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Which Symptom Of Thyroid Disease Is Seen In Older Adults

Incident Atrial Fibrillation By Thyroid Status

Symptoms of Thyroid Problems In Women

After excluding those with prevalent atrial fibrillation, individuals with subclinical hyperthyroidism had a greater incidence of atrial fibrillation over the 13-year follow-up than the euthyroid group, with 67 vs. 31 events per 1000 person-years . This effect persisted after sequential adjustment for other risk factors for atrial fibrillation. As shown in , after adjustment for age, sex, clinical CVD at baseline, subsequent thyroid medication use, and other known risk factors for atrial fibrillation, participants with subclinical hyperthyroidism had nearly twice the risk of developing atrial fibrillation .

Cumulative incidence of A. atrial fibrillation, B. coronary heart disease, C. cerebrovascular disease, and D. death from all causes over the 13 years of follow-up, according to thyroid status. Number at risk for atrial fibrillation plot: n=47 for subclinical hyperthyroid, 2502 for euthyroid, 472 for subclinical hypothyroid, and 49 for hypothyroid. Number at risk for coronary heart disease, cerebrovascular disease, and mortality plots: n=31 for subclinical hyperthyroid, 1838 for euthyroid, 347 for subclinical hypothyroid, and 30 for hypothyroid. P< .001 for comparison of atrial fibrillation incidence between subclinical hyperthyroid and euthyroid groups. P=.02 for comparison of mortality between subclinical hyperthyroid and euthyroid groups. All other comparisons are not statistically significant.

Hypothyroidism Symptoms And Signs In An Older Person

Some people over age 60 have few, if any, symptoms of an underactive thyroid gland , while others experience the same symptoms younger people do. Still others have hypothyroidism symptoms that are not typical at all, making the diagnosis even more difficult. Any of the following signs and symptoms can indicate hypothyroidism in an older person.

Unexplained high cholesterol. High cholesterol is sometimes the only evidence of an underactive thyroid in an older person. Because this sign may stand alone, high cholesterol warrants a thyroid evaluation.

Heart failure. Reduced blood volume, weaker contractions of the heart muscle, and a slower heart rateall caused by low thyroid hormone levelscan contribute to heart failure, when your heart can’t pump out blood as effectively as it should The ineffective pumping may cause subtle symptoms such as feeling less energetic or just walking more slowly. In more advanced stages, fluid can back up in the lungs and legs causing shortness of breath and leg swelling.

Bowel movement changes. An older person with hypothyroidism might have constipation because stool moves more slowly through the bowels.

Joint or muscle pain. Vague joint pain is a classic hypothyroidism symptom. It sometimes is the only symptom of hypothyroidism in an older person. Many people experience general muscle aches, particularly in large muscle groups like those in the legs.

Definition: What Do The Following Patients Over The Age Of 60 Years Have In Common

  • A 72 year old woman with fluttering of the heart and vague chest discomfort on climbing stairs
  • An 80 year old man with severe constipation who falls asleep often
  • A 65 year old woman who has lost strength in her legs, causing difficulty in climbing stairs she has recently lost 15 lbs in spite of a very good appetite
  • A 75 year old woman who has developed difficulty swallowing and a dry cough, accompanied by hoarseness, weight gain, and dry, itchy skin
  • A 78 year old man with hearing loss
  • An 84 year old woman in whom a hand tremor has caused her to give up favorite activities. She is so depressed that she will not eat, and she has lost 12 lbs in the last 4 months.
  • All of these patients have abnormal function of their thyroid glands. Patients 1, 3 and 6 have hyperthyroidism, that is, excessive production of thyroid hormone by their thyroid glands. Patients 2, 4 and 5 have hypothyroidism, or reduced production of thyroid hormone. While some of the symptoms of hyperthyroidism and hypothyroidism are similar to those in younger patients, it is not uncommon for both hyperthyroidism and hypothyroidism to be manifest in subtle ways in older patients, often masquerading as diseases of the bowel or heart or a disorder of the nervous system. An important clue to the presence of thyroid disease in an elderly patient is a history of thyroid disease in another close family member such as a brother, sister or child of the patient.

