Thyroid disorders in elderly patients.
Thyroid disorders are common in the elderly and are associated with significant morbidity if left untreated. Typical symptoms may be absent and may be erroneously attributed to normal aging or coexisting disease. Physical examination of the thyroid gland may not be helpful, as the gland is often shrunken and difficult to palpate. Usually only myxedema coma requires levothyroxine parenterally; all other forms of hypothyroidism can be treated with oral levothyroxine. Low-dose levothyroxine should be initiated and increased gradually over several months. In unstable elderly patients with hyperthyroidism, antithyroid medication can quickly produce a euthyroid state. Radioactive iodine therapy is more definitive and is well tolerated, effective, and preferred. Surgical thyroid ablation may be necessary in patients who fail to respond to radioactive iodine therapy and in patients with multinodular goiter. If there is a suspicion of malignant disease, early biopsy or fine needle aspiration for cytology should be considered.
Rehman
Shakaib U
SU
Primary Care Service Line and Geriatrics Service Line, Ralph H. Johnson VA Medical Center, Charleston, SC, USA. Shakaib.rehman@med.va.gov
Cope
Dennis W
DW
Senseney
Anna D
AD
Brzezinski
Walter
W
D000368:Aged; D013956:Antithyroid Agents / Q000627:therapeutic use; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D007037:Hypothyroidism / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D013959:Thyroid Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D013974:Thyroxine / Q000627:therapeutic use
D013956:Antithyroid Agents; D007457:Iodine Radioisotopes; D013974:Thyroxine