{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T11:29:44Z","timestamp":1793791784348,"version":"4.6.1"},"reference-count":85,"publisher":"Deutscher Arzte-Verlag GmbH","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"DOI":"10.3238\/arztebl.m2026.0161","type":"journal-article","created":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T11:05:53Z","timestamp":1793790353000},"source":"Crossref","is-referenced-by-count":0,"title":["Indications for dose adjustment of thyroid hormones in older patients"],"prefix":"10.3238","author":[{"given":"Joerg","family":"Bojunga","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktoria Florentine","family":"Koehler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Drey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelia","family":"Jaursch-Hancke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Denkinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"11437","published-online":{"date-parts":[[2026,11,13]]},"reference":[{"key":"10.3238\/arztebl.m2026.0161_ref1","doi-asserted-by":"crossref","unstructured":"Diab N, Daya NR, Juraschek SP, et al.: Prevalence and risk factors of thyroid dysfunction in older adults in the community. Sci Rep 2019; 9: 13156.","DOI":"10.1038\/s41598-019-49540-z"},{"key":"10.3238\/arztebl.m2026.0161_ref2","doi-asserted-by":"crossref","unstructured":"Hou X, Sun X, Xu S, Li Y: Thyroid disease in ageing populations. Endocr Connect 2025; 14: e250393.","DOI":"10.1530\/EC-25-0393"},{"key":"10.3238\/arztebl.m2026.0161_ref3","doi-asserted-by":"crossref","unstructured":"Garmendia Madariaga A, Santos Palacios S, Guillen-Grima F, Galofre JC: The incidence and prevalence of thyroid dysfunction in Europe: A meta-analysis. J Clin Endocrinol Metab 2014; 99: 923\u201331.","DOI":"10.1210\/jc.2013-2409"},{"key":"10.3238\/arztebl.m2026.0161_ref4","doi-asserted-by":"crossref","unstructured":"Mendes D, Alves C, Silverio N, Batel Marques F: Prevalence of undiagnosed hypothyroidism in Europe: A systematic review and meta-analysis. Eur Thyroid J 2019; 8: 130\u201343.","DOI":"10.1159\/000499751"},{"key":"10.3238\/arztebl.m2026.0161_ref5","doi-asserted-by":"crossref","unstructured":"Ingoe L, Phipps N, Armstrong G, Rajagopal A, Kamali F, Razvi S: Prevalence of treated hypothyroidism in the community: Analysis from general practices in North-East England with implications for the United Kingdom. Clin Endocrinol (Oxf) 2017; 87: 860\u20134.","DOI":"10.1111\/cen.13440"},{"key":"10.3238\/arztebl.m2026.0161_ref6","doi-asserted-by":"crossref","unstructured":"Surks MI, Boucai L: Age- and race-based serum thyrotropin reference limits. J Clin Endocrinol Metab 2010; 95: 496\u2013502.","DOI":"10.1210\/jc.2009-1845"},{"key":"10.3238\/arztebl.m2026.0161_ref7","unstructured":"DEGAM Leitlinie S2k: Erh\u00f6hter TSH-Wert in der Hausarztpraxis. https:\/\/register.awmf.org\/assets\/guidelines\/053-046l_S2k_Erhoehter-TSH-Wert-in-der-Hausarztpraxis_2024-07.pdf (last accessed on 27 May 2026)."