinical risk factors with thyroid hormone levels. Results: In this population of older adults (mean age 76; 56% women and 22% black), the prevalence of thyroid dysfunction was up to 25% when accounting for treated and untreated thyroid dysfunction categories. 15.6% reported use of medication for thyroid dysfunction. Among those not being treated, the prevalence of overt chemical hypothyroidism was 6.0% and subclinical hypothyroidism was 0.82%. Overt chemical hyperthyroidism and subclinical hyperthyroidism affected 0.26% and 0.78% of the population, respectively. Multivariable adjusted cardiovascular risk factor associations for TSH, FT4 and T3 levels are presented in Table . Men were less likely to be anti-TPO positive compared to women (OR=0.59, CI: 0.47,0.75, P Conclusions: There is a high prevalence of thyroid dysfunction in this older, community-based population. Prevalence of thyroid dysfunction and thyroid hormone levels vary with sex, race, age group and multiple cardiovascular risk factors. Accounting for these associations in the clinical setting might prove useful in improving thyroid function assessment in this age group.

Introduction: Systemic sclerosis related pulmonary arterial hypertension (SScPAH) is characterized by a worse prognosis in comparison to idiopathic pulmonary arterial hypertension (IPAH). The estimated mortality risk reported in the current European guidelines for pulmonary hypertension has been evaluated mostly in IPAH patients. The aim of this study was to explore the ability of the risk assessment proposed in the guidelines to predict long-term mortality in SScPAH patients. Methods: The study population constituted patients diagnosed with SScPAH and prospectively enrolled in the Johns Hopkins Pulmonary Hypertension Program from 2000-2016. Patients with assessment of WHO functional class, 6-minute walking distance (6MWD), and right heart catheterization measurements at diagnosis were included in the analysis. A Cox proportional hazards model was used to examine the adjusted hazard ratio (HR) of mortality for each of the following four low-risk criteria: WHO functional class I-II, 6MWD >440m, right atrial pressure 2 . A Kaplan-Meier curve was plotted to describe overall survival at 5 years. Results: 151 patients (mean age 61.2, 84.8% female) were included in the analysis. Over a mean follow-up period of 4.9 years, 87 patients (57.6%) died. In Cox proportional hazards multivariate analysis, the HR (95%CI) of mortality compared to the presence of no low-risk criteria was 0.65 for one criterion (0.37-1.15), 0.34 for two (0.17-0.68), 0.16 for three (0.06-0.44), and 0.10 for four (0.01-0.78). Figure 1 describes the 5-year survival according to the number of criteria. Conclusion: Our study highlights that only a small proportion of SScPAH patients are diagnosed at an early stage of PAH disease, suggesting the need of more intense PAH screening programs for this population. Current guidelines for risk assessment in IPAH patients can also be helpful in SScPAH patients, particularly in identifying patients at higher risk of mortality.