Thyrotoxicosis in the elderly

Can thyroid dysfunction explicate severe menopausal symptoms?

Many of the menopausal manifestations look like those accredited to thyroid hyperfunction or hypofunction. Can thyroid dysfunction explicate severe menopausal symptoms? The study comprised 350 women with different menopausal symptoms. All women had serum TSH, T3 and free T4 estimated. Women with thyroid dysfunction were appropriately treated and other women were treated with ERT. The study showed that 21 women (6%) had hypothyroidism and 18 (5.1%) had hyperthyroidism. Marked improvement in the menopausal-like symptoms occurred after treatment of the thyroid dysfunction. Elderly women with severe or resistant menopausal symptoms can be offered TSH, T3 and T4 assays to rule out the thyroid disturbances before attempting hormone replacement therapy.

Altered laboratory thyroid parameters indicating hyperthyroidism in elderly subjects

The most common laboratory alterations of thyroid function indicating hyperthyroidism were evaluated in a series of 3015 subjects over 65 years of age by determining total T3, total T4 and TSH. Ultrasound and scintigraphy of the thyroid were performed where necessary. Our results showed a high prevalence of laboratory alterations hyperthyroidism type of around 8.09%, whereas the real prevalence (both clinical and laboratory) is 2.00% with a female/male ratio of 2.00. The most frequent hyperfunctioning thyreopaty is thyroidal adenoma (50%), followed by toxic multinodular goiter (33%) and Basedow's disease (17%). The most common clinical signs of hyperthyroidism involve the neuromuscular system and are often present in the so called 'euthyroid' elderly subject. We conclude that it is very difficult to diagnose hyperthyroidism in the elderly on clinical and laboratory grounds. The most significative laboratory thyroid parameter indicating hyperthyroidism seems to be TSH values below 0.2 IU/ml determined using the ultrasensitive IRMA method.

Clinical epidemiology of endocrine disorders in the elderly

Many epidemiologic studies have examined age-related processes in humans. Some of the difficulties with these studies are noted. Endocrinologic changes of aging often are compensated for by feedback mechanisms and do not cause dysfunction. Common aging changes are reviewed.

Is idiopathic atrial fibrillation caused by occult thyrotoxicosis? A study of one hundred consecutive patients with atrial fibrillation

In this study we evaluated the possible relationship between idiopathic atrial fibrillation and occult thyrotoxicosis, diagnosed by lack of response of thyroid stimulating hormone to administration of thyrotropin releasing hormone. Three groups were compared: 25 patients with idiopathic atrial fibrillation; 52 with cardiovascular atrial fibrillation; and 27 with sinus rhythm. Patients were excluded with any clinical evidence of thyrotoxicosis or with elevated serum FT4 level, as well as those with diseases or on medications known to be associated with a diminished response to administration of the releasing hormone. A flat test (lack of response) was found in only 4% of the patients. There was no significant difference among the 3 groups. Based on these data we believe that there is no relationship between idiopathic atrial fibrillation or any other type of atrial fibrillation and occult thyrotoxicosis.