Assignment: Hypothyroidism Is More Prevalent In Older Adult Populations

Assignment: Hypothyroidism Is More Prevalent In Older Adult Populations

Assignment: Hypothyroidism Is More Prevalent In Older Adult Populations

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Demographics

            Hypothyroidism is characterized by increased levels of thyroid-stimulating hormone (TSH) and decreased circulating thyroid hormones tri-iodothyronine (T3) and thyroxine (T4). TSH levels naturally increase with aging with over 97% of patients above 80 years having a TSH range of between 6.3-7.5 mIU/L while the reference range is between 0.27-4.20mIU/L (Calsolaro et al., 2018). It is more dominant in the elderly population, with 2-30% of older adults having some degree of hypothyroidism. In the United States, the condition’s prevalence in women above 60 years of age is at a rate of 5.9% and in men is 2.4% (Calsolaro et al., 2018). According to the American Thyroid Association, females are five to eight times more likely to have thyroid dysfunctions than males. Besides, one in eight women will have a thyroid condition in her lifetime (Hennessey & Espaillat, 2015).

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Pathophysiology

            The hypothalamic-pituitary-thyroid axis governs the secretion of thyroid hormones and dysfunction in one of the organs causes reduced T3 and T4 production. Under normal physiologic processes, the thyroid gland secretes a daily amount of 100-125 nmol of T4 as well as negligible small levels of T3. T4 is converted to T3, which is the active thyroid hormone (Hennessey & Espaillat, 2015). Moreover, the prevalent cause of hypothyroidism among the elderly population is chronic autoimmune thyroiditis, commonly referred to as Hashimoto thyroiditis, which results from the immune system attacking the thyroid gland (Razvi, 2019). Other causes include medications such as lithium, atrophy of the thyroid gland due to aging, iodine deficiency, surgical and medical procedures on the neck region. Also, aging is characterized by a decreased iodine absorption and a reduced sensitivity of thyroid gland to TSH, resulting in a reduced thyroid hormone production.

Clinical Manifestations

            The symptoms of hypothyroidism include: fatigue, muscle pain, weakness in the extremities, joint pain, loss of appetite, hair loss, blurred vision, decreased hearing, constipation, depression and mental confusion (Hennessey & Espaillat, 2015). The clinical presentations of hypothyroidism are mostly atypical in the elderly population, and they may have few or none of the symptoms until the condition becomes severe (Razvi, 2019). Furthermore, the symptoms may be mistaken for the aging process or other medical conditions. The major early symptoms in the elderly are depression, apathy, significant weight loss, and a fourth of the patients with the condition experience constipation.

Morbidity and Mortality

            Hypothyroidism has various systemic effects since thyroid hormones play a role in the process of oxygen consumption, production of heat, synthesis, and absorption of glucose in the body. Low levels of circulating thyroid hormones result in decreased heart contractility, cardiomegaly, pericardial effusion, and reduced cardiac output  (Hennessey & Espaillat, 2015). The effects on the cardiovascular system result in heart failure, renal failure, and hypotension. Failure to appropriately treat hypothyroidism in geriatric patients can lead to coma and death. Thus, hypothyroidism is associated with increased risks of cardiac mortality.

Evaluation and Management

            The goal of medical management in hypothyroidism is to correct the metabolic state and lower morbidity by supplementing or through thyroid hormone replacement (TRH). Generally, the condition is managed with a daily administration of levothyroxine (LT4), and the achievement of a normal TSH level can take months as the hypothalamic-pituitary axis readapts (Ruggeri, Trimarchi & Biondi, 2017). An elderly patient should first be evaluated for the body mass index, etiology, and severity of the condition and the presence of cardiac disease.  In geriatric patients, TRH should be initiated with low dosages of LT4 12.5-25 mcg PO qid and the dose should be gradually increased after 4-6 weeks to avoid neurological and cardiovascular side effects (Ruggeri, Trimarchi & Biondi, 2017). For instance, elderly patients with a known coronary artery disease may experience angina if initiated with the normal dosage of HRT of 300 mcg/day, and it may result in heart failure and arrhythmias. Furthermore, after the dose has been stabilized, the patients should be evaluated for signs of overtreatment such as palpitations, nervousness, atrial fibrillation, tachycardia, tremors, insomnia, and angina.

References

Calsolaro, V., Niccolai, F., Pasqualetti, G., Tognini, S., Magno, S., Riccioni, T., Bottari, M., Caraccio, N., & Monzani, F. (2018). Hypothyroidism in the elderly: who should be treated and how? Journal of the Endocrine Society, 3(1), 146-158.

Hennessey, J. V., & Espaillat, R. (2015). Diagnosis and management of subclinical hypothyroidism in elderly adults: a review of the literature. Journal of the American Geriatrics Society, 63(8), 1663-1673.

Razvi, S. (2019). Subclinical hypothyroidism in the elderly. In 21st European Congress of Endocrinology (Vol. 63). BioScientifica.

Ruggeri, R. M., Trimarchi, F., & Biondi, B. (2017). MANAGEMENT OF ENDOCRINE DISEASE: l-Thyroxine replacement therapy in the frail elderly: a challenge in clinical practice. European journal of endocrinology, 177(4), R199-R217.