Seniors and Thyroid Treatment: The Controversies

Seniors and Thyroid Treatment: The Controversies

Diagnosing and treating thyroid disease in seniors is surprisingly a controversial issue. While it's easy to assume that thyroid problems in seniors should be diagnosed and treated the same way they are for adults, there are actually a number of special concerns related to seniors.

1. Thyroid Issues are Easy to Overlook in Seniors

Fatigue, brain fog, mood changes, hair loss, aches and pains are all common thyroid symptoms, but also common symptoms of aging.

This makes thyroid issues more difficult to diagnose in seniors, because thyroid symptoms cross over with many normal symptoms of aging, and of other age-related conditions like dementia and arthritis. With seniors, it may be more common for doctors to assume that symptoms are related to age, rather than to suspect a thyroid condition and go through the diagnosis process.

2. To Screen or Not to Screen...

A number of groups recommend standardized thyroid screening that affect older patients. For example:

  • The American Thyroid Association recommends screening for men and women every 5 years after the age of 35.
  • The American Association of Clinical Endocrinologists recommends screening in older patients, especially women.
  • The American College of Pathologists recommends screening for women aged 50+ who have one or more general symptoms that could be thyroid-related.
  • The American Academy of Family Physicians recommends screening for men and women over 60 years old.

    At the same time, there are other groups that recommend against screening in seniors, including: the US Preventive Services Task Force, the Canadian Task Force on the Periodic Health Examination, and the British Royal College of Physicians.

    3. To Treat or Not to Treat...

    Some studies have found that even subclinical hypothyroidism, with TSH levels above the reference range but below 10.0, may not cause symptoms in seniors, and may even extent life span.

    One study from the Annals of Internal Medicine looked at whether people over 65 who had borderline thyroid conditions were more likely to suffer depression, anxiety, and problems with memory or thinking than people with normal thyroid function. The researchers concluded that the seniors with borderline thyroid conditions were not more likely to suffer these symptoms, and there was no justification for widespread thyroid screening programs based on these criteria. There is some evidence that treating borderline or subclinical thyroid issues in seniors may help lower cholesterol, or help heart health, but there aren't studies showing any link between thyroid treatment and a decrease in death due to heart disease or other causes in seniors.

    4. The Heart Risk

    Seniors have higher rates of heart disease than younger adults. Having a heart condition means that treating hypothyroidism with thyroid hormone replacement medication has to be done very carefully, with a special focus on not overmedicating these patients.

    Underlying heart conditions can be aggravated by too much thyroid medication, or ramping up a doseage too quickly.

    5. The Lack of Research

    It's clear that much more research is needed into thyroid disease in seniors. Research is needed to establish:

    • the optimal (and not just normal) thyroid reference ranges in seniors of both genders.
    • whether some of the "symptoms" of aging -- i.e., brain fog, dementia, fatigue -- may actually be symptoms of undiagnosed/untreated thyroid conditions
    • whether there would be benefits to standardizing thyroid screening in seniors, to help identify undiagnosed thyroid conditions
    • whether there is any demonstrable health or quality of life benefit to treating subclinical hypothyroidism in seniors

    What Should Seniors Do?

    It's a concern that there are periodically headlines like: "Study: No ill effects from mild thyroid disease in seniors." These headlines are not typically based on large, double-blind, peer-reviewed studies, and may cause some physicians to bypass thyroid testing in seniors.

    If you or a loved one are suffering from depression, anxiety, memory/cognition issues, brain fog, fatigue, aches/pains, weight gain, chronic constipation, or dramatic hair loss -- among many other symptoms -- I don't care what your age is: You should have a comprehensive thyroid evaluation.

    Given that some researchers estimate that we have as many as 59 million Americans with thyroid conditions -- and less than 20 million of them diagnosed -- we need doctors to be more aware of the prevalence of undiagnosed thyroid disease, and the importance of proper testing -- for all age groups. As far as screening, the American Thyroid Association's recommendations for screening at the age of 35, and every five years thereafter, is a minimum starting point.

    More Information

    Learn more about thyroid diagnosis and treatment in seniors:

    Sources: 

    U.S. Preventive Services Task Force on screening for thyroid disease, January 2004 (http://www.ahrq.gov/clinic/uspstf/uspsthyr.htm)
    "Is Subclinical Thyroid Dysfunction in the Elderly Associated with Depression or Cognitive Dysfunction?," Abstract, Annals of Internal Medicine, Oct. 17 (http://www.annals.org/cgi/content/abstract/145/8/573)
    "Study: No ill effects from mild thyroid disease," December 2006, AMNews, (http://www.ama-assn.org/amednews/2006/12/25/hlsc1225.htm)
    NCBI http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340110/

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