Relationship between thyroid hormone levels and frailty in elderly community members
LIU Yutong1, CHEN Wei2, GAO Yang3, GUAN Bo4, LIU Ruihan1, YANG Mingyan1, CAO Jian1
1. the Fourth Department of Healthcare, National Clinical Research Center for Geriatric Diseases, the Second Medical Center of PLA General Hospital,Beijing 100853,China; 2. Outpatient Department, the 16th Recreation Center for Retired Cadres in Fengtai District of Beijing Garrison, Beijing 100071,China; 3. Outpatient Department, the 55th Recreation Center for Retired Cadres in Haidian District of Beijing Garrison,Beijing 101199,China; 4. Department of Geriatrics, Suzhou Municipal Hospital, Suzhou 215002, China
Abstract：Objective To analyze the relationship between thyroid hormones (THs), frailty and the five components of frailty phenotype (fatigue, resistance, walking ability, number of illnesses, and weight loss) in the elderly. Methods Cross-sectional study with 487 community-dwelling elderly residents aged ≥80 years was conducted. A clear diagnosis of frailty was made based on the FRAIL scale (fatigue, resistance, walking, disease, and weight loss), and positive scores were recorded for each frailty subdomain. Demographic information (age, sex, marital status and education), comorbidities, and details of the participants’ lifestyles were also recorded. Laboratory tests were performed to determine serum THs, including free triiodothyronine (fT3), triiodothyronine (T3), free thyroxine (fT4), and thyroxine (T4), and thyroid stimulating hormone (TSH) levels. logistic regression of the data was performed to screen out potential risk factors for frailty and its subdomains. Results Of the 487 subjects enrolled, 60 (12.23%) were diagnosed with subclinical hypothyroidism, and 110 (22.59%) had a positive frailty score. Logistic regression analysis adjusted for all potential confounders showed that frailty was significantly associated with serum TSH concentration (OR:1.06), fT3 concentration (OR:0.54), and subclinical hypothyroidism (OR:2.18).The study showed no association between fT4 and frailty, whereas fT3/fT4 was associated with frailty. Conclusions Subclinical hypothyroidism, higher TSH levels, lower fT3 levels, and lower fT3/fT4 ratio are all associated with frailty as assessed by the FRAIL scale in community-dwelling elderly. Future longitudinal studies are needed to continue to determine the association between thyroid dysfunction and frailty in the elderly.
Zhang L,Zeng X,He F,et al. Inflammatory biomarkers of frailty: a review[J]. Exp Gerontol,2023,179:112253.
[2]
Clegg A, HassanS Z.Frailty and the endocrine system[J]. Lancet Diabetes Endo,2018,6(9):743-752.
[3]
He B,Ma Y,Wang C,et al.Prevalence and risk factors for frailty among community-dwelling older people in China: a systematic review and meta-analysis[J]. J Nutr Health Aging,2019,23(5):442-450.
[4]
Sharma P K,Reddy B M,Ganguly E.Frailty syndrome among oldest old individuals,aged≥80 years:prevalence ＆correlates[J]. J Frailty Sarcopenia Falls,2020,5(4):92-101.
[5]
Kamwa V,Welch C,Hassan S Z K.The endocrinology of sarcopenia and frailty[J].Minerva Endocrinol,2021,46(4):453-468.
[6]
Bertoli A,Valentini A,Cianfarani M A, et al. Low ft3: a possible marker of frailty in the elderly[J].Clin Interv Aging,2017,12:335-341.
[7]
Pilotto A,Custodero C,Maggi S,et al.A multidimensional approach to frailty in older people[J].Ageing Res Rev,2020,60:101047.
[8]
Clegg A,Young J,Iliffe S,et al.Frailty in elderly people[J].Lancet,2013,381(9868):752-762.
[9]
Rodriguez-Mañas L,Fried L P.Frailty in the clinical scenario[J]. Lancet,2015,385(9968):e7-e9.
[10]
Yeap B B,AlfonsoH,Chubb S A,et al. Higher free thyroxine levels are associated with frailty in older men: the health in men study[J].Clin Endocrinol,2012,76(5):741-748.
[11]
Murphy E,Glüer C C,Reid D M,et al. Thyroid function within the upper normal range is associated with reduced bone mineral density and an increased risk of nonvertebral fractures in healthy euthyroid postmenopausal women[J].J Clin Endocrinol Metab,2010,95(7):3173-3181.
[12]
Zeng L,Kong L N,Fang Q,et al.Diagnostic accuracy of the frail scale for frailty screening in community-dwelling older adults with diabetes: a cross-sectional study[J].Geriatr Nurs,2023,52:115-120.
[13]
Liu Y,Sun Q,Zhang M,et al. Association between thyroid hormone levels and frailty in an older inpatient cohort: a cross-sectional study[J]. Ann Palliat Med,2021,10(6):6678-6686.
[14]
Lee Y J,Kim M H,Lim D J,et al.Exploring the association between thyroid function and frailty: Insights from representative Korean data[J].Endocrinol Metab,2023,38(6):729-738.
[15]
Franceschi C,Ostan R,Mariotti S,et al.The aging thyroid: a reappraisal within the geroscience integrated perspective[J]. Endocr Rev,2019,40(5):1250-1270.
[16]
Woo J,Leung J,Morley J E.Comparison of frailty indicators based on clinical phenotype and the multiple deficit approach in predicting mortality and physical limitation[J]. J Am Geriatr Soc,2012,60(8):1478-1486.
[17]
Hyde Z,Flicker L,Almeida O P,et al.Low free testosterone predicts frailty in older men: the health in men study[J]. J Clin Endocrinol Metab,2010,95(7):3165-3172.
[18]
Borzì A M,BiondiA,Basile F,et al.Diagnosis and treatment of hypothyroidism in old people: a new old challenge[J].Wien Klin Wochenschr,2020,132(5-6):161-167.
[19]
Bano A,Chaker L,Schoufour J, et al.High circulating free thyroxine levels may increase the risk of frailty: the rotterdam study[J]. J Clin Endocrinol Metab,2018,103(1):328-335.
[20]
Veronese N,Fernando W S,MaggiS,et al.Serum thyroid-stimulating hormone levels and frailty in the elderly: the progettoveneto anziani study[J].Rejuvenation Res,2017,20(3):165-172.
[21]
Kannan L,Shaw P A,Morley M P,et al.Thyroid dysfunction in heart failure and cardiovascular outcomes[J]. Circ Heart Fail,2018,11(12):e5266.
[22]
Xiu S,MuZ,Zhao L, et al.Low free triiodothyronine levels are associated with risk of frailty in older adults with type 2 diabetes mellitus[J].Exp Gerontol,2020,138:111013.
[23]
Pasqualetti G,Calsolaro V,Bernardini S,et al. Degree of peripheral thyroxin deiodination, frailty, and long-term survival in hospitalized older patients[J]. J Clin Endocrinol Metab,2018,103(5):1867-1876.
[24]
Ostan R,Monti D,Mari D,et al.Heterogeneity of thyroid function and impact of peripheral thyroxine deiodination in centenarians and semi-supercentenarians: association with functional status and mortality[J].J Gerontol A Biol Sci Med Sci,2019,74(6):802-810.
[25]
Arosio B,Monti D,Mari D,et al.Thyroid hormones and frailty in persons experiencing extreme longevity[J]. Exp Gerontol,2020,138:111000.
2024, Vol. 35 
