Fatigue, change in mood, hair and nail changes, weight change and memory issues. Sound like signs of aging? Maybe not. These could also be signs of a malfunctioning thyroid—a condition that can be mistaken for other reasons in older adults. The thyroid, a butterfly-shaped gland just above the collarbone at the base of the neck, is responsible for secreting hormones into the bloodstream that regulate the body’s metabolic processes such as temperature, heartbeat and digestion. The thyroid also regulates muscle function, brain development and overall mood.
The thyroid gland produces mainly thyroxine (T4) and a smaller amount of triiodothyronine (T3), both types of thyroid hormone to help keep the vital functions of the brain, heart, kidneys and liver running smoothly. The pituitary gland in the brain regulates the production of these thyroid hormones. Dr. Whitney Goldner, an endocrinologist with the Thyroid and Endocrine Multidisciplinary Program at Nebraska Medicine in Omaha, NE, notes, “Thyroid disorders are common in all age groups but are overall more common in women than men by a three-to-one ratio. But as we age, thyroid disorders in general increase.”
In older adults, clinical signs of thyroid problems can be subtler than in younger people. Many of the symptoms may be attributed to the aging process.
“That’s the tricky part,” Goldner explains. “With older patients, one of the big distinctions is that they may not have the classic symptoms that you’d expect to see in a younger population. A lot of thyroid conditions in general are very nonspecific. So sometimes people can have fatigue, weight loss, changes in their mood or worsened depression. Sometimes they can have effects on skin and hair. But because these symptoms are not specific just to the thyroid, they may be attributed to other conditions or aging alone.”
Because problems with the thyroid often manifest as other health disorders such as diseases of the heart, bowel or nervous system, accurately identifying and treating thyroid diseases in seniors requires special attention. Common thyroid disorders in the elderly include hypothyroidism, in which the thyroid is underactive and not producing enough thyroid hormone for the body to work properly; hyperthyroidism, which occurs when the thyroid is overactive and releasing too much thyroid hormone and speeding up body systems; thyroid nodules, an abnormal growth of thyroid cells within the thyroid gland that can form a lump and thryoid cancer, which is a malignant tumor on the thyroid gland.
Hyperthyroidism can increase the risk of bone loss and osteoporosis, so in addition to treating hyperthyroidism, Goldner also recommends that hyperthyroid persons get adequate amounts of calcium and vitamin D for optimal bone health.
Hyperthyroidism can also put older people at increased risk for heart arrhythmias, such as atrial fibrillation (AFib). Any person with onset or worsened AFib should have their thyroid further evaluated.
Gregg Balbera, president of Right at Home Nassau Suffolk sees firsthand the difference their professional caregivers make in monitoring the health of their senior care clients.
“Because thyroid problems can be challenging to detect in older adults, we stress that our elder clients go in for regular physicals and medical checkups,” Balbera said. “When we work with seniors who take thyroid medication, we are there to help ensure they follow their doctor’s specific dosing instructions.”
Treatment of hypothyroidism requires a daily thyroid medicine taken in the morning or several hours after eating, as it is best absorbed on an empty stomach. Professional and family caregivers can make sure older adults don’t miss a dose, or don’t take it with food or other medications. Caregivers can also monitor for changes in symptoms as noted above. It is not necessary to routinely do neck exams, but if a mass or lump is detected, this should prompt evaluation by a healthcare provider.
If any of the symptoms noted above are new, then it is also reasonable to have blood work done to check for thyroid hormone levels (TSH and Free T4).
Guidelines for screening for thyroid disease are conflicting, but societies agree that if persons are having symptoms that could be attributable to an overactive or underactive thyroid, further workup is indicated.
—Submitted by Right at Home of Nassau Suffolk