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Vol. 49, No. 5, 2003
Issue release date: September–October 2003
Section title: Clinical Section
Gerontology 2003;49:316–323
(DOI:10.1159/000071713)

Hyperthyroidism in Patients Older than 55 Years: An Analysis of the Etiology and Management

Díez J.J.
Department of Endocrinology, Hospital La Paz, Madrid, Spain

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Article / Publication Details

First-Page Preview
Abstract of Clinical Section

Received: 9/18/2002
Accepted: 12/18/2002
Published online: 8/22/2003
Issue release date: September–October 2003

Number of Print Pages: 8
Number of Figures: 0
Number of Tables: 5

ISSN: 0304-324X (Print)
eISSN: 1423-0003 (Online)

For additional information: http://www.karger.com/GER

Abstract

Background: Hyperthyroidism is a common disease in the elderly. Although some studies on the prevalence of this thyroid disorder have been performed in the aged population, several aspects of hyperthyroidism, such as etiology and treatment effectiveness, have not been fully characterized in large series of aged patients. Objective: The aims of the present study were to determine the frequency of the diverse etiologies of hyperthyroidism, and to assess the effectiveness of therapy in adult patients older than 55 years. Methods: We performed a descriptive, observational, cross-sectional study in the setting of a hospital endocrinology clinic. We studied a group of 313 patients with hyperthyroidism. There were 246 women (78.6%, age 67.02 ± 8.35 years) and 67 men (21.4% age 63.34 ± 7.63 years). Overt hyperthyroidism was diagnosed in 167 patients (53.4%) and subclinical hyperthyroidism in the remaining 146 subjects (46.6%). In every patient we studied: the etiology; presence or absence of goiter; time of evolution from diagnosis; previously and presently used treatments; current thyroid functional status (free thyroxine and thyrotropin concentrations); adequacy of disease control, and thyroid autoimmune status. Results: The different etiologies of hyperthyroidism were as follows: toxic multinodular goiter 43.1%; Graves’ disease 21.4%; iatrogenic thyrotoxicosis 16.0%; toxic adenoma 11.8%; iodine-induced thyrotoxicosis 1.2%; subacute thyroiditis 1.0%; painless thyroiditis 0.3%; factitious thyrotoxicosis 0.3%; TSH-secreting pituitary adenoma 0.6%, and unknown etiology 3.8%. Etiology was related to age, sex, presence of goiter, degree of hyperthyroidism and autoimmune status. 77.6% of patients had been diagnosed in the last 5 years, and 91.3% in the last 10 years. Preferred therapies were thionamide drugs in patients with Graves’ disease and radioiodine in patients with hyperthyroidism due to nodular disease. Surgery was performed in a limited number of patients. Periodic follow-up was used in patients with subclinical hyperthyroidism. Control of the disease was adequate in 65.3% and inadequate in 34.7% of patients who received any kind of previous therapy. In this group of patients, logistic regression analysis showed that the probability of attaining good control of hyperthyroidism was greater in patients with overt thyrotoxicosis compared to patients with subclinical thyrotoxicosis. Conclusion: In patients older than 55 years, toxic multinodular goiter is the most frequent etiology of spontaneous hyperthyroidism, followed by Graves’ disease and toxic adenoma. Most patients with thyroid hyperfunction can be adequately controlled, provided that effective therapy is administered. Patients with overt hyperthyroidism seem to have a higher probability of attaining adequate control of their disease than patients with subclinical hyperthyroidism, regardless of age, sex or etiology.

© 2003 S. Karger AG, Basel


  

Author Contacts

Juan J. Díez
Travesía Téllez 8, 4R
ES–28007 Madrid (Spain)
Tel. +34 91 501 7284
E-Mail mibarsd@infomed.es

  

Article Information

Received: September 18, 2002
Accepted: December 18, 2002
Number of Print Pages : 8
Number of Figures : 0, Number of Tables : 5, Number of References : 32

  

Publication Details

Gerontology (International Journal of Experimental, Clinical and Behavioural Gerontoloy)
Founded 1957 by F. Verzàr as ‘Gerontologia’, merged 1975 with ‘Gerontologia Clinica’, founded 1959 by E. Woodford-Williams and A.N. Exton-Smith
Organ of the International Association of Gerontology (IAG)

Vol. 49, No. 5, Year 2003 (Cover Date: September-October 2003)

Journal Editor: W. Meier-Ruge, Basel
ISSN: 0304–324X (print), 1423–0003 (Online)

For additional information: http://www.karger.com/journals/ger


Article / Publication Details

First-Page Preview
Abstract of Clinical Section

Received: 9/18/2002
Accepted: 12/18/2002
Published online: 8/22/2003
Issue release date: September–October 2003

Number of Print Pages: 8
Number of Figures: 0
Number of Tables: 5

ISSN: 0304-324X (Print)
eISSN: 1423-0003 (Online)

For additional information: http://www.karger.com/GER


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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