Mortality after hip fractures in the elderly is one of the most important patient outcome measures. Subclinical thyroid dysfunction is common in the elderly population. This is a prospective study of 131 elderly patients with a mean (SD) age of 82.0 (8.9) years (range: 61–94) admitted consecutively to our trauma unit. The aim of the study was to determine the prevalence of subclinical thyroid dysfunction in an elderly cohort of patients with hip fracture and to determine if this affects the one-year mortality.
There were three times more women (n = 100) than men (n = 31) in this cohort. All patients underwent surgical treatment for the hip fracture. The prevalence of subclinical hypothyroidism (TSH > 5.5 mU/L) was 15% (n = 20) and of subclinical hyperthyroidism (TSH < 0.35 mU/L) was 3% (n = 4). Overall 18% (n = 24) of patients had a subclinical thyroid dysfunction. The twelve-month mortality was 27% (n = 36).
Age, gender, heart rate at admission, pre-existing coronary heart disease, ASA grade and presence of overt or subclinical thyroid dysfunction were analysed for association with twelve-month mortality using a forward stepwise logistic regression analysis. Only ASA grade was found to significantly affect mortality at twelve months (χ2 = 3.98, df = 1, p = 0.046). Independently the presence of subclinical hypo- or hyperthyroidism was not associated with a higher mortality (p = 0.477). We conclude that subclinical thyroid dysfunction does not affect the one-year mortality in elderly patients treated surgically for hip fracture.
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- Thyroid status, cardiovascular risk, and mortality in older adults.JAMA. 2006; 295: 1033-1041
- Consensus statement: subclinical thyroid dysfunction: a joint statement on management from the American Association of Clinical Endocrinologists, the American Thyroid Association, and The Endocrine Society.J Clin Endocrinol Metab. 2005; 90: 581-585
- Thyroid status, disability and cognitive function, and survival in old age.JAMA. 2004; 292: 2591-2599
- Hip fracture mortality: relation to age, treatment, preoperative Illness, time of surgery, and complications.Clin Orthop Relat Res. 1984; 186: 45-56
- Meta-analysis: subclinical thyroid dysfunction and the risk for coronary heart disease and mortality.Ann Intern Med. 2008; 148: 832-845
- Predictors of mortality after hip fracture: a 10-year prospective study.Bull NYU Hosp Joint Dis. 2008; 66: 111-117
- Quality of life, morbidity, and mortality after low trauma hip fracture in men.Ann Rheum Dis. 2006; 65: 87-92
- A new mobility score for predicting mortality after hip fracture.J Bone Joint Surg (Br). 1993; 75: 797-798
- Sheppard MC prevalence and follow-up of abnormal thyrotropin (TSH) concentrations in the elderly in the United Kingdom.Clin Endocrinol. 1991; 34: 77-83
- Mortality risk after hip fracture.J Orthop Trauma. 2003; 17: 53-56
- The influence of cognitive function on outcome after a hip fracture.J Bone Joint Surg (Am). 2006; 88-A: 2115-2123
- Subclinical thyroid disease: scientific review and guidelines for diagnosis and management.JAMA. 2004; 291: 228-238
UK guidelines for the Use of Thyroid Function Tests. www.british-thyroid-association.org/guidelines; June 2006 [accessed 26.07.08].
- The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham survey.Clin Endocrinol (Oxf). 1995; 43: 55-68
- Thyroid hormone replacement for subclinical hypothyroidism.Cochrane Database Syst Rev. 2007; : CD003419
- Subclinical thyroid dysfunction as a risk factor for cardiovascular disease.Arch Intern Med. 2005; 165: 2467-2472
- The effect of hospital type and surgical delay on mortality after surgery for hip fracture.J Bone Joint Surg (Br). 2005; 87-B: 361-366
- Prevalence of subclinical thyroid dysfunction and its relation to socioeconomic deprivation in the elderly: a community-based cross-sectional survey.J Clin Endocrinol Metab. 2006; 91: 4809-4816
Accepted: October 5, 2009
© 2009 Published by Elsevier Inc. All rights reserved.