Thyroid Disorders in the Elderly

• Learn about the commonality of thyroid disorders in elderly patients and why aging can increase the risk of disorders like hypothyroidism and hyperthyroidism. 
• Understand how to spot hypothyroidism in an elderly patient and treatment options such as Levothyroxine to manage thyroid stimulating hormones. 
• Review the symptoms of hyperthyroidism in elderly patients and the treatment options such as radioactive iodine ablation therapy, antithyroid medications, and thyroidectomy. 

What do the elderly patients below all 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 disorders of the thyroid gland in further detail and why they are often present in the elderly population. 

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 serum thyroid stimulating hormone, 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 the Elderly Patient

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 of this would be an elderly patient experiencing memory loss or a decrease in 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. Speaking of symptoms, 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 (thyroid stimulating hormone) level is achieved.  

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

Symptoms that are possible with hyperthyroidism are 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 with hypothyroidism everything is slowed (hypo=slow), while with hyperthyroidism everything is faster than normal (hyper=fast). This will help you when figuring out which thyroid disorder the patient may be struggling with.  

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 prior to initiating treatment. Radioactive iodine ablation therapy, antithyroid medications, or thyroidectomy are all treatment options for hyperthyroidism. 

Radioactive iodine ablation therapy

Often used in older adults due to safety and cost-effectiveness. The drawback to this therapy 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 as a result of 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 medication.  

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

In conclusion, 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.  

Symptoms are not always as obvious as other factors, such as symptoms of other diseases present, which makes thyroid disorders difficult to diagnose in the elderly. This can cause a delay in 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 important to carry out a thorough assessment to diagnose thyroid disease in the elderly. Elderly patients struggling with thyroid disorders require special attention to gradual and careful treatment and require lifelong follow-up to achieve positive health outcomes.  

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