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      MANAGEMENT OF ENDOCRINE DISEASE: l-Thyroxine replacement therapy in the frail elderly: a challenge in clinical practice.

      1 , 2 , 3
      European journal of endocrinology
      Bioscientifica

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          Abstract

          The number of elderly people, mostly aged over 85 years (the 'oldest old'), is increasing worldwide. As a consequence, accompanying morbidity and disability have been increasing, and frailty, defined as an age-related condition of decline of physiological reserves and vulnerability, represents an emerging problem. Caring for older frail people may represent a challenge, since the elderly differ significantly from younger adults in terms of comorbidity, polypharmacy, pharmacokinetics and greater vulnerability to adverse drug reactions. Specific criteria of therapeutic appropriateness and modified goals of care are needed in such patients, also in endocrine care settings. Indeed, thyroid dysfunctions are among the most common conditions in older, multimorbid populations. The prevalence of overt and subclinical hypothyroidism is as high as 20% and thyroid hormone prescription is common in the elderly, with a trend toward levothyroxine treatment of more marginal degrees of hypothyroidism. In addition, older patients have the highest rate of overtreatment during replacement therapy and are more susceptible to developing adverse effects from thyroid hormone excess. Recently, results of a multicentric randomized controlled trial, the TRUST-IEMO collaboration trial, added further insights to the debated question of whether and when levothyroxine treatment is required and if it is beneficial in the elderly. With this in mind, we revised the relevant literature on the impact of thyroid dysfunction and replacement therapy among older people, with the aim to better define indications, benefits and risks of l-T4 replacement therapy in the frail elderly.

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          Author and article information

          Journal
          Eur. J. Endocrinol.
          European journal of endocrinology
          Bioscientifica
          1479-683X
          0804-4643
          Oct 2017
          : 177
          : 4
          Affiliations
          [1 ] Department of Clinical and Experimental MedicineUOC Endocrinology, University of Messina, Italy.
          [2 ] Accademia Peloritana dei PericolantiUniversity of Messina, Messina, Italy.
          [3 ] Department of Clinical Medicine and SurgeryUniversity of Naples Federico II, Naples, Italy bebiondi@unina.it.
          Article
          EJE-17-0321
          10.1530/EJE-17-0321
          28566447
          48b4488a-487d-4df9-a42b-835c9d36c1f7
          History

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