Shakaib U. Rehman, MD, Primary Care Service Line, Ralph H. Johnson V.A. Medical Center; Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Jan N. Basile, MD, Director, Primary Care Service Line, Ralph H. Johnson VA Medical Center; Professor of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Florence N. Hutchison, MD, Chief of Staff, Ralph H. Johnson V.A. Medical Center; Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.

Older patients with hyperthyroidism present with atypical symptoms such as difficulty concentrating. This is in contrast to younger patients, who present with classic symptoms such as heat intolerance, tremor, and tachycardia. Hyperthyroidism in older adults is most often caused by toxic multinodular goiter and Graves’ disease. Thyroid hