chapter  10
38 Pages

Thyroid Disease in the Elderly

WithAnne R. Cappola, Myron Miller, Steven R. Gambert

A 30-year-old woman presents with unintentional weight loss, difficulty concentrating, insomnia, and palpitations. An 80-year-old woman presents with “not feeling right.” What is the diagnosis?

Both have overt hyperthyroidism. Yet in the elderly woman, the initial list of differential diagnoses is far greater, the diagnostic testing likely to be more extensive, and the time for diagnosis is potentially longer than in her young counterpart. The 80-year-old woman may attribute some of the same symptomsthe weight loss, difficulty concentrating, and insomnia-to old age. She is more likely to be taking a medication, such as amiodarone, that could play a role in the etiology of hyperthyroidism, and she is more likely to see an exacerbation of a preexisting chronic disease, such as osteoporosis, in conjunction with the hyperthyroidism. Even after diagnosis, her other medical problems will potentially affect the older woman’s treatment course.