Hostname: page-component-76fb5796d-x4r87 Total loading time: 0 Render date: 2024-04-28T00:12:34.464Z Has data issue: false hasContentIssue false
  • English
  • Français

Thyroid disorders in older people

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  18 November 2009

Ajit Verma  and
Taj Hasan
Ajit Verma
Affiliation:
Department of Integrated Medicine, University Hospital of Wales, Cardiff
Taj Hasan*
Affiliation:
Section of Geriatric Medicine, School of Medicine, Cardiff University, UK
*
Address for correspondence: Dr Taj Hasan, Academic Centre, University Hospital Llandough, Penarth CF64 2XX, UK. Email: hasanm@cf.ac.uk
Get access Rights & Permissions [Opens in a new window]

Summary

Thyroid disorders become more common with advancing age. Clinical features of hypothyroidism overlap with signs and symptoms often present in euthyroid older people and there is high likelihood of misdiagnosis. Conversely, there may be a relative paucity of signs and symptoms in hyperthyroid older people. A large number of patients may have subclinical disease. High suspicion and confirmation by laboratory assay is the key to correct diagnosis, though thyroid function tests should be interpreted with caution during acute illnesses. There is a reduced requirement for levothyroxine replacement in elderly hypothyroid patients and dosage should be titrated up cautiously as it can unmask symptoms of ischaemic heart disease. Drug interactions should be taken into account because a number of drugs interfere with levothyroxine absorption and metabolism. Radioactive iodine ablation of overactive thyroid tissue is the preferred treatment of hyperthyroidism in older people.

Keywords

thyroidhypothyroidismhyperthyroidismgoitrethyroid cancerelderlyageing
Type
Clinical geriatrics
Information
Reviews in Clinical Gerontology , Volume 19 , Issue 3 , August 2009 , pp. 193 - 206
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Finucane, P, Anderson, C. Thyroid disease in older patients: diagnosis and treatment. Drugs Aging 1995; 6: 268–77.CrossRefGoogle ScholarPubMed
2Mochizuki, Y, Mowafy, R, Pasternack, B. Weights of human thyroids in New York City. Health Phys 1963; 9: 1299–301.CrossRefGoogle ScholarPubMed
3Mariotti, S, Franceschi, C, Cossarizza, A, Pinchera, A. The aging thyroid. Endocr Rev 1995; 16: 686–715.CrossRefGoogle ScholarPubMed
4Hegedus, L, Perrild, H, Poulsen, LR, Andersen, JR, Holm, B, Schnohr, P, Jensen, G, Hansen, JM. The determination of thyroid volume by ultrasound and its relationship to body weight, age and sex in normal subjects. J Clin Endocrinol Metab 1983; 56: 260–3.CrossRefGoogle ScholarPubMed
5Oiknine, RF, Mooradian, AD. Thyroid disorders. In Pathy, MSJ, Sinclair, AJ, Morley, JE (eds), Principles and Practice of Geriatric Medicine, 4th edition. London, Wiley Blackwell, 2006, pp. 1406–12.Google Scholar
6Harman, SM, Wehmann, RE, Blackman, MR. Pituitary-thyroid hormone economy in healthy aging man: basal indices of thyroid function and thyrotropin responses to constant infusion of thyrotropin releasing hormone. J Clin Endocrinol Metab 1984; 58: 320–6.CrossRefGoogle ScholarPubMed
7Synder, PJ, Utiger, RD. Thyrotropin response to thyrotropin releasing hormone in normal females over forty. J Clin Endocrinol Metab 1972; 34: 1096–8.CrossRefGoogle Scholar
8Osler, T, Lauberg, P, Weeke, J. Low serum triiodothyronine and high serum reverse triiodothyronine in old age: an effect of disease not age. J Clin Endocrinol Metab 1978; 42: 1111–5.Google Scholar
