AACE MENA 2025-When to Treat and When Not to Treat for Thyroid Disease in Geriatrics

When to Treat and When Not to Treat for Thyroid Disease in Geriatrics

Video Transcription

Video Summary

Dr. Samer El-Kaysi discusses the diagnosis and management of subclinical thyroid dysfunction in older adults, focusing on when treatment is warranted. Subclinical hypothyroidism is characterized by elevated TSH with normal thyroid hormones, while subclinical hyperthyroidism shows suppressed TSH with normal hormones. Prevalence increases with age but is overdiagnosed when standard TSH reference ranges are used; age-specific ranges are recommended. Subclinical hypothyroidism often remains stable or reverts to normal, with progression rates to overt hypothyroidism around 2-4% annually. Risks include increased coronary heart disease and heart failure if TSH exceeds 10, while lower TSH levels (<7) generally do not increase these risks in the elderly. Treatment benefits are unclear below TSH of 10; however, treatment is advised if TSH is above 10 or between 7-10 with symptoms or goiter. For subclinical hyperthyroidism (TSH <0.1), treatment reduces atrial fibrillation risk and is recommended. Overall, careful diagnosis, age-appropriate TSH reference ranges, and individualized treatment decisions are emphasized for optimal elderly care.

Keywords

subclinical thyroid dysfunction

older adults

subclinical hypothyroidism

subclinical hyperthyroidism

TSH reference ranges

treatment guidelines