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RUNNING HEAD: THYROID DISORDERS IN GERIATRIC PATIENTS 1

Thyroid Disorders in Geriatric Patients

Savannah Southard

James Madison University


THYROID DISORDERS IN GERIATRIC PATIENTS 2

Abstract

This paper explores the differences in thyroid function in geriatric patients. Hypothyroidism and

hyperthyroidism tend to affect the elderly at an increased rate because of changes the thyroid

gland undergoes during the natural aging process. These changes will be examined with

particular attention to physiology and symptomology. Four published articles, one professional

website, and one nursing textbook were used to examine how thyroid disorders in geriatric

patients should be managed with best practice recommendations.

Keywords: endocrine function, thyroid disorder, hypothyroidism, hyperthyroidism,

geriatric, elderly, aging


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Thyroid Disorders in Geriatric Patients

Aging affects many bodily functions, including those of the thyroid gland. The thyroid is

responsible for making hormones that help the body use energy and thermoregulate, and it also

keeps other organs such as the brain and heart working correctly (American Thyroid Association,

2017). That being said, an increase in age and decline in thyroid function can cause multiple

systems in the body to be negatively affected. Nurses should be educated on best practices to

prevent further decline in thyroid function as seen in patients with hypothyroidism and

hyperthyroidism, and with new recommendations geriatric patients with thyroid disorders can

reach optimal health.

The thyroid gland goes through several changes with aging that contribute to a diagnosis

of hypothyroidism. These include atrophy, fibrosis, increased colloid nodules, and lymphocytic

infiltration. With hypothyroidism, concentration of thyroid hormone in the tissues is below

normal (Eliopoulos, 2014). However, the standard changes to the thyroid gland from aging are

not the only processes that may cause a low concentration of thyroid hormone. According to

Ajish & Jayakumar (2012), seven to fourteen percent of elderly people have abnormal serum

thyroid stimulating hormone (TSH) levels with the presence of autoantibodies that attack the

thyroid, making autoimmune thyroid failure a major cause of hypothyroidism in the geriatric

population. Hypothyroidism in the elderly can be traced back to drugs such as lithium and

amiodarone, or the use of radioiodine contrast agents. External radiotherapy in the head and

neck region for head and neck malignancies can also cause thyroid dysfunction (Ajish &

Jayakumar, 2012, p. 545).

Subclinical hypothyroidism is the most common thyroid disorder seen in geriatric

patients, affecting up to ten percent of women ages sixty and over. It is defined as high serum
THYROID DISORDERS IN GERIATRIC PATIENTS 4

TSH concentration with normal serum free thyroxine and free triiodothyronine concentrations,

associated with few or no signs and symptoms of hypothyroidism (Kumar, Singh, Meena, Gaur,

Singla, & Sisodiya, 2016, p. 101). Thyroid nodules and cancers are also more prevalent with age.

Patients may present with fatigue, depression, anorexia, weight gain, impaired hearing,

peripheral edema, constipation, cold intolerance, paresthesia, dry skin, and coarse hair. Because

many of these signs and symptoms can be attributed to the normal process of aging, they may be

overlooked. Heat intolerance seen in younger patients with hypothyroidism may be absent in

older patients (Ajish & Jayakumar, 2012).

At the other extreme, the thyroid goes through changes with aging that may contribute to

hyperthyroidism, which is when the thyroid secretes excess amounts of thyroid hormone.

Atrophy, fibrosis, and nodules, along with reduced radioactive iodine uptake can cause

hyperthyroidism in elderly patients. Hyperthyroidism occurs less in the geriatric population than

hypothyroidism, and it affects women more than men (Eliopoulos, 2014). As with

hypothyroidism, amiodarone can be a major cause of hyperthyroidism in older adults, since it is

a cardiac drug that many older adults may take. Amiodarone contains iodine that deposits in

tissue and delivers iodine to the circulation over very long periods of time.. [and] may also

interfere with thyroid hormone transport into cells and with pathways of intracellular thyroid

hormone metabolism (Eliopoulos, 2014, p. 384). Fifteen percent of patients diagnosed with

hyperthyroidism are over the age of sixty, with Graves disease being the most common cause

(Ajish & Jayakumar, 2012).

In geriatric patients, common signs and symptoms associated with hyperthyroidism

include diaphoresis, tachycardia, hypertension, insomnia, nervousness, confusion, increased

hunger, heat intolerance, hyperreflexia, muscle weakness, osteoporotic fractures, angina pectoris,
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and cardiac failure. As seen with hypothyroidism, some symptoms may be mistaken for common

occurrences in the aging population. Ajish and Jayakumar (2012) wrote that atypical

presentations of hyperthyroidism in elderly adults make it difficult to diagnose, because classic

signs of hyperthyroidism in younger adults such as tremor, weight loss, palpitations, diarrhea,

and heat intolerance may be absent. Atrial fibrillation with a slow ventricular rate is seen in up

to 20% of the hyperthyroid patients (Ajish & Jayakumar, 2012, p. 543).

