Size and structure of the thyroid in old age.

Abstract

Journal of the American Geriatrics SocietyVolume 45, Issue 12 p. 1539-1539 Free Access SIZE AND STRUCTURE OF THE THYROID IN OLD AGE First published: 27 April 2015 https://doi.org/10.1111/j.1532-5415.1997.tb03215.xCitations: 1AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat To the Editor: Morphological changes in the thyroid are found more frequently in old people than are functional disturbances.1 In particular, the number of thyroid nodules increases in old age.2 The data on thyroid size and weight in old age are not all uniform; both increases and decreases in thyroid size have been found in clinical-pathological and sonographic studies.3 In a region with moderate iodine deficiency, we conducted a study to answer the following questions: * What is the average thyroid weight and volume? * How many older people have thyroids that are normal on macroscopic examination? * How often does sonography detect morphological changes in the thyroid? * How frequent are malignant alterations? The thyroids were examined in 62 unselected patients (33 women, 29 men) who had died from various underlying diseases in a large German teaching hospital and who had undergone postmortem examination. The thyroids were examined sonographically for volume and internal structure and were then weighed together with the capsule. They were next examined macroscopically, and finally microscopically, for their histology. The women were 78 years old, on average, and the men were, on average, 75 years old. The reference weight stated for the thyroid is 17 g for women and 20 g for men.4 The mean weight determined in this study was distinctly higher than these values, at 38.2 g (SD 25.3 g; median 32.1 g). Women had heavier thyroids, with a mean of 44.1 g (SD 32.0), than men, whose mean thyroid weight was 31.4 g (SD 11.3). Massive goiters, one weighing 118.5 g and the other 150.8 g, were found in two women. The mean thyroid volume found in this study was higher at 36.1 mL (standard deviation 23.6; median 30.9) than the reference value of 20 mL. Women had larger thyroids, at 41.7 mL (SD 29.9) than men, in whom the mean volume was 29.6 mL (SD 10.8) On gross pathological examination, thyroid nodules were found in 79% of the cases. Women were affected more frequently than men, having nodules in 88% of the cases (n = 29). Five women had solitary nodules, and 24 had multiple nodules. Thyroid nodules appeared in 69% of the men (n = 20). Three men had solitary nodules and 17 had multiple nodules. In women there was a correlation between thyroid weight and the number of nodules. All thyroids weighing more than 60 g had at least five nodules. In the sonographic examination, the true number of nodules was underestimated. Nodules were detected in only 45% of the patients (n = 28). Cysts were found in a further 8% (n = 5). In no patient was a malignant tumor suspected on the basis of the sonography. On microscopic examination, malignant cells were found in two thyroids (3.2%). In one patient with known small-cell carcinoma of the bronchus, thyroid metastases appeared that had not come to light before. In one 73-year-old man, a highly differentiated, 5-mm papillary thyroid carcinoma, which had not been found earlier, was discovered. Summarizing, it may be concluded that morphological changes in the thyroid are very common in old people in regions with moderate iodine deficiency. Only 21% of the thyroids (n = 13) proved nodule-free on gross pathological examination. Of these 13 thyroids, 11 weighed more than 20 g. This means that only 3.2% of all thyroids examined were morphologically normal. The high frequency of morphological alterations thus justifies a cautious attitude in the evaluation of morphological thyroid alterations in old age. REFERENCES 1 Hintze G, Burghardt U, Baumert J et al. Prevalence of thyroid dysfunction in elderly subjects from the general population in an iodine deficiency area. Aging 1991; 3: 325– 331. 2 Hurley DL, Gharib H. Thyroid nodular disease: Is it toxic or nontoxic, malignant or benign?. Geriatrics 1995; 50: 24– 31. 3 Mokshagundam S, Barzel US. Thyroid disease in the elderly. J Am Geriatr Soc 1993; 41: 1361– 1369. 4 Pankow BG, Michalak J, McGee MK. Adult human thyroid weight. Health Phys 1985; 49: 1097– 1103. Citing Literature Volume45, Issue12December 1997Pages 1539-1539 ReferencesRelatedInformation