Hypothyroidism in the elderly: diagnosis and management

Isabela M Bensenor1,2, Rodrigo D Olmos1,2, Paulo A Lotufo1,21Division of Internal Medicine, Hospital Universitário, University of São Paulo, São Paulo, Brazil; 2Department of Internal Medicine, School of Medicine, University of São Paulo, São Pa...

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Autores principales:	Bensenor IM, Olmos RD, Lotufo PA
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2012
Materias:	overt hypothyroidism subclinical hypothyroidism diagnosis treatment elderly Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/69373b84be534676bfd56f06549d3859
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spelling	oai:doaj.org-article:69373b84be534676bfd56f06549d38592021-12-02T11:28:37ZHypothyroidism in the elderly: diagnosis and management1178-1998https://doaj.org/article/69373b84be534676bfd56f06549d38592012-04-01T00:00:00Zhttps://www.dovepress.com/hypothyroidism-in-the-elderly-diagnosis-and-management-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Isabela M Bensenor1,2, Rodrigo D Olmos1,2, Paulo A Lotufo1,21Division of Internal Medicine, Hospital Universitário, University of São Paulo, São Paulo, Brazil; 2Department of Internal Medicine, School of Medicine, University of São Paulo, São Paulo, BrazilAbstract: Thyroid disorders are highly prevalent, occurring most frequently in aging women. Thyroid-associated symptoms are very similar to symptoms of the aging process; thus, improved methods for diagnosing overt and subclinical hypothyroidism in elderly people are crucial. Thyrotropin measurement is considered to be the main test for detecting hypothyroidism. Combined evaluations of thyroid stimulating hormone (TSH) and free-thyroxine can detect overt hypothyroidism (high TSH with low free-thyroxine levels) and subclinical hypothyroidism (high TSH with normal free-thyroxine levels). It is difficult to confirm the diagnosis of thyroid diseases based only on symptoms, but presence of symptoms could be an indicator of who should be evaluated for thyroid function. The most important reasons to treat overt hypothyroidism are to relieve symptoms and avoid progression to myxedema. Overt hypothyroidism is classically treated using L-thyroxine; elderly patients require a low initial dose that is increased every 4 to 6 weeks until normalization of TSH levels. After stabilization, TSH levels are monitored yearly. There is no doubt about the indication for treatment of overt hypothyroidism, but indications for treatment of subclinical disease are controversial. Although treatment of subclinical hypothyroidism may result in lipid profile improvement, there is no evidence that this improvement is associated with decreased cardiovascular or all-cause mortality in elderly patients. In patients with a high risk of progression from subclinical to overt disease, close monitoring of thyroid function could be the best option.Keywords: overt hypothyroidism, subclinical hypothyroidism, diagnosis, treatment, elderlyA Letter to the Editor has been received nad published for this article.Bensenor IMOlmos RDLotufo PADove Medical Pressarticleovert hypothyroidismsubclinical hypothyroidismdiagnosistreatmentelderlyGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 7, Pp 97-111 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	overt hypothyroidism subclinical hypothyroidism diagnosis treatment elderly Geriatrics RC952-954.6
spellingShingle	overt hypothyroidism subclinical hypothyroidism diagnosis treatment elderly Geriatrics RC952-954.6 Bensenor IM Olmos RD Lotufo PA Hypothyroidism in the elderly: diagnosis and management
description	Isabela M Bensenor1,2, Rodrigo D Olmos1,2, Paulo A Lotufo1,21Division of Internal Medicine, Hospital Universitário, University of São Paulo, São Paulo, Brazil; 2Department of Internal Medicine, School of Medicine, University of São Paulo, São Paulo, BrazilAbstract: Thyroid disorders are highly prevalent, occurring most frequently in aging women. Thyroid-associated symptoms are very similar to symptoms of the aging process; thus, improved methods for diagnosing overt and subclinical hypothyroidism in elderly people are crucial. Thyrotropin measurement is considered to be the main test for detecting hypothyroidism. Combined evaluations of thyroid stimulating hormone (TSH) and free-thyroxine can detect overt hypothyroidism (high TSH with low free-thyroxine levels) and subclinical hypothyroidism (high TSH with normal free-thyroxine levels). It is difficult to confirm the diagnosis of thyroid diseases based only on symptoms, but presence of symptoms could be an indicator of who should be evaluated for thyroid function. The most important reasons to treat overt hypothyroidism are to relieve symptoms and avoid progression to myxedema. Overt hypothyroidism is classically treated using L-thyroxine; elderly patients require a low initial dose that is increased every 4 to 6 weeks until normalization of TSH levels. After stabilization, TSH levels are monitored yearly. There is no doubt about the indication for treatment of overt hypothyroidism, but indications for treatment of subclinical disease are controversial. Although treatment of subclinical hypothyroidism may result in lipid profile improvement, there is no evidence that this improvement is associated with decreased cardiovascular or all-cause mortality in elderly patients. In patients with a high risk of progression from subclinical to overt disease, close monitoring of thyroid function could be the best option.Keywords: overt hypothyroidism, subclinical hypothyroidism, diagnosis, treatment, elderlyA Letter to the Editor has been received nad published for this article.
format	article
author	Bensenor IM Olmos RD Lotufo PA
author_facet	Bensenor IM Olmos RD Lotufo PA
author_sort	Bensenor IM
title	Hypothyroidism in the elderly: diagnosis and management
title_short	Hypothyroidism in the elderly: diagnosis and management
title_full	Hypothyroidism in the elderly: diagnosis and management
title_fullStr	Hypothyroidism in the elderly: diagnosis and management
title_full_unstemmed	Hypothyroidism in the elderly: diagnosis and management
title_sort	hypothyroidism in the elderly: diagnosis and management
publisher	Dove Medical Press
publishDate	2012
url	https://doaj.org/article/69373b84be534676bfd56f06549d3859
work_keys_str_mv	AT bensenorim hypothyroidismintheelderlydiagnosisandmanagement AT olmosrd hypothyroidismintheelderlydiagnosisandmanagement AT lotufopa hypothyroidismintheelderlydiagnosisandmanagement
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Hypothyroidism in the elderly: diagnosis and management

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