title: The natural history of subclinical hypothyroidism in the elderly: the cardiovascular health study.
abstract: BACKGROUND
  Studies of long-term outcomes of subclinical hypothyroidism have assessed only baseline thyroid function, despite natural transitions to euthyroidism and overt hypothyroidism over time.
  
  
  OBJECTIVE
  We provide estimates of persistence, resolution, and progression of subclinical hypothyroidism over 4 yr, stratified by baseline TSH, anti-thyroid peroxidase antibody (TPOAb) status, age, and sex.
  
  
  METHODS
  Participants were 3996 U.S. individuals at least 65 yr old enrolled in the Cardiovascular Health Study. Subclinical hypothyroidism was detected at baseline in 459 individuals not taking thyroid medication.
  
  
  METHODS
  Thyroid function was evaluated at 2 and 4 yr and initiation of thyroid medication annually. Results were stratified by baseline TSH, TPOAb status, age, and sex.
  
  
  RESULTS
  Persistence of subclinical hypothyroidism was 56% at 2 and 4 yr. At 2 yr, resolution was more common with a TSH of 4.5-6.9 mU/liter (46 vs. 10% with TSH 7-9.9 mU/liter and 7% with TSH ≥10 mU/liter; P < 0.001) and with TPOAb negativity (48 vs. 15% for positive; P < 0.001). Higher TSH and TPOAb positivity were independently associated with lower likelihood of reversion to euthyroidism (P < 0.05). TSH of 10 mU/liter or higher was independently associated with progression to overt hypothyroidism (P < 0.05). Transitions between euthyroidism and subclinical hypothyroidism were common between 2 and 4 yr. Age and sex did not affect transitions.
  
  
  CONCLUSIONS
  Subclinical hypothyroidism persists for 4 yr in just over half of older individuals, with high rates of reversion to euthyroidism in individuals with lower TSH concentrations and TPOAb negativity. Future studies should examine the impact of transitions in thyroid status on clinical outcomes.
authors.affiliation: Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104-5160, USA.
authors.forename: Lily L
authors.initials: LL
authors.lastname: Somwaru
authors.forename: Chevon M
authors.initials: CM
authors.lastname: Rariy
authors.forename: Alice M
authors.initials: AM
authors.lastname: Arnold
authors.forename: Anne R
authors.initials: AR
authors.lastname: Cappola
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000188:drug therapy* / Q000453:epidemiology*; D007453:Iodide Peroxidase / Q000276:immunology; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D013972:Thyrotropin / Q000097:blood
chemical_list: D001323:Autoantibodies; D013972:Thyrotropin; D007453:Iodide Peroxidase