Hyperthyroidism

Hyperthyroidism

The disease known as hyperthyroidism is brought on by the thyroid gland producing too much thyroid hormone. Graves disease and toxic multinodular are more common in older people because of the relative prevalence of nodular goiter, which accounts for the majority of cases. Due to its self-limitation and quick resolution, transient hyperthyroidism of subacute thyroiditis is less frequent and rarely clinically relevant.

Symptoms

The signs and symptoms of hyperthyroidism might mimic other common illnesses that affect this age group and are frequently unusual rather than classic. They might not exist, be undetectable, or be covered up by comorbid illnesses. The most frequent signs and symptoms of hyperthyroidism in elderly people are cardiac issues. They typically showed up as atrial arrhythmias, congestive heart failure (typically high output heart failure), and angina pectoris (common atrial fibrillation with slow ventricular rates, as opposed to rapid rates in young patients). Weight loss associated with anorexia may be seen as opposed to an increase in hunger. In young patients with hyperthyroidism, diarrhea is typical. Neuromuscular symptoms like fatigue, weakness, lethargy, agitation, confusion, and dementia are frequently present along with decreased patient activity. Osteoporosis can also result from untreated hyperthyroidism. An apathetic variant of hyperthyroidism may emerge in elderly people as placid, apathetic features, sadness, no or a little goiter, and no ocular signs.

Treatment

In order to cure hyperthyroidism, one can choose between surgery to remove the hyperactive tissue, radioactive iodine (RAI), or medication to suppress the gland.

For many years, RAI has been the treatment of choice for older patients. When the agent is administered, the RAI is concentrated in the gland, causing localized damage. Some individuals may see an increase in FTI after receiving AI because their thyroid cells were destroyed, temporarily releasing an active thyroid storm. TSH is the test of choice to identify the development of hypothyroidism in patients who have received RAI treatment. Antithyroid drugs may be administered for a few weeks prior to RAI treatment to minimize this excess hormone spike.

Despite the high recurrence rate and possibility of adverse effects, drug therapy is not the most preferred form of treatment. Since these medications act quickly, the antithyroid drop (propylthiouracil or methimazole) play a special role in elderly patients whose unstable comorbid disease necessitates a rapid suppression of hyperthyroid safe. For both methimazole and propylthiouracil, the initial dose is typically 10 mg four times per day.

When a patient has hyperthyroidism and is elderly, surgery is a less appealing alternative. Patients with dysphagia, tracheal compression, or if a malignant condition is suspected may also require surgery.

Beta-blockers can be used to reduce tremors and tachycardia in the beginning, but they cannot change how a disease develops over time. If beta-blockers are not recommended, calcium channel blockers, such as diltiazem, can be used instead. Patients who present with atrial fibrillation may benefit from anticoagulation; however, it's important to keep in mind that patients with hyperthyroidism require lower doses of warfarin.