The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Special Section

The Oldest Old Subclinically Hypothyroid Subjects with Pre-Existing Atrial Fibrillation Might not Benefit from Replacement Therapy

Authors: Oscar Jolobe, MRCP

Abstract

To the Editor:


Notwithstanding the proposal by Pipili and Cholongitas1 in the August issue of the SMJ, that subclinical hypothyroidism is detrimental to cardiovascular status, it is worth noting that “in the general population of the oldest old, elderly individuals with abnormally high levels of thyrotropin do not experience adverse effects and may have a prolonged life span”.2 In that prospective, observational, and population-based follow-up study of subjects aged 85 or more with complete thyroid status at baseline, increasing levels of thyrotropin were associated with a decreased risk of cardiovascular mortality (sex-adjusted hazard rate, 0.66; 95% confidence interval, 0.48–0.98) as well as noncardiovascular mortality (sex-adjusted hazard ratio 0.84; 95% confidence interval, 0.66–1.07), and this remained true even after adjustments were made for baseline disability and health status.2

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References

1. Pipili C, Cholongitas E. Is pulverised levothyroxine a better therapeutic option in patients with heart failure? South Med J 2009;102:870–871.
 
2. Gussekloo J, van Exel E, de Craen AJM, et al. Thyroid status, disability and cognitive function, and survival in old age. JAMA 2004;292:2591–2599.
 
3. O'Donnell MJ, Valens N, Lansberg MG, et al. Thyroid replacement therapy and atrial fibrillation in acute ischemic stroke. Neurology 2006;67:1714–1715.
 
4. Cappola AR, Fried LP, Arnold AM, et al. Thyroid status, cardiovascular risk, and mortality in older adults. JAMA 2006;295:1033–1041.
 
5. Stewart S, Hart CL, Hole DJ, et al. A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley Study. Am J Med 2002;113:359–364.