9Ordene, KW, Pan, C, Barzel, US, Surks, MI. Variable thyrotrophin response to thyrotrophin releasing hormone after small decreases in plasma thyroid hormone concentrations in patients of advanced age. Metabolism 1983; 32: 881–8.CrossRefGoogle ScholarPubMed
10Gregerman, RI, Gaffney, GW, Shock, NW, Crowder, SE. Thyroxine turnover in euthyroid man with special reference to changes with age. J Clin Invest 1962; 41: 2065–74.CrossRefGoogle ScholarPubMed
11Hershman, JM, Pekary, AE, Berg, L, Solomon, DH, Sawin, CT. Serum thyrotropin and thyroid hormone levels in the elderly and middle aged euthyroid patients. J Am Geriatr Soc 1993; 41: 825–8.CrossRefGoogle Scholar
12Mariotti, S, Chiovato, L, Franceschi, C, Pinchera, A. Thyroid autoimmunity and aging. Exp Gerontol 1998; 33: 535–41.CrossRefGoogle ScholarPubMed
13Jameson, JL, Weetman, AP. Disorders of thyroid gland. In Fauci, AS, Braunwald, E, Kesper, DL et al. (eds), Harrison's Principles of Internal Medicine, 17th edition. New York, McGraw Hill Medical, 2008, pp. 2224–7.Google Scholar
14Hay, ID, Klee, CG. Thyroid dysfunction. Endocr Metab Clin North Am 1988; 17: 473–509.CrossRefGoogle ScholarPubMed
15Robuschi, G, Safran, M, Braverman, LE, Gnudi, A, Roti, E. Hypothyroidism in the elderly. Endocr Rev 1987; 8: 142–53.CrossRefGoogle ScholarPubMed
16Blumenthal, HT, Perlstein, IB. The aging thyroid II. An immunocytochemical analysis of the age-associated lesions. J Am Geriatr Soc 1987; 35: 855–63.CrossRefGoogle Scholar
17Tunbridge, WMC, Brewis, M, French, J. Natural history of autoimmune thyroiditis. Br Med J 1981; 282: 258–62.CrossRefGoogle ScholarPubMed
18Sawin, CT, Bigos, ST, Land, S, Bacharach, P. The aging thyroid. Relationship between elevated thyrotropin level and thyroid antibodies in elderly patients. Am J Med 1985; 79: 591–5.CrossRefGoogle ScholarPubMed
19Wong, KT, Ahuja, AT. Ultrasound of thyroid cancer. Cancer Imaging 2005; 5: 157–66.CrossRefGoogle ScholarPubMed
20Levy, EG. Thyroid disease in the elderly. Med Clin North Am 1991; 75: 151–67.CrossRefGoogle ScholarPubMed
21Bemben, DA, Winn, P, Hamm, RM, Morgan, L, Davis, A, Barton, E. Thyroid disease in the elderly. J Fam Pract 1994; 38: 577–88.Google ScholarPubMed
22Bilous, RW, Tunbridge, WM. The epidemiology of hypothyroidism – an update. Baillieres Clin Endocrinol Metab 1988; 2: 531–40.CrossRefGoogle ScholarPubMed
23Flatau, E, Trougouboff, P, Kaufman, N, Reichman, N, Luboshitzky, R. Prevalence of hypothyroidism and diabetes mellitus in elderly kibbutz members. Eur J Epidemiol 2000; 16: 43–6.CrossRefGoogle ScholarPubMed
24Tunbridge, WM, Evered, DC, Hall, R, Appleton, D, Brewis, M, Clark, F, Evans, JG, Young, E, Bird, T, Smith, PA. The spectrum of thyroid disorder in a community: the Whickham survey. Clinical Endocrinol 1977; 7: 481–93.CrossRefGoogle Scholar
25Bagchi, N, Brown, TR, Parish, RF. Thyroid dysfunction in adults over 55 years. A study in an urban US community. Arch Intern Med 1990; 150: 785–7.CrossRefGoogle Scholar
26Sawin, CT, Castelli, WP, Hershman, JM, McNamara, P, Bacharach, P. The aging thyroid: thyroid deficiency in the Framingham study. Arch Intern Med 1985; 145: 1386–8.CrossRefGoogle ScholarPubMed
27Hurley, JR. Thyroid disease in the elderly. Med Clin North Am 1983; 67: 497–516.CrossRefGoogle ScholarPubMed
28Diez, JJ. Hypothyroidism in patients older than 55 years: An analysis of the etiology and assessment of the effectiveness of therapy. J Gerontol 2002; 57: M315–20.CrossRefGoogle ScholarPubMed
29Lloyd, WH, Goldberg, IJL. Incidence of hypothyroidism in the elderly. Br Med J 1961; 2: 1256–9.CrossRefGoogle ScholarPubMed
