Thyroid Dysfunction in the Elderly

Kim, Jin Hwa

Abstract

The normal aging process is accompanied by changes in the appearance of the thyroid gland, both macroscopic and microscopic. The changes in thyroid function attributable solely to aging are subtle and of questionable clinical significance. Instead, there is an increase in thyroid disease with increasing age. It can be challenging to accurately diagnose thyroid dysfunction in the elderly, since presenting symptoms may be atypical, and other co-morbid conditions may obscure the diagnosis. For these reasons, it is always important to consider the possibility of thyroid disease in the elderly. The lack of consensus about what constitutes a normal thyroid stimulating hormone (TSH) level for an elderly patient in turn leads to disparate recommendations on the threshold for initiating therapy for sub-clinical thyroid dysfunction and the target TSH level during therapy. We review the existing data on the prevalence, causes, clinical manifestations, diagnostic issues, and treatment of thyroid dysfunction in the elderly.