Endogenous and Exogenous Thyrotoxicosis and Risk of Incident Cognitive Disorders in Older Adults
Main finding · Cognitive disorder diagnosisResult — go to the resultAdjusted hazard ratio 1.39 95% CI 1.18–1.64Authors' conclusion
In this cohort study among patients 65 years and older, a low TSH level from either endogenous or exogenous thyrotoxicosis was associated with higher risk of incident cognitive disorder. Iatrogenic thyrotoxicosis is a common result of thyroid hormone therapy. With thyroid hormone among the most common prescriptions in the US, understanding the negative effects of overtreatment is critical to help guide prescribing practice.
Study context
- Population
- Patients ≥65 years with ≥2 primary care visits 30 days apart, Johns Hopkins Community Physicians Network, 2014–2023; no history of low TSH or cognitive disorder within 6 months of first visit; median age 68.0 years, 56% female
- Participants
- 65,931 patients
- Exposure
- Thyrotoxicosis vs no exposure
- Outcome
- Incident cognitive disorders, including mild cognitive impairment and all-cause dementia
Methodological detailslongitudinal time-varying analysis, electronic health records
- Longitudinal time-varying analysis
- Electronic health records
Main finding
Cognitive disorder diagnosis
Adjusted hazard ratio
1.39
95% CI 1.18–1.64
P < 0.001
Thyrotoxicosisvs Not exposed
aHR 1.39 (95% CI 1.18–1.64); P < 0.001
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | aHR (95% CI) | P value | |
|---|---|---|---|
| Cognitive disorder diagnosis, exogenous thyrotoxicosisExogenous thyrotoxicosisvs Not exposedPoint estimates suggestive of a dose response | 1.34 (1.10–1.63) | P = 0.003 | |
| 0.512Adjusted hazard ratio (log scale) |
| Outcome | Thyrotoxicosis | Not exposed |
|---|---|---|
| Cognitive disorder incidence by age 75 years | 11.0% (CI 8.4%–14.2%) | 6.4% (CI 6.0%–6.8%) |
Original publication
Endogenous and Exogenous Thyrotoxicosis and Risk of Incident Cognitive Disorders in Older Adults. JAMA Intern Med. Published 1 December 2023. doi:10.
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