Thyroid disease affects people of all walks of life and ages, but some types of thyroid disease are more common in senior citizens. Furthermore, it is often more difficult to diagnose thyroid disease in the elderly than in people below the age of 50, and this can lead to senior citizens suffering from undiagnosed thyroid disease for years.

Undetected thyroid disease often occurs as a result of other potential illnesses that exhibit similar symptoms to thyroid disorders being more prevalent in the elderly and therefore making the diagnosis process rather murky.

This guide, specifically written for senior citizens, in the United States and beyond, will give you detailed information on thyroid disease, outlining what you should look out for and the treatment options available to you.

Note: This thyroid disease article will not cover the topic of Thyroid Cancer but we will do an in-depth article on Thyroid Cancer in the near future.

What is the Thyroid Gland and What Does it do?

The thyroid is a butterfly-shaped gland situated just in front of the windpipe. It forms part of the endocrine system – a system of glands that produce various hormones to control and regulate key body functions, including tissue function, sexual function, growth, mood, and metabolism.

Metabolism encompasses all the life-sustaining chemical reactions which take place in your body, including the conversion of the food and drink you eat into energy to fuel cellular activity.

Metabolism includes how quickly your body burns calories and how fast your heartbeats. The thyroid gland, therefore, plays a very important role in the healthy functioning of your body.

As we age and become less active, our metabolism slows down. That’s why senior citizens often find themselves gaining weight and at the same time, find it difficult to lose weight. Adding daily exercise will add muscle and help increase metabolism.

How Does the Thyroid Work?

The thyroid regulates the body’s metabolic activity by producing thyroid hormones, such as T3 (triiodothyronine) and T4 (thyroxine) hormones.

The thyroid gland produces hormones by extracting iodine from the bloodstream. It then incorporates the extracted iodine into the aforementioned hormones.

A normally functioning thyroid gland produces around 80% T4 and 20% T3. It should be noted that the T3 hormone is stronger than the T4 hormone.

The thyroid also produces other hormones, such as calcitonin, which works to regulate blood calcium levels.

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Complications of Diagnosing Thyroid Problems in the Elderly

Thyroid disease is widespread in people aged 65 and above, in the US and globally, and becomes more prevalent as we continue to age, according to several scientific studies.

A Colorado screening study involving over 25,000 individuals found that 10 percent of men and 16 percent of women aged 65-74 likely had Hypothyroidism, and 16 percent of men and 21 percent of women sampled aged 75 and older likely had the condition.

Seniors should pay special attention and care to thyroid disease, as despite the prevalence of such ailments increasing with age, many go undiagnosed for years.

This is the case because diagnosing thyroid disease in senior citizens can be very tricky, as the symptoms they show are often shared by other diseases and illnesses very common in the elderly, such as bowel diseases or disorders of the nervous system.

Moreover, there are further difficulties in diagnosing and identifying the specific thyroid disease a senior citizen is suffering from than in a younger adult.

For example, the two main thyroid illnesses – hyperthyroidism and hypothyroidism – show very different and distinct symptoms in younger patients, making it relatively straightforward to distinguish between the two.

However, in the elderly, hyperthyroidism and hypothyroidism often exhibit many of the same symptoms.

Symptoms of both of these thyroid diseases include depression, confusion, heart failure and changes in bowel movements/patterns, and, to make matters worse, all of these symptoms are common in other diseases prevalent in seniors.

What are Some Common Thyroid Issues in Seniors?

Hypothyroidism

Hypothyroidism is a disorder of the thyroid, resulting in the gland not producing sufficient quantities of thyroid hormones, such as T3 and T4 hormones, among others.

Around 10 million people in the US are believed to suffer from hypothyroidism, though there is significant variation in other estimates. Meanwhile, other surveys suggest that up to 10 percent of women suffer from thyroid hormone deficiency, on some level.

Given the thyroid’s importance in managing the body’s metabolic activity and metabolic rate, this deficiency directly affects a person’s metabolic rate. Hypothyroidism patients have a slow metabolism as a result of this disorder.

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Common Causes of Hypothyroidism

Hypothyroidism is principally caused by one of two underlying issues with the thyroid. Hypothyroidism can be caused by a previous or active inflammation of the thyroid, which results in a high proportion of thyroid cells being either dead or damaged. This damage results in the cells not being able to produce thyroid hormones, and thus contribute to a deficiency of thyroid hormones in the body.

