|Year : 2016 | Volume
| Issue : 3 | Page : 101-105
Clinical profile of thyroid dysfunction in elderly: An overview
Harish Kumar, Veer Bahadur Singh, Babu Lal Meena, Subhash Gaur, Rahul Singla, Mahendra Singh Sisodiya
Department of Medicine, S P Medical College, Bikaner, Rajasthan, India
|Date of Web Publication||27-Oct-2016|
Department of Medicine, S P Medical College, B-3, Shastri Nagar, Bikaner - 334 001, Rajasthan
Source of Support: None, Conflict of Interest: None
Aim and Objective: To study the presentation and clinical profile of thyroid disorder in elders in the North-West Rajasthan. Subjects and Methods: This study was carried out on 553 elderly patients in the Department of Medicine, S P Medical College, Bikaner, North-Western Rajasthan. All patients above 60 years were included. Clinical examination was done for detection of thyroid disorders and, keep in mind, the sign and symptoms of hypothyroidism and hyperthyroidism. Recently, a new immunoassay methodology has been applied to the measurement of thyroid stimulating hormone (TSH)/T3/T4 level. The analysis was undertaken using SPSS (version 10). Chi-square test was used to examine the association and trends for categorical. Results: There were 456 cases in the age group 60-71 years. 71-80 and >80 years patients were in numbers of 57 and 20, respectively. Prevalence of hyperthyroidism, euthyroidism, and hypothyroidism according to age was 5.9%, 80.9%, and 13.2%, respectively. When we compared TSH with age, no statistically difference was found (χ2 = 9.366, df = 4; P = 0.05). Of 456 cases, 27 (5.9%) were in decrease level, 359 (80.9%) were within normal range, and 60 (13.2%) cases were having increasing pattern of TSH. Around 8 (4.8%) females having decrease level, 135 (81.8%) were having within normal range of TSH, 22 (13.3%) females having increase level. Around 24 (6.5%) male having decrease level while 40 (10.9%) were having increase level of TSH. Weakness is the most common symptoms of thyroid dysfunction. A highly significant difference was found in weakness, feeling cold, constipation, palpitation, and diarrhea (P < 0.001) while significant difference was found in menstrual irregularity, hoarseness of voice, and irritability (P < 0.01). Conclusion: The current study aimed at spectrum of various clinical aspects in the elderly population that differs from typical presentation. As the age advances, the incidence of thyroid disorders increases. Hypothyroidism was more common than hyperthyroidism. Hence, we recommended that more study required knowing clinical presentation of thyroid disorder in elderly populations.
Keywords: Clinical profile, elder, T3, T4, thyroid dysfunction, thyroid stimulating hormone
|How to cite this article:|
Kumar H, Singh VB, Meena BL, Gaur S, Singla R, Sisodiya MS. Clinical profile of thyroid dysfunction in elderly: An overview. Thyroid Res Pract 2016;13:101-5
|How to cite this URL:|
Kumar H, Singh VB, Meena BL, Gaur S, Singla R, Sisodiya MS. Clinical profile of thyroid dysfunction in elderly: An overview. Thyroid Res Pract [serial online] 2016 [cited 2022 Nov 29];13:101-5. Available from: https://www.thetrp.net/text.asp?2016/13/3/101/193127
| Introduction|| |
Subclinical thyroid dysfunction is a biochemical diagnosis, and patients have few, clinical sign or symptoms of thyroid dysfunction.  Subclinical hypothyroidism (ScHt) is defined as high serum thyroid stimulating hormone (TSH) concentration with normal serum free thyroxine and free triiodothyronine concentrations, associated with few or no signs and symptoms of hypothyroidism. The relationship between overt hypothyroidism and deficits in cognitive functioning  and other clinical endpoints is relatively well established.  The potential consequences of ScHt are much less well-established, and although an elevated TSH in the elderly has been recently suggested as conferring a mortality advantage,  most of the literature refers to adverse consequences such as the possibility of cardiac dysfunction or adverse cardiac end point (including atherosclerotic disease and cardiovascular mortality),  elevation of total and low-density lipoprotein cholesterol,  systemic or neuropsychiatric symptoms,  and progression to overt symptomatic hypothyroidism.  Thyroid disease is frequent in older individuals, and symptoms of hypothyroidism such as tiredness, fatigue, lack of concentration, or dry skin can be very similar to complaints associated to aging. , Even for hyperthyroidism, clinical presentation in elderly people is much more silent when compared to middle-aged people.  Beyond symptoms associated with thyroid disorders, epidemiologic studies have shown a possible association between subclinical and overt thyroid disorder and cardiovascular disease. ,,, Thyroid disorders are common in women. Thyroid disorders increase morbidity and mortality in elders, so dictation of thyroid disorders in elderly become very important. Several thyroid function abnormalities are observed in the elderly. An increase prevalence of serum thyroid antibodies and clinical hypothyroidism has been consistently reported reaching a value as high as 20% in women older than 60-65 years. Indeed, serum TSH concentration is considered the best single marker of thyroid function. In previous epidemiological studies, effects of subtle thyroid dysfunction are probably different in elderly populations with different age range. Older and more recent studies provide evidence that mild thyroid dysfunction may represent a significant health problem for the elderly. Subclinical hyperthyroidism appears to be a significant risk factor for all cause and cardiovascular mortality in subject aged from 55 to 60 years to the oldest old. Subclinical hypothyroidism might be also associated with increased mortality in middle-aged and young elderly.
Presentation and clinical profile of thyroid disorders in elders in differs from younger age group; hence, the study of thyroid disorders in elders in being conducted globally, but this type of study in North-Western Rajasthan is not conducted as yet. However, among older people with unspecified complaints, to rule out thyroid dysfunction is always a dilemma considering that only one-third cases show typical sign and symptoms of the diseases, and treatment is cost-effective. 
| Subjects and methods|| |
This study was carried out on 533 elderly patients in the Department of Medicine, S P Medical College, Bikaner, North-Western Rajasthan. Institutional ethical clearance was obtained before commencement of the study. Criteria of the study were as follows: All elders above 60 years of age were included and age below 60 years, patients of diabetes mellitus, hypertension, critically ill patients, were excluded from the study. The data regarding age, sex, residence, weight, height and past history was collected. Clinical examination and sign, symptoms of thyroid dysfunction kept in mind. Systemic examination, especially cardiovascular system and skin were also being conducted. TSH, T3, and T4 measurements were done by new immunoassay methodology. The analysis was undertaken using SPSS (version 10). Chi-square test was used to examine the association and trends for categorical variables.
| Observation and results|| |
In present study according to TSH level there were total 456 cases in the age group 60-71 years. out of 456 cases 27(5.9%) were in decrease level, 369(80.9%) were within normal range and 60(13.2%) cases were having increasing pattern of TSH. In age group 71-80 years there were total 57 cases and out of them 3(5.3%) were in decrease level, 54 were in normal range and none of the case had increasing level of TSH while in age group >80 years there were only 20 cases and out of them 2 cases each in increasing and decrease level while other 18 had within normal range of TSH. When we compare TSH with age no statistically significant difference was found (X2=9.366;df 4; P>0.05).
[Table 1] showing relationship between symptoms and TSH. There were total 352 patients who had symptoms of weakness and out of them 21(6.0%) having decrease level of TSH while 58(16.5%) having increase level of TSH while remaining 273(77.6%) patients had within normal rang of TSH. Weakness was the most common symptom in elderly with both decrease and increase level of TSH.
[Table 2] showing Dry skin was the most common physical sign in patients of increase level of TSH while warm moist skin commonly present in patients of decrease level of TSH.
High systolic BP is commonly present in patients of low TSH level while low diastolic BP was the feature of high TSH level [Table 3] and [Table 4]. <80 pulse rate were present in patients of 18% in cases of high TSH level and >100 pulse rate were found in 12% of low TSH level [Table 5]. TWNL was the most common ECG finding in both low and high level of TSH [Table 6]. 50% cases of high level of TSH patients having >30 BMI [Table 7].
| Discussion|| |
This study was carried out in the patients of thyroid disorder attending or already enrolled in PBM Hospital, Bikaner. In the present study, prevalence of hyperthyroidism, euthyroidism, and hypothyroidism according to age was 5.9%, 80.9%, and 13.2%, respectively. There is no statistically significant difference was found with age. Chuo and Lin in their study found the prevalence of total thyroid disorder was 15.8%, 0.5%, and 15.3% in hyperthyroidism, euthyroidism, and hypothyroidism, respectively. In our study, there were 165 females; out of them, 4.8% have hyperthyroidism, and 13.3% have hypothyroid while, in males, 6.5% were hyperthyroidism, and 10.9% have hypothyroid. Hintze et al. found the same result.  Benseñor et al. found that female prevalence of hyperthyroidism.  In our study, complaint of weakness was found in N = 352(22.5%) where 6% cases have hyperthyroidism, and 16.5% cases had hypothyroidism. Statistically higher significant difference was found when we compare. Feeling cold was present in 36.1%, and out of them, 3.1% had hyperthyroidism, and 33% had hypothyroidism. About 26.1% of constipation cases have thyroid disorder (0% hyperthyroidism, 26.5% hypothyroidism) [Table 1].
On statistical analysis, statistically highly significant difference was found in weakness, feeling cold, constipation, palpitation, and diarrhea (P < 0.001) while significant difference was found in menstrual irregularity, hoarseness of voice, and irritability (P < 0.01), and no statistically significant difference was found in weight loss (P > 0.05). Bemben et al. reported that there were no significant differences (P > 0.05) in the frequencies of any of the clinical sign and symptoms of hypothyroidism between euthyroidism and hypothyroid patients. There was a significant relationship between TSH level and the total number of hypothyroid symptoms experienced by all patients (r = 0.004, P = 0.99). They concluded that thyroid status could not be predicted from clinical sign and symptoms in the elderly community-dwelling patients. In the year 2004, Limpawattana et al.  did a study to compare the clinical features of hyperthyroidism in patients older and younger than 60-year-old. The more significant clinical presentation in the elder group was atrial fibrillation (AF), weakness, and anorexia whereas exophthalmos, goiter, heat intolerance, and hyperhidrosis were not as frequent. Therefore, unexplained AF weakness and anorexia should not exclude hyperthyroidism even with a paucity of typical clinical feature. In the present study, edema was present in 111 patients; out of them, 25 (22.5%) having increase level of TSH while remaining 86 (77.5%) patients were having within normal range of TSH, whereas dry skin was present in 127 patients, and out of them, 3 (2.4%) patients having decrease level of TSH while 32 (25.2%) were having increase level of TSH. Tachycardia and moist skin were present in 29 and 80 patients, respectively, and out of them, 12 (41.4%) and 23 (28.8%) were having decrease level of TSH, respectively, and whereas none of them had increase level of TSH. In lid retraction, none of the patients had increase and decrease levels of TSH [Table 2].
In systolic group of blood pressure (BP) (121-139 mmHg), there were 291 patients, and out of them, 29 (10%) had increase level of TSH, and 18 (6.2%) patients had decrease level of TSH. Whereas, in diastolic group of BP (81-90 mmHg), there were 248 patients, and out of them, 3 (1.2%) had increase level of TSH, and 14 (5.6%) patients had decrease level of TSH [Table 3] and [Table 4].
In the present study, maximum number of patients were in pulse rate <80/min [Table 5].
There were total 12 cases whose electrocardiogram (ECG) suggestive of sinus tachycardia, and out of them, 8 (66.7%) were in decrease level of TSH while none of the patient were in increase level. ECG suggestive of T wave normal limit (TWNL) there were 521 patients, and out of them, 24 (4.6%) had decrease level of TSH and 62 (11.9%) were having increase level of TSH. Remaining 435 patients were having normal level of TSH. There was statistically highly significant difference found between ECG finding and TSH (P < 0.001) [Table 6].
Most of the cases were within the limit of fasting blood sugar. In body mass index (BMI) 25.0-29.99 kg/m 2 group, there were total 225 patients, and out of them, 14 (6.2%) had decrease level of TSH, and 21 (9.3%) had increase level of TSH. In BMI >30 kg/m 2 group, there were only 8 patients, and out of them, 4 (50%) had increase level of TSH while remaining 4 (50%) had within the normal range of TSH [Table 7]. Palpitation was present in 37 patients. 20 and 14 cases were irritable in cases of hyper and hypothyroidism and weight loss was present in 13 and I case of the same. Diarrhea was present in 18 and 3 patients in decrease and increase level, respectively. Hoarseness of voice was present in total 26 patients, and out of them, 8 had increase level of TSH while 18 had within normal range of TSH. Limpawattana et al.  in their study found that common presentation were dyspnea (94.1%, 96.5%), weight loss (93.8%, 87.9%), and palpitation (83.3%, 93.1%) in the elder and younger, respectively.
| Conclusion|| |
Older and more recent studies provide evidence that mild thyroid dysfunction may represent a significant health problem for the elderly. Subclinical hyperthyroidism appears to be a significant risk factor for all cause and cardiovascular mortality in subject aged from 55 to 60 years to the oldest old. Presentation and clinical profile of thyroid disorder in elders is differed from younger age group, so the study of thyroid disorder in elders in being conducted globally, but this type of study in North-Western Rajasthan is not conducted as yet.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH, et al.
Subclinical thyroid disease: Scientific review and guidelines for diagnosis and management. JAMA 2004;291:228-38.
Leentjens AF, Kappers EJ. Persistent cognitive defects after corrected hypothyroidism. Psychopathology 1995;28:235-7.
Hak AE, Pols HA, Visser TJ, Drexhage HA, Hofman A, Witteman JC. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: The Rotterdam Study. Ann Intern Med 2000;132:270-8.
Danese MD, Ladenson PW, Meinert CL, Powe NR. Clinical review 115: Effect of thyroxine therapy on serum lipoproteins in patients with mild thyroid failure: A quantitative review of the literature. J Clin Endocrinol Metab 2000;85:2993-3001.
Haggerty JJ Jr, Stern RA, Mason GA, Beckwith J, Morey CE, Prange AJ Jr. Subclinical hypothyroidism: A modifiable risk factor for depression? Am J Psychiatry 1993;150:508-10.
Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F, et al.
The incidence of thyroid disorders in the community: A twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf) 1995;43:55-68.
Abstract Sawin CT, Castelli WP, Hershman JM, McNamara P, Bacharach P. The aging thyroid. Thyroid deficiency in the Framingham Study. Arch Intern Med 1985;145:1386-8.
Bemben DA, Winn P, Hamm RM, Morgan L, Davis A, Barton E. Thyroid disease in the elderly. Part 1. Prevalence of undiagnosed hypothyroidism. J Fam Pract 1994;38:577-82.
Sawin CT, Geller A, Wolf PA, Belanger AJ, Baker E, Bacharach P, et al.
Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med 1994;331:1249-52.
Luboshitzky R, Aviv A, Herer P, Lavie L. Risk factors for cardiovascular disease in women with subclinical hypothyroidism. Thyroid 2002;12:421-5.
Parle JV, Maisonneuve P, Sheppard MC, Boyle P, Franklyn JA. Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: A 10-year cohort study. Lancet 2001;358:861-5.
Bahemuka M, Hodkinson HM. Screening for hypothyroidism in elderly inpatients. Br Med J 1975;2:601-3.
Hintze G, Burghardt U, Baumert J, Windeler J, Köbberling J. Prevalence of thyroid dysfunction in elderly subjects from the general population in an iodine deficiency area. Aging (Milano) 1991;3:325-31.
Benseñor IM, Goulart AC, Lotufo PA, Menezes PR, Scazufca M. Prevalence of thyroid disorders among older people: Results from the São Paulo Ageing and Health Study. Cad Saude Publica 2011;27:155-61.
Limpawattana P, Sawanyawisut K, Mahankanukrau A, Wongwipaporn C. Clinical manifestations of primary hyperthyroidism in the elderly patients at the out-patient clinic of Srinagarind Hospital. J Med Assoc Thai 2006;89:178-81.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]