Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 276

The USPSTF does not currently recommend TSH screening of all older adults on the basis of lack of data. However, they recommend targeted TSH screening for symptomatic patients and those with certain risk factors for thyroid disease. The ACP suggests office screening of women older than 50 may be indicated. However, the evidence for treating subclinical thyroid dysfunction is inconclusive. The American Thyroid Association (ATA) issued guidelines that recommend measuring TSH levels starting at age 35 and every five years thereafter. The American Academy of Clinical Endocrinology (AACE) recommends routine TSH screening in older adults without specifying the age to start screening.⁴⁷ Hypothyroidism may not be associated with adverse outcomes in the oldest individuals when detected by screening alone. A prospective study involving individuals 85 or older did not show an association of elevated TSH levels with reduction in cognitive function, mood, or performance of ADLs. Higher TSH levels were associated with lower all‐cause and cardiovascular mortality.⁴⁸ Many geriatricians advocate screening high‐risk patients such as the nursing home population, frail elderly, and patients with dementia.⁴⁹ The sensitive TSH assay is probably the screening test of choice