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    Adherence And Risk Of Overtreatment In Elderly Patients With Hypothyroidism

    The limited QoL-impact of hypothyroidism and the associated subtle treatment effect experienced in elderly patients challenges treatment motivation and thus adherence. As mentioned above, polypharmacy, a high degree of co-morbidity, particularly cognitive co-morbidity, further challenge adherence. For the latter, the often-complex L-T4 regimen, with doses varying over weekdays to achieve optimal titration, may be a particular challenge. Polypharmacy also leads to difficulties obtaining ideal absorption patients with e.g., dementia may have difficulty taking levothyroxine separate from other medications and in the fasting state, as generally recommended. Management strategies to counteract these obstacles may involve dosing boxes and possibly even weekly dosing. Efficacy of such action remains to be elucidated, as does e.g. a potentially useful dosing at bedtime, separate from other medication . In case L-T4 tablet malabsorption is suspected, different formulation of L-T4 could be considered .

    Figure 2 Examples of presentations of results from patient-reported outcomes recorded prior to a patient visit. Patient-oriented presentation with reference to previous ratings. Patient-oriented presentation with reference values as percentiles and general population reference. Clinician-oriented multidimensional quality of life presentation.

    Table 5 Major risks from overtreatment with levothyroxine of elderly patients with overt or subclinical hypothyroidism.

    Who Is More Likely To Develop Hyperthyroidism

    Getting To Know Diseases of the Thyroid

    Hyperthyroidism is more common in women and people older than 60.2 You are more likely to have hyperthyroidism if you

  • eat large amounts of food containing iodine, such as kelp
  • use medicines that contain iodine
  • use nicotine products3
  • were pregnant within the past 6 months
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    What Are The Symptoms Of Hyperthyroidism

    The symptoms of hyperthyroidism can vary from person to person and may include:

    • Nervousness or irritability
    • Imaging tests, such as a thyroid scan, ultrasound, or radioactive iodine uptake test. A radioactive iodine uptake test measures how much radioactive iodine your thyroid takes up from your blood after you swallow a small amount of it.

    Treatment Of Hypothyroidism And Sht

    Overall, in managing older patients with sHT, we should consider the values of TSH and their trend over time, and international guidelines suggest a cutoff of 10 mIU/L and a double check of TSH level before treatment is recommended . Beside serum TSH cutoff levels, the presence of symptoms and signs of hypothyroidism should be checked before starting any treatment . Unfortunately, the identification of the clinical pattern of hypothyroidism in the elderly is quite challenging for the presence of unspecific symptoms , especially in frail older patients with comorbidity . According to these considerations, a comprehensive, multidimensional geriatric assessment may be helpful in the clinical approach to older patients with increased serum TSH values . Moreover, it is conceivable to perform a complete thyroid function assessment, including either laboratory tests or ultrasound examination, to recognize an actual thyroid disease , which may imply permanent TSH elevation or an increasing trend. Moreover, it is crucial to collect an accurate pharmacological history and evaluate whether the patient is receiving treatments affecting thyroid function , especially in the elderly with several comorbidities. However, it is worth noting that the physiological age-related increase of serum TSH values usually does not reach levels > 7 to 8 mIU/L .

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    Thyroid Function Changes In Aging

    Thyroid function is precisely assessed by measurements of serum thyroid stimulating hormone and thyrotropin. In the absence of pituitary disease, a precise inverse relationship between free thyroxine and the logarithm of TSH can be derived across the spectrum of primary thyroid function and dysfunction. Given the logarithmic response of TSH to changes in FT4 levels, TSH measurement allows for more precise estimation of thyroid function than the thyroid hormones themselves. In addition, compared with many other hormonal axes, thyroid secretion is fairly stable over time, so that much of the variation appears to be inter-individual rather than intra-individual . Part of the inter-individual variation has indeed been linked to distinct genetic loci in several genome-wide association studies . Interestingly, many of the loci seem to involve genes expressed in thyroid cells, either in the TSH receptor pathway, or transcription factors expressed in the thyroid cell, while factors related directly to TSH secretion and expressed in the thyrotrope have not been involved. This is in keeping with studies in the mouse, indicating a strain-dependent difference in thyroidal T4 production in response to TSH . The genetically determined variation in thyroid function tests is contained within the normal range in most large studies however, it may change the threshold for developing an abnormal TSH, for example, as a consequence of thyroid autoimmunity .

