Hypothyroidism in the elderly: diagnosis and management

Abstract

Thyroid disorders are highly prevalent, occurring most frequently in aging women. Thyroid-associated symptoms are very similar to symptoms of the aging process; thus, improved methods for diagnosing overt and subclinical hypothyroidism in elderly people are crucial. Thyrotropin measurement is considered to be the main test for detecting hypothyroidism. Combined evaluations of thyroid stimulating hormone (TSH) and free-thyroxine can detect overt hypothyroidism (high TSH with low free-thyroxine levels) and subclinical hypothyroidism (high TSH with normal free-thyroxine levels). It is difficult to confirm the diagnosis of thyroid diseases based only on symptoms, but presence of symptoms could be an indicator of who should be evaluated for thyroid function. The most important reasons to treat overt hypothyroidism are to relieve symptoms and avoid progression to myxedema. Overt hypothyroidism is classically treated using L-thyroxine; elderly patients require a low initial dose that is increased every 4 to 6 weeks until normalization of TSH levels. After stabilization, TSH levels are monitored yearly. There is no doubt about the indication for treatment of overt hypothyroidism, but indications for treatment of subclinical disease are controversial. Although treatment of subclinical hypothyroidism may result in lipid profile improvement, there is no evidence that this improvement is associated with decreased cardiovascular or all-cause mortality in elderly patients. In patients with a high risk of progression from subclinical to overt disease, close monitoring of thyroid function could be the best option.

Ultrasonographic assessment of thyroid volume in oldest-old individuals

“…In a clinical context, overt hypothyroidism is preceded by a period of subclinical thyroid dysfunction, with a range of nonspecific symptoms that can be confounded with other geriatric syndromes (27) and may, as a consequence, be undertreated (28,29). According to some authors, the volume of the thyroid decreases with aging (6)(7)(8)24).…”

Dietary high-fat lard intake induces thyroid dysfunction and abnormal morphology in rats

“…TSH then acts via specific receptors on the membrane of thyroid follicular cells to facilitate compensatory stimulation of thyroid hormone production and secretion, which involves a number of thyroid hormone synthesis-related molecules, such as sodium/iodide symporter (NIS), thyroglobulin (Tg), and thyroperoxidase (TPO). The combined measurements of serum TT4, FT4, and TSH levels are widely recommended to fully assess thyroid function [13,14] .…”

Nutrition Therapy Regulates Caffeine Metabolism with Relevance to NAFLD and Induction of Type 3 Diabetes

“…Repression of Sirt 1 in cells is responsible for major intracellular defects and caffeine induced mitochondrial apoptosis relevant to adipogenesis defects [31,32] related to NAFLD with NAFLD to reach 30% of the developing world [159][160][161][162]. Defective hepatic caffeine clearance rates in the developing world may be connected to pancreatic [163][164][165][166][167][168][169][170] and thyroid disease [171][172][173] but xenobiotics may also be the inducing factor in these chronic diseases. LPS induced Sirt 1 repression may involve both caffeine and xenobiotic toxic effects with the induction of NAFLD, NAFLD linked to gall bladder disease [174][175][176][177] and cardiovascular disease [107][108][109].…”