Thyroid problems in older patients
It can be challenging to diagnose thyroid problems older patients not least because they can be misinterpreted as age-related conditions.
For example hypothyroidism causes many different symptoms such as
- Feeling below par or fatigued
- Having dry skin and nails that break more easily
- Feeling the cold more than others
- Memory problems or having trouble thinking clearly.
- Putting on weight
And hyperthyroidism may manifest itself in the form of
- Heart flutter
- Hand tremor
- Weight loss
- Anxiety and emotional reactions
The difficulty of diagnosis
A 2011 study found that 8% of women over 50 and men over 65 had an undiagnosed underactive thyroid gland. This may not sound as bad as it initially seems as more recent analysis has shown that older patients seem to tolerate a slight degree of hypothyroidism and may actually benefit from it. (see this Clinical Endocrinology News article)
That said, however, the problem should not be ignored not least because untreated hypothyroidism can lead to heart problems and undiagnosed hyperthyroidism can lead to increased bone loss and fast irregular heart rhythm disturbances that can increase the risk of stroke. There are several factors why thyroid disease in those over 65 years old is much more likely to remain undiagnosed as compared with thyroid disease in 30 to 40 year olds.
One of those factors is due to symptoms being mistaken for indications of general ageing.
Another is the fact that, over your lifetime your thyroid levels will deplete but as these are in step with your slowing metabolism most thyroid function tests will still show you as being in the reference range.
Unsurprisingly then, GP’s need to have a high level of suspicion to do further investigations as thyroid disorders often look like disorders in another part of the body system.
For example, there are often indications such as a history of thyroid disease in another close family member such as a sibling or child of the patient. There may also be evidence of an enlarged thyroid gland (benign nodular goitre) which is more common in older patients.
Other flags may be that ageing patients who present with persistently increased cholesterol levels and may have thyroid failure contributing to this. Osteoporosis and increased fracture risk and atrial fibrillation may have been caused by hyperthyroidism.
The challenges of treatment
In older hypothyroid patients with cardiac disease a conservative approach regarding treatment with levothyroxine should be adopted as too vigorous a schedule may precipitate angina, rhythm disturbances or even a heart attack. So the dosage should be gradually increased with a check at 6 weeks to ensure that the correct daily dose required to normalise the TSH towards the upper end of the reference range has been achieved.
Senior hyperthyroid patients can be successfully treated with radioiodine but will need to follow-up thyroid function tests annually, as like younger patients, they are at risk of this treatment tipping them over into hypothyroidism.
I hope this has been helpful.
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