THYROID DISEASE IN GERIATRICS

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CHOOSE TOPIC
Lab Value & Thyroid
Function

Hyperthyroidism

Hypothyroidism

Risk & Further Complication

Lab Value & Thyroid Function
Normal lab values[1]

T3 Resin
Total T4 Uptake

4.5-10.9 Total T3 22-34%

mcg/dL TSH
60-181
ng/dL
0.5-4.7
Free T4 mIU/L

0.8-2.7
ng/dL Free
Thyroxine
index

1.0-4.3
units

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 Thyroid function dependent on age

Main Topic
 Hyperthyroidism
Definition & Etiology Sign & Symptom

Epidemiology & Statistics

Clinical Representation

Pharmacological
Treatment

Non-pharmacological
Main Topic
Treatment
 DEFINITION & ETIOLOGY

Excess secretion
definition
Etiology
thyrotoxicosis
Subclinical hyperthyroidism
Commonly observed Description
disease in elderly
Graves’ Disease Autoimmune disorder that cause thyroid gland to grow and
increase synthesis of thyroid hormone[1]
Toxic multinodular Prevalence increase with age in those with long-standing
goiter goiter[1]
Toxic nodular Excess secretion of thyroid hormone from benign monoclonal
adenomas tumour that suppress TSH levels [4]
Iodine-induced Increase iodine uptake from sources such as mucolytics and
hyperthyroidism amiodarone [4] [7] Next
Signs & Symptoms

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 Age-Related difference in clinical
presentation specifically geriatrics

Lipid
mask and glucose
hyperadrenergic
Less
Maskedabnormalities
symptoms
signs
Hypercalcemia
atrialhyperthyroidism
Muscle and symptoms
Beta-blockers
tachycardia
osteoporosis
Weight
Non-specific
fibrillation
weakness
loss

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Epidemiology of and Statistic of
Hyperthyroidism
0.5-4%

WM
70 3-8%

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 Non-Pharmacological
Management of Hyperthyroidism

Prognosis
Indication:
Before:
After:
-failed
Propythiouracil
-propanololdrug treatment
@
excellent
Thyroidecto
my
-Large goiters
Methimazole
90bpm
-Prefer
| surgery
Total iodide Partial

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 PHARMACOLOGICAL TREATMENT
FOR HYPERTHYROIDISM

Radioactive
Symptomatic
AntiThyroid[Beta-Blocker]
Radioactive
-effective
Primary Iodine
Treatment
medication
Treatment inIodine
ablation elderlyAblation
Reduce
-Dose heart
– Thyroid
Antithyroid rate & BP
Uptake
medication Test
-Develop hypothyroidism
-Need hormone
Maintenance
Replacement therapy
therapy
Initial therapy for
Drug (gradual reduction over 3-6
4-6 weeks
months from initial dose)

Carbimazole 30- 45 mg/day 5-10 mg/day

Propylthiouracil 300-450 mg/ day 50-100 mg/day

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 Hypothyroidism
Sign & Symptom

Clinical
Definition & Etiology
Representation

Epidemiology &
Statistics

Non-pharmacological Treatment

Pharmacological
Main Topic
Treatment
 DEFINITION & ETIOLOGY
Endocrine disorder
definition
EtiologyDeficiency of thyroid hormo

Main Topic
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 Sign & Symptom
Common Signs and Symptoms

Fatigue Bradycardia Modest weight gain

Hypokinesia Periorbital oedema Constipation

Hoarse Voice Yellowing of skin Hearing impairment

Dry skin and hair Thickening of tongue Slow Speech

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 weight gain
not more overlook
than 10-20 lbs hypothyroidism

Clinical Presentation
Unique features of
hypothyroidism in the
elderly
cardiovascular
or
fatigue and
Neuropsychiatric
weakness
symptoms

Main Topic Next

EPIDEMIOLOGY & STATISTICS

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 EPIDEMIOLOGY & STATISTICS

higher prevalence

better screening

diagnosis and
Levothyroxine (T4) Sodium Usage
treatment

higher Utilisation
radioactive iodine

Main Topic Next

 subclinical hypothyroidism

non-drug approach available.

Non-pharmacological

after six weeks

Treatment

TSH thyroid test

results remain the same
refer to physician

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 Non-pharmacological Treatment
I
L-Tyrosine:
500 mg 3 times daily L Iodine: 150-600 mcg

F S
Ferrous sulfate:
Selenium: 50-300 mcg
325 mg

Vitamin A: 800-3,000 mcg

V Z Zinc: 10-40 mg

Main Topic Next

 Pharmacological Treatment
increased slowly
first drug of choice
constant
within 2-4daily
weeksdose
interval
levothyroxine sodium L-thyroxine
usual starting dose
declining metabolic clearance
lower L-thyroxine dose

25 ug/
body mass
interactions with other
medications
day
underlying thyroid failure
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 T3 deficiency
hormone
L-thyroxine
hormone
severe deficiency in T4 T3
both hormones

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 Reduced Rapid clearance
absorption of of
L-thyroxine L-thyroxine

Iron Tablets Phenytoin

Cholestyramine
carbamazepine
Calcium
Rifampicin
Carbonate
Valproate
Soya

Main Topic
 Complications of untreated Hashimoto’s disease may include:

Myxedema
Heart Condition
Emotional
Goitre
Congetinal
Problem
defects
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 Hypothyroidism Hyperthyroidism

RISK & FURTHER COMPLICATION

Main Topic
 RISK
Genetic
Aging Lithium Defect

Exposure Amioda
to cold rone

Myxo
75 edema
coma Next
 COMPLICATION OF
HYPERTHYROIDISM
disorder
-with pre-existing
of rhythm organic heart
often difficult to establish if
Congestivehave heart failure
disease
cardiac murmur
-Old
congestive heart failure

Main Topic