How to recognise early signs of hyperthyroidism

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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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How to recognise early signs of hyperthyroidism

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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 symptoms Nonspecific symptoms 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 % Natural history: 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: Atrial fibrillation in Multinodular goiter osteoporosis 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

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