    Management And Treatment Of The Disease

    Thyroid Disease Symptoms: How to diagnose your thyroid problems with Dr. Christianson!
    Treatment of hypothyroidism in elderly patients

    Levothyroxine should be administered at a low starting dose to avoid potential harmful cardiovascular effects, especially in patients with coronary disease or multiple cardiovascular risk factors. Doses should be adjusted every 6-12 weeks. In elderly patients, there is a narrow range between TSH suppressive and replacement doses, and close monitoring is required.

    Whether subclinical hypothyroidism should be treated in elderly subjects is still a matter of debate. Advantages of thyroid hormone replacement therapy in elderly patients with subclinical hypothyroidism have not been demonstrated. Circulating concentrations of TSH between 4 and 6 mIU/L represent a reasonable goal of LT4 therapy in elderly patients treated for hypothyroidism.

    Treatment of hyperthyroidism in elderly patients

    Before considering treatment, other causes of a low serum TSH should be excluded. It is important to note that non-thyroidal illness and the effects of certain drugs will rarely result in serum TSH concentrations lower than 0.1 mIU/L. Thus, endogenous subclinical hyperthyroidism in elderly patients, with serum TSH values lower than 0.1 mIU/L, usually requires treatment. Treatment should also be considered for elderly patients with serum TSH values between 0.1 and 0.5 mIU/L when cardiovascular risks or osteoporosis are present.

    Reasons for failure of LT4 treatment:

    When treatment for hyperthyroidism fails

    Emerging potential therapeutic options

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    What Does The Thyroid Do

    Your thyroid has an important job to do within your body releasing and controlling thyroid hormones that control metabolism. Metabolism is a process where the food you take into your body is transformed into energy. This energy is used throughout your entire body to keep many of your bodys systems working correctly. Think of your metabolism as a generator. It takes in raw energy and uses it to power something bigger.

    The thyroid controls your metabolism with a few specific hormones T4 and T3 . These two hormones are created by the thyroid and they tell the bodys cells how much energy to use. When your thyroid works properly, it will maintain the right amount of hormones to keep your metabolism working at the right rate. As the hormones are used, the thyroid creates replacements.

    This is all supervised by something called the pituitary gland. Located in the center of the skull, below your brain, the pituitary gland monitors and controls the amount of thyroid hormones in your bloodstream. When the pituitary gland senses a lack of thyroid hormones or a high level of hormones in your body, it will adjust the amounts with its own hormone. This hormone is called thyroid stimulating hormone . The TSH will be sent to the thyroid and it will tell the thyroid what needs to be done to get the body back to normal.

    Hyperthyroidism In The Older Patient

    As in all hyperthyroid patients, if there is too much thyroid hormone, every function of the body tends to speed up . However, while the younger patient often has multiple symptoms related to the overactive thyroid, the elderly patient may only have one or two symptoms. For example, patient number 1, above, experienced only a sensation of her heart fluttering, and some chest discomfort on climbing stairs. Other patients may also have few symptoms, such as patient number 6, whose main symptoms are depression and tremor. Such a patient may withdraw from interactions with friends and family.

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    How Do Doctors Treat Hyperthyroidism

    Your doctor will treat your hyperthyroidism to bring your thyroid hormone levels back to normal. Treating the disease will prevent long-term health problems, and it will relieve uncomfortable symptoms. No single treatment works for everyone.

    Your treatment depends on whats causing your hyperthyroidism and how severe it is. When recommending a treatment, your doctor will consider

    • your age
    • When part of the thyroid is removed, your thyroid hormone levels may return to normal.
  • Cons
  • Thyroid surgery requires general anesthesia, which can cause a condition called thyroid storma sudden, severe worsening of symptoms. Taking antithyroid medicines before surgery can help prevent this problem.
  • When part of your thyroid is removed, you may develop hypothyroidism after surgery and need to take thyroid hormone medicine. If your whole thyroid is removed, you will need to take thyroid hormone medicine for life. After surgery, your doctor will continue to check your thyroid hormone levels.

    Researchers are looking into new ways to treat hyperthyroidism. An example is radiofrequency ablation , a new approach to treating thyroid nodules that cause hyperthyroidism.5,6 RFA is used mainly in cases where medicines or surgery wont help, and is not yet widely available.

