Managing thyroid dysfunction in the elderly. Answers to seven common questions

Despite the high prevalence of thyroid dysfunction in the elderly, there is often considerable delay and difficulty in diagnosis because symptoms are subtle and attributed to normal aging. Atypical presentations also are common. Routine screening of asymptomatic, healthy adults is not recommended; however, physicians should maintain a high index of suspicion and have a low threshold for testing thyroid function. Subclinical abnormalities of thyroid function are even more prevalent than overt disease. Although observational studies have shown that subclinical disease affects function, adverse clinical outcomes have not been demonstrated. In addition, the benefits of treatment of subclinical disease are unclear. Therefore, treatment should be individualized and restricted to high-risk patients. The elderly are vulnerable to the side effects of thyroid replacement and antithyroid medications, which mandates cautious use of drugs and careful dose adjustments.