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Prevalence of hypothyroidism in a southeastern nursing home.
MedLine Citation:
PMID:  12818044     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: It is common to find older patients who have received thyroid hormone replacement for years without clear-cut documentation of hypothyroidism. The diagnosis of hypothyroidism in older patients presents a difficult problem. OBJECTIVE: We sought to determine the prevalence of hypothyroidism and the sensitivity of clinical determinants for hypothyroidism during withdrawal of thyroid hormone therapy (vital signs, weight, MMSE, and depression scale) in a nursing home population. METHODS: We studied a cohort of patients in two nursing centers in southeast Georgia. Those receiving thyroid hormone without documented hypothyroidism had complete a physical examination and serum TSH, MMSE,depression scale assessment at baseline and 3 and 6 weeks after discontinuation of thyroid therapy. Weights and vital signs were monitored throughout the study. The hypothyroid state was defined by an attending physician by clear documentation of elevated TSH > 10 microIU/mL and clinical manifestation of hypothyroidism. RESULTS: Thirteen of 129 patients were receiving thyroid supplement; seven had documented hypothyroidism. Five of the six without documented hypothyroidism completed the study. Three of those five were found to be hypothyroid (TSH: 69.4-110.4 microIU/mL at 6 weeks of thyroid therapy). Among the clinical determinants, only weight correlated with elevated TSH and hypothyroidal state. At 6 weeks, the other two patients had borderline elevation of TSH, and one patient normalized at 4 months. Both had negative antimicrosomal antibodies and were considered euthyroid. CONCLUSIONS: The prevalence of true hypothyroidism ranged from 6.2% to 7.8%. We identified unnecessary therapy in two of 13 patients. Increased weight was the most sensitive indicator of evolving hypothyroidism.
Authors:
H Thong; A R Rahimi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American Medical Directors Association     Volume:  1     ISSN:  1525-8610     ISO Abbreviation:  J Am Med Dir Assoc     Publication Date:    2000 Jan-Feb
Date Detail:
Created Date:  2003-06-23     Completed Date:  2003-10-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100893243     Medline TA:  J Am Med Dir Assoc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  25-8     Citation Subset:  -    
Affiliation:
Department of Internal Medicine Education, Division of Geriatrics, Memorial Health University Medical Center, Savannah, GA 31403-3089, USA.
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