TSH: The impact of increasing age and increasing weight

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TSH: The impact of increasing age and increasing weight

E-learning Modules

Launch: 29 July 2024


Authoritative guidelines recommend targeting treatment TSH levels to within the lower half of the normal range, but TSH levels are subject to multiple factors that are patient-specific, including obesity, age, gender, ethnicity, iodine status, smoking, concomitant diseases, supplements, adrenal status, pregnancy, and genetic conditions, as well as time of day, and time of year that the blood is drawn for testing [Hashimoto, 2022; Urgatz, 2023; Razvi, 2019]. This makes one size fits all cut-off reference values a question for debate. As well as reference range issues preventing or delaying early, accurate diagnosis of thyroid dysfunction, imbalance of TSH can lead to multiple negative health consequences for patients including cardiovascular disease, cognitive decline and dementia, type 2 diabetes,  infertility or sub-fertility, adverse pregnancy outcomes, as well as symptoms causing impaired quality of life, such as fatigue [Hashimoto, 2022; Urgatz, 2023]. As patients age and their bodies change, their TSH levels rise, and can surpass the upper limit of the traditional reference range for elderly patients even though the patient does not have thyroid disease. This podcast will highlight the issues with reference ranges for TSH and the lifestyle issues that need to be factored into clinical decisions.

Learning Objectives

After listening to this podcast, participants will be able to:

Target Audience

Clinicians involved in endocrinology, particularly thyroid disorders and general practice.


English with voice-over into Spanish and Chinese


Salman Razvi

Salman Razvi

Senior Lecturer in Endocrinology at Newcastle University
Consultant Endocrinologist at Queen Elizabeth Hospital
Newcastle, UK

Save the Date

· Salman Razvi ·

Salman Razvi is a Senior Lecturer in Endocrinology at Newcastle University and a Consultant Endocrinologist at Queen Elizabeth Hospital. His doctoral thesis was based on assessing cardiovascular risk in subclinical hypothyroidism. After this, he has continued to pursue research evaluating the action of thyroid hormones particularly on the cardiovascular system. The focus of his research has been on investigating the association of thyroid function with cardiovascular events in various populations. He is the chief investigator of several projects funded by various statutory funding bodies as well as charities. He has more than 110 peer-reviewed publications and book chapters mainly relating to thyroid dysfunction. His main research programmes include investigating the treatment of subclinical hypothyroidism with thyroid hormones in acute myocardial infarction and age-appropriate treatment of hypothyroidism in the elderly. Dr Razvi is also the Director of Research and Development at the Queen Elizabeth Hospital NHS Trust, Gateshead and the Metabolic and Endocrine Lead for the North East England Local Clinical Research Network. He is a member of the editorial board of JCEM, Thyroid, Frontiers in Endocrinology and Journal of Endocrinological Investigations.  In addition, Dr Razvi is a member of the executive committee of the European Thyroid Association, Programme Organising Committee of the British Society for Endocrinology and the medical advisor to the patient-led charity the British Thyroid Foundation.

· Martin O. Savage ·

Martin Savage is Emeritus Professor of Paediatric Endocrinology at William Harvey Research Institute, Barts and the London School of Medicine & Dentistry, Queen Mary, University of London. He was head of the Paediatric Endocrine Unit at Barts and the London School of Medicine from 1982 to 2007. He has interests in growth disorders, specifically those with abnormalities in the GH-IGF-1 axis and in phenotype-genotype relationships of GH-IGF-1 axis defects, notably GH resistance. He published the first human case of an IGF-1 gene defect in the New England Journal of Medicine in 1996.  His other interests are Cushing’s syndrome and growth in chronic inflammatory diseases. He was General Secretary of the European Society for Paediatric Endocrinology (ESPE) from 1997 to 2004. He has lectured in 60 countries and has published 482 original articles, reviews, textbook chapters and books. In 2007, he was awarded the ESPE Andrea Prader Prize for contributions to paediatric endocrinology and in 2018 he received a Visionary Award from the American Human Growth Foundation. In 2022, he received a Research Excellence Award from the Dr Sulaiman Al Habib Medical Journal in Riyadh, and the British Society of Paediatric Endocrinology & Diabetes James M. Tanner Lifetime Achievement Award. He continues to lecture nationally and internationally.