Thyroid Dysfunction is Prevalent in Older Adults

Helpful Highlights

• Studies show that thyroid illness is very much a disease of the elderly and it often goes undiagnosed.

• Thyroid disorder is sometimes difficult to diagnose in older adults, as symptoms are not always as widespread or obvious as those in younger people.

• Many changes in thyroid function have been described in the elderly and are attributed to age-related physiological changes in thyroid function, coexisting illnesses, and polypharmacy (regularly taking five or more medications).

• Thyroid dysfunction may be associated with significant morbidity if misdiagnosed and left untreated.

What is the thyroid?

The thyroid is a butterfly-shaped gland located in the neck, just below the Adam's apple. It plays a crucial role in regulating the body's metabolism by producing hormones that influence energy production, growth, and the functioning of organs and tissues throughout the body. The thyroid is controlled by the hypothalamus which releases thyrotropin-releasing hormone (TRH), which then stimulates the pituitary gland to release thyroid-stimulating hormone (TSH).

The thyroid volume decreases due to progressive fibrosis and atrophy with advancing age.

Why is thyroid health important?

In a sentence - because it is a powerful endocrine gland that affects different functions throughout the body.

When overactive (hyper-) or not active enough (hypo-), it affects your loved one's physical and mental well-being because of its impact on function (mobility and strength) and cognition (mental processing and clarity in thinking).

Low thyroid function (hypothyroidism) is present in up to 5% of older adults and subclinical hypothyroidism is present in up to 15% of people aged 65 and older.

Thyroid disorder diagnosis can be tricky since it often shows up as a disorder of another system in the body, such as the gut, heart, or nervous system. Older persons with thyroid disorders require special attention to gradual and careful treatment, as well as lifelong follow-up.

What can I do for my loved one?

Foremost, ensure that you are regularly checking in with your loved one on how they're feeling and what physical or mental changes they may be experiencing from day to day.

Also ensure that any new or worsening symptoms are reported to your loved one's primary care provider, even if they are subtle or your loved one doesn't seem worried about them.

Encourage your loved one to attend all healthcare-related appointments and engage in any testing, scheduled follow-ups, or additional recommendations, no matter who the appointment is with - their primary care provider, dentist, cardiologist, home health nurse, physical therapist, VA liaison... Whomever.

If your loved one has already been diagnosed with thyroid disease, ensure that they are referred to an endocrinologist and faithfully follow their treatment regimen.

Symptoms of thyroid disease

Symptoms of thyroid disease in those aged 60 and over are often nonspecific and present as weakness, falls, and confusion or other cognitive impairments. Other indicators might include:

• "Fluttering" heart and vague chest discomfort with moderate activity

• Constipation

• Falling asleep frequently

• Loss of strength in legs

• Joint or muscle pain

• Excess weight loss despite a good appetite

• Unexplained weight gain

• Difficulty swallowing, dry cough, hoarseness

• Dry, itchy skin

• Eye problems, including changes in vision, sensation, or physical appearance

• Hearing loss

• Hand tremors

• Persistent and significant depressive symptoms

Thyroid abnormalities may also be detected with routine testing (i.e., annual wellness visits and blood tests).

Another important indicator of thyroid disease in an older adult is a history of thyroid disease in a close family member (sibling or child).

Treatment

Specific treatment depends on the thyroid disorder, though typically consists of oral medications and monitoring, and sometimes involves iodine therapy or surgery.

The approach to the management of thyroid disorders in the elderly differs from that for younger individuals in that it considers frailty, coexisting medical illness and medications, clearance rate of medications, and drug-drug interactions along with target organ sensitivity to the treatment.