Endocrine surgical diseases of elderly patients

The causes, evaluation, and preoperative and postoperative care of primary hyperparathyroidism and thyroid nodules in the elderly patient population have been described. Primary hyperparathyroidism is easily diagnosed and is almost always curable by surgery. Elderly patients with asymptomatic disease are candidates for nonoperative, expectant management. If they become symptomatic, surgery should be performed. Postoperative care of the elderly patient who has undergone parathyroid exploration is potentially complicated by the patient's other medical problems, including cardiac and pulmonary difficulties, variable severity of symptoms of hypocalcemia, and sensitivity to medications. Thyroid nodules in the elderly may present later than in younger patients and are more likely to contain malignant tissue. Tissue diagnosis preoperatively, usually by FNA testing, is mandatory. Anaplastic thyroid carcinoma and thyroid lymphoma are both treated nonoperatively. Thyroid surgery in the elderly is usually well tolerated, although other medical conditions, as mentioned above, may complicate postoperative care. Thyroid carcinoma in the elderly carries a worse prognosis than in younger patients and should always be treated with postoperative adjuvant (radioablative) therapy. Although this does not affect survival (from the thyroid cancer), it does extend the disease-free interval. As the number of elderly patients increases, the frequency with which these disorders are encountered will also rise. It is important to realize that almost all elderly patients can both tolerate and benefit from surgical correction of these two disorders, if appropriate preoperative evaluation is coupled with excellent intraoperative and postoperative care.