{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T18:35:19Z","timestamp":1780338919170,"version":"3.54.1"},"reference-count":26,"publisher":"Georg Thieme Verlag KG","issue":"09","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Horm Metab Res"],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The aim of this study was to investigate in a longitudinal approach whether levothyroxine (LT4) substitution has a different impact on quality of life (QoL) and thyroid related QoL in younger (&lt;40 years) and older subjects (&gt;60 years) with elevated thyroid-stimulating hormone (TSH) concentrations. The study included male and female patients with newly diagnosed, untreated subclinical hypothyroidism defined by TSH&gt;8\u2009mU\/l. Patients were recruited throughout Germany from 2013\u20132016 and evaluated by clinical assessment, blood sampling and questionnaires for health related QoL and thyroid-disease thyroid-related QoL (ThyPRO) at time of diagnosis and six months after initiation of LT4 treatment. We found significantly lower QoL in both young and old patients with subclinical hypothyroidism compared to age-matched healthy individuals. Higher scores on follow-up were found in all patients irrespective of age, indicating better QoL on LT4 therapy. Analysis of the ThyPRO questionnaire showed that old patients experienced less Emotional Susceptibility, Tiredness, and Impaired Day Life on LT4, while young patients reported less Cognitive Complaints, Emotional Susceptibility, and Impaired Day Life compared to baseline assessment. Hypothyroidism with TSH concentrations&gt;8\u2009mU\/l is associated with impairment in general and ThyPRO QoL in young and old age. Older patients benefited from LT4 therapy and remarkably show similar degree of improvement as younger patients, albeit with some thematic variation in ThyPRO QoL. Our data confirm current recommendations on initiation of LT4 substitution and suggest that this should not be withheld in elderly with TSH concentration above 8\u201310\u2009mU\/l.<\/jats:p>","DOI":"10.1055\/a-0897-8785","type":"journal-article","created":{"date-parts":[[2019,9,10]],"date-time":"2019-09-10T22:52:31Z","timestamp":1568155951000},"page":"568-574","source":"Crossref","is-referenced-by-count":18,"title":["Thyroid Related Quality of Life in Elderly with Subclinical Hypothyroidism and Improvement on Levothyroxine is Distinct from that in Young Patients (TSAGE)"],"prefix":"10.1055","volume":"51","author":[{"given":"Stefanie","family":"Recker","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Clinical Chemistry \u2013 Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Voigtl\u00e4nder","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Clinical Chemistry \u2013 Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Viehmann","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Clinical Chemistry \u2013 Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Dunschen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Clinical Chemistry \u2013 Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Kerp","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Clinical Chemistry \u2013 Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Frank-Raue","sequence":"additional","affiliation":[{"name":"Endocrine Practice, Molecular Laboratory, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gudrun","family":"Leidig-Bruckner","sequence":"additional","affiliation":[{"name":"Endocrine Practice, Molecular Laboratory, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dieter","family":"Graf","sequence":"additional","affiliation":[{"name":"Endocrine and Nuclear Medicine Center L\u00fcneburg, L\u00fcneburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Lederbogen","sequence":"additional","affiliation":[{"name":"Private Endocrine Practice, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes W.","family":"Dietrich","sequence":"additional","affiliation":[{"name":"Endocrinology and Diabetes Department, Medical Hospital I, Bergmannsheil University Hospitals, Ruhr University Bochum, Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"G\u00f6rges","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Medical Faculty, University Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Brabant","sequence":"additional","affiliation":[{"name":"Experimental and Clinical Endocrinology, Medical Clinic I, University of Luebeck, Luebeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe","family":"V\u00f6lker","sequence":"additional","affiliation":[{"name":"Institute for Genetics and Functional Genome Research, University of Greifswald, Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torquil","family":"Watt","sequence":"additional","affiliation":[{"name":"Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Zwanziger","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Clinical Chemistry \u2013 Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars Christian","family":"Moeller","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Clinical Chemistry \u2013 Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0357-4192","authenticated-orcid":false,"given":"Dagmar","family":"F\u00fchrer","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Clinical Chemistry \u2013 Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2019,9,10]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1159\/000356507","article-title":"ETA Guideline: Management of Subclinical Hypothyroidism","volume":"2","author":"S H Pearce","year":"2013","journal-title":"Eur Thyroid J"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1089\/thy.2016.0229","article-title":"American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis","volume":"26","author":"D S Ross","year":"2016","journal-title":"Thyroid"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1017\/S0959259809990281","article-title":"Thyroid disorders in older people","volume":"19","author":"A Verma","year":"2009","journal-title":"Rev Clin Gerontol"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1210\/jc.2008-2325","article-title":"Extreme longevity is associated with increased serum thyrotropin","volume":"94","author":"G Atzmon","year":"2009","journal-title":"J Clin Endocrinol Metab"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1210\/jcem.87.2.8182","article-title":"Serum TSH, T4, and Thyroid Antibodies in the