The underlying issue (the inflation of the thyroid) is known as Thyroiditis, and the most common cause is autoimmune Thyroiditis, also known as Hashimoto’s Thyroiditis. In this case, the thyroid becomes inflamed as a result of the body’s immune system.

Secondly, Hypothyroidism can be caused by medical treatments that remove or damage a significant chunk (or all) of the thyroid gland. This unsurprisingly reduces the capacity of the thyroid gland to produce the required thyroid hormones to regulate the body’s metabolism well.

The surgical treatment for thyroid cancer, in which all or some of the gland is removed, can lead to Hypothyroidism, though the thyroid may be able to produce a sufficient quantity of hormones if some of it is left intact.

In addition to these two main causes of Hypothyroidism, the condition may come about even if the thyroid isn’t inflamed nor damaged.

For example, if the pituitary gland (commonly referred to as the “master gland”, as it regulates other glands in the body) doesn’t produce a sufficient amount of thyroid-stimulating hormone (TSH), then the thyroid doesn’t produce enough hormones.

Symptoms Associated with Hypothyroidism

An underactive thyroid gland results in an array of symptoms, with varying levels of seriousness. Patients may experience some or all of the below symptoms, and the severity of each depends on just how underactive your thyroid is.

Symptoms of Hypothyroidism include:

• Depression
• Fatigue and weakness
• Weight gain or difficulty losing weight
• Coarse and dry hair
• Increased cholesterol levels
• Dry, rough pale skin
• Hair loss
• Fall in libido
• Loss of memory
• Heightened cold intolerance
• Muscle cramps
• Muscle aches
• Constipation
• Irritability
• Eyebags
• Slowed growth and development (in children)
• Abnormal menstrual cycles

It should be noted that in very mild cases of Hypothyroidism there may be no visible symptoms, so the only way to find out if you have an underactive thyroid is via a thyroid function blood test.

It is often advisable for senior patients to take this blood test even if they aren’t exhibiting many symptoms, as the chances of Hypothyroidism increase with age, and as many of the above symptoms can easily be attributed to other diseases or even just the natural aging process.

How to Find out if you Have Hypothyroidism

If you have exhibited some of the above symptoms and are worried that you may be suffering from Hypothyroidism, you can book a blood test with your doctor. This will allow them to easily check if you do indeed have an underactive thyroid.

The thyroid function blood test is often accompanied by a physical examination of the gland, which is located just in front of the trachea.

After a sample of blood has been drawn from the patient and analyzed, the doctor will look for a thyroid-stimulating hormone (TSH) level in excess of the reference range, and a thyroxine hormone level below the reference range.

A test for thyroid antibodies is also advisable, as this allows your doctor to check if your underactive thyroid is autoimmune (a case of Hashimoto’s Thyroiditis.)

How to Treat Hypothyroidism

Hypothyroidism certainly is a treatable condition, but there are additional factors to consider and potential complications when treating a senior patient suffering from an underactive thyroid.

Levothyroxine is commonly prescribed, as tablets or a liquid, to patients suffering from Hypothyroidism. This medication works to compensate on behalf of your thyroid and make up for the thyroid hormone deficiency in your body.

When treating a senior patient, the dose of levothyroxine is started at a low level and increased incrementally to avoid putting any strain on the heart or the central nervous system, though healthier patients with no history of stroke or dementia may be started on a higher dose, despite their old age.

Treatment typically starts at around 25-50mcg of levothyroxine per day and the dosage is slowly increased around every 4-6 weeks. Blood tests are regularly carried out, and once they indicate thyroid hormone and TSH levels are moving closer to the healthy range, the dosage stops being increased.

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Hyperthyroidism

In stark contrast to hypothyroidism, hyperthyroidism is when the thyroid gland is overactive and therefore produces more hormones than required by the body.

Hyperthyroidism, also known as thyrotoxicosis, is around ten times more common in women than men and can lead to severe complications and symptoms if it goes untreated.

Common Causes of Hyperthyroidism

Hyperthyroidism can be caused by several factors and conditions. Graves’ disease, a disorder in which the immune system attacks and damages the thyroid, is the most common cause of an overactive thyroid, from a broad brush of the various age groups, accounting for around 75 percent of cases.

A toxic thyroid adenoma, a tumor of the thyroid gland, is another cause of hyperthyroidism, as is Thyroiditis, though both are far less common culprits of an overactive thyroid than Graves’ disease.

