Hypothyroidism in Older Adults

Hypothyroidism is more common among elderly individuals due to the increasing incidence and prevalence of autoimmune thyroiditis that occurs with aging. Accurate diagnosis of this condition in the elderly may be challenging due to a number of factors including a relative paucity of referable symptoms, confounding findings that may be related to comorbid disorders, changes in thyroid hormone levels that may be related to nonthyroidal illness, and upward shifts in TSH levels that may occur with normal aging. Effective treatment of hypothyroidism in the elderly relies on consideration of potential drug interactions and changes in the metabolic clearance of thyroid hormone that occur with aging. Specific attention should be paid to minimizing the risks of atrial arrhythmias and progressive bone loss that may be associated with iatrogenic thyrotoxicosis caused by over-treatment with excessive doses of levothyroxine. Mild hypothyroidism identified in the elderly does not appear to be associated with any changes in cognitive function or functional status. Studies that have sought to determine the risk of cardiovascular disease associated with mild hypothyroidism and the potential benefits of treatment targeted to normalize thyroid hormone levels in elderly individuals with mild hypothyroidism have reported conflicting results. Elderly patients presenting with untreated or undertreated severe hypothyroidism may be particularly susceptible to decompensation that may progress to a state of myxedema coma. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG .