A Neglected Point: Frailty in Older Adults with Differentiated Thyroid Cancer.

IF 3.9 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrinology and Metabolism Pub Date : 2024-11-05 DOI:10.3803/EnM.2024.2046

Meric Coskun, Esra Cataltepe, Hacer Dogan Varan, Eda Ceker, Yasemin Bektas, Yasemin Kuscu, Mehmet Muhittin Yalcin, Mujde Akturk, Fusun Balos Toruner, Mehmet Ayhan Karakoc, Alev Eroglu Altinova

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Abstract

Background: This study investigated the risk of frailty in older adults with differentiated thyroid cancer (DTC) and the effect of thyroid- stimulating hormone (TSH) levels on frailty.

Methods: This single-center, cross-sectional study included 70 DTC patients aged ≥60 years with stable TSH levels during the previous year while receiving levothyroxine. Frailty was assessed using the fried frailty phenotype (FFP). Anterior thigh muscle thickness was measured by ultrasound, and the sonographic thigh adjustment ratio (STAR) index was calculated. Muscle strength was measured using a hand dynamometer. Physical activity was determined by the physical activity scale for the elderly (PASE).

Results: The median (interquartile range) age and follow-up time were 65 years (62 to 71) and 11 years (7.0 to 14.2), respectively. The median TSH level was 1.10 μIU/mL (0.49 to 1.62), and 58.6% of patients were prefrail/frail. Muscle mass and strength were reduced in 35.7% and 17.2% of patients, respectively. TSH levels were lower in those with prefrailty/frailty (P=0.002), low muscle mass (P=0.014), and low strength (P=0.037) than in their normal counterparts. TSH levels correlated negatively with FFP (P= 0.001) and positively with the STAR index (P=0.034). TSH below 1.325 μIU/mL was associated with an increased frailty risk (area under the curve=0.719; P=0.001). Low TSH, female sex, low handgrip strength, and low PASE leisure time scores emerged as independent predictors of frailty (P<0.05).

Conclusion: Older adults with lower TSH levels due to DTC are at high frailty risk and have low muscle mass and strength. Therefore, TSH targets should be set based on a comprehensive evaluation with consideration of the risk-benefit ratio.

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一个被忽视的问题：患有分化型甲状腺癌的老年人的虚弱。

研究背景这项研究调查了患有分化型甲状腺癌（DTC）的老年人出现虚弱的风险，以及促甲状腺激素（TSH）水平对虚弱的影响：这项单中心横断面研究纳入了70名年龄≥60岁、前一年促甲状腺激素水平稳定且正在接受左甲状腺素治疗的DTC患者。评估虚弱程度时使用了 "油炸虚弱表型"（FFP）。通过超声波测量大腿前侧肌肉厚度，并计算超声大腿调整比（STAR）指数。使用手部测力计测量肌肉力量。体力活动量由老年人体力活动量表（PASE）确定：中位年龄（四分位数间距）和随访时间分别为 65 岁（62 至 71 岁）和 11 年（7.0 至 14.2 年）。促甲状腺激素水平中位数为 1.10 μIU/mL （0.49 至 1.62），58.6% 的患者为先天性或后天性体弱。分别有 35.7% 和 17.2% 的患者肌肉质量和力量下降。与正常人相比，体弱前期/体弱患者的促甲状腺激素水平较低（P=0.002），肌肉质量较低（P=0.014），力量较低（P=0.037）。TSH 水平与 FFP 呈负相关（P= 0.001），与 STAR 指数呈正相关（P=0.034）。TSH 低于 1.325 μIU/mL 与虚弱风险增加有关（曲线下面积=0.719；P=0.001）。低促甲状腺激素、女性性别、低手握力和低 PASE 闲暇时间得分是导致虚弱的独立预测因素（结论：因 DTC 导致促甲状腺激素水平较低的老年人有较高的虚弱风险，且肌肉质量和力量较低。因此，应在综合评估的基础上设定 TSH 目标，并考虑风险效益比。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Endocrinology and Metabolism Medicine-Endocrinology, Diabetes and Metabolism

CiteScore

6.60

自引率

5.90%

发文量

145

审稿时长

24 weeks

期刊介绍： The aim of this journal is to set high standards of medical care by providing a forum for discussion for basic, clinical, and translational researchers and clinicians on new findings in the fields of endocrinology and metabolism. Endocrinology and Metabolism reports new findings and developments in all aspects of endocrinology and metabolism. The topics covered by this journal include bone and mineral metabolism, cytokines, developmental endocrinology, diagnostic endocrinology, endocrine research, dyslipidemia, endocrine regulation, genetic endocrinology, growth factors, hormone receptors, hormone action and regulation, management of endocrine diseases, clinical trials, epidemiology, molecular endocrinology, neuroendocrinology, neuropeptides, neurotransmitters, obesity, pediatric endocrinology, reproductive endocrinology, signal transduction, the anatomy and physiology of endocrine organs (i.e., the pituitary, thyroid, parathyroid, and adrenal glands, and the gonads), and endocrine diseases (diabetes, nutrition, osteoporosis, etc.).