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December 23, 2022 8 min read

Hypothyroidism in the elderly: what you need to know

As we age, it becomes increasingly important to be aware of our health and any changes that might occur. Hypothyroidism is one such change that is often overlooked among seniors, yet the condition can have a significant impact on overall health. It's essential to understand what hypothyroidism is, how it affects seniors, and how to mitigate potential risks. So whether you're a senior or you're looking into this topic for a loved one, this article will take you through the basics of hypothyroidism in the elderly, from its causes and symptoms to treatment options.

The basics of hypothyroidism

Hypothyroidism is a condition that occurs when your thyroid gland, a butterfly-shaped gland in the base of your neck, doesn't produce and release enough hormones. Also known as underactive thyroid, this condition can cause your metabolism to slow down and affect your entire bodily function. It may make you gain weight, feel tired all the time, have low libido, and even have problems with your sinus. However, a lack of these symptoms doesn't mean you don't have hypothyroidism since the symptoms of this thyroid problem are non-specific in all patients.

Is hypothyroidism common in elderly?

There's been some debate about changes in thyroid function and thyroid hormone concentrations as we get older, and it can be a little confusing.

According to various studies, hypothyroidism is among the most common chronic diseases in people over 60 years of age. In fact, up to 1 in 4 nursing home residents may be hypothyroid without knowing it. Women are more likely to have these issues than men.

Many believe that hypothyroidism in elderly is common because as you get older, your thyroid gland tends to work less efficiently. This can be measured by looking at the levels of a hormone called thyroid stimulating hormone (TSH) in the blood.

TSH, also known as thyrotropin, is released by your pituitary gland to stimulate your thyroid to produce and release the hormones thyroxine (T4) and triiodothyronine (T3). These are the two main hormones released by your thyroid that regulate your body's metabolism.

Some studies have found that as we age, the levels of TSH tend to increase, especially in people with a condition called subclinical hypothyroidism (more on this below). However, other research has suggested that TSH levels may actually decrease with age in people who don't have any thyroid problems.

One reason for this difference may be that the cells in the pituitary gland, which help regulate TSH production, become less sensitive as we get older. This can lead to lower TSH levels. Additionally, the normal nighttime increase in TSH production may also decrease with age.

On the other hand, some researchers have proposed that the increase in TSH levels seen in older adults may be due to changes in the way that TSH works in the body rather than a decline in the function of the thyroid. For example, people who have lower TSH levels at the start of a study may see larger increases in TSH as they age, while those with higher baseline TSH levels may see smaller increases.

Overall, it's important to keep in mind that the function of the thyroid can vary from person to person and may change over time. It's a good idea for everyone to have their thyroid health checked regularly to make sure everything is working as it should. This is especially true for older adults since decreased thyroid function is common among those 60 years and older.

Subclinical hypothyroidism in older patients

Subclinical hypothyroidism in older patients

Sometimes, even if the thyroid hormone levels are still within a normal range, the levels of TSH may be slightly higher than usual. This is a condition called subclinical hypothyroidism. An illness is described as "subclinical" if it's not severe enough to produce definite symptoms.

You don't technically have hypothyroidism (commonly called overt hypothyroidism) when you have subclinical hypothyroidism. However, the condition can develop into overt hypothyroidism.

Subclinical thyroid dysfunction is usually a temporary condition. However, it can be long-lasting, and you may or may not need treatment. This thyroid condition is more likely to affect women and people over the age of 65.

The effects of subclinical thyroid disease on older adults are not yet fully understood, largely because there have been few randomized controlled trials (RCTs) on this topic. It's possible that a slight increase could indicate a problem with your thyroid, but it could also be a normal part of aging. In general, normal thyroid function is indicated by normal TSH levels in the blood unless there are other causes of thyroid issues.

What causes hypothyroidism in older patients?

Hashimoto's thyroiditis is one of the most common causes of hypothyroidism in older patients, just as it is in younger people. With this autoimmune thyroid disease, your immune system creates thyroid antibodies that attack your thyroid cells as if they were viruses, bacteria, or some other foreign body that may compromise your health.

According to a survey of patients seen in endocrinology clinics, older patients (55 and up) who have primary hypothyroidism are more likely to have autoimmune thyroiditis. Meanwhile, patients aged 35-44 are more at risk for post-surgical hypothyroidism, and those aged 45-54 are more likely to have post-radioiodine hypothyroidism.

In the case of subclinical hypothyroidism, the condition often occurs due to a problem in your endocrine system. In normal conditions, all the glands in your endocrine system work in synergy to control the level of TSH in your bloodstream.

First, your hypothalamus releases a thyroid-releasing hormone (TRH) to trigger your pituitary gland to release the TSH. Then, TSH stimulates the release of thyroid hormones from your thyroid gland into the bloodstream. If your T4 and T3 hormones are too high, they stop your pituitary gland from releasing additional TSH. Thus, the cycle ends. However, thyroid disorders can disrupt this process. Thyroid hormone production does not rise as it ordinarily would in response to elevated TSH levels, leading to subclinical hypothyroidism due to increased TSH levels and normal T4 levels.

What are the signs and symptoms of hypothyroidism in the elderly?