Hypothyroidism can ultimately result in hyperthyroidism if the patient takes too high a dosage of levothyroxine, resulting in the thyroid overcompensating and producing more thyroid hormones than the body requires.

Your thyroid may also become overactive due to a toxic multinodular goiter. It’s noteworthy that although Graves’ disease is the most common cause of an overactive thyroid in younger patients, toxic multinodular goiter (MNG) is the most prevalent cause in senior patients.

Toxic multinodular goiter symptoms vary depending on your age. Patients aged 50-70 often experience heart palpitations, insomnia, weight loss, weakness, and heat intolerance.

Meanwhile, patients aged over 70 years of age are likely to experience atrial fibrillation, tachyarrhythmias, and anorexia.

Symptoms Associated With Hyperthyroidism

As with hypothyroidism, an overactive thyroid leads to your body exhibiting various symptoms, again, with greatly varying levels of seriousness. Patients may experience some or all of the below symptoms, and the severity is contingent on how overactive your thyroid is.

Symptoms of Hyperthyroidism Include:

• Fatigue
• Insomnia and other sleeping troubles
• Changes in appetite (decrease or increase)
• Frequent bowel movement
• Diarrhea · Fertility issues
• Heart palpitations· Increased sweating
• Light menstrual periods/missed periods
• Heat intolerance
• Heightened irritability
• Weakness and muscular pain
• Nervousness
• Hives
• Shortness of breath
• Tremors
• Vision changes
• Sudden paralysis
• Dizziness
• Thinning of hair
• Itching
• Increase in blood sugar levels
• Weight loss or weight gain

As already mentioned, many of these symptoms may not be exhibited in older adults, or they are often attributed to other illnesses common in the elderly, leading to a missed diagnosis.

Symptoms most often exhibited by elderly sufferers of hyperthyroidism are heart palpitations, tremors, chest pain, and depression.

Furthermore, distinguishing between hyperthyroidism and hypothyroidism is much more difficult in senior patients, as fewer symptoms are exhibited and the symptoms shown often don’t match those exhibited by the broader population.

How to Find Out if You Have Hyperthyroidism

As with hypothyroidism, a blood test is carried out to analyze your thyroid hormone levels and check if they are within a healthy range. However, if you suspect your thyroid is producing too much thyroid hormones, your doctor is likely to first conduct a medical history check and physical examination.

The physical exam is likely to consist of your doctor looking for a slight tremor in your hands, though this isn’t an ideal indication for older patients, as they may have tremors due to other ailments.

The medical professional will also check for overactive reflexes, warm, moist skin, eye changes, and a rapid or irregular pulse. Moreover, they will examine your thyroid, asking you to swallow as they do so, to see if the gland is enlarged, bumpy or tender.

Due to the aforementioned complications, a blood test is the best way to detect and diagnose hyperthyroidism in older adults. A doctor will examine a sample of the patient’s blood to measure their thyroxine and thyroid-stimulating hormone (TSH) levels.

The doctor will be looking out for high levels of thyroxine in the bloodstream, and low levels of TSH, as this suggests the patient has an overactive thyroid.

It’s important to notify your doctor if you’re currently taking biotin (a common Vitamin B supplement), either as a separate supplement or in some multivitamin tablets, as it can interfere with the test and give a false result.

To ensure no interference, you shouldn’t consume biotin at least 12 hours before the blood test is administered.

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Determining the Cause of Your Hyperthyroidism

If the blood test comes back positive, your medical professional is likely to recommend further tests to find out the cause of your hyperthyroidism.

These further tests include a radioiodine uptake test, in which the patient consumes a small dose of radioactive iodine (radioiodine) to check how much iodine the thyroid gland collects.

After orally consuming the dose, you will be checked after four, six or 24 hours (or after all three intervals).

If your thyroid absorbs a large amount of iodine, this suggests it is producing too much thyroxine, and your hyperthyroidism is likely being caused by Graves’ disease or hyperfunctioning thyroid nodules.

On the other hand, if your radioiodine uptake is low, this suggests the thyroxine stored in the gland is leaking into your bloodstream, indicating that thyroiditis is the underlying issue.

Following a positive blood test for hyperthyroidism, a doctor may suggest a scan of the gland as the next course of action. This involves high-frequency sound being targeted at your neck and absorbed by the gland to create an image of it.

