While everyone needs to be careful about their health, when it comes to the elderly population, especially those living with an ailment, one needs to be extra cautious. The same also applies for the elderly diagnosed with thyroid. As such, this World Thyroid Day, observed annually on May 25, let’s understand more about the disorder and how it manifests in the elderly.
What is a thyroid?
The thyroid is a butterfly-shaped gland in the neck that produces hormones, namely T3 (Triiodothyronine) and T4 (Thyroxine). “TSH (Thyroid Stimulating Hormone) is a hormone produced by the pituitary gland, which controls the secretions of the thyroid gland. In more than 90 per cent of cases, thyroid dysfunction can be diagnosed by doing simple blood tests of TSH thyroid disorders,” said Dr Harshal Ekatpure, consultant endocrinologist and diabetologist, Ruby Hall Clinic, Pune.
Does it affect the elderly more commonly?
According to Dr Ekatpure, thyroid dysfunction in the elderly is not very uncommon, but it often remains undiagnosed for years together because classical signs and symptoms associated with thyroid dysfunction are lacking in the population.
“Under-functioning of the thyroid gland is commonly known as primary hypothyroidism. In the elderly, it can present with atypical symptoms or a single symptom, namely sluggishness of movement, excessive sleepiness, facial puffiness, depressive mood, loss of energy and appetite, loss of libido, or sexual dysfunction,” Dr Ekatpure said, adding that these symptoms are “commonly attributed to old age, vitamin deficiencies, and some other neurological disorders”.
Hence, according to Dr Ekatpure, it is essential to rule out hypothyroidism in the elderly who are exhibiting the above symptoms by doing a simple blood test of T4 and TSH levels. “If properly diagnosed and treated, these symptoms are completely reversible and improve the quality of life significantly in elderly patients. If it remains undiagnosed and untreated, it is associated with significant deterioration in the quality of life and increased risk for cardiovascular events,” Dr Ekatpure noted.
Hyperfunctioning thyroid gland or elevated levels of thyroid hormones in the blood (T3 and T4) is known as thyrotoxicosis. Dr Ekatpure said, “It can present with a variety of isolated symptoms in the elderly, namely progressive and unexplained weight loss, shakiness of hands, elevated heartbeats and palpitations, excessive sweating, anxiety, one can feel jittery often, and insomnia.”
Diagnosis and management
Dr Aditya G Hegde, consultant – diabetes and endocrinology, Manipal Hospital, Old Airport Road, Bangalore said that the treating doctor should be sure that the patient has primary or secondary hypothyroidism as “subclinical hypothyroidism management in the elderly is a grey area”.
He added that females have a higher preponderance of thyroid disorders as compared to males. “If they are found deficient, they must take levothyroxine on an empty stomach. The treatment doesn’t need to be started on a very emergent basis except in cases of profound hypothyroidism or emergency surgeries. Usually, the dosage is weight-based and is mostly around 1.6 micrograms per kg,” said Dr Hegde.
However, emphasising that treating doctors “shouldn’t be overzealous in treating the patients”, Dr Hegde said that they can become more prone to other complications, especially those with “underlying heart conditions like CAD (Coronary Artery Disease), and sub-clinical heart failure”. Once the treatment is started, the patients are asked to be followed up once every three months,” Dr Hegde said.
Diagnosis and management of thyrotoxicosis is a little more complex than hypothyroidism as sometimes patients need to undergo tests like thyroid scans or blood tests for antibodies against thyroid, mentioned Dr Ekatpure. “But irrespective of the cause, all these disorders are completely manageable with proper doses of medications. Undiagnosed and untreated hyperthyroidism or thyrotoxicosis can significantly increase the risk of cardiovascular events (irregular heartbeats, angina, heart failure etc), hence timely diagnosis and intervention is very important in thyrotoxicosis,” he said.
In a nutshell, thyroid disorders are more common in the elderly and often remain undiagnosed. “Any new onset symptoms in the elderly, which are not fully explainable, should warrant an evaluation of thyroid function tests. For proper diagnosis and treatment of thyroid dysfunction, one should seek the guidance of an endocrinologist,” Dr Ekatpure said.
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