If you're over 60 and have an underactive thyroid gland, you might not experience any symptoms at all, or you might experience the same symptoms as younger people. However, some people with hypothyroidism have unusual symptoms that make it harder to diagnose. Here are some possible signs that you might have hypothyroidism:

  • Heart failure - When your thyroid hormones are low, it can cause reduced blood volume, weaker heart muscle contractions, and a slower heart rate. These can eventually lead to heart failure as your heart doesn't pump blood as efficiently as it should, and you'll feel low on energy or notice that you walk more slowly. In more severe cases, fluid can build up in the lungs and legs, causing leg swelling and shortness of breath.

  • Joint and muscle pain - This is a common hypothyroidism symptom among patients of all ages. However, it's often overlooked among older patients since many people see it as a part of the normal aging process. In addition, it's sometimes the only symptom of hypothyroidism in people over the age of 60.

  • Changes in bowel movements - Since stool moves slowly through the bowels, constipation is one of the most common symptoms of hypothyroidism, especially in older adults.

  • Unexplained high cholesterol - If you're dealing with unexplained high cholesterol, you might find an answer to your problem in your thyroid levels. High cholesterol is sometimes the only sign of changes in thyroid function, so it could be worth looking into thyroid tests.

  • Psychiatric conditions - Clinical depression doesn't only affect younger patients but also older people with hypothyroidism. In older people, however, it might be the only symptom. Aside from clinical depression, some older people may also experience psychosis with hallucinations and delusional behavior.

Can hypothyroidism look like dementia in elderly patients?

Yes, cognitive decline is one of the many hypothyroidism symptoms in older patients. Unfortunately, the condition is frequently misdiagnosed as dementia, leading to a delay in treatment. That's why doctors often order thyroid tests for those who have experienced a new cognitive decline - just to make sure that their diagnosis is correct.

If you suspect that someone you know may be experiencing cognitive decline due to hypothyroidism rather than dementia, talk to their doctor about having them tested for this condition.

How is hypothyroidism in the elderly diagnosed?

Doctors diagnose hypothyroidism through thyroid function tests. When TSH and free-T4 levels are tested together, both overt hypothyroidism (high TSH and low free-T4 levels) and subclinical hypothyroidism (high TSH with normal free-T4 levels) can be identified. Symptoms alone may not be enough to diagnose a thyroid disorder or subclinical thyroid dysfunction, but they could be a reason to check for thyroid function.

According to the American Thyroid Association, the normal serum TSH level in older people is between 4-6 mIU/L. If your serum TSH levels are higher than this range and you have low levels of T4, you may have hypothyroidism. On the other hand, high levels of serum TSH and normal levels of T4 may indicate that you have subclinical hypothyroidism.

How is hypothyroidism treated in the elderly?

Treating hypothyroidism, or low thyroid function, in the elderly population requires careful consideration due to the potential risks and side effects of thyroid hormone replacement therapy. Two commonly used medications for hypothyroidism are levothyroxine and natural desiccated thyroid (NDT).

Levothyroxine is a synthetic form of T4 and is the most commonly prescribed medication for hypothyroidism. It is usually taken once daily and can be taken on an empty stomach.

On the other hand, NDT, also known as desiccated thyroid extract (DTE), is derived from the thyroid glands of pigs and is a source of both T4 and T3. Many patients prefer NDT over levothyroxine as it more closely resembles the thyroid hormone produced by the human body. It's also preferred by many people because many brands of NDT, such as VitaliThy, is free from allergens like gluten, lactose, artificial colors and flavors, egg, shellfish, and fish. VitaliThy is a natural desiccated thyroid available to buy online.

The dose

Whether you decide to take levothyroxine or NDT, it's important that you start with a lower dose, as starting hormone replacement too quickly can put stress on the heart and central nervous system. Be sure to start your treatment slowly with a low dose, then gradually increase it as your body becomes accustomed to the rising levels of hormones.

Taking the right dose is also very important since too many thyroid medications may cause you to experience hyperthyroidism, which may lead to conditions like atrial fibrillation. Too low, on the other hand, won't alleviate your hypothyroidism symptoms. That's why regular monitoring is very important.


As we get older, the risk of developing a thyroid disorder such as hypothyroidism actually increases. However, the symptoms can sometimes mimic the symptoms of other medical issues, causing hypothyroidism to be left undiagnosed and untreated.

If you're over the age of 65 and have a thyroid condition, it's important to work with your healthcare provider to establish a treatment plan that takes a more gradual and cautious approach, with ongoing monitoring to ensure the best possible outcome. Remember, it's never too late to take charge of your health and well-being!

Levothyroxine and natural desiccated thyroid (NDT) are both commonly used as treatment options for thyroid disorders in elderly patients. While levothyroxine is a synthetic hormone replacement, NDT is made from dried pig thyroid glands and is often seen as a more natural and potentially more effective treatment option. However, some doctors may be hesitant to prescribe NDT, or it may not be readily available. In these cases, you can always find an alternative option.

One such alternative is VitaliThy, a natural desiccated thyroid you can buy online. This NDT supplement is made with Thyroid (USP) and is specially formulated to support thyroid health. It's easy to take, and it's gentle on the stomach.

Wojciech Majda
Wojciech Majda

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