Thyroid disease in the elderly


Authors: Zdeňka Límanová
Authors‘ workplace: III. interní klinika – klinika endokrinologie a metabolismu 1. LF UK a VFN v Praze
Published in: Vnitř Lék 2018; 64(11): 993-1002
Category:

Overview

The incidence of most thyroid diseases are prevalent in women in ratio 8 : 1 to men, and especially hypothyroidism arises with age. Unrecognized thyroid dysfunction leads to increased: cardiovascular risk, bone fractures, cognitive impairment, depression, and mortality. The symptoms of thyroid diseases can be nonspecific or common in seniors with ageing complaints. The interpretation of thyroid function tests, the physiological changes in secretion and metabolism of thyrotropin (TSH) and thyroid hormones must be considered, as well as the influence of comorbidities, certain drugs, and individual „set point“ of pituitary gland. According to many observations the serum TSH, thyroxine (T4), concentrations depend on age, comorbidities, and medical treatment – these together sometimes make the diagnosis of thyroid dysfunction complicated in older population. The observational data may suggest a diminished pituitary sensitivity to T4 in the ageing population. According to several studies, serum TSH concentration is probably age-dependant and the upper limit of TSH could be 5.28–5.9 mIU/l in those who are > 70 years old. Therapy of thyroid dysfunction is different in elderly persons than in young people; hypothyroidism should be treated with caution, because high doses of thyroxine can lead to cardiac arrhythmias and increased bone turnover. Hyperthyroidism could be treated either with surgery or preferable with radioiodin. Especially the diagnosis of subclinical hypothyroidism should be made with caution after concerning different important circumstances. Nevertheless there are certain conditions, when subclinical hypothyroidism must be treated.

Key words:

