Endocrine Abstracts

It has been shown that aging is associated with ‘physiological’ alterations in both the hypothalamo–pituitary–thyroid axis and at the peripheral level such as elevation of basal TSH levels, often with normal T₃ and T₄ levels and decreased nuclear binding of thyroid hormones, particularly of T₃. The frequency of nodular goiter and of an altered thyroid status increases with advancing age. The aim of our study was to analyze the clinical and paraclinical features of thyrotoxicosis in patients over 65 years of age, hospitalized at the Clinic of Endocrinology Cluj-Napoca, Romania. The study was performed on 51 patients (9 men and 42 women) with a mean age of 67.6±0.62 years. Aside from clinical data, thyroid ultrasonography, radionuclide imaging of the thyroid, thyroid hormone levels and other laboratory examinations were performed. Graves’disease was observed in only 10 patients while toxic nodular goiter/adenoma was noticed in 41 patients. The majority of hyperthyroid patients over 65 presented with cardiovascular symptoms (96%), followed by tremor (84%) and weight loss (78%). Of the 51 patients, 8 presented with atrial fibrillation. Nervousness, anxiety and hyperkinetic motor activity were seen in only 40% of patients. The most sensitive laboratory test for the diagnosis of hyperthyroidism was the concentration of basal TSH. Serum alkaline phosphatase concentrations were slightly increased (56.1±4.1 U/l) probably due to an enhanced rate of bone remodeling. Screening for osteoporosis by ultrasonography revealed the presence of the disease in 30% of patients while 60% had osteopenia. In 17 patients, radioiodine therapy or surgical ablation of the gland was decided.

Conclusions: The study suggests that at the time of presentation hyperthyroidism in elderly is associated to a distinct clinical pattern. With regard to the complications of hyperthyroidism, aged patients are more likely to develop cardiovascular and skeletal abnormalities.