Thyroid disorders in older people

Do the symptoms of thyroid disorders vary in the elderly? 

The diagnosis and treatment of thyroid disorders in older people is not always easy. Although the incidence of thyroid problems increases with age, it is sometimes difficult to diagnose as symptoms are not always as widespread or obvious as those in younger patients.

The difficulty in diagnosing older people is that thyroid abnormalities can appear much differently from the way they are supposed to. Whereas hyper- and hypothyroidism present very differently in younger patients, in older patients there are similarities between the two disorders.

In both conditions in older people there can be confusion, depression, falling, heart failure and changes in bowel habits. Not only do these signs make it difficult to distinguish hyper- from hypothyroidism in this age group, but they are also signs of other common illnesses of older people.

Hyperthyroidism (overactive thyroid) in older people

As in all hyperthyroid patients, if there is too much thyroid hormone, every function of the body tends to speed up. However, while younger people with thyroid disorders often experience multiple symptoms related to the overactive thyroid (weight loss, palpitations, sweating, nervousness, tremors) older people may only have a few symptoms, for example some heart palpitations and chest discomfort on climbing stairs. Others may have a tremor and feel depressed but not have any other symptoms.

Hypothyroidism (underactive thyroid) in the older patient

Hypothyroidism is the most common thyroid condition in patients over 60 years of age and increases steadily with age. A study that evaluated more than 25,000 individuals attending a health fair in Colorado revealed that 10% of men and 16% of women aged 65-74 had TSH levels that were increased above the upper limit of the reference range, while 16% of men and 21% of women aged 75 and older had increased TSH levels.

The symptoms of hypothyroidism are very non-specific in all patients, and even more so in older people. The severity and extent of symptoms also depend on the degree of hypothyroidism. As with hyperthyroidism, the frequency of multiple symptoms (dry skin, thinning hair, constipation, weight gain, low mood, tiredness) decreases with age. For example, memory loss or a decrease in cognitive functioning, often attributed to advancing age, may be the only symptom of severe hypothyroidism in an older person. Clues to the possibility of hypothyroidism include a positive family history of thyroid disease, past treatment for hyperthyroidism, or a history of extensive surgery and/or radiotherapy to the neck.

Thyroid reference ranges for older patients

It is well known that thyroid hormone requirements change with age and there is currently a debate as to whether the practice of treating everyone with an underactive thyroid in the same way, regardless of their age, is appropriate.

An increasing number of older people are diagnosed with a mild underactive thyroid (subclinical hypothyroidism) when their blood thyroid hormone levels (T3 and T4) are normal and their TSH levels are high. Given that the standard TSH reference range used has been obtained from mainly younger people it may not be suitable to make a diagnosis of hypothyroidism in older people. It has also been found that TSH levels increase naturally in older people (70+ years of age) and this is not always associated with poorer health.

To answer these questions there are a number of studies being undertaken to try and pinpoint what TSH levels for older people with an underactive thyroid and whether the treatments offered should vary.

Further information

Read our article on 'Older patients and thyroid disease'

Read about subclinical thyroid disease

Learn more about hypothyroidism

Learn more about hyperthyroidism

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