},{"key":"10.3238\/arztebl.m2026.0161_ref8","doi-asserted-by":"crossref","unstructured":"Ehrenkranz J, Bach PR, Snow GL, et al.: Circadian and circannual rhythms in thyroid hormones: Determining the TSH and free T4 reference intervals based upon time of day, age, and sex. Thyroid 2015; 25: 954\u201361.","DOI":"10.1089\/thy.2014.0589"},{"key":"10.3238\/arztebl.m2026.0161_ref9","doi-asserted-by":"crossref","unstructured":"Dayan CM, Saravanan P, Bayly G: Whose normal thyroid function is better\u2014yours or mine? Lancet 2002; 360: 353.","DOI":"10.1016\/S0140-6736(02)09602-2"},{"key":"10.3238\/arztebl.m2026.0161_ref10","doi-asserted-by":"crossref","unstructured":"Gu Y, Song Z, Li Q, et al.: Association of thyroid-stimulating hormone with all-cause mortality: A 2-sample mendelian randomization study. J Clin Endocrinol Metab 2023; 108: e396\u2013e403.","DOI":"10.1210\/clinem\/dgad025"},{"key":"10.3238\/arztebl.m2026.0161_ref11","doi-asserted-by":"crossref","unstructured":"Jasim S, Papaleontiou M: Considerations in the diagnosis and management of thyroid dysfunction in older adults. Thyroid 2025; 35: 624\u201332.","DOI":"10.1089\/thy.2025.0128"},{"key":"10.3238\/arztebl.m2026.0161_ref12","doi-asserted-by":"crossref","unstructured":"Bremner AP, Feddema P, Leedman PJ, et al.: Age-related changes in thyroid function: A longitudinal study of a community-based cohort. J Clin Endocrinol Metab 2012; 97: 1554\u201362.","DOI":"10.1210\/jc.2011-3020"},{"key":"10.3238\/arztebl.m2026.0161_ref13","doi-asserted-by":"crossref","unstructured":"Jansen HI, Dirks NF, Hillebrand JJ, et al.: Age-specific reference intervals for thyroid-stimulating hormones and free thyroxine to optimize diagnosis of thyroid disease. Thyroid 2024; 34: 1346\u201355.","DOI":"10.1089\/thy.2024.0346"},{"key":"10.3238\/arztebl.m2026.0161_ref14","doi-asserted-by":"crossref","unstructured":"Coene KL, Demir AY, Broeren MA, Verschuure P, Lentjes EG, Boer AK: Subclinical hypothyroidism: A \u201alaboratory-induced\u2018 condition? Eur J Endocrinol 2015; 173: 499\u2013505.","DOI":"10.1530\/EJE-15-0684"},{"key":"10.3238\/arztebl.m2026.0161_ref15","doi-asserted-by":"crossref","unstructured":"Xu Y, Derakhshan A, Hysaj O, et al.: The optimal healthy ranges of thyroid function defined by the risk of cardiovascular disease and mortality: Systematic review and individual participant data meta-analysis. Lancet Diabetes Endocrinol 2023; 11: 743\u201354.","DOI":"10.1016\/S2213-8587(23)00227-9"},{"key":"10.3238\/arztebl.m2026.0161_ref16","unstructured":"Feldkamp J: L-Thyroxin sinnvoll einsetzen. Dtsch Artztebl 2024; 121: A607\u2013A10."},{"key":"10.3238\/arztebl.m2026.0161_ref17","doi-asserted-by":"crossref","unstructured":"Pearce SH, Brabant G, Duntas LH, et al.: 2013 ETA guideline: Management of subclinical hypothyroidism. Eur Thyroid J 2013; 2: 215\u201328.","DOI":"10.1159\/000356507"},{"key":"10.3238\/arztebl.m2026.0161_ref18","doi-asserted-by":"crossref","unstructured":"Johansen ME, Marcinek JP, Doo Young Yun J: Thyroid hormone use in the United States, 1997\u20132016. J Am Board Fam Med 2020; 33: 284\u20138.","DOI":"10.3122\/jabfm.2020.02.190159"},{"key":"10.3238\/arztebl.m2026.0161_ref19","doi-asserted-by":"crossref","unstructured":"Brito JP, Ross JS, El Kawkgi OM, et al.: Levothyroxine use in the United States, 2008\u20132018. JAMA Intern Med 2021; 181: 1402\u20135.","DOI":"10.1001\/jamainternmed.2021.2686"},{"key":"10.3238\/arztebl.m2026.0161_ref20","doi-asserted-by":"crossref","unstructured":"Vardarli I, Brandenburg T, Hegedus L, et al.: A questionnaire survey of German thyroidologists on the use of thyroid hormones in hypothyroid and euthyroid patients: The THESIS (treatment of hypothyroidism in Europe by specialists: An international survey) collaborative. Exp Clin Endocrinol Diabetes 2022; 130: 