ageing – hyperthyroidism – hypothyroidism – thyroid diseases


Sources
  1. Vanderpump MPJ, Tunbridge WMG, French JM et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol 1995; 43(1): 55–68.
  2. Peeters RP. Subclinical hypothyroidism. N Engl J Med 2017; 377(14): 1404. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMc1709853>.
  3. Kumar S, Hermsen D, Distelmaier F. Biotin treatment mimicking Graves´disease. N Engl J Med 2016; 375(7): 704–765. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMc1602096>.
  4. Kaniuka-Jakubowska S, Lewczuk A, Majkowicz M et al. Nontoxic Goiter (NTG) and Radioiodine: What Do Patients Think About It? Quality of Life in Patients with NTG Before and After 131-I Therapy. Front Endocrinol (Lausanne) 2018; 9: 114. Dostupné z DOI: <http://dx.doi.org/10.3389/fendo.2018.00114>.
  5. Dobning H, Amrein K. Monopolar radiofrequency ablation of thyroid nobles. A prospective Austrian single-center study. Thyroid 2018; 28(4): 472–480. Dostupné z DOI: <http://dx.doi.org/10.1089/thy.2017.0547>.
  6. Toplis DJ, Eastman CJ. 5. Diagnosis and management of hyperthyroidism and hypothyroidism. Med J Aust 2004; 180(4): 186–193.
  7. Laurberg P, Andersen S, Bülow Pedersen I et al. Hypothyroidism in the elderly: pathophysiology, diagnosis and treatment. Drugs Aging 2005; 22(1): 23–38. Dostupné z DOI: <http://dx.doi.org/10.2165/00002512–200522010–00002>.
  8. Husebye ES, Anderson MS, Kampe O. Autoimmune polyendocrine syndromes. N Engl J Med 2018; 378(12): 1132–1141. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMra1713301>.
  9. Hoogendoorn EH, Hermus AR, de Vegt F et al. Thyroid function and prevalence of anti-thyroperoxidase antibodies in a population with borderline sufficient iodine intake: influences of age and sex. Clin Chem 2006; 52(1): 104–111. Dostupné z DOI: <http://dx.doi.org/10.1373/clinchem.2005.055194>.
  10. Tunbridge WM, Evered DC, Hall R et al. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol (Oxf) 1977; 7(6): 481–493.
  11. Peeters RP. Subclinical hypothyroidism. N Engl J Med 2017; 376(26): 2556–2565. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMcp1611144>.
  12. Somwaru LL, Rariy CM, Arnold AM et al. The natural history of subclinical hypothyroidism in the elderly: the cardiovascular health study. J Clin Endocrinol Metab 2012; 97(6): 1962–1969. Dostupné z DOI: <http://dx.doi.org/10.1210/jc.2011–3047>.
  13. Parle J, Roberts L, Wilson S et al. A randomized controlled trial of the effect of thyroxine replacement on cognitive function in community-living elderly subjects with subclinical hypothyroidism: the Birmingham Elderly Thyroid study. J Clin Endocrinol Metab 2010; 95(8): 3623–3631. Dostupné z DOI: <http://dx.doi.org/10.1210/jc.2009–2571>.
  14. Stott DJ, Rodondi N, Kearney PM et al. Thyroid hormone therapy for older adults with subclinical hypothyroidism. N Engl J Med 2017; 376(26): 2534–2544. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1603825>.
  15. Zhao M, Tang X, Yang T et al. Lipotoxicity, a potential risk factor for the increasing prevalence of subclinical hypotyhroidism? J Clin Endocrinol Metab 2015; 100(5): 1887–1894. Dostupné z DOI: <http://dx.doi.org/10.1210/jc.2014–3987>.
  16. Hyland KA, Arnold AM, Lee JS et al. Persistent subclinical hypothyroidism and cardiovascular risk in elderly. Cardiovascular health study. J Clin Endocrinol Metab 2013; 98(2): 533–540. Dostupné z DOI: <http://dx.doi.org/10.1210/jc.2012–2180>.
  17. Grossman A, Weiss A, Koren-Morag N et al. Subclinical thyroid disease and mortality in the elderly: a retrospective cohort study. Examination Survey. Am J Med 2016; 129(4): 423–430. Dostupné z DOI: <http://dx.doi.org/10.1016/j.amjmed.2015.11.027>.
  18. Holowell JG, Staehling NW, Flanders WD et al. Serum TSH.T(4) and thyroid antibodies in the United States population 1988–1994 (NHANES III). J Clin Endocrinol Metab 2002; 87(2): 489–499. Dostupné z DOI: <http://dx.doi.org/10.1210/jcem.87.2.8182>.
  19. Krátký J, Ježková J, Vítková H et al: Positive anti-thyroid antibodies and non-sppressed TSH are associated with thyroid cancer: A retrospective cross-sectional study. Int J Endocrinol 2018; online. <http://dx.doi.org/10.1155/2018/9793850>.
  20. Jiskra J. Hypotyreóza u pacientů se srdečním onemocněním. Vnitř Lék 2017; 63(9): 566–571.
  21. Singer RB. Mortality in a complete 4 year follow up of 85 year old residents of Leiden, classified by serum level of thyrotropin and thyroxine J Insur med 2006; 38(1): 14–19.
