Because problems with the thyroid often manifest as other health disorders such as diseases of the heart, bowel or nervous system, accurately identifying and treating thyroid diseases in elders requires special attention.

By Beth Lueders

Fatigue, change in mood, hair and nail changes, weight changes, and memory issues. Sound like signs of ageing? Maybe not. These could also be signs of a malfunctioning thyroid — a condition that can be mistaken for other reasons in older adults. The thyroid, a butterfly-shaped gland just above the collarbone at the base of the neck, is responsible for secreting hormones into the bloodstream that regulate the body's metabolic processes such as temperature, heartbeat and digestion. The thyroid also regulates muscle function, brain development and overall mood.

The thyroid gland produces mainly thyroxine (T4) and a smaller amount of triiodothyronine (T3), both types of thyroid hormone to help keep the vital functions of the brain, heart, kidneys and liver running smoothly. The pituitary gland in the brain regulates the production of these thyroid hormones. Dr. Whitney Goldner, an endocrinologist with the Thyroid and Endocrine Multidisciplinary Program at Nebraska Medicine in Omaha, Neb., USA, notes, "Thyroid disorders are common in all age groups but are overall more common in women than men. But as we age, thyroid disorders in general increase."

In older adults, clinical signs of thyroid problems can be subtler than in younger people. Many of the symptoms may be attributed to the ageing process. "That's the tricky part," Dr. Goldner explains. "With older patients, one of the big distinctions is that they may not have the classic symptoms that you'd expect to see in a younger population. A lot of thyroid conditions in general are very nonspecific. So sometimes people can have fatigue, weight loss, changes in their mood or worsened depression. Sometimes they can have effects on skin and hair. But because these symptoms are not specific just to the thyroid, they may be attributed to other conditions or ageing alone."

Common Thyroid Disorders in Older Adults

Because problems with the thyroid often manifest as other health disorders such as diseases of the heart, bowel or nervous system, accurately identifying and treating thyroid diseases in elders requires special attention.

Common thyroid disorders in the elderly include:

Hypothyroidism, in which the thyroid is underactive and not producing enough thyroid hormone for the body to work properly. A common cause of hypothyroidism is an autoimmune disorder, Hashimoto's thyroiditis. Thyroiditis is a broad term referring to inflammation of the thyroid gland, and Hashimoto's thyroiditis is a prevalent cause of hypothyroidism. If the thyroiditis causes slow and chronic cell damage, thyroid hormone levels in the blood drop and cause symptoms of hypothyroidism. Hypothyroidism's symptoms are nonspecific and may include weight gain, sleepiness, dry skin and constipation.

Hyperthyroidism, which occurs when the thyroid is overactive and releasing too much thyroid hormone and speeding up body systems. In younger people, hyperthyroidism typically presents with increased appetite, weight loss, rapid heartbeat, sweating, irritability and tremor. The autoimmune disorder Graves' disease is a common cause of hyperthyroidism. In older adults, it can also be caused by a thyroid nodule that makes too much thyroid hormone (toxic nodule), or thyroiditis (inflammation causing leaking of thyroid hormone into the blood system). If there is accelerated cell damage, thyroid hormone in the thyroid gland leaks out and increases levels in the blood, which can cause hyperthyroidism.

Older adults often have symptoms of fatigue, apathy, and irregular or rapid heartrate, which can misleadingly appear more like hypothyroidism.

Thyroid nodules, an abnormal growth of thyroid cells within the thyroid gland that can form a lump, or what is called a "thyroid nodule." These nodules are predominantly noncancerous but need to be evaluated by a physician to determine the possibility of thyroid cancer. Thyroid nodules generally do not cause symptoms and are often detected incidentally during a routine physical or neck scan for other health reasons. Conditions like Hashimoto's disease and iodine deficiency increase the risk for thyroid nodules..

Thyroid cancer, which is a malignant tumor on the thyroid gland. There are several types of thyroid cancer including papillary, follicular, medullary and anaplastic. One common type, papillary thyroid carcinoma, is very treatable, but aggressiveness of the tumor can increase with age. It can present as an asymptomatic neck mass or can be detected incidentally on imaging done for other reasons. In contrast, anaplastic thyroid cancer is the most aggressive thyroid cancer and occurs most commonly in people over age 60. Fortunately, anaplastic thyroid cancer is quite rare. Anaplastic thyroid cancer can present as a rapidly growing neck mass that can cause hoarseness and difficulty with swallowing or breathing.

The Thyroid's Effect on the Bones and Heart

Hyperthyroidism can increase the risk of bone loss and osteoporosis, so in addition to treating hyperthyroidism, Dr. Goldner also recommends that hyperthyroid persons get adequate amounts of calcium and vitamin D for optimal bone health.

Hyperthyroidism can also put older persons at increased risk for heart arrhythmias, such as atrial fibrillation (AFib). Any person with onset or worsened AFib should have their thyroid further evaluated.

Helping Older Adults With Thyroid Issues

Treatment of hypothyroidism requires a daily thyroid medicine taken in the morning or several hours after eating, as it is best absorbed on an empty stomach. Professional and family caregivers can make sure older adults don't miss a dose, or don't take it with food or other medications. Caregivers can also monitor for changes in symptoms as noted above. It is not necessary to routinely do neck exams, but if a mass or lump is detected, this should prompt evaluation by a healthcare provider.

If any of the symptoms noted above are new, then it is also reasonable to have blood work done to check for thyroid hormone levels (TSH and Free T4).

Guidelines for screening for thyroid disease are conflicting, but medical societies agree that if persons are having symptoms that could be attributable to an overactive or underactive thyroid, further workup is indicated.

For additional information on a healthy and unhealthy thyroid, contact the following endocrinology resources:

• Thyroid Federation International, visit thyroid-fed.org or email tfi@thyroid-fed.org
• The Australian Thyroid Foundation visit https://www.thyroidfoundation.org.au

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