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Hypothyroidism and Older Adults

Research suggests that 1 in 4 older adults in nursing homes have undiagnosed hypothyroidism. However, it often goes unidentified and untreated because we attribute the symptoms to other health conditions like cardiovascular disease. Yet, treating hypothyroidism in older adults can have powerful benefits on your overall health and well-being. Suppose you or a loved one is over age 60. In that case, this article will help you understand how hypothyroidism presents itself and what you can expect with treatment.

What does hypothyroidism look like in older adults?

People over age 60 are at an increased risk for hypothyroidism. Like adults younger than 60, autoimmune thyroiditis is the primary cause of hypothyroidism in this population. In particular, women are much more likely to receive a diagnosis of hypothyroidism than men. 

Hypothyroidism looks differently in older adults than younger adults. Specifically, older adults tend to have a vague presentation of hypothyroidism. Their symptoms are often subtle and sometimes dismissed as typical aging signs. For example, constipation and dry skin are common in older adults. Still, these symptoms could also indicate low thyroid hormone levels.

Older adults tend to have fewer symptoms, whereas people younger than 60 often have multiple symptoms. For example, an older adult may only exhibit some cognitive changes. In contrast, someone younger may experience most, or all, of the following symptoms of hypothyroidism.

Common symptoms of hypothyroidism include:

  • Fatigue
  • Weight gain
  • Puffy face
  • Muscle weakness
  • Dry skin and thinning hair
  • Constipation
  • Cold intolerance
  • Joint pain and stiffness
  • Slowed heart rate
  • Depression
  • Cognitive changes like memory loss
  • Goiter

Older adults can experience any of the above symptoms. However, many of these symptoms coincide with other common health conditions. And, as you can see, some symptoms are classified as a normal part of aging. 

While hair does thin as we get older, and joint pain is more common with age, these symptoms can signify that more is going on inside the body.

Diagnosing hypothyroidism in older adults

Because we often miss hypothyroidism in older adults, your doctor needs to have a complete understanding of your health history, current symptoms, and medications you are taking. People with a family history of thyroid disease or a history of treatment for hyperthyroidism should be especially aware of the risk of hypothyroidism. Furthermore, people with a history of surgery or radiation to the neck area may also be at a greater risk for an underactive thyroid in older adulthood. 

Getting a firm diagnosis for hypothyroidism as an older adult can be challenging. Often, thyroid function tests can fall in the normal range or be just slightly below normal. 

To check for hypothyroidism, you should get a complete thyroid panel to look at your TSH, T4, T3, and TPO antibody levels. Suppose your blood test shows a slightly elevated TSH, but you do not have symptoms. In that case, your doctor may suggest you repeat the test in three months’ time before prescribing treatment. 

Treating hypothyroidism

Older adults require a different treatment plan if they have subclinical or overt hypothyroidism. Subclinical hypothyroidism is where your T4 level is normal, but your TSH is slightly elevated. Studies show that older adults with subclinical hypothyroidism often have no symptoms. Intriguingly, your risk for cardiovascular disease does not increase if you have subclinical hypothyroidism. Thus, a thyroid doctor may not treat subclinical hypothyroidism with medication if you do not have symptoms. 

Older adults with overt hypothyroidism, where TSH is high and T4 is low, tend to need medication. With those lab results, you likely have some symptoms. Other systems in your body may be negatively affected if you do not get treatment. 

Treatment for hypothyroidism usually involves replacing low T4 levels with thyroid hormone replacement medication like levothyroxine, a synthetic thyroid hormone medication. Usually, a thyroid doctor will start an older adult on a lower dose than people under 60 to ensure their heart can tolerate the medication. Once cardiovascular tolerance is determined, the doctor may start slowly increasing the dose and re-checking thyroid function test every 4-6 weeks. 

Some doctors may start their older patients on a normal starting dose (1.6mcg/kg) if they do not have any risk factors or history of heart disease. 

Age-related changes that affect treatment

Regular changes in the body can affect how the body metabolizes synthetic thyroid hormone. Therefore, a doctor needs to follow the dosing carefully to ensure an older patient is not over-treated. Too much medication can cause hyperthyroidism, which can have severe consequences in older adults.

Regular age-related changes that can compromise your treatment with medication include:

  • Declining metabolic clearance of medications
  • Decreasing body mass 
  • Progression of underlying failure of the thyroid gland
  • Interactions with other drugs and diseases

A thyroid doctor may take a “start low, go slow” approach to treating hypothyroidism because of these age-related changes. This means that your doctor may start you on a lower than normal dose and may take more time between dose increases to assess how your whole body responds to treatment wholly.

Hypothyroidism has no age limit: it can affect infants in utero to people in their last years of life. If you or a loved one suspects you may have an underactive thyroid gland, find an endocrinologist in your area or via telemedicine to get the care you deserve.