  22. Kahaly GJ, Bartalena L, Hegedus L. The American Thyroid Association/American Association of Clinical Endocrinologists guidelines for hyperthyroidism and other causes of thyrotoxicosis: a European perspective. Thyroid 2011; 21(6): 585–591. Dostupné z DOI: <http://dx.doi.org/10.1089/thy.2011.2106.ed3>.
  23. Smith T, Hegedus L. Graves‘ disease. NEJM 2016; 375(16): 1552–1565. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMra1510030>.
  24. Lee SJ, Kim KM, Lee E et al. Low Normal TSH levels are Associated with Impaired BMD and Hip Geometry in the Elderly. Aging Dis 2016; 7(6): Dostupné z DOI: <http://dx.doi.org/734–743.10.14336/AD.2016.0325>.
  25. Biondi B, Bartalena L, Cooper DS et al. The 2015 European Thyroid Association guidelines on diagnosis and treatment of endogenous subclinical hyperthyroidism. Eur Thyroid J 2015; 4(3): 149–163. Dostupné z DOI: <http://dx.doi.org/10.1159/000438750>.
  26. Donangelo I, Young S. Subclinical hyperthyroidism: when to consider treatment. Am Fam Physician 2017; 95(11): 710–716.
  27. Parker WA, Edafe O, Balasubramanian SP. Long term treatment related morbidity in differentiated thyroid cancer: a systematic review of the literature. Pragmat Obs Res 2017; 8: 57–67. Dostupné z DOI: <http://dx.doi.org/.2147/POR.S130510>.
  28. Vlček P, Nováková D, Katra R. Karcinomy štítné žlázy: současný pohled na diagnostiku a léčbu. Vnitř Lék 2017; 63(9): 572–579.
  29. Ahn HS, Kim HJ, Welch HG. Korea´s thyroid cancer „epidemic“ – screening and overdiagnosis. N Engl J Med 2014; 371(19): 1765–1767. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMp1409841>.
  30. Ito Y, Miyauchi A. Prognostic factors and therapeutic strategies for differentiated carcinomas of the thyroid. Prognostic factors and therapeutic strategies for differentiated carcinomas of the thyroid. Endocr J 2009; 56(2): 177–192.
  31. Ito Y, Miyauchi A, Kudo T et al. Trends in the implementation of active surveillance for low risk papillary thyroid microcarcinomasat Kuma hospital: gradual increase and heterogenity in the acceptance of this new management option. Thyroid 2018; 28(4): 488–495. Dostupné z DOI: <http://doi: 10.1089/thy.2017.0448>.
  32. Wang L, Liu S, Li L, at al. Non-thyroidal illness syndrome in patients with cardiovascular diseases: A systematic review and meta-analysis. Int J Cardiol 2017; 226: 1–10. Dostupné z DOI: <http://dx.doi.org/10.1016/j.ijcard.2016.10.039>.
  33. Tajtáková M. Lieky a štítná žlaza. Vnitř Lék 2012; 58(2): 140–144.
  34. Bartalena L, Bogazzi F, Chiovato L et al. 2018 European Thyroid Association (ETA) Guidelines for the management of amiodarone-associated thyroid dysfunction. Eur Thyroid J 2018; 7(2): 55–66. Dostupné z DOI: <http://dx.doi.org/10.1159/000486957>.
  35. Postow MA, Sidlow R, Hellman MD. Immune related adverse events associated with immune checkpoint blocade. N Engl J Med 2018; 378(2): 158–168. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMra1703481>.
  36. Latteyer S, Tiedje V, Schilling B et al. Perspective immunotherapy in endocrine cancers. Endocr Relat Cancer 2016; 23(10): 469–484. <http://dx.doi.org/10.1530/ERC-16–0169>.
  37. Inoue K, Tsujimoto T, Saito J et al. Association Between Serum Thyrotropin Levels and Mortality Among Euthyroid Adults in the United States. Thyroid 2016; 26(10): 1457–1465. Dostupné z DOI: <http://dx.doi.org/10.1089/thy.2016.0156>.
  38. van de Ven AC, Netea-Maier RT, de Vegt F et al. Associations between thyroid function and mortality: the influence of age. Eur J Endocrinol 2014; 171(2): 183–191. Dostupné z DOI: <http://dx.doi.org/10.1530/EJE-13–1070>.
  39. Razvi S, Weaver JU, Vanderpump H et al. The incidence of ischemic heart diseases and mortality in people with DH. Reanalysis of the Wickham survey cohort. J Clin Endocrinolmetab 2010; 95(4): 1734–1740. Dostupné z DOI: <http://dx.doi.org/10.1210/jc.2009–1749>.
  40. Yeap BB, Manning L, Chubb SA et al. Reference Ranges for Thyroid-Stimulating Hormone and Free Thyroxine in Older Men: Results From the Health In Men Study. J Gerontol A Biol Sci Med Sci 2017; 72(3): 444–449. Dostupné z DOI: <http://dx.doi.org/10.1093/gerona/glw132>.
  41. Chaker L, Korevaar T, Rizopoulos D. Defining Optimal Health Range for Thyroid Function Based on the Risk of Cardiovascular Disease. J Clin Endocrinol Metab 2017; 102(8): 2853–2861. Dostupné z DOI: <http://dx.doi.org/10.1210/jc.2017–00410>.
  42. Gussekloo J, van Exel E, de Craen AJ et al. Thyroid status, disability and cognitive function, and survival in old age. JAMA 2004; 292(21): 2591–2599. Dostupné z DOI: <http://dx.doi.org/10.1001/jama.292.21.2591>.
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Diabetology Endocrinology Internal medicine

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