Thyroid function and life expectancy with and without noncommunicable diseases: A population-based study


Autoři: Arjola Bano aff001;  Layal Chaker aff001;  Francesco U. S. Mattace-Raso aff005;  Natalie Terzikhan aff002;  Maryam Kavousi aff002;  M. Arfan Ikram aff002;  Robin P. Peeters aff001;  Oscar H. Franco aff002
Působiště autorů: Department of Internal Medicine and Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, the Netherlands aff001;  Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands aff002;  Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland aff003;  Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland aff004;  Section of Geriatric Medicine, Erasmus Medical Center, Rotterdam, the Netherlands aff005
Vyšlo v časopise: Thyroid function and life expectancy with and without noncommunicable diseases: A population-based study. PLoS Med 16(10): e32767. doi:10.1371/journal.pmed.1002957
Kategorie: Research Article
doi: 10.1371/journal.pmed.1002957

Souhrn

Background

Variations in thyroid function within reference ranges are associated with increased risk of diseases and death. However, the impact of thyroid function on life expectancy (LE) with and without noncommunicable diseases (NCDs) remains unknown. We therefore aimed to investigate the association of thyroid function with total LE and LE with and without NCD among euthyroid individuals.

Methods and findings

The study was embedded in the Rotterdam Study, a prospective population-based study carried out in the Netherlands. In total, 7,644 participants without known thyroid disease and with thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels within reference ranges were eligible. NCDs were defined as presence of cardiovascular disease, diabetes mellitus type 2, or cancer. We used the demographic tool of multistate life tables to calculate LE estimates at the age of 50 years, using prevalence, incidence rates, and hazard ratios for three transitions (healthy to NCD, healthy to death, and NCD to death). The total LE and LE with and without NCD among TSH and FT4 tertiles were calculated separately in men and women. Analyses were adjusted for sociodemographic and cardiovascular risk factors. The mean (standard deviation) age of the participants was 64.5 (9.7) years, and 52.3% were women. Over a median follow-up of 8 years (interquartile range 2.7–9.9 years), 1,396 incident NCD events and 1,422 deaths occurred. Compared with those in the lowest TSH tertile, men and women in the highest TSH tertile were expected to live 1.5 years (95% confidence interval [CI] 0.8–2.3, p < 0.001) and 1.5 years (CI 0.8–2.2, p < 0.001) longer, respectively, of which 1.4 years (CI 0.5–2.3, p = 0.002) and 1.3 years (CI 0.3–2.1, p = 0.004) with NCD. Compared with those in the lowest FT4 tertile, the difference in LE for men and women in the highest FT4 tertile was −3.7 years (CI −5.1 to −2.2, p < 0.001) and −3.3 years (CI −4.7 to −1.9, p < 0.001), respectively, of which −1.8 years (CI −3.1 to −0.7, p = 0.003) and −2.0 years (CI −3.4 to −0.7, p = 0.003) without NCD. A limitation of the study is the observational design. Thus, the possibility of residual confounding cannot be entirely ruled out.

Conclusions

In this study, we found that people with low–normal thyroid function (i.e., highest tertile of TSH and lowest tertile of FT4 reference ranges) are expected to live more years with and without NCD than those with high–normal thyroid function (i.e., lowest tertile of TSH and highest tertile of FT4 reference ranges). These findings provide support for a re-evaluation of the current reference ranges of thyroid function.

Klíčová slova:

Cardiovascular diseases – Diabetes mellitus – Chronic obstructive pulmonary disease – Life expectancy – Medical education – Thyroid – Thyroid-stimulating hormone – Thyroxine


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2019 Číslo 10

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