Thyroid Disease in the Elderly

Abstract

Thyroid dysfunction, benign and much less commonly, malignant neoplastic changes in the thyroid gland occur frequently in the general population but are more likely to result in undesirable clinical consequences in the elderly, usually because of coexistent pathology such as diminished cardiovascular reserve. This review will highlight the common problem of thyrotoxicosis in nodular thyroid disease in the elderly; such thyrotoxicosis frequently has an iatrogenic basis and is therefore potentially preventable. The treatment of thyrotoxicosis and the relative advantages/disadvantages of therapeutic modalities such as antithyroid drugs, radioiodine and surgical intervention tend to vary between younger and older patients. Radioiodine is more often the treatment of choice in the elderly. Monitoring and treatment of hypothyroidism is also discussed, with emphasis on the substantial risks of rapid correction of low thyroid hormone levels in elderly patients with coexistent ischaemic heart disease. Also discussed is the need to potentially adjust dosage of other pharmacological agents frequently used by elderly patients (e.g. digoxin, warfarin) in states of as yet uncontrolled hypothyroidism or thyrotoxicosis.