Medication and low serum thyroxine values in nursing home residents.

Abstract:

BACKGROUND:The nursing home clinician may encounter euthyroid residents with low total serum thyroxine (T4) values associated with certain medications or nonthyroidal illness (NTI). Hypothyroidism may be incorrectly diagnosed and thyroid hormone prescribed. METHODS:We reviewed all T4 determinations and individuals with low T4 and normal thyroid-stimulating hormone (TSH) levels were identified. Pharmacy and medical records were reviewed. RESULTS:We reviewed 1,153 T4 determinations and identified 22 individuals with low T4 and normal TSH values. Eight of the 22 (36%) were being treated with high-dose salicylates, 4 (18%) with phenytoin, 3 (14%) with carbamazepine, and 2 (9%) with prednisone (15 mg/day). Three residents were on two of these medications. None was on prednisone as a single medication. Eight were on none of the medications, and 5 of these had albumin values of < or = 3.2 g/dL (a marker of NTI). After a low T4 value was determined in these individuals, 6 of the 22 were placed on T4 replacement with no documentation of hypothyroidism. In 5 of these, low T4 level could be attributed to a medication effect. CONCLUSIONS:Low total T4 with normal TSH levels are commonly associated with medications and NTI.

journal_name

South Med J

journal_title

Southern medical journal

authors

Amberson J,Drinka PJ

doi

10.1097/00007611-199805000-00005

subject

Has Abstract

pub_date

1998-05-01 00:00:00

pages

437-40

issue

5

eissn

0038-4348

issn

1541-8243

journal_volume

91

pub_type

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