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Higher Serum Free T4 Is Associated With Increased Risk of Mortality and Cerebrovascular Events in Elderly Men

Svensson, Johan ; Ohlsson, Claes ; Karlsson, Magnus K. LU ; Tivesten, Åsa ; Herlitz, Hans ; Lorentzon, Mattias ; Lewerin, Catharina and Mellström, Dan (2025) In Journal of the Endocrine Society 9(9).
Abstract

Background: It is unclear whether thyroid hormone levels are associated with the risk of mortality, cardiovascular disease (CVD) events, or cancer in men with normal TSH. Objectives: We analyzed if serum free T4 (FT4) or TSH is associated with the risk of mortality, incident CVD events, or cancer in Swedish men. Methods: Elderly men (n = 1801; mean age 75 years) in the Gothenburg and Malmö subcohorts of the prospective, population-based Osteoporotic Fractures in Men Study-Sweden study were followed for median 12.2 years regarding all-cause mortality [1207 (67%) died] and for median 5.1 years regarding incident CVD events (n = 338) and cancer (n = 249). The statistical analyses included Cox proportional hazards regression with adjustment... (More)

Background: It is unclear whether thyroid hormone levels are associated with the risk of mortality, cardiovascular disease (CVD) events, or cancer in men with normal TSH. Objectives: We analyzed if serum free T4 (FT4) or TSH is associated with the risk of mortality, incident CVD events, or cancer in Swedish men. Methods: Elderly men (n = 1801; mean age 75 years) in the Gothenburg and Malmö subcohorts of the prospective, population-based Osteoporotic Fractures in Men Study-Sweden study were followed for median 12.2 years regarding all-cause mortality [1207 (67%) died] and for median 5.1 years regarding incident CVD events (n = 338) and cancer (n = 249). The statistical analyses included Cox proportional hazards regression with adjustment for covariates including prevalent atrial fibrillation (AF). Results: Serum FT4 (per SD increase) was associated with increased risk of mortality [men with normal TSH: fully adjusted hazard ratio (HR) 1.23, 95% confidence interval (CI): 1.11-1.35] and incident CVD events (HR 1.25, 95% CI: 1.05-1.48) but not with the risk of cancer. The association between FT4 and CVD events was mainly due to increased risk of cerebrovascular (CBV) events (HR 1.56, 95% CI: 1.24-1.96). Finally, TSH was not associated with the risk of mortality, CVD events, or cancer. Conclusion: FT4, but not TSH, is a predictor of mortality risk in elderly men. The association between FT4 and elevated risk of CVD events was mostly due to increased risk of CBV events, which remained significant also after adjustment for prevalent AF.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cancer, cerebrovascular events, mortality, older men, serum free T4, serum TSH
in
Journal of the Endocrine Society
volume
9
issue
9
article number
bvaf121
publisher
Oxford University Press
external identifiers
  • pmid:40741419
  • scopus:105012126055
ISSN
2472-1972
DOI
10.1210/jendso/bvaf121
language
English
LU publication?
yes
id
5753b066-aeb0-44d0-a4ca-82c2af6d09cc
date added to LUP
2025-11-05 09:33:20
date last changed
2025-12-17 13:38:04
@article{5753b066-aeb0-44d0-a4ca-82c2af6d09cc,
  abstract     = {{<p>Background: It is unclear whether thyroid hormone levels are associated with the risk of mortality, cardiovascular disease (CVD) events, or cancer in men with normal TSH. Objectives: We analyzed if serum free T4 (FT4) or TSH is associated with the risk of mortality, incident CVD events, or cancer in Swedish men. Methods: Elderly men (n = 1801; mean age 75 years) in the Gothenburg and Malmö subcohorts of the prospective, population-based Osteoporotic Fractures in Men Study-Sweden study were followed for median 12.2 years regarding all-cause mortality [1207 (67%) died] and for median 5.1 years regarding incident CVD events (n = 338) and cancer (n = 249). The statistical analyses included Cox proportional hazards regression with adjustment for covariates including prevalent atrial fibrillation (AF). Results: Serum FT4 (per SD increase) was associated with increased risk of mortality [men with normal TSH: fully adjusted hazard ratio (HR) 1.23, 95% confidence interval (CI): 1.11-1.35] and incident CVD events (HR 1.25, 95% CI: 1.05-1.48) but not with the risk of cancer. The association between FT4 and CVD events was mainly due to increased risk of cerebrovascular (CBV) events (HR 1.56, 95% CI: 1.24-1.96). Finally, TSH was not associated with the risk of mortality, CVD events, or cancer. Conclusion: FT4, but not TSH, is a predictor of mortality risk in elderly men. The association between FT4 and elevated risk of CVD events was mostly due to increased risk of CBV events, which remained significant also after adjustment for prevalent AF.</p>}},
  author       = {{Svensson, Johan and Ohlsson, Claes and Karlsson, Magnus K. and Tivesten, Åsa and Herlitz, Hans and Lorentzon, Mattias and Lewerin, Catharina and Mellström, Dan}},
  issn         = {{2472-1972}},
  keywords     = {{cancer; cerebrovascular events; mortality; older men; serum free T4; serum TSH}},
  language     = {{eng}},
  number       = {{9}},
  publisher    = {{Oxford University Press}},
  series       = {{Journal of the Endocrine Society}},
  title        = {{Higher Serum Free T4 Is Associated With Increased Risk of Mortality and Cerebrovascular Events in Elderly Men}},
  url          = {{http://dx.doi.org/10.1210/jendso/bvaf121}},
  doi          = {{10.1210/jendso/bvaf121}},
  volume       = {{9}},
  year         = {{2025}},
}