30Mintzer, MJ. Hypothyroidism and hyperthyroidism in the elderly. J Fla Med Assoc 1992; 79: 231–5.Google ScholarPubMed
31Davis, PJ, Davis, FB. Hypothyroidism in the elderly. Comprehens Ther 1984; 10: 17–23.Google ScholarPubMed
32Case, CC, Mooradian, AD. Thyroid changes with aging. In Morley, JE, Armbrecht, HJ, Coe, RM, Vellas, B (eds), The Science of Geriatrics, Facts, Research and Intervention in Geriatrics Series 2000; 1: 273–281. Paris, Serdi Publisher.Google Scholar
33Mohandas, R, Gupta, KL. Managing thyroid dysfunction in the elderly. Postgrad Med 2003; 113: 54–68.CrossRefGoogle ScholarPubMed
34Doucet, J, Trivalle, C, Chassagne, P, Perol, MB, Vuillermet, P, Manchon, ND, Menard, JF, Bercoff, E. Does age play a role in clinical presentation of hypothyroidism? J Am Geriatr Soc 1994; 42: 984–6.CrossRefGoogle ScholarPubMed
35Trivalle, C, Doucet, J, Chassagne, P, Landrin, I, Kadri, N, Menard, JF, Bercoff, E. Differences in the signs and symptoms of hyperthyroidism in older and younger patients. J Am Geriatr Soc 1996; 44: 50–3.CrossRefGoogle ScholarPubMed
36Obuobie, K, Smith, J, Evans, LM, John, R, Davies, JS, Lazarus, JH. Increased central arterial stiffness in hypothyroidism. J Clin Endocrinol Metab 2002; 87: 4662–6.CrossRefGoogle ScholarPubMed
37Vanhaelst, L, Neve, P, Chailly, P, Bastenie, PA. Coronary artery disease in hypothyroidism: observations in clinical myxoedema. Lancet 1967; 2: 800–2.CrossRefGoogle ScholarPubMed
38Miller, M. Disorders of thyroid. In Tallis, RC, Fillit, HM (eds), Brocklehurst's Textbook of Geriatric Medicine, 6th edition. New York, Churchill Livingstone, 2002, pp. 1023–41.Google Scholar
39Davis, PJ, Katz, PR. Disorders of the thyroid gland. In Evans, JG, Williams, TF, Beattie, BL (eds), Oxford Textbook of Geriatric Medicine, 2nd edition. New York, Oxford University Press, 2000, pp. 171–9.Google Scholar
40Felicetta, JV. The aging thyroid: its effects and how it affects diagnosis and therapy. Consultant 1996; 36: 837–45.Google Scholar
41Rehman, SU, Cope, DW, Senseney, AD, Brzezinski, W. Thyroid disorders in elderly patients. South Med J 2005; 98: 543–9.CrossRefGoogle ScholarPubMed
42Dugbartey, AT. Neurocognitive aspects of hypothyroidism. Arch Intern Med 1998; 158: 1413–8.CrossRefGoogle ScholarPubMed
43Tan, ZS, Bieser, A, Vasan, RS, Au, R, Auerbach, S, Kiel, DP, Wolf, PA, Seshadri, S. Thyroid function and risk of Alzheimer disease: The Framingham study. Arch Intern Med 2008; 168: 1514–20.CrossRefGoogle ScholarPubMed
44Green, YB, Robinson, B. Elderly patients with tremors and depression. Hosp Pract 1985; 20: 68c–68d.CrossRefGoogle Scholar
45Tapp, A. Affective cycling in thyroid disease. J Clin Psychiatry 1988; 49: 199–200.Google ScholarPubMed
46Bahemuka, M, Hodkinson, HM. Screening for hypothyroidism in elderly inpatients. Br Med J 1975; 2: 601–3.CrossRefGoogle ScholarPubMed
47Khaira, JS, Franklin, JA. Thyroid disease in older patients. Practitioner 1999; 243: 214–21.Google ScholarPubMed
48Aronow, WS. The heart and thyroid disease. Clin Geriatr Med 1995; 11: 219–29.CrossRefGoogle ScholarPubMed
49Ellyin, F, Fuh, CY, Singh, SP, Kumar, Y. Hypothyroidism with angina pectoris. A clinical dilemma. Postgrad Med 1986; 79: 93–8.CrossRefGoogle ScholarPubMed
50Ladenson, PW. Recognition and management of cardiovascular disease related to thyroid dysfunction. Am J Med 1990; 88: 638–41.CrossRefGoogle ScholarPubMed
51Helfand, M, Crapo, LM. Monitoring therapy in patients taking levothyroxine. Ann Intern Med 1990; 113: 450–4.CrossRefGoogle ScholarPubMed
