A Guide for Thyroid Disorders in the Elderly

• Changes in hormone secretion, metabolism, and action can lead to thyroid disorders in the elderly.  
• Hypothyroidism is most common in patients aged 60 and older.  
• Treatment of hyperthyroidism in the elderly can be more complex than treatment of hypothyroidism due to the possible complications.  

What do all the elderly patients below share?  

• A 70-year-old woman experiencing significant weight gain.  
• A 68-year-old man who cannot tolerate cold temperatures.  
• A 76-year-old woman experiencing extreme fatigue.  
• An 80-year-old man with heart palpitations.  
• A 60-year-old woman experiencing frequent episodes of agitation.  
• An 82-year-old man experiencing significant weight loss.  

You guessed it! All these patients have problems with their thyroid function. Patients 1, 2, and 3 all struggle with hypothyroidism, while patients 4, 5, and 6 all struggle with hyperthyroidism.  

Let’s discuss these thyroid gland disorders and why they are often present in the elderly.

Why are Thyroid Disorders Common in the Elderly?

Several changes in thyroid hormone secretion, metabolism, and action occur with the increase in age. Aging is often associated with a decrease in the serum thyroid stimulating hormone (TSH), resulting in hypothyroidism.   

Hyperthyroidism can also occur in the elderly, which is an increase in the thyroid-stimulating hormone. However, hypothyroidism is more common in the elderly than hyperthyroidism.   

Hypothyroidism in Elderly Patients

Hypothyroidism is common in patients aged 60 and older, and the chance of developing hypothyroidism increases with age. Symptoms of hypothyroidism are usually non-specific.   

It is also important to note that the frequency of multiple hypothyroidism symptoms decreases in older patients.   

An example is an elderly patient experiencing memory loss or decreased cognitive function. This is often assumed to be a symptom of advanced age; however, this is also a symptom of hypothyroidism and may be the only presenting symptom in an elderly patient.   

Other symptoms that can be attributed to hypothyroidism are constipation, dry skin, weight gain, cold sensitivity, and fatigue.   

Treatment for Hypothyroidism in Elderly Patients

Management of hypothyroidism should focus on ensuring the patient receives appropriate thyroid hormone replacement therapy and monitoring their response.   

Levothyroxine is a commonly prescribed thyroid hormone replacement therapy drug used to treat hypothyroidism in the elderly. Levothyroxine should be started at a low dose and increased gradually until the desired TSH level is achieved.   

Once this desired level is achieved, lifelong monitoring will be necessary to prevent potential complications. As always, the benefits of thyroid hormone replacement therapy should outweigh the possible adverse effects on the patient.  

Hyperthyroidism in Elderly Patients  

Hyperthyroidism means there is too much thyroid hormone, and this causes every bodily function to speed up. In contrast to hyperthyroidism in young adults, where patients struggle with several hyperthyroidism symptoms, elderly patients may only present with one or two symptoms.  

Possible hyperthyroidism symptoms include weight loss, mood changes, sensitivity to heat, heart palpitations, increase in bowel movements, and difficulty sleeping.   

If you need an easy way to differentiate between hyperthyroidism and hypothyroidism, keep in mind that everything is slowed (hypo=slow), while with hyperthyroidism, everything is faster than average (hyper=fast). This will help you determine which thyroid disorder the patient might have. 

Treatment for Hyperthyroidism in Elderly Patients

Treatment of hyperthyroidism in the elderly can be more complex and complicated than the treatment of hypothyroidism due to the possible complications of treatment options. Treatment should be individualized, and risks and benefits must be weighed before initiating treatment. Radioactive iodine ablation therapy, antithyroid medications, or thyroidectomy are all treatment options for hyperthyroidism.  

Radioactive Iodine Ablation Therapy: They are often used in older adults due to safety and cost-effectiveness. The drawback is that it gradually reverses hyperthyroidism, which means cardiac problems resulting from hyperthyroidism may become more severe. It is also possible the patient develops hypothyroidism from this treatment and requires thyroid hormone replacement therapy.  

Antithyroid Medications: Methimazole is an antithyroid medication for hyperthyroidism. This medication may cause elderly patients to be at a greater risk of recurring hyperthyroidism even after treatment with the drug.  

Thyroidectomy: Surgical approaches for the treatment of hyperthyroidism are not commonly used in elderly patients, as there is an increased risk of morbidity.  

The Bottom Line

Thyroid disorders have no age limits, with hypothyroidism being more common in older adults than in younger adults. Hypothyroidism is also more common in the elderly than hyperthyroidism.   

Thyroid disorders are challenging to diagnose in the elderly because symptoms are not always as apparent as those of other diseases. This can delay diagnosis and proper treatment. Untreated thyroid dysfunction is linked to an increased risk of cardiovascular issues in older people.   

Due to this risk, it is essential to conduct a thorough assessment to diagnose thyroid disease in the elderly. Elderly patients who have a thyroid disorder require special attention to gradual and careful treatment and require lifelong follow-up to achieve positive health outcomes.   

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