The ABCs of managing hyperthyroidism in the older patient

Hyperthyroidism in the older patient often presents with nonspecific symptoms, such as apathy, weight loss, and atrial fibrillation. General screening is not cost-effective, with the exception of two populations: women over age 40 with one or more nonspecific complaints and patients being admitted to a specialized geriatric unit. The sensitive TSH test is an excellent screen; a low TSH should be confirmed by an actual or estimated high free thyroxine test (FT4). The RAIU can help narrow the differential diagnosis. Radioiodine is the preferred treatment for the older patient with Graves' disease, the most common form of thyrotoxicosis. Graves' must be differentiated from thyroiditis and toxic nodular goiters, as treatment regimens differ for each disorder.