577\u201386.","DOI":"10.1055\/a-1832-0644"},{"key":"10.3238\/arztebl.m2026.0161_ref21","doi-asserted-by":"crossref","unstructured":"Feldkamp J, Schott M, Gogol M, et al.: [The choosing wisely initiative of the German Society of Internal Medicine: Recommendations of the German Society for Endocrinology and the German Society for Geriatrics]. Internist (Berl) 2016; 57: 532\u20139.","DOI":"10.1007\/s00108-016-0072-4"},{"key":"10.3238\/arztebl.m2026.0161_ref22","doi-asserted-by":"crossref","unstructured":"Schubel J, Stahl A, Feldkamp J, Werner F, Uebel T, Voigt K: Thyroid nodules: Diagnosis and treatment in primary care. Dtsch Arztebl Int 2025; 122: 341\u20137.","DOI":"10.3238\/arztebl.m2025.0067"},{"key":"10.3238\/arztebl.m2026.0161_ref23","doi-asserted-by":"crossref","unstructured":"Flynn RW, Bonellie SR, Jung RT, MacDonald TM, Morris AD, Leese GP: Serum thyroid-stimulating hormone concentration and morbidity from cardiovascular disease and fractures in patients on long-term thyroxine therapy. J Clin Endocrinol Metab 2010; 95: 186\u201393.","DOI":"10.1210\/jc.2009-1625"},{"key":"10.3238\/arztebl.m2026.0161_ref24","doi-asserted-by":"crossref","unstructured":"Turner MR, Camacho X, Fischer HD, et al.: Levothyroxine dose and risk of fractures in older adults: Nested case-control study. BMJ 2011; 342: d2238.","DOI":"10.1136\/bmj.d2238"},{"key":"10.3238\/arztebl.m2026.0161_ref25","unstructured":"Grandt D, Lappe V, Schubert I: BARMER Arzneimittelreport 2023. Schriftenreihe zur Gesundheitsanalyse. Berlin: BARMER 2024."},{"key":"10.3238\/arztebl.m2026.0161_ref26","doi-asserted-by":"crossref","unstructured":"Kopanos S, Scheel SN, Eggert B, Thiem U, Feldkamp J: Association of polypharmacy and bone mineral density: A cross-sectional analysis of geriatric inpatients in Germany. J Clin Med 2026; 15: 1197.","DOI":"10.3390\/jcm15031197"},{"key":"10.3238\/arztebl.m2026.0161_ref27","doi-asserted-by":"crossref","unstructured":"Thiyagarajan A, Koenen N, Ittermann T, Volzke H, Haug U: Trends in the use of thyroid diagnostics and treatments between 2008 and 2019 in Germany. Sci Rep 2024; 14: 26710.","DOI":"10.1038\/s41598-024-77896-4"},{"key":"10.3238\/arztebl.m2026.0161_ref28","doi-asserted-by":"crossref","unstructured":"Ayala IN, Soto Jacome C, Toro-Tobon D, et al.: Appropriateness of levothyroxine prescription: A multicenter retrospective study. J Clin Endocrinol Metab 2024; 109: e765\u2013e72.","DOI":"10.1210\/clinem\/dgad517"},{"key":"10.3238\/arztebl.m2026.0161_ref29","doi-asserted-by":"crossref","unstructured":"Chiardi I, Croce L, Caccavale P, et al.: Establishing the adequate levothyroxine dose after total thyroidectomy: A systematic review with meta-analysis. J Clin Endocrinol Metab 2025; 110: 3301\u20138.","DOI":"10.1210\/clinem\/dgaf417"},{"key":"10.3238\/arztebl.m2026.0161_ref30","doi-asserted-by":"crossref","unstructured":"Adams R, Mammen JS: Sex differences in risk for Iatrogenic thyrotoxicosis among older adults: An analysis from real-world clinical data. Thyroid 2025; 35: 485\u201393.","DOI":"10.1089\/thy.2024.0604"},{"key":"10.3238\/arztebl.m2026.0161_ref31","doi-asserted-by":"crossref","unstructured":"Virili C, Bruno G, Santaguida MG, et al.: Levothyroxine treatment and gastric juice pH in humans: The proof of concept. Endocrine 2022; 77: 102\u201311.","DOI":"10.1007\/s12020-022-03056-1"},{"key":"10.3238\/arztebl.m2026.0161_ref32","doi-asserted-by":"crossref","unstructured":"Benvenga S, Bartolone L, Pappalardo MA, et al.: Altered intestinal