The elderly and thyrotoxicosis

Thyrotoxicosis is gaining recognition as a significant clinical problem in the elderly. However, distinguishing thyrotoxicosis is difficult because the elderly usually present with nonspecific and atypical clinical manifestations. The most common cause of hyperthyroidism in the elderly is toxic multinodular goiter. The second most common cause is diffuse toxic goiter (Graves' disease). With the elderly thyrotoxic patient, cardiovascular clinical manifestations usually predominate. The elderly frequently have palpitations, tachycardia, atrial fibrillation, and congestive heart failure. Atrial fibrillation and congestive heart failure are resistant to conventional cardiac glycoside therapy. The elderly may be treated with thioureas, beta-blockers, and when they are euthyroid, radioactive iodine. At risk for thyroid storm, the elderly thyrotoxic patient must be monitored carefully for predisposing factors; especially respiratory infections. Treatment for thyroid storm includes recognition and elimination of the precipitating factor(s); control of fever, if present; thioureas (antithyroid medications); beta-blockers, and sodium iodine.