Overt and Subclinical Hypothyroidism in the Elderly: When to Treat?

Abstract

Hypothyroidism is characterized by increased thyrotropin (TSH) levels and reduced free thyroid hormone fractions while, subclinical hypothyroidism (sHT) by elevated serum TSH in the face of normal thyroid hormones. The high frequency of hypothyroidism among the general population in Western Countries made levothyroxine (LT4) one of the 10 most prescribed drugs. However, circulating TSH has been demonstrated to increase with aging, regardless the existence of an actual thyroid disease. Thus, when confronting an increase in circulating TSH levels in the elderly, especially in the oldest old, it is important to carry an appropriate diagnostic path, comprehensive of clinical picture as well as laboratory and imaging techniques. In the current review, we summarize the recommendations for a correct diagnostic workup and therapeutic approach to older people with elevated TSH value, with special attention to the presence of frailty, comorbidities, and poly-therapy. The treatment of choice for hypothyroid patients is hormone replacement with LT 4 but, it is important to consider multiple factors before commencing the therapy, from the age dependent TSH increase to the presence of an actual thyroid disease and comorbidities. When treatment is necessary, a tailored therapy should be chosen, considering poly-pharmacy and frailty. A careful follow-up and treatment re-assessment should be always considered to avoid the risk of over-treatment. It is important to stress the need of educating the patient for a correct administration of LT 4 , particularly when poly-therapy is in place, and the importance of a tailored therapeutic approach and follow-up, to avoid overtreatment.

Prevalence of hypothyroidism in different occupational groups of Bangladeshi population

“…There is a plausible explanation that hypothyroidism reduces dopaminergic activity in central nervous system, which in turn increases norepinephrine leading to hypertension. Several statistical analyses were undertaken based on this theory, but we found no significant association between hypothyroidism and hypertension (Table-3 As regards to age, it has been observed that TSH increased with age [5,26] though with much genetic variation. We found that age had no significant correlations with TSH and FT4 (Table-5, Figure 1).…”

“…Hypothyroidism is a common endocrine problem that is encountered everywhere in the world, be it in developed or developing countries [1][2][3]. This endocrine disorder affects health from utero to childhood and even extends to adulthood [4,5]. Hypothyroidism in pregnancy may lead to premature delivery or even its loss [6].…”

Frequency Distribution of Spectrum of Clinical Presentations in Hypothyroidism of Both Clinical and Subclinical Cases in SRM Medical College Hospital and Research Centre

“…According to Calsolaro V, et al 'The high frequency of hypothyroidism among the general population in Western Countries made levothyroxine (LT4) one of the 10 most prescribed drugs.' (3) Individuals from all age groups and both sexes, irrespective of young or old can be affected, especially in elderly individuals the clinical features may be atypical, and the diagnosis easily missed (4) and studies have shown that as much as 4.8% of elderly can have thyroid disorders. (5) Yet this disease has not been fully understood i.e.…”

Individualised requirements for optimum treatment of hypothyroidism: complex needs, limited options

“…This is higher than the upper limit of the diagnostic reference range defining the disease, which for most assays is approximately 4 mIU/L 7. This elevated decision point setting appears to stem from a desire to minimise the application of therapy in patients who may not require it 7,67,68. Accordingly, as for indicating treatment of hypothyroidism, clinicians are left with a paradox that establishing a diagnosis of subclinical hypothyroidism no longer implies that the disease may warrant treatment.…”