Clinical conundrums in management of hypothyroidism in critically ill geriatric patients.
BACKGROUND
Articles in various international and national bibliographic indices were extensively searched with an emphasis on thyroid and hypothyroid disorders, hypothyroidism in elderly hospitalized patients, hypothyroidism in critically ill geriatric population, thyroxine in elderly hypothyroid, drug interactions and thyroid hormones, and thyroid functions in elderly.


METHODS
Entrez (including PubMed), NIH.gov, Medscape.com, WebMD.com, MedHelp.org, Search Medica, MD consult, yahoo.com, and google.com were searched. Manual search was performed on various textbooks of medicine, critical care, pharmacology, and endocrinology.


RESULTS
Thyroid function tests in elderly hospitalized patients must be interpreted with circumspection. The elderly are often exposed to high iodide content and critical care settings. This may occur because of either decreased iodine excretion or very high intake of iodine. This is especially true for elderly population with underlying acute or chronic kidney diseases or both. Amiodarone, with a very high iodine content, is also often used in this set of population. Moreover, other medications including iodinated contrast are often used in the critical care settings. These may affect different steps of thyroid hormone metabolism, and thereby complicate the interpretation of thyroid function tests.


CONCLUSIONS
The current review is aimed at analyzing and managing various clinical aspects of hypothyroidism in hospitalized elderly, and critically ill geriatric patients.
The Commonwealth Medical College, Scranton, PA, USA.
Vishal
V
Sehgal
Department of Anaesthesiology and Intensive Care Medicine, Gian Sagar Medical College, Banur, Patiala, India.
Sukhminder Jit Singh
SJ
Bajwa
The Wright Center for Graduate Medical education, Scranton, PA, USA.
Rinku
R
Sehgal
The Wright Center for Graduate Medical education, Scranton, PA, USA.
Anurag
A
Bajaj
Amiodarone; Chronic; Critical Illness; Hypothyroidism; Kidney Failure; Polypharmacy