Endocrine Abstracts

Thyroid dysfunction affects a considerable number of elderly subjects. However the role of screening and treatment of thyroid disorders in geriatric population is still debated. The aim of this study was the evaluation of the prevalence of thyroid dysfunction and its impact on comorbidity and comedication.

Two independent populations were evaluated: 2001 residents in 21 federated nursing homes in the province of Pavia (Northern Italy), age >60 y, and 1275 age-matched hospitalized subjects. In the former population functional status, drugs currently administered on a scheduled basis and clinical diagnosis from patients’ chart were available, while in the latter also thyroid hormones serum levels were evaluated.

Age and sex distribution were similar in the two groups with a remarkable predominance of the female gender.

In elderly subjects residents in nursing homes the overall prevalence of diagnosed thyroid dysfunction was 2.6% for hypothyroidism and 0.7% for hyperthyroidism. In hypothyroid patients the prevalence of implanted pace-makers, hypostenic-hypocinetic syndromes and autoimmune arthritis was higher than in euthyroid subjects. In hyperthyroid patients a clear increase of atrial fibrillation, heart failure, ischemic heart disease and cognitive impairment was found. In both cases the number of comedications was significantly higher than euthyroid controls.

In hospitalized patients, in whom hormonal evaluation was available, the prevalence of hypothyroidism, new or previously diagnosed, was 8.15%, while the prevalence of hyperthyroidism (TSH suppressed or suggestive for non-thyroidal illness or current antithyroid therapy) was 6.9%. In hospitalized patients the number was similar in euthyroid and hypo- or hyperthyroid patients.

Our findings suggest that in elderly subjects many cases of hyper- and hypothyroidism are undiagnosed probably because symptoms are subtle and attributed to normal aging. The lack of an appropriate diagnosis seems to be associated to a more severe comorbidity and comedication.