Lay opinion vs evidence: TSH Senioren

Lay opinion often holds that any elevated TSH in seniors requires treatment, similar to younger adults. However, evidence shows that TSH reference ranges shift upward with age; values up to 4–6 mU/L in those over 70 may be normal. Randomized trials (e.g., TRUST study) found no benefit from levothyroxine in subclinical hypothyroidism for symptoms, quality of life, or cardiovascular outcomes in older adults. Overtreatment can increase risks like atrial fibrillation or bone loss. Guidelines (ATA, ETA) recommend a cautious approach, considering symptoms, comorbidities, and patient preference. Conclusion: The common lay view is too simplistic; evidence-based geriatrics advises watchful waiting for mildly elevated TSH without clear symptoms.