absorption of L-thyroxine caused by coffee. Thyroid 2008; 18: 293\u2013301.","DOI":"10.1089\/thy.2007.0222"},{"key":"10.3238\/arztebl.m2026.0161_ref33","doi-asserted-by":"crossref","unstructured":"Benvenga S: L-T4 Therapy in the presence of pharmacological interferents. Front Endocrinol (Lausanne) 2020; 11: 607446.","DOI":"10.3389\/fendo.2020.607446"},{"key":"10.3238\/arztebl.m2026.0161_ref34","doi-asserted-by":"crossref","unstructured":"Pang X, Pu T, Xu L, Sun R: Effect of l-thyroxine administration before breakfast vs at bedtime on hypothyroidism: A meta-analysis. Clin Endocrinol (Oxf) 2020; 92: 475\u201381.","DOI":"10.1111\/cen.14172"},{"key":"10.3238\/arztebl.m2026.0161_ref35","doi-asserted-by":"crossref","unstructured":"Pazan F, Wehling M: Polypharmacy in older adults: A narrative review of definitions, epidemiology and consequences. Eur Geriatr Med 2021; 12: 443\u201352.","DOI":"10.1007\/s41999-021-00479-3"},{"key":"10.3238\/arztebl.m2026.0161_ref36","doi-asserted-by":"crossref","unstructured":"Centanni M, Duntas L, Feldt-Rasmussen U, et al.: ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism. Eur Thyroid J 2025; 14: e250123.","DOI":"10.1530\/ETJ-25-0123"},{"key":"10.3238\/arztebl.m2026.0161_ref37","doi-asserted-by":"crossref","unstructured":"Sachmechi I, Reich DM, Aninyei M, Wibowo F, Gupta G, Kim PJ: Effect of proton pump inhibitors on serum thyroid-stimulating hormone level in euthyroid patients treated with levothyroxine for hypothyroidism. Endocr Pract 2007; 13: 345\u20139.","DOI":"10.4158\/EP.13.4.345"},{"key":"10.3238\/arztebl.m2026.0161_ref38","doi-asserted-by":"crossref","unstructured":"Hassan MM, Ahmad Z, Hassan MB, Tasawar Z, Hassan Q, Ur Rahman S: Outcomes of bariatric surgery in hypothyroid patients taking levothyroxine: A systematic review and meta-analysis. Cureus 2025; 17: e88354.","DOI":"10.7759\/cureus.88354"},{"key":"10.3238\/arztebl.m2026.0161_ref39","doi-asserted-by":"crossref","unstructured":"Julia H, Benaiges D, Molla P, et al.: Changes in thyroid replacement therapy after bariatric surgery: Differences between laparoscopic roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy. Obes Surg 2019; 29: 2593\u20139.","DOI":"10.1007\/s11695-019-03890-9"},{"key":"10.3238\/arztebl.m2026.0161_ref40","doi-asserted-by":"crossref","unstructured":"Virili C, Antonelli A, Santaguida MG, Benvenga S, Centanni M: Gastrointestinal malabsorption of thyroxine. Endocr Rev 2019; 40: 118\u201336.","DOI":"10.1210\/er.2018-00168"},{"key":"10.3238\/arztebl.m2026.0161_ref41","doi-asserted-by":"crossref","unstructured":"Virili C, Brusca N, Capriello S, Centanni M: Levothyroxine therapy in gastric malabsorptive disorders. Front Endocrinol (Lausanne) 2020; 11: 621616.","DOI":"10.3389\/fendo.2020.621616"},{"key":"10.3238\/arztebl.m2026.0161_ref42","doi-asserted-by":"crossref","unstructured":"Karhunen P, Tuomisto S, Goebeler S, Martiskainen M, Kok E: Common occurrence of atrophic gastritis in an ageing non-hospitalised population: An autopsy study. Age Ageing 2025; 54: afaf047.","DOI":"10.1093\/ageing\/afaf047"},{"key":"10.3238\/arztebl.m2026.0161_ref43","doi-asserted-by":"crossref","unstructured":"Centanni M, Gargano L, Canettieri G, et al.: Thyroxine in goiter, helicobacter pylori infection, and chronic gastritis. N Engl J Med 2006; 354: 1787\u201395.","DOI":"10.1056\/NEJMoa043903"},{"key":"10.3238\/arztebl.m2026.0161_ref44","doi-asserted-by":"crossref","unstructured":"Castoro