United States Population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III)","volume":"87","author":"J G Hollowell","year":"2002","journal-title":"J Clin Endocrinol Metab"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1210\/jc.2009-1845","article-title":"Age- and race-based serum thyrotropin reference limits","volume":"95","author":"M I Surks","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1210\/jc.2004-1231","article-title":"Subclinical thyroid dysfunction: a joint statement on management from the American Association of Clinical Endocrinologists, the American Thyroid Association, and the Endocrine Society","volume":"90","author":"H Gharib","year":"2005","journal-title":"J Clin Endocrinol Metab"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1093\/eurheartj\/ehr404","article-title":"End-of-life preferences of elderly patients with chronic heart failure","volume":"33","author":"H P Brunner-La Rocca","year":"2012","journal-title":"Eur Heart J"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/j.kjms.2016.06.006","article-title":"Autoimmunity affects health-related quality of life in patients with Hashimoto's thyroiditis","volume":"32","author":"H Bektas Uysal","year":"2016","journal-title":"Kaohsiung J Med Sci"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1530\/eje.1.02124","article-title":"Quality of life in patients with benign thyroid disorders. A review","volume":"154","author":"T Watt","year":"2006","journal-title":"Eur J Endocrinol"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1023\/B:QURE.0000015315.35184.66","article-title":"Health-related quality of life in patients with thyroid disorders. A study based on Short-Form 36 and Nottingham Health Profile Questionnaires","volume":"13","author":"G P Bianchi","year":"2004","journal-title":"Qual Life Res"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1007\/BF02598988","article-title":"Does treatment with l-thyroxine influence health status in milddle-aged and older adults with subclinical hypothyroidism?","volume":"11","author":"R Jaeschke","year":"1996","journal-title":"J Gen Intern Med"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"3708","DOI":"10.1210\/jc.2014-1322","article-title":"The thyroid-related quality of life measure ThyPRO has good responsiveness and ability to detect relevant treatment effects","volume":"99","author":"T Watt","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"e0156925","DOI":"10.1371\/journal.pone.0156925","article-title":"Disease-specific as well as generic quality of life is widely impacted in autoimmune hypothyroidism and improves during the first six months of levothyroxine therapy","volume":"11","author":"K H Winther","year":"2016","journal-title":"PLoS One"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"2534","DOI":"10.1056\/NEJMoa1603825","article-title":"Thyroid hormone therapy for older adults with subclinical hypothyroidism","volume":"376","author":"D J Stott","year":"2017","journal-title":"N Engl J Med"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.archger.2006.02.001","article-title":"Subclinical hypothyroidism increases the risk for depression in the elderly","volume":"44","author":"V B Chueire","year":"2007","journal-title":"Arch Gerontol Geriatr"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1055\/s-2004-825925","article-title":"Depression and anxiety in different thyroid function states","volume":"36","author":"R Larisch","year":"2004","journal-title":"Horm Metab Res"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1530\/EJE-09-0521","article-title":"Validity and reliability of the novel thyroid-specific quality of life questionnaire, ThyPRO","volume":"162","author":"T Watt","year":"2010","journal-title":"Eur J Endocrinol"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1007\/s11136-014-0798-1","article-title":"Cross-cultural validity of the thyroid-specific quality-of-life patient-reported outcome measure, ThyPRO","volume":"24","author":"T Watt","year":"2015","journal-title":"Qual Life Res"},{"key":"ref20","volume-title":"SF-36 Fragebogen zum Gesundheitszustand","author":"M Bullinger","year":"1998"},{"key":"ref21","volume-title":"Statistical power analysis for the behavioral sciences","author":"J Cohen","year":"1988"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1111\/cen.12939","article-title":"Natural history of subclinical hypothyroidism with TSH \u226410 mIU\/l: a prospective study","volume":"84","author":"P W Ros\u00e1rio","year":"2016","journal-title":"Clin Endocrinol"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.amjmed.2015.11.027","article-title":"Subclinical Thyroid Disease and Mortality in the Elderly: A Retrospective Cohort Study","volume":"129","author":"A Grossman","year":"2016","journal-title":"Am J Med"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1530\/EJE-10-1021","article-title":"Variation in thyroid function in subclinical hypothyroidism: importance of clinical follow-up and therapy","volume":"164","author":"J Karmisholt","year":"2011","journal-title":"Eur J Endocrinol"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1111\/cen.13174","article-title":"Levothyroxine therapy in the subclinical hypothyroidism: a lifelong therapy? A long-term study","volume":"85","author":"P W Rosario","year":"2016","journal-title":"Clin Endocrinol (Oxf)"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"2545","DOI":"10.1210\/jc.2007-0011","article-title":"Health status, mood, and cognition in experimentally induced subclinical hypothyroidism","volume":"92","author":"M H Samuels","year":"2007","journal-title":"J Clin Endocrinol Metab"}],"container-title":["Hormone and Metabolic Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-0897-8785.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,4]],"date-time":"2021-08-04T22:58:39Z","timestamp":1628117919000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-0897-8785"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9]]},"references-count":26,"journal-issue":{"issue":"09","published-online":{"date-parts":[[2019,9,10]]},"published-print":{"date-parts":[[2019,9]]}},"URL":"https:\/\/doi.org\/10.1055\/a-0897-8785","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0018-5043","1439-4286"],"issn-type":[{"value":"0018-5043","type":"print"},{"value":"1439-4286","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9]]}}}