LTC Resources - Thyroid

The most common thyroid problems in older people are hypothyroidism, hyperthyroidism and thyroid nodules. (1)

Why is it important?

  • Thyroid diseases are very much the diseases of older people and often are not properly diagnosed
  • 4% of older people may have undiagnosed hypothyroidism and 2% have unsuspected hyperthyroidism
  • Thyroid problems are more common in older women than in men:  female to male ratio 10:1 (2)
  • Clinical examination of women is complicated by the changes in posture and anatomy brought on by thinning of the bone or osteoporosis
  • Calcified thyroid nodules can cause much discomfort and can appear as rock hard masses or lumps in the chest and be misidentified as metastases of cancer from the breast or stomach that have spread to the lymph glands or the neck.

Common Causes

  • The most common cause of hypothyroidism (or under activity) in older people is Hashimoto's Thyroiditis. It results in an enlargement of the thyroid gland, caused by an autoimmune condition
  • The most common cause of hyperthyroidism is Plummer's Disease. It is characterized by a bumpy, lumpy enlarged thyroid with nodules that are overactive.

Key Considerations

  • In hypothyroidism,  signs include:
    • Abnormalities in the cerebellum at the back of the brain which leads to an ataxic or drunken gait;
    • Aches and pains that are not in or around the joints - rheumatism that is not arthritis;
    • Carpal Tunnel Syndrome - a compression of an important nerve to our hand in the wrist causes tingling sensations which can be corrected without surgery.
  • With hyperthyroidism 3/4 of older patients present atypically; 1/3 are clinically euthyroid (have no external symptoms of thyroid dysfunction) while 15% have a syndrome called Apathetic Thyrotoxicosis, a form of hyper-thyroidism which in fact looks like hypothyroidism.
  • In both conditions there will be a failure to thrive, confusion, depression, falling, walking disturbances, incontinence from immobility, heart failure and change of bowel habits (either constipation or diarrhea). Not only do these signs make it difficult to distinguish hyper from hypothyroidism in the elderly, they are, in fact, the signs of many other common illnesses of older people.
  • The TSH level is the most accurate indicator of thyroid function and is an even better test than direct measurement of thyroid hormone in the bloodstream.
  • Signs and symptoms of hypothyroid  include: weak slow heart beat; muscular weakness and constant fatigue; sensitivity to cold; thick puffy skin and/or dry skin;  slowed mental processes and poor memory; constipation; goiter (increased size of the thyroid)
  • Signs and symptoms of hyperthyroidism include:  rapid forceful heartbeat; tremor; muscular weakness; weight loss in spite of increased appetite; restlessness, anxiety and sleeplessness; profuse sweating and heat intolerance; diarrhea; eye changes and goiter (increased size of the thyroid)

References

1.  Thyroid Foundation of Canada.  Retrieved March 10, 2014 from: 
      http://www.thyroid.ca/

2.  Tahboub, R.  Thyroid Dysfunction in the Elderly.  Retrieved March 2014 from: 
      http://www.naama.com/pdf/thyroid-dysfunction-in-elderly-rund-tahboob-md.pdf