    Can Hyperthyroidism Cause Mental Health Issues

    Hypothyroidism Symptoms treatment and more

    Hyperthyroidism is frequently associated with: irritability, insomnia, anxiety, restlessness, fatigue, impairment in concentrating and memory, these symptoms can be episodic or may develop into mania, depression and delirium. In some cases motor inhibition and apathy are symptoms that accompany hyperthyroidism.

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    What Is The Thyroid

    The thyroid gland is a small organ thats located in the front of the neck, wrapped around the windpipe . Its shaped like a butterfly, smaller in the middle with two wide wings that extend around the side of your throat. The thyroid is a gland. You have glands throughout your body, where they create and release substances that help your body do a specific thing. Your thyroid makes hormones that help control many vital functions of your body.

    When your thyroid doesnt work properly, it can impact your entire body. If your body makes too much thyroid hormone, you can develop a condition called hyperthyroidism. If your body makes too little thyroid hormone, its called hypothyroidism. Both conditions are serious and need to be treated by your healthcare provider.

    Which Types Of Doctors Treat Hyperthyroidism

    Endocrinologists are specialists in diagnosing and treating hormonal disorders such as hyperthyroidism. Primary care physicians, including family practitioners and internists, may also be involved in treating patients with hyperthyroidism. Ophthalmologists and ophthalmic surgeons may be involved in the care of patients with Graves’ disease.

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    How Can I Check My Thyroid At Home

    How to Take the Thyroid Neck CheckHold a handheld mirror in your hand, focusing on the lower front area of your neck, above the collarbones, and below the voice box .

    While focusing on this area in the mirror, tilt your head back.Take a drink of water while tilting your head back and swallow.More itemsApr 16, 2015.

    Too Much Thyroid Hormone Medicine

    Signs of Thyroid Problems in Women (Warning Signs that your Thyroid is NOT working properly!)

    Some people who take thyroid hormone medicine for hypothyroidism may take too much. If you take thyroid hormone medicine, see your doctor at least once a year to have your thyroid hormone levels checked. You may need to adjust your dose if your doctor finds your thyroid hormone level is too high.

    Some other medicines may also interact with thyroid hormone medicine and raise hormone levels. If you take thyroid hormone medicine, ask your doctor about interactions when starting new medicines.

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    What Causes Hypothyroidism Elderly

    hypothyroidismcausehypothyroidismelderly

    Do thyroid levels change with age?

    The endocrine system and particular endocrine organs, including the thyroid, undergo important functional changes during aging. Intriguingly, decreased thyroid function, as well as thyrotropin levels progressively shifting to higher values with age may contribute to the increased lifespan.

    does hypothyroidism worsen with age?Hypothyroidism canageagehypothyroidismhypothyroidismcanworse

    Contents

    Treatment Of The Older Patient With Hyperthyroidism

    As with younger patients, treatment of hyperthyroidism in the older patient includes antithyroid drugs and radioactive iodine . Surgery is rarely recommended due to increased operative risks in the older patient. While Graves disease is still a common cause of hyperthyroidism, toxic nodular goiter is seen more frequently in the older patient. During therapy, the effects of change in thyroid function on other body systems must be closely monitored, due to an increased likelihood of co-existing cardiac, central nervous system and thyroid disease in older patients. Most often, thyroid function is brought under control first with antithyroid drugs ) before definitive treatment with radioactive iodine.

    During the initial phase of treatment, doctors will observe cardiac function closely due to the effect of changing thyroid hormone levels on the heart. Symptoms of hyperthyroidism may be brought under control with adjunctive medications, such as beta-adrenergic blockers , which are often given to slow a rapid heart rate, although they must be given with caution in the patient with co-existing congestive heart failure and the dose should be reduced once thyroid function is controlled in the normal range. Symptoms and signs of angina pectoris and heart failure must be treated in tandem with the treatment to bring thyroid function under control.

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    What Are Clinical Trials For Hyperthyroidism

    Clinical trialsand other types of clinical studiesare part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future.

    Researchers are studying many aspects of hyperthyroidism, such as its natural history, clinical presentation, and genetics.

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