Hyperthyroidism in the elderly. Prevalence 2 %twice that in younger populationsCauses differ: young<50old>70M. Graves92 3%Multinod.Goiter4# %Solit.Tox.Nod4%7%Iodine.ind.Thyreotox.07%. Symptoms differ. Which elderly patient is hyp
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1. How to recognise early signs of hyperthyroidism ? Jos van Campen
Sion, June 2003
2. Hyperthyroidism in the elderly Prevalence 2 %
twice that in younger populations
Causes differ: young<50 old>70
M. Graves 92 % 33%
Multinod.Goiter 4% 23 %
Solit.Tox.Nod 4% 7%
Iodine.ind.Thyreotox. 0% 37%
3. Symptoms differ Which elderly patient is hyperthyroid ?
A 80 yr old woman with complaints of heat intolerance, diarrhea and increased appetite
B 80 yr old woman complaining of tachycardia, weight loss and fatigue
4. Symptoms differ 1996 Rouan: symptoms in elderly (>70yr) vs young(<50yr) new hyperthyroid patients:
Tachycardia, fatigue and weight loss are the most frequent presenting symptoms in the elderly.
In more than 50 % one of these symptoms
Triad in 32 %
Next 5 most frequent symptoms in elderly: Tremor, Dyspnea, Apathy, Anorexia, Nervousness
5. Symptoms differ Classical symptoms are less frequent : Old Young
Hyperactive reflexes 28 vs 96%
Increased sweating 24 vs 95%
Heat intolerance 15 vs 92%
Tremor 44 vs 84%
Nervousness 31 vs 84%
Polydipsia 21 vs 67%
Increased appetite 0 vs 57%
6. Symptoms/signs more frequent in the elderly
Atrial fibrillation: 32 vs 2 %
Anorexia: 32 vs 4 %
7. Conclusion Presentation of hyperthyroidism in the elderly:
Less typical (adrenergic) symptoms
8. Diagnosis To establish the diagnosis of hyperthyroidism: TSH most sensitive test.
If TSH<0,1 mU/L and FT4 above upper limit: Hyperthyroidism
If TSH<0,1 mU/L and FT4 in normal range: Subclinical hyperthyroidism
but DD: Steroids, Dopamine, NTI, Fasting
9. Subclinical hyperthyroidism Prevalence in the elderly 2%, F>M
Prevalence in general population 1 %
5% per year progression to hyperthyroidism
55% TSH returns to normal in 1 yr
40% remains subclinical hyperthyroid
10. Is subclinical hyperthyroidism (SCH) subclinical ? Patients score higher on an index of hyperthyroidism
RR of developing atrial fibrillation is 3,1 (CI 1,7-5,1)
In 10 % of patients with Afib SCH
In postmenopausal woman 2% loss of bone per year, reversible after restoring TSH
RR of developing dementia is 3 (CI=1,2-10)
11. Recommendations Subclinical hyperthyroidism may present with signs of hyperthyroidism
Consider treatment in:
in Multinodular goiter
symptoms of hyperthyroidism
Always follow up (6 months`intervals): risk of developing hyperthyroidism
12. Literature Trivalle C et al. Differences in the signs and symptomes of hyperthyroidism in older and younger patients. JAGS 1996; 44: 50-3.
Toft A et al. Subclinical hyperthyroidism. NEJM 2001; 245: 512-6.
Wiersinga WM et al. Subclinical hyperthyroidism and hypothyroidism. Neth J Med 1995; 46: 197-204.
Samuels MH et al. Subclinical thyroid disease in the elderly. Thyroid 1998; 8: 803-13