Hypothyroidism clinical aspects

Serum thyroid-stimulating hormone (TSH) and thyroid hormone levels should be measured in any patient with a goiter to determine the hormonal status. TSH concentrations increase with age, but the levels remain within the normal range in the healthy population throughout life up to 100 years of age (Canaris et al., 2000 Mariotti et al, 1995). See Chapter 106 by Diez and Iglesias on Hypothyroidism in the Middle Aged and Elderly Clinical Aspects for details of thyroid hormone changes in the elderly. Serum calcitonin levels are not needed unless there is a family history of medullary thyroid cancer or multiple endocrine neoplasia (MEN) type 2. 

Hypothyroidism in the Middle Aged and Elderly Clinical Aspects... 

The clinical, biochemical, and therapeutic aspects of amiodarone-induced hypothyroidism have been reviewed in the light of 18 elderly patients (75). Free thyroxine (T4) concentrations were reduced only in those with severe hypothyroidism and free triiodothyronine (T3) concentrations were always normal. Withdrawal of amiodarone in five patients led to improvement in four and worsening in one. 

The clinical manifestations of hyperthyroidism and hypothyroidism are listed in Table 31-2. From a pharmacotherapeutic standpoint, hyperthyroidism is treated with drugs that attenuate the synthesis and effects of thyroid hormones. Hypothyroidism is usually treated by thyroid hormone administration (replacement therapy). The general aspects and more common forms of hyperthyroidism and hypothyroidism are discussed here, along with the drugs used to resolve these primary forms of thyroid dysfunction. 

Thyroid hypofunction is the most common hormonal deficiency in the general population (Roberts and Ladenson, 2004). The prevalence of hypothyroidism seems to rise with age, and is clearly higher in middle age and the elderly in relation to the younger population. However, hypothyroidism in aged people may go unnoticed because of its paucity of clinical manifestations, or because many of the chnical signs and symptoms are unspecific and may be confounded with the normal ageing process (Di ez, 1998). We herein review the main chnical aspects of this common condition in middle age and in the elderly. 

In this chapter, after presenting an outline of both hypertensive and hypothyroid states, we will review the cardiovascular and (neuro)endocrine relationships between the two disorders, beginning with a discussion of basic cellular mechanisms and concluding with a discussion of pathophysiological and clinically related aspects. 

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