PREVALENCE OF THYROID-DYSFUNCTION IN DIFFERENT GERIATRIC SUBPOPULATIONS FROM A MODERATELY IODINE-DEFICIENT HUNGARIAN REGION - COMPARATIVE CLINICAL AND HORMONAL SCREENING

The aim of this study was to investigate the prevalence of thyroid dysfunction in different geriatric subpopulations from a moderately iodine-deficient Hungarian region and to compare the efficacy of clinical versus hormonal screening. A screening study was done on 279 chronically ill geriatric patients (Group I) and 256 consecutive hospital admissions over 60 years of age (Group II). The method of clinical screening was different from those used so far: the object was not to search for symptoms of hypo- or hyperthyroidism but to find any sign justifying a further thyrotrophin-based biochemical evaluation, i.e. history of thyroid disease or goitre or any clinical sign of hormonal dysfunction. The rates of overt hypothyroidism, overt hyperthyroidism, subclinical hypothyroidism and subclinical hyperthyroidism discovered by the hormonal screening were 2.9, 1.1, 3.6 and 5.7% in Group I and 3.5, 2.3, 3.9 and 2.01 in Group II. The sensitivities of the clinical screening to suspect overt or overt + subclinical dysfunctions were, respectively, 0.82 and 0.64 in Group I and 1.0 and 0.7 in Group II (or 0.67 and 0.4 if the clinical investigation was done not by an endocrinologist but by the medical attendants). A primarily clinical investigation-based screening would have spared 171/279 thyrotrophin estimation in Group I and 161/256 in Group II, but would have missed 3/11 overt and 11/26 subclinical dysfunctions in Group I. In Group II, no overt but 9/15 subclinical dysfunctions would have been lost in this way, Our approach of a clinical investigation-based screening was rather efficient in suspicion of overt thyroid dysfunction but failed to detect many cases with subclinical dysfunction. As there is increasing evidence from the literature on the clinical importance of subclinical thyroid dysfunction states, the primary screening method should be biochemical, at least in the elderly sick. The prevalence of overt and subclinical dysfunctions would justify the screening of chronically ill hospitalized geriatric patients.