5 Things Older Adults Need to Know About Thyroid Disorders

These conditions aren’t always easy to detect, especially after age 60. Here’s how to protect yourself.

Your thyroid, a butterfly-shaped gland in your neck, is small but powerful.

When everything is working properly, it secretes hormones that control your metabolism and, in turn, impact everything from your body temperature and weight to your cholesterol levels and heart rate. But when things aren’t working properly—say, if you have hypothyroidism, or an underactive thyroid—many of your body’s functions can be affected.

The catch: Thyroid conditions aren’t always easy to detect, especially after age 60. Here’s what you should know about these disorders and how to protect yourself.

1. They’re More Common Than You Think

About five out of 100 people age 12 and up have hypothyroidism, but as you age, the risk increases. By the time you’re in your 60s, the chances of having it are about 6 to 10 percent, says Aaron Vinik, M.D., Ph.D., a board member of the American Association of Clinical Endocrinologists (AACE).

Once you’re in your 70s or 80s, the risk is likely higher. Up to one in four people in nursing homes are believed to have undiagnosed hypothyroidism, according to the American Thyroid Association.

The opposite problem—hyperthyroidism, or an overactive thyroid—happens less frequently, but it’s still worth knowing about. Up to 3 percent of older adults have hyperthyroidism, Dr. Vinik says.

2. The Warning Signs Can Be Sneaky

When younger people develop thyroid problems, the symptoms tend to be straightforward. Although older adults with hypothyroidism may also become constipated, feel cold and sluggish, and have dry skin, those symptoms “are all features you’d typically find in older people in general,” Dr. Vinik says.

How do you sort it out? Even doctors can have trouble with getting the right diagnosis, but Dr. Vinik says that if a patient’s voice has become a bit creaky, they’ve developed unusually thick or stout ankles, or they’re newly depressed, then it’s possible that hypothyroidism is to blame. He also checks a patient’s ankle jerk reflex. People with hypothyroidism tend to react more slowly to the Achilles tendon being tapped.

An overactive thyroid is also harder to spot in older adults. While hyperthyroidism normally causes sweating and heart palpitations, many older people take blood pressure and heart medications that mask those symptoms. If a patient has atrial fibrillation, or an abnormal heartbeat, or is losing weight for no clear reason, Dr. Vinik says he might order tests to check their thyroid function.

3. Your Blood Tests Might Be Inaccurate

Both hypothyroidism and hyperthyroidism are usually diagnosed with blood tests that check your levels of different hormones. But these tests aren’t always accurate in older adults, Dr. Vinik says.

What’s more, some people have so-called subclinical thyroid disorders, meaning that their thyroid-stimulating hormone (TSH) levels are high but their level of another hormone, called free T4, is normal. But these patients may still need to be treated.

The takeaway: These tests can give clues about your hormone levels, but they’re not the final word.

4. Treatment Involves a Bit of Trial and Error

If your doctor suspects that you need treatment for hypothyroidism, you’ll likely be given medication that contains synthetic thyroid hormone. For the reasons noted above, your doctor may decide to start you on this even if your tests are partially normal. Dr. Vinik says that’s a reasonable option, provided you start on a low dose to see how you respond.

Hyperthyroidism is usually treated with medication or radioactive iodine, but sometimes surgery is necessary.

5. When in Doubt, See an Expert

Your primary care physician might be well-versed in thyroid disorders, but that’s not always the case. If you suspect you might have an underactive or overactive thyroid, consider making an appointment with an endocrinologist and ideally one who has experience working with older adults. Check with your health plan to find an endocrinologist, or search for one through AACE.

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