Ultrasound is often more effective than other available tests at detecting thyroid nodules.

Alternatively, your doctor may recommend a thyroid scan, though, unlike an ultrasound scan, you are exposed to potentially harmful and carcinogenic radiation.

This test consists of a radioactive isotope being injected into a vein in your hand before a camera generates an image of your thyroid on a computer screen. As with the first test, this checks how much iodine is absorbed by your thyroid.

How to Treat Hyperthyroidism

There are various treatment options available for patients suffering from hyperthyroidism, including surgery (a thyroidectomy), which is often the best option for pregnant women or people who can’t tolerate anti-thyroid drugs for other reasons.

However, this procedure, in which a surgeon removes most of the thyroid gland, is not advisable for senior patients, as there are increased risks for older adults.

Alternatively, your doctor may recommend taking radioactive iodine. In this treatment, the patient orally administers a dose of radioactive iodine, which is then absorbed by the thyroid, causing it to shrink and produce lower levels of thyroid hormone.

The symptoms gradually decrease in the following weeks and months, but treatment may result in the patient developing hypothyroidism if the gland shrinks too much.

If this occurs, the patient will need to consume a course of Levothyroxine to ensure there’s enough thyroid hormone in the blood.

Another option to treat hyperthyroidism is to take anti-thyroid medication, such as methimazole (Tapazole) or propylthiouracil. These medicaments restrict your thyroid’s ability to produce hormones, to help bring them back to normal levels in the blood.

Although you may see progress as early as a few weeks, you’re likely to need to take these anti-thyroid drugs for over a year, and even then, relapse is still possible.

Both of the aforementioned medicaments may cause serious and potentially fatal liver damage. Propylthiouracil is considered far more dangerous, so it is advisable to only consume it if your body is unable to tolerate methimazole.

Furthermore, a minority of patients are allergic to Tapazole and propylthiouracil. Side effects include skin rashes, fever or joint pain.

Finally, your doctor may recommend taking beta-blockers. Beta-blockers won’t actually influence blood thyroid hormone levels, but they can alleviate some of the symptoms, particularly tremors and heart palpitations, as they help to calm your body. They are not, however, without potential side effects (fatigue and sexual dysfunction may ensue if you take these drugs.)

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Quick Thyroid Disease Summary

• Thyroid disorders affect people across all age groups but are more prevalent in older adults and women
• Thyroid disease is far more difficult to diagnose in senior patients, as the symptoms exhibited may just be passed off as part of the aging process, or attributed to other diseases common in the elderly.
• This often leads to elderly patients suffering from an overactive or underactive thyroid a – or other thyroid problems, such as a toxic multinodular goiter (MNG) – for years undiagnosed.
• The thyroid is a butterfly-shaped gland located just in front of the windpipe, in the neck, and it forms part of your body’s endocrine system.
• It is in charge of regulating your body’s metabolism, by releasing hormones into the bloodstream and therefore affects your heart rate and metabolic rate, among other things.
• Hypothyroidism results in your thyroid gland failing to produce enough thyroid hormones, principally T3 and T4 hormones.
• Some 10 million people in the United States are estimated to suffer from hypothyroidism, though other estimates suggest the figure could be much higher.
• Hypothyroidism patients have a slower metabolism as a result of the disorder.
• Hypothyroidism is principally caused by one of two underlying issues – Thyroiditis (including autoimmune Thyroiditis), or a prior surgical operation on the gland.
• Patients suffering from an underactive thyroid exhibit various symptoms, including weight gain or difficulty losing weight, increased cholesterol levels, drop in libido and muscle aches.
• A blood test is an effective way to determine if you have an underactive thyroid.
• Medication is often prescribed to increase thyroid hormone levels in the blood, though older patients are typically put on an initially lower dosage.
• Hyperthyroidism is when the thyroid is overactive and produces more hormones than required by the body.
• Women are ten times more likely than men to have an overactive thyroid.
• This condition is most often caused by Graves’ disease, though there are other underlying issues that may result in hyperthyroidism, such as a toxic multinodular goiter (MNG).
• Symptoms of hyperthyroidism include increased sweating, hives, shortness of breath and muscular pain.
• A blood test and a physical exam should be carried out to determine if a patient has hyperthyroidism.
• An overactive can be treated via a thyroidectomy (this isn’t recommended for senior patients), radioactive iodine or beta-blockers.