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Increased reverse triiodothyronine is associated with shorter survival in independently-living elderly: the Alsanut study

¹ Service de Médecine Interne et Nutrition, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Avenue Molière, 67098 Strasbourg Cedex, France² Faculté de Médecine,, 4 rue Kirschleger, 67085 Strasbourg Cedex, France³ Laboratoire de Biophysique, ULP/CNRS UMR 7191, Hôpital Civil, 67091 Strasbourg Cedex, France

(Correspondence should be addressed to B Goichot; Email: bernard.goichot{at}chru-strasbourg.fr)

Objective: Increased reverse tritiodothyronine (T₃) used to be described as a part of euthyroid sick syndrome (ESS). It was demonstrated to be associated with increased mortality in acutely ill patients. It can also be found with low or normal T₃ in non-severely ill subjects but its significance remains unclear.

Patients and design: The Alsanut study included a representative sample of 440 independently-living subjects aged 65 or over constituted between January 1988 and September 1989. Past and current medical history and nutritional data were collected at inclusion. Baseline thyroid hormone (TSH, FT₄, FT₃ and rT₃) serum levels were measured. Life status was determined on 1 December 2005.

Results: Of the 374 elderly subjects included in the final analysis, 52 had abnormal TSH (43 with hyperthyroidism, nine with hypothyroidism) and 80.7% had died by 1 December 2005. There was no statistical difference in survival between subjects according to thyroid function (P=0.54). Of the 322 elderly subjects with normal TSH, mortality rate was 81.1%. ESS was found in 3.4%, whereas 8.1% of the participants displayed elevated rT₃ with normal FT₃. Time to death was strongly related to rT₃ (P<0.0001) and FT₃ (P<0.0001) in a univariate analysis. After adjusting for other confounding variables, rT₃ was the only thyroid hormone associated with shorter survival (P=0.014).

Conclusions: RT₃ was the only thyroid hormone associated with shorter survival in a representative population of independently-living elderly. In these subjects, isolated elevated rT₃ might be an equivalent of ESS, reflecting declining health.

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