Endocrine Abstracts

In the healthy elderly there seems to be an age dependent decrease of TSH and FT3 but not FT4. The prevalence of TPOAb positivity increases with age but surprisingly it has been found to be decreased in centenarians. Antibody positivity is not predictive for future thyroid dysfunction in old age. The upper range of normal TSH for the healthy elderly living in sufficient iodine intake areas is higher than in case of iodine deficiency. In iodine deficient areas there is a high prevalence of nodular goiter and hyperthyroidism is mainly caused by toxic nodules. Radioiodine should be prefered for therapy of Graves’ disease in old age, long term thyrostatic therapy is not safe. TAO is more severe in old age and there is a less favourable outcome of the therapeutical options. In an elderly subject subclinical hyperthyroidism with suppressed TSH is a risk factor for progression to overt disease, for atrial fibrillation, osteoporosis and may be associated with increased cardiovascular and all-cause mortality, thus we believe that it should be treated. The clinical significance of subnormal but measurable TSH is less clear, but in old age treatment may be considered in case of heart disease or osteoporosis. Subclinical hypothyroidism is a risk factor for atherosclerosis but slightly elevated TSH in old age should not be treated: it may even be favourable to have a longer life. In any case, TSH levels outside the reference intervals should first be controlled before considering treatment. The cancer risk in cold thyroid nodules increases with advanced age. According to most but not all studies, in older differentiated thyroid cancer-patients poor prognostic features are more frequent, total thyroidectomy and radioablation are recommended and additional treatment of progressive disease should not be denied because of advanced age.