[Thyroid dysfunction in the elderly]

Abstract

In the elderly, thyroid dysfunction usually develops insidiously and is dominated by non-specific symptoms and clinical findings, typically related to normal aging or to age-associated disease. Case finding, in combination with a low threshold for biochemical control, is recommended. In Denmark, hyperthyroidism is more frequent than hypothyroidism. Subclinical hyperthyroidism is generally temporary. In subclinical hypothyroidism the annual progression rate to manifest hypothyroidism is 2-3%, but higher (5-10%) in the presence of thyroid autoantibodies. Treatment recommendation is related to the serum level of thyroid stimulating hormone and the presence of thyroid peroxidase autoantibodies. Hypothyroidism should be treated with lower doses of thyroxine, and the titration phase is longer. An antithyroid drug is the initial treatment in hyperthyroidism, often followed by radioiodine therapy. In Denmark, radioiodine therapy of nontoxic goitre has become more common.