52Levine, HD. Compromise therapy in the patient with angina pectoris and hypothyroidism. A clinical assessment. Am J Med 1980; 69: 411–8.CrossRefGoogle ScholarPubMed
53Coll, PP, Abourizk, NN. Successful withdrawal of thyroid hormone therapy in nursing home patients. J Am Board Fam Pract 2000; 13: 403–7.CrossRefGoogle ScholarPubMed
54Stall, GM, Harris, S, Sokoll, LJ, Dawson, HB. Accelerated bone loss in hypothyroid patients over treated with L-thyroxine. Ann Intern Med 1990; 113: 265–9.CrossRefGoogle Scholar
55Solomon, BL, Wartofsky, L, Burman, KD. Prevalence of fractures in postmenopausal women with thyroid disease. Thyroid 1993; 3: 17–23.CrossRefGoogle ScholarPubMed
56Nishikawa, M, Inada, M, Naito, K, Ishii, H, Tanaka, K, Mashio, Y, Imura, H. Age related changes of serum 3,3’-diiodothyronine, 3’,5’-diiodothyronine, and 3,5- diiodothyronine concentrations in man. J Clin Endocrinol Metab 1981; 52: 517–52.CrossRefGoogle ScholarPubMed
57Canaris, GJ, Manowitz, NR, Mayor, G, Ridgway, EC. The Colorado thyroid disease prevalence study. Arch Intern Med 2000; 160: 526–34.CrossRefGoogle ScholarPubMed
58Tunbridge, WM, Brewis, M, French, JM, Appleton, D, Bird, T, Clark, F, Evered, DC, Evans, JG, Hall, R, Smith, P, Stephenson, J, Young, E. Natural history of autoimmune thyroiditis. Br Med J 1981; 282: 258–62.CrossRefGoogle ScholarPubMed
59Hak, AE, Pols, HA, Visser, TJ, Drexhage, HA, Hofman, A, Witteman, JC. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: The Rotterdam study. Ann Intern Med 2000; 132: 270–8.CrossRefGoogle ScholarPubMed
60Kahaly, GJ. Cardiovascular and atherogenic aspects of subclinical hypothyroidism. Thyroid 2000; 10: 665–79.CrossRefGoogle ScholarPubMed
61British National Formulary 2008; 56: 381–2.Google Scholar
62Davis, PJ, Davis, FB. Hyperthyroidism in patients aged over the age of 60 years: clinical features in 85 patients. Medicine 1974; 53: 161–82.CrossRefGoogle ScholarPubMed
63Ronnov-Jessen, V, Kirkegaard, C. Hyperthyroidism – a disease of old age? Br Med J 1973; 1: 41–43.CrossRefGoogle ScholarPubMed
64Diez, JJ. Hyperthyroidism in patients older than 55 years: An analysis of the etiology and management. Gerontology 2003; 49: 316–23.CrossRefGoogle ScholarPubMed
65Federman, DD. Hyperthyroidism in geriatric population. Hosp Pract 1991; 26: 61–76.CrossRefGoogle ScholarPubMed
66Waldenstorm, J. Acute thyrotoxic encephalomyopathy or myopathy: its causes and treatment. Acta Med Scand 1945; 121: 251CrossRefGoogle Scholar
67Seed, L, Lindsay, AM. Hyperthyroidism in the aged – a review of 100 cases over 60 years of age. Geriatrics 1949; 4: 136.Google ScholarPubMed
68Nordyke, RA, Gilbert, FI, Harada, ASM. Graves’ disease: influence of age in clinical findings. Arch Int Med 1988; 148: 626–31.CrossRefGoogle ScholarPubMed
69Seeman, E, Wahner, HW, Offord, KP, Kumar, R, Johnson, WJ, Riggs, BL. Differential effects of endocrine dysfunction on the axial and appendicular skeleton. J Clin Invest 1982; 69: 1302–9.CrossRefGoogle ScholarPubMed
70Lahey, FH. Apathetic thyroidism. Ann Surg 1931; 93: 1026–30.CrossRefGoogle ScholarPubMed
71Hall, RC, Beresford, TP. Psychiatric manifestations of physical illness. In Cavenar, J (ed), Psychiatry Volume 2. Philadelphia, PA Lippincott, 1988, pp. 7–8.Google Scholar
72Gambert, SR. Hyperthyroidism in the elderly. Clin Geriatr Med 1995; 11: 181–8.CrossRefGoogle ScholarPubMed
73Marsden, P, Facer, P, Acosta, M, McKerron, CG. Serum triiodothyronine in solitary autonomous nodule of the thyroid. Clin Endocrinol 1975; 4: 327–30.CrossRefGoogle Scholar
