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Hypothyroidism in elderly, the problem of diagnosis and treatment, part 2
Contributor: Anna Ilyushchenko
Affiliation: Second-year resident Russian Gerontology Research and Clinical Centre, Moscow
Hello friends. Lets continue with the article about subclinical hypothyroidism in elderly/
Diagnosis of hypothyroidism is based on investigation of the level of TSH and T4 in the blood. TSH is a marker of both- clinical and subclinical hypothyroidism. However TSH is a dynamic figure. Diagnosis should be based on several detections of increasing of TSH in the blood. More over, changes in functional activity of thyroid gland can be connected with accompanying diseases and with taking of medications.
The treatment of hypothyroidism is a lifelong substituted therapy. Elderly patients should begin with small doses and then gradually increase the dose under control of the TSH level. It's very important to titrate up the dose because development of thyrotoxicosis has risk of cardiac arrhythmias and fractures. Currently there is no evidence of advantages of combined therapy of L-thyroxine and liothyronine (synthetic T3) in comparison with monotherapy of L- thyroxine.
Substituted therapy of L- thyroxine is required if there is permanent subclinical hypothyroidism, in particular while there is increasing of TSH level in the blood more than 10 mEd/l, and also while there us detection of TSH level between 4 and 10 mED/l, registered at least twice. If elderly patients have cardiovascular diseases substituted therapy of L- thyroxine is conducted only if it is well tolerated and if there are no symptoms of decompensation of these diseases during taking L-thyroxine. Treatment of hypothyroidism of elderly patients requires mire attention, in particular more slow increasing of dose of L- thyroxine, more careful control of tolerability and detection of every side effect.
If the level of thyroid hormones is adjusted, elderly patients note improvement of functional status and reducing symptoms of hypothyroidism.
Thanks for attention!