Importance Variations in thyroid function within reference ranges are associated with an increased risk of cardiovascular disease (CVD) and mortality. However, the impact of thyroid function on life expectancy (LE) and the number of years lived with and without CVD remains unknown. Objective To investigate the association of thyroid function with total LE and LE with and without CVD among euthyroid individuals. Design, Setting, and Participants The Rotterdam Study, a population-based, prospective cohort study. We included participants without known thyroid disease and with thyrotropin and free thyroxine (FT4) levels within the reference ranges. Main Outcomes and Measures Multistate life tables were used to calculate total LE and LE with and without CVD among thyrotropin and FT4 tertiles. Life expectancy estimates in men and women aged 50 years and older were obtained using prevalence, incidence rates, and hazard ratios for 3 transitions (healthy to CVD, healthy to death, and CVD to death), adjusting for sociodemographic and cardiovascular risk factors. Results The mean (SD) age of the 7785 participants was 64.7 (9.8) years, and 52.5% were women. Over a median follow-up of 8.1 (interquartile range, 2.7-9.9) years, we observed 789 incident CVD events and 1357 deaths. Compared with those in the lowest tertile, men and women in the highest thyrotropin tertile lived 2.0 (95% CI, 1.0 to 2.8) and 1.4 (95% CI, 0.2 to 2.4) years longer, respectively, of which, 1.5 (95% CI, 0.2 to 2.6) and 0.9 (95% CI, −0.2 to 2.0) years longer without CVD. Compared with those in the lowest tertile, the difference in life expectancy for men and women in the highest FT4 tertile was −3.2 (95% CI, −5.0 to −1.4) and −3.5 (95% CI, −5.6 to −1.5) years, respectively, of which, −3.1 (95% CI, −4.9 to −1.4) and −2.5 (95% CI, −4.4 to −0.7) years without CVD. Conclusions and Relevance At the age of 50 years, participants with low-normal thyroid function live up to 3.5 years longer overall and up to 3.1 years longer without CVD than participants with high-normal thyroid function. These findings provide supporting evidence for a reevaluation of the current reference ranges of thyroid function and can help inform preventive and clinical care.

中文翻译：

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甲状腺功能与有无心血管疾病预期寿命的关联

重要性 参考范围内甲状腺功能的变化与心血管疾病 (CVD) 和死亡率的风险增加有关。然而，甲状腺功能对预期寿命 (LE) 和患有和不患有 CVD 的年数的影响仍然未知。目的 探讨甲状腺功能正常人群中总 LE 和 LE 与 CVD 和非 CVD 的关系。设计、设置和参与者 鹿特丹研究，一项基于人群的前瞻性队列研究。我们纳入了没有已知甲状腺疾病且促甲状腺激素和游离甲状腺素 (FT4) 水平在参考范围内的参与者。主要结果和测量多态生命表用于计算促甲状腺素和 FT4 三分位数中有和没有 CVD 的总 LE 和 LE。50 岁及以上男性和女性的预期寿命估计值是使用流行率、发病率和 3 次转变（健康到 CVD、健康到死亡和 CVD 到死亡）的风险比获得的，并针对社会人口统计学和心血管危险因素进行了调整。结果 7785 名参与者的平均 (SD) 年龄为 64.7 (9.8) 岁，52.5% 为女性。在中位随访 8.1（四分位距，2.7-9.9）年中，我们观察到 789 起 CVD 事件和 1357 例死亡。与最低三分位数的男性和女性相比，最高促甲状腺激素三分位数的男性和女性分别多活了 2.0（95% CI，1.0 至 2.8）和 1.4（95% CI，0.2 至 2.4）年，其中，1.5（95%） CI，0.2 至 2.6）和 0.9（95% CI，-0.2 至 2.0）年，而没有 CVD。与最低三分位数相比，FT4 最高三分位数的男性和女性的预期寿命差异分别为 -3.2（95% CI，-5.0 至 -1.4）和 -3.5（95% CI，-5.6 至 -1.5）年，其中， - 3.1（95% CI，-4.9 至 -1.4）和 -2.5（95% CI，-4.4 至 -0.7）年无 CVD。结论和相关性 在 50 岁时，甲状腺功能低正常的参与者比甲状腺功能正常的参与者总体多活 3.5 年，没有 CVD 的参与者多活 3.1 年。这些发现为重新评估当前的甲状腺功能参考范围提供了支持证据，并有助于为预防和临床护理提供信息。结论和相关性 在 50 岁时，甲状腺功能低正常的参与者比甲状腺功能正常的参与者总体多活 3.5 年，没有 CVD 的参与者多活 3.1 年。这些发现为重新评估当前的甲状腺功能参考范围提供了支持证据，并有助于为预防和临床护理提供信息。结论和相关性 在 50 岁时，甲状腺功能低正常的参与者比甲状腺功能正常的参与者总体多活 3.5 年，没有 CVD 的参与者多活 3.1 年。这些发现为重新评估当前的甲状腺功能参考范围提供了支持证据，并有助于为预防和临床护理提供信息。