74Parle, JV, Franklyn, JA, Cross, KW, Jones, SC, Sheppard, MC. Prevalence and follow up of abnormal thyrotropin (TSH) concentrations in the elderly in the United Kingdom. Clin Endocrinol 1991; 34: 77–83.Google ScholarPubMed
75Sawin, CT, Geller, A, Kaplan, MM, Bacharach, P, Wilson, PW, Hershman, JM. Low serum thyrotropin (thyroid-stimulating hormone) in older persons without hyperthyroidism. Arch Intern Med 1991; 151: 165–8.CrossRefGoogle ScholarPubMed
76Foldes, J, Tarj, G, Szathmari, M, Varga, F, Krasznai, I, Horvath, C. Bone mineral density in patients with endogenous subclinical hyperthyroidism: is this thyroid status a risk factor for osteoporosis? Clin Endocrinol 1993; 39: 521–7.CrossRefGoogle ScholarPubMed
77Biondi, B, Palmieri, EA, Fazio, S, Cosco, C, Nocera, M, Sacca, L, Filetti, S, Lombardi, G, Perticone, F. Endogenous subclinical hyperthyroidism affects quality of life and cardiac morphology and function in young and middle-aged patients. J Clin Endocrinol Metab 2000; 85: 4701–5.Google Scholar
78Weetman, AP. Graves’ disease. N Engl J Med 2000; 343: 1236–48.CrossRefGoogle ScholarPubMed
79Sheng, WH, Hung, CC, Chen, YC, Fang, CT, Hsieh, SM, Chang, SC, Hsieh, WC. Antithyroid-drug-induced agranulocytosis complicated by life-threatening infections. QJM 1999; 92: 455–61.CrossRefGoogle ScholarPubMed
80Weetman, AP, Pickerill, AP, Watson, P, Chatterjee, VK, Edwards, OM. Treatment of Graves’ disease with the block-replace regimen of antithyroid drugs: the effect of treatment duration and immunogenetic susceptibility on relapse. QJM 1994; 87: 337–41.Google ScholarPubMed
81Massart, C, Guilhem, I, Lorcy, Y, Lescouarch, J, Herry, JY, Allannic, H. Antithyroid drugs and Graves’ disease – prospective randomized assessment of long-term treatment. Clin Endocrinol 1999; 50: 127–32.Google Scholar
82Gross, MD, Shapiro, B, Sisson, JC. Radioiodine therapy of thyrotoxicosis. Rays 1999; 24: 334–47.Google ScholarPubMed
83Gupta, KL. Neoplasm of the thyroid gland. Clin Geriatr Med 1995; 11: 271–90.CrossRefGoogle ScholarPubMed
84Lin, JD, Chao, TC, Chen, ST, Weng, HF, Lin, KD. Characteristic of thyroid carcinomas in aging patients. Eur J Clin Invest 2000; 30: 147–53.CrossRefGoogle ScholarPubMed
85Hundahl, SA, Fleming, ID, Fremgen, AM, Menck, HR. A national cancer data base report on 53,856 cases of thyroid carcinoma treated in the US, 1985–1995. Cancer 1998; 83: 2638–48.3.0.CO;2-1>CrossRefGoogle Scholar
86Aldinger, KA, Samaan, NA, Ibanez, M, Hill, CS Jr. Anaplastic carcinoma of the thyroid: a review of 84 cases of spindle and giant cell carcinoma of the thyroid. Cancer 1975; 41: 2267–75.3.0.CO;2-7>CrossRefGoogle Scholar
87Cooper, DS, Doherty, GM, Haugen, BR, Kloos, RT, Lee, SL, Mandel, SJ, Mazzaferri, EL, McIver, B, Sherman, SI, Tuttle RM, ; American Thyroid Association Guidelines Taskforce. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006; 16: 109–42.CrossRefGoogle ScholarPubMed
88Roberts, LM, Pattison, H, Roalfe, A, Franklyn, J, Wilson, S, Hobbs, FD, Parle, JV. Is subclinical thyroid dysfunction in the elderly associated with depression or cognitive dysfunction? Ann Intern Med 2006; 145: 573–81.CrossRefGoogle ScholarPubMed
89Razvi, S, Shakoor, A, Vanderpump, M, Weaver, JU, Pearce, SH. The influence of age on the relationship between subclinical hypothyroidism and ischemic heart disease: A meta-analysis. J Clin Endocrinol Metab 2008; 93: 2998–3007.CrossRefGoogle Scholar
90Holm, LE. Changing annual incidence of hypothyroidism after iodine-131 therapy for hyperthyroidism. 1951–1975. J Nuclear Med 1982; 23: 108–12.Google ScholarPubMed