Thyroidal disorder in older adults

What is the most common thyroid disorder in older adults?

• Graves disease
• Thyroid cancer
• Subclinical hypothyroidism
• Subacute thyroiditis

Answer explanation

Subclinical hypothyroidism is common in the elderly, often detected incidentally.

Which symptom is more specific for hyperthyroidism in older adults?

• Weight gain
• Heat intolerance
• Atrial fibrillation
• Tremor

Answer explanation

Older adults often present with "apathetic" hyperthyroidism, including cardiac arrhythmias.

78F with fatigue, constipation. TSH 6.8, normal T4. Next step?

• Start levothyroxine
• Repeat TFT in 6–8 weeks
• Check anti-TPO antibodies
• Reassure, no action

Answer explanation

Anti-TPO antibodies help assess the likelihood of progression to overt hypothyroidism.

What is a potential consequence of levothyroxine overtreatment in the elderly?

• Constipation
• Hyperlipidemia
• Atrial fibrillation
• Myxedema

Answer explanation

Excess thyroid hormone increases the risk of arrhythmia and osteoporosis.

Low TSH, normal free T4 and T3. Asymptomatic 70M. Diagnosis?

• Euthyroid sick syndrome
• Subclinical hyperthyroidism
• Overt hyperthyroidism
• Pituitary failure

Answer explanation

Subclinical hyperthyroidism is common and may increase risk for AF and bone loss.

Which thyroid change aligns with normal aging?

• Increased T3
• Decreased TSH
• Mild TSH elevation
• High free T4

Answer explanation

TSH may rise slightly with age; this may not indicate disease.

When is treatment of subclinical hypothyroidism most strongly considered in older adults?

• TSH 5.5 and asymptomatic
• TSH 7.0 with fatigue
• TSH ≥10
• Normal TSH, low T4

Answer explanation

Treatment is generally advised when TSH is ≥10, regardless of symptoms.

Which is true about thyroid nodules in older adults?

• All nodules must be biopsied
• Risk of cancer decreases with age
• Nodules <1 cm should always be removed
• Risk of malignancy rises with age

Answer explanation

Thyroid nodules are common, and malignancy risk increases with age.

In non-thyroidal illness, what TFT pattern is expected?

• Elevated TSH
• Low TSH, low T3
• High T4, high TSH
• Normal labs

Answer explanation

Euthyroid sick syndrome often shows low T3, sometimes with low TSH and T4.

Best way to start levothyroxine in a frail 85-year-old with new hypothyroidism?

• Full dose immediately
• 50 mcg daily
• Start 25 mcg and adjust slowly
• Use liothyronine

Answer explanation

Older or frail patients should start low and go slow to avoid cardiac strain.