Dr.Guttler’s Patient Thyroid Blog Post: Hypothyroidism in the Elderly

Reference:

• Leonidas H. Duntas  et al

Endocrine volume 66, pages 63–69 (2019)

Dr.Guttler’s comments:

1. The population is aging with millions of people today living into their 90 s.

2.Hypothyroidism, is widespread and it is expected to steadily increase as the population gets older.

3.Clinical diagnosis of hypothyroidism is challenging, as the TSH reference range needs to be evaluated according to age.

4.Evaluation of TSH levels must also take into account body weight and other variants such as polypharmacy, comorbidities, and general health condition.

5.The possibility of thyroid dysfunction should be considered in cases of unexplained dyslipidemia.

6.Once hypothyroidism has been confirmed, treatment requires caution, frequent cardiovascular monitoring, and individualized (precision) medicine.

7. Treatment of subclinical hypothyroidism (SCH) in the elderly should be undertaken with care.

8. Guided by age and the degree of SCH: a TSH higher than 10 mU/l seems a reasonable threshold.

9.T4 Dosing needs to be regularly re-evaluated

10. LT4 dose needs to be tailored, taking into account the patient’s health condition and the potential presence of dyslipidemia as well as other metabolic derangements.

In my clinic I see hypothyroid patients at least twice a year to titrate the T4 dose and keep TSH in the normal range.