As previously mentioned in causes of both hypothyroidism and hyperthyroidism, iodine

overload is a major factor that should be considered carefully for future practice when reaching a

diagnosis of a thyroid disorder. Because it is frequently overlooked, elderly patients with an

already increased susceptibility to thyroid disorders are developing complications because of

medication interactions, iodinated contrast media exposure, topical cleansers, and nutritional

supplements. Foppiani, Cascio, and Lo Pinto (2016) completed a case report on an elderly

patient taking amiodarone who was admitted to the hospital following a period of shortness of

breath and tachycardia. Computed tomography scans were completed using iodinated contrast

media to rule out pulmonary embolism. In reviewing medical records and lab values, TSH levels

were found to be low. Since thyroid function had not been tested in about a year, it was checked

again revealing hyperthyroidism. Ultimately, this patient could have suffered catastrophic

cardiac affects because of excess iodine intake related to the antiarrhythmic drug amiodarone and

iodinated contrast media used during this hospital visit. In current nursing practice it would be

useful for any patient taking amiodarone to have specific thyroid function tests performed on a

regular basis to prevent such complications.

The incidence of thyroid disease in the elderly is five to twenty times higher in women

than in men, meaning that postmenopausal women are most often affected (Gietka-Czernel,
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2017). Hypothyroidism, thyroid cancer, and nodular goiter are diagnosed more frequently than

hyperthyroidism in this gender and age group. Levothyroxine, a manufactured form of thyroid

hormone, is used to treat hypothyroidism. In postmenopausal women it is important to examine

any comorbidities, and also to determine if hormone replacement therapy is being utilized.

Women taking hormone replacement therapy need the higher doses of L-thyroxine due to the

greater capacity of the main thyroxine protein blood transporter TBG (thyroxine-bounding

globulin) (Gietka-Czernel, 2017, p. 34). In current nursing practice, paying close attention to

symptoms that may be associated with menopause can be useful in detecting underlying thyroid

dysfunction. For future nursing direction, more extensive lab testing with correct interpretation

of thyroid function tests should be considered, corresponding to presence of symptoms,

coexisting cardiovascular risk, patients age, and severity of thyroid dysfunction.

In conclusion, thyroid disorders often affect geriatric patients because of bodily changes

that occur with aging. These changes can be within the thyroid gland itself, because of the

presence of autoantibodies, or due to drug interactions. Nurses and other healthcare team

members should know the differences between and demonstrate awareness of normal changes

associated with aging and those that may be present with hypothyroidism or hyperthyroidism.

Thyroid function tests have proven to be an essential tool to determine if an unusual symptom

commonly seen in the aging population is related to an underlying thyroid disorder. It is

important to investigate all possibilities, as presentation of thyroid dysfunction in the elderly can

be atypical. As for treating a geriatric patient with a diagnosed thyroid disorder, it is critical that

healthcare providers keep up to date on any lab work and obtain a thorough history including a

medication list during each follow-up with the patient. These practices will aid in preventing

further decline in thyroid function of geriatric patients and yield ideal health.
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References

American Thyroid Association. (2017). Retrieved from https://www.thyroid.org

Ajish, T. P., Jayakumar, R. V. (2012). Geriatric thyroidology: An update. Indian Journal of

Endocrinology and Metabolism, 16(4), p. 542-546. doi: 10.4103/2230-8210.98006

Eliopoulos, C. (2014). Gerontological Nursing (8th ed.). Philadelphia, PA: Wolters Kluwer

Health | Lippincott Williams & Wilkins

Foppiani, L., Cascio, C., Lo Pinto, G. (2016). Iodine-induced hyperthyroidism as combination of

different etiologies: An overlooked entity in the elderly. Aging Clinical and Experimental

Research, 28(5), p. 1023-1027. Retrieved from https://www.ebscohost.com

Gietka-Czernel, M. (2017). The thyroid gland in postmenopausal women: Physiology and

diseases. Menopausal Review, 16(2), p. 33-37. doi: 10.5114/pm.2017.68588

Kumar, H., Singh, V. B., Meena, B. L., Gaur, S., Singla, R., Sisodiya, M. S. (2016). Clinical

profile of thyroid dysfunction in elderly: An overview. Thyroid Research and Practice,

13(3), p. 101-105. doi:10.4103/0973-0354.193127