Detection and treatment of hypothyroidism and Graves' disease

The clinical presentations of thyroid disorders are often subtle in older adults and may be confused with "normal" aging. To avoid delay in diagnosis, we recommend routine TSH screening of all patients age 60 and older in the primary care practice. With hypothyroidism, pursue treatment cautiously; start with small doses of levothyroxine and closely monitor serum TSH values. When hyperthyroidism is caused by Graves' disease, begin symptomatic therapy with a beta blocker or antithyroid drugs, followed by definitive thyroid ablation with radioiodine. Surgical treatment may be indicated if a goiter causes compressive symptoms.