Disturbances of thyroid function in the elderly

Abstract

Disturbances of thyroid function occur more often in the elderly than in the young. This short review gives an up-to-date overview of this topic. After discussing the difference in epidemiology of thyroid dysfunction in elderly persons in areas with different iodine nutrient status, the physiologic age-induced changes of the hypothalamic-pituitary-thyroid axis are discussed, especially with regard to their consequences on normal ranges of thyroid hormones. Although slight decreases in thyrotropin (TSH) and free triiodothyronine (T3) have been described as occurring in healthy elderly persons, it is concluded from the available data that abnormal values of thyroid hormones in serum of old people should be further investigated, since none of the described changes lead to values outside the normal range. Special emphasis is given to the fact that disturbances of thyroid function are oligosymptomatic or may even be asymptomatic in old persons. Therefore, laboratory screening for thyroid dysfunction in patients over 65 years of age seems to be justified. Lastly, differences of treatment in comparison with younger patients with hyper- or hypothyroidism are presented. The impact of subclinical disturbances of thyroid function in the elderly and their possible therapeutic consequences are also included in this discussion.