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Thyroid disease in the older patient – symptoms and treatment

Hypothyroidism is very common in patients over 60 years of age and steadily increases with age. Unlike symptoms of hyperthyroidism, the symptoms of hypothyroidism are very non-specific in all patients, even more so in the older patient. Symptoms and signs of hypothyroidism may include weight gain, sleepiness, dry skin and constipation but lack of these symptoms does not rule out the diagnosis. To make this diagnosis in the elderly patient, a doctor often needs a high index of suspicion. Clues to the possibility of hypothyroidism include a positive family history of thyroid disease, past treatment for hyperthyroidism, or a history of extensive surgery and/or radiotherapy to the neck.

What do many potential thyroid patients over the age of 60 years have in common? 

  • “Fluttering of the heart” and vague chest discomfort especially when doing minor exercise
  • Severe constipation
  • Falls asleep often
  • Loss of strength in legs
  • Difficulty swallowing and a dry cough
  • Hearing loss
  • Hand tremors
  • Loss of appetite 

Treatment of the older patient with hypothyroidism

A decision to treat the patient with a new diagnosis of hypothyroidism will rest on several factors, including whether the patient is symptomatic from hypothyroidism, or just has an elevated thyroid-stimulating hormone (TSH) level. In the case of the latter finding, many doctors will repeat the test in 3-4 months and elect to begin thyroid hormone replacement when the TSH level stays above the normal range. The presence or absence, and severity, of thyroid-related symptoms and co-existing diseases such as coronary artery disease or heart failure will determine the dose of thyroid hormone replacement that is given.

Treatment of the older patient with hyperthyroidism 

As with younger patients, treatment of hyperthyroidism in the older patient includes anti-thyroid drugs and radioactive iodine. While Graves’ disease is still a common cause of hyperthyroidism, toxic nodular goiter is seen more frequently in the older patient. During therapy, the effects of change in thyroid function on other body systems must be closely monitored, due to an increased likelihood of co-existing cardiac, central nervous system and thyroid disease in older patients. Most often, thyroid function is brought under control first with anti-thyroid drugs before definitive treatment with radioactive iodine. Once thyroid function is maintained in the normal range with oral medication, the doctor and patient can make a decision on definitive treatment with radioactive iodine together.

Thyroid disorders have no age limits; indeed, hypothyroidism is clearly more common in older than in younger adults. Despite the increased frequency of thyroid problems in older individuals, physicians need a high index of suspicion to make the diagnosis since thyroid disorders often manifest as a disorder of another system in the body. Older patients with thyroid disorders require special attention to gradual and careful treatment, and, as always, require lifelong follow-up.

If you feel that you are unsure of how to deal with hypothyroidism or hyperthyroidism, then you need to contact the medical expert in the field, Dr Alain Sanua. Through a consultation with Dr Alain Sanua, he will be able to properly diagnose the symptoms and find a natural way of dealing with your thyroid problems. From irritable bowel syndrome to thyroid disorders, Dr Alain Sanua can help. To find out more about the services on offer through Dr Alain Sanua, visit his website www.homeopathjohannesburg.co.za

 

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