C, Le Moli R, Arpi ML, et al.: Association of autoimmune thyroid diseases, chronic atrophic gastritis and gastric carcinoid: Experience from a single institution. J Endocrinol Invest 2016; 39: 779\u201384.","DOI":"10.1007\/s40618-016-0445-5"},{"key":"10.3238\/arztebl.m2026.0161_ref45","doi-asserted-by":"crossref","unstructured":"Lahner E, Centanni M, Agnello G, et al.: Occurrence and risk factors for autoimmune thyroid disease in patients with atrophic body gastritis. Am J Med 2008; 121: 136\u201341.","DOI":"10.1016\/j.amjmed.2007.09.025"},{"key":"10.3238\/arztebl.m2026.0161_ref46","doi-asserted-by":"crossref","unstructured":"Virili C, Capriello S, Stramazzo I, et al.: Daily requirement of softgel thyroxine is independent from gastric juice pH. Front Endocrinol (Lausanne) 2022; 13: 1002583.","DOI":"10.3389\/fendo.2022.1002583"},{"key":"10.3238\/arztebl.m2026.0161_ref47","doi-asserted-by":"crossref","unstructured":"Oteri V, Volpe S, Lopes M, et al.: Therapeutic efficacy and patient compliance of levothyroxine liquid and softgel formulations taken with meals: A systematic review. Endocrine 2025; 87: 48\u201358.","DOI":"10.1007\/s12020-024-04016-7"},{"key":"10.3238\/arztebl.m2026.0161_ref48","doi-asserted-by":"crossref","unstructured":"Cooper DS, Biondi B: Subclinical thyroid disease. Lancet 2012; 379: 1142\u201354.","DOI":"10.1016\/S0140-6736(11)60276-6"},{"key":"10.3238\/arztebl.m2026.0161_ref49","doi-asserted-by":"crossref","unstructured":"Surks MI, Ortiz E, Daniels GH, et al.: Subclinical thyroid disease: Scientific review and guidelines for diagnosis and management. JAMA 2004; 291: 228\u201338.","DOI":"10.1001\/jama.291.2.228"},{"key":"10.3238\/arztebl.m2026.0161_ref50","doi-asserted-by":"crossref","unstructured":"Somwaru LL, Rariy CM, Arnold AM, Cappola AR: The natural history of subclinical hypothyroidism in the elderly: The cardiovascular health study. J Clin Endocrinol Metab 2012; 97: 1962\u20139.","DOI":"10.1210\/jc.2011-3047"},{"key":"10.3238\/arztebl.m2026.0161_ref51","doi-asserted-by":"crossref","unstructured":"van der Spoel E, van Vliet NA, Poortvliet RKE, et al.: Incidence and determinants of spontaneous normalization of subclinical hypothyroidism in older adults. J Clin Endocrinol Metab 2024; 109: e1167\u2013e74.","DOI":"10.1210\/clinem\/dgad623"},{"key":"10.3238\/arztebl.m2026.0161_ref52","doi-asserted-by":"crossref","unstructured":"Selmer C, Olesen JB, Hansen ML, et al.: Subclinical and overt thyroid dysfunction and risk of all-cause mortality and cardiovascular events: A large population study. J Clin Endocrinol Metab 2014; 99: 2372\u201382.","DOI":"10.1210\/jc.2013-4184"},{"key":"10.3238\/arztebl.m2026.0161_ref53","doi-asserted-by":"crossref","unstructured":"Hyland KA, Arnold AM, Lee JS, Cappola AR: Persistent subclinical hypothyroidism and cardiovascular risk in the elderly: The cardiovascular health study. J Clin Endocrinol Metab 2013; 98: 533\u201340.","DOI":"10.1210\/jc.2012-2180"},{"key":"10.3238\/arztebl.m2026.0161_ref54","doi-asserted-by":"crossref","unstructured":"Du Puy RS, Poortvliet RKE, Snel M, et al.: Associations of elevated antithyroperoxidase antibodies with thyroid function, survival, functioning, and depressive symptoms in the oldest old: The Leiden 85-plus study. Thyroid 2019; 29: 1201\u20138.","DOI":"10.1089\/thy.2019.0129"},{"key":"10.3238\/arztebl.m2026.0161_ref55","doi-asserted-by":"crossref","unstructured":"Zhao T, Chen BM, Zhao XM, Shan ZY: Subclinical hypothyroidism and depression: A meta-analysis. Transl Psychiatry 2018; 8: 239.","DOI":"10.1038\/s41398-018-0283-7"},{"key":"10.3238\/arztebl.m2026.0161_ref56","doi-asserted-by":"crossref","unstructured":"Bode H, Ivens B, Bschor T, Schwarzer G, Henssler J, Baethge C: Association of hypothyroidism and clinical depression: A systematic review and meta-analysis. JAMA Psychiatry 2021; 78: 1375\u201383.","DOI":"10.1001\/jamapsychiatry.2021.2506"},{"key":"10.3238\/arztebl.m2026.0161_ref57","doi-asserted-by":"crossref","unstructured":"Ojala AK, Schalin-Jantti C, Pitkala KH, Tilvis RS, Strandberg TE: Serum thyroid-stimulating hormone and cognition in older people. Age Ageing 2016; 45: 155\u20137.","DOI":"10.1093\/ageing\/afv160"},{"key":"10.3238\/arztebl.m2026.0161_ref58","doi-asserted-by":"crossref","unstructured":"Pasqualetti G, Pagano G, Rengo G, Ferrara N, Monzani F: Subclinical hypothyroidism and cognitive impairment: Systematic review and meta-analysis. J Clin Endocrinol Metab 2015; 100: 4240\u20138.","DOI":"10.1210\/jc.2015-2046"},{"key":"10.3238\/arztebl.m2026.0161_ref59","doi-asserted-by":"crossref","unstructured":"Simonsick EM, Newman AB, Ferrucci L, et al.: Subclinical hypothyroidism and functional mobility in older adults. Arch Intern Med 2009; 169: 2011\u20137.","DOI":"10.1001\/archinternmed.2009.392"},{"key":"10.3238\/arztebl.m2026.0161_ref60","doi-asserted-by":"crossref","unstructured":"van Vliet NA, van Heemst D, Almeida OP, et al.: Association of thyroid dysfunction with cognitive function: An individual participant data analysis. JAMA Intern Med 2021; 181: 1440\u201350.","DOI":"10.1001\/jamainternmed.2021.5078"},{"key":"10.3238\/arztebl.m2026.0161_ref61","doi-asserted-by":"crossref","unstructured":"Cordido M, Juiz-Valina P, Urones P, Sangiao-Alvarellos S, Cordido F: Thyroid function alteration in obesity and the effect of bariatric surgery. J Clin Med 2022; 11: 1340.","DOI":"10.3390\/jcm11051340"},{"key":"10.3238\/arztebl.m2026.0161_ref62","doi-asserted-by":"crossref","unstructured":"Stott DJ, Rodondi N, Kearney PM, et al.: Thyroid hormone therapy for older adults with subclinical hypothyroidism. N Engl J Med 2017; 376: 2534\u201344.","DOI":"10.1056\/NEJMoa1603825"},{"key":"10.3238\/arztebl.m2026.0161_ref63","doi-asserted-by":"crossref","unstructured":"Mooijaart SP, Du Puy RS, Stott DJ, et al.: Association between levothyroxine treatment and thyroid-related symptoms among adults aged 80 years and older with subclinical hypothyroidism. JAMA 2019; 322: 1977\u201386.","DOI":"10.1001\/jama.2019.17274"},{"key":"10.3238\/arztebl.m2026.0161_ref64","doi-asserted-by":"crossref","unstructured":"Ravensberg J, Poortvliet RKE, Du Puy R, et al.: Patient-reported satisfaction with thyroid hormone replacement therapy for subclinical hypothyroidism in older adults: A pooled analysis of individual participant data from two randomized controlled trials. Thyroid 2024; 34: 702\u201312.","DOI":"10.1089\/thy.2023.0624"},{"key":"10.3238\/arztebl.m2026.0161_ref65","doi-asserted-by":"crossref","unstructured":"Wildisen L, Feller M, Del Giovane C, et al.: Effect of levothyroxine therapy on the development of depressive symptoms in older adults with subclinical hypothyroidism: An ancillary study of a randomized clinical trial. JAMA Netw Open 2021; 4: e2036645.","DOI":"10.1001\/jamanetworkopen.2020.36645"},{"key":"10.3238\/arztebl.m2026.0161_ref66","doi-asserted-by":"crossref","unstructured":"Zijlstra LE, Jukema JW, Westendorp RGJ, et al.: Levothyroxine treatment and cardiovascular outcomes in older people with subclinical hypothyroidism: Pooled individual results of two randomised controlled trials. Front Endocrinol (Lausanne) 2021; 12: 674841.","DOI":"10.3389\/fendo.2021.674841"},{"key":"10.3238\/arztebl.m2026.0161_ref67","unstructured":"Diederich S, Freitag M: L-Thyroxin bei \u00c4lteren: Wann einsetzen? Arzneiverordnung in der Praxis 2024; 51: 128\u201331."},{"key":"10.3238\/arztebl.m2026.0161_ref68","doi-asserted-by":"crossref","unstructured":"Adams R, Oh ES, Yasar S, Lyketsos CG, Mammen JS: Endogenous and exogenous thyrotoxicosis and risk of incident cognitive disorders in older adults. JAMA Intern Med 2023; 183: 1324\u201331.","DOI":"10.1001\/jamainternmed.2023.5619"},{"key":"10.3238\/arztebl.m2026.0161_ref69","doi-asserted-by":"crossref","unstructured":"Biondi B, Cooper DS: The clinical significance of subclinical thyroid dysfunction. Endocr Rev 2008; 29: 76\u2013131.","DOI":"10.1210\/er.2006-0043"},{"key":"10.3238\/arztebl.m2026.0161_ref70","doi-asserted-by":"crossref","unstructured":"Taylor PN, Iqbal A, Minassian C, et al.: Falling threshold for treatment of borderline elevated thyrotropin levels-balancing benefits and risks: Evidence from a large community-based study. JAMA Intern Med 2014; 174: 32\u20139.","DOI":"10.1001\/jamainternmed.2013.11312"},{"key":"10.3238\/arztebl.m2026.0161_ref71","doi-asserted-by":"crossref","unstructured":"Mammen JS, McGready J, Oxman R, Chia CW, Ladenson PW, Simonsick EM: Thyroid hormone therapy and risk of thyrotoxicosis in community-resident older Adults: Findings from the Baltimore longitudinal study of aging. Thyroid 2015; 25: 979\u201386.","DOI":"10.1089\/thy.2015.0180"},{"key":"10.3238\/arztebl.m2026.0161_ref72","doi-asserted-by":"crossref","unstructured":"Yamauchi I, Yabe D: Best practices in the management of thyroid dysfunction induced by immune checkpoint inhibitors. Eur Thyroid J 2025; 14: e240328.","DOI":"10.1530\/ETJ-24-0328"},{"key":"10.3238\/arztebl.m2026.0161_ref73","doi-asserted-by":"crossref","unstructured":"Das G, Ojewuyi TA, Baglioni P, Geen J, Premawardhana LD, Okosieme OE: Serum thyrotrophin at baseline predicts the natural course of subclinical hyperthyroidism. Clin Endocrinol (Oxf) 2012; 77: 146\u201351.","DOI":"10.1111\/j.1365-2265.2012.04345.x"},{"key":"10.3238\/arztebl.m2026.0161_ref74","doi-asserted-by":"crossref","unstructured":"Bervini S, Trelle S, Kopp P, Stettler C, Trepp R: Prevalence of Iodine-Induced hyperthyroidism after administration of Iodinated contrast during radiographic procedures: A systematic review and meta-analysis of the literature. Thyroid 2021; 31: 1020\u20139.","DOI":"10.1089\/thy.2020.0459"},{"key":"10.3238\/arztebl.m2026.0161_ref75","doi-asserted-by":"crossref","unstructured":"Sawin CT, Geller A, Wolf PA, et al.: Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med 1994; 331: 1249\u201352.","DOI":"10.1056\/NEJM199411103311901"},{"key":"10.3238\/arztebl.m2026.0161_ref76","doi-asserted-by":"crossref","unstructured":"Nanchen D, Gussekloo J, Westendorp RG, et al.: Subclinical thyroid dysfunction and the risk of heart failure in older persons at high cardiovascular risk. J Clin Endocrinol Metab 2012; 97: 852\u201361.","DOI":"10.1210\/jc.2011-1978"},{"key":"10.3238\/arztebl.m2026.0161_ref77","doi-asserted-by":"crossref","unstructured":"Blum MR, Bauer DC, Collet TH, et al.: Subclinical thyroid dysfunction and fracture risk: A meta-analysis. JAMA 2015; 313: 2055\u201365.","DOI":"10.1001\/jama.2015.5161"},{"key":"10.3238\/arztebl.m2026.0161_ref78","doi-asserted-by":"crossref","unstructured":"Svensson J, Ohlsson C, Karlsson MK, Lorentzon M, Lewerin C, Mellstrom D: Subclinical hyperthyroidism is associated with increased risk of vertebral fractures in older men. Osteoporos Int 2021; 32: 2257\u201365.","DOI":"10.1007\/s00198-021-05964-w"},{"key":"10.3238\/arztebl.m2026.0161_ref79","doi-asserted-by":"crossref","unstructured":"Wilson S, Parle JV, Roberts LM, et al.: Prevalence of subclinical thyroid dysfunction and its relation to socioeconomic deprivation in the elderly: A community-based cross-sectional survey. J Clin Endocrinol Metab 2006; 91: 4809\u201316.","DOI":"10.1210\/jc.2006-1557"},{"key":"10.3238\/arztebl.m2026.0161_ref80","doi-asserted-by":"crossref","unstructured":"Bode H, Ivens B, Bschor T, Schwarzer G, Henssler J, Baethge C: Hyperthyroidism and clinical depression: A systematic review and meta-analysis. Transl Psychiatry 2022; 12: 362.","DOI":"10.1038\/s41398-022-02121-7"},{"key":"10.3238\/arztebl.m2026.0161_ref81","doi-asserted-by":"crossref","unstructured":"Scott IA, Hilmer SN, Reeve E, et al.: Reducing inappropriate polypharmacy: The process of deprescribing. JAMA Intern Med 2015; 175: 827\u201334.","DOI":"10.1001\/jamainternmed.2015.0324"},{"key":"10.3238\/arztebl.m2026.0161_ref82","doi-asserted-by":"crossref","unstructured":"Moretti B, Livecchi R, Taylor SR, et al.: Physician-reported barriers and facilitators to thyroid hormone deprescribing in older adults. J Am Geriatr Soc 2025; 73: 566\u201373.","DOI":"10.1111\/jgs.19219"},{"key":"10.3238\/arztebl.m2026.0161_ref83","doi-asserted-by":"crossref","unstructured":"Liu Y, Shan Z, Endocrine metabolic diseases group of the Chinese Geriatrics Society, Thyroid Group of the Chinese Society of Endocrinology, Chinese Medical Association: Expert consensus on diagnosis and treatment for elderly with thyroid diseases in China (2021). Aging Med (Milton) 2021; 4: 70\u201392.","DOI":"10.1002\/agm2.12165"},{"key":"10.3238\/arztebl.m2026.0161_ref84","doi-asserted-by":"crossref","unstructured":"Burgos N, Toloza FJK, Singh Ospina NM, et al.: Clinical outcomes after discontinuation of thyroid hormone replacement: A systematic review and meta-analysis. Thyroid 2021; 31: 740\u201351.","DOI":"10.1089\/thy.2020.0679"},{"key":"10.3238\/arztebl.m2026.0161_ref85","doi-asserted-by":"crossref","unstructured":"Maraka S, Owen RR, Singh Ospina NM, et al.: Discontinuation of levothyroxine therapy in patients with subclinical hypothyroidism: A pilot randomized clinical trial. Endocrine 2025; 90: 781\u201392.","DOI":"10.1007\/s12020-025-04371-z"}],"container-title":["Deutsches \u00c4rzteblatt international"],"original-title":[],"link":[{"URL":"https:\/\/www.aerzteblatt.de\/10.3238\/arztebl.m2026.0161","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T11:06:03Z","timestamp":1793790363000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.aerzteblatt.de\/10.3238\/arztebl.m2026.0161"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,11,13]]},"references-count":85,"URL":"https:\/\/doi.org\/10.3238\/arztebl.m2026.0161","relation":{},"ISSN":["1866-0452"],"issn-type":[{"value":"1866-0452","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,11,13]]}}}