[Thyroid diseases in the elderly]

Thyroid dysfunction in the elderly differs from that in the young, because most symptoms at presentation are absent, or non specific or atypical. Hypothyroid patients generally present with cardiovascular or central nervous system symptoms. A serious complication, occurring more easily in elderly is hypothyroid coma. The diagnosis of hypothyroidism is confirmed by a high serum TSH and low values of FT4 and T4. Elderly patients should be started on low doses of thyroid-hormone replacement that are increased slowly. Particular caution must be used in patients with underlying cardiovascular disease. Hyperthyroid patients are more likely to show cardiovascular symptoms, central nervous system symptoms or gastrointestinal symptoms. The diagnosis is confirmed by a low serum TSH value and elevated values for the serum FT4 and/or T3. Radioiodine (131I) therapy is the most efficient treatment in this age group. A diffusely enlarged thyroid gland in the elderly is most often caused by a multinodular goiter. Solitary thyroid nodules which appear cold on isotope scan may represent a carcinoma. The diagnosis of malignancy can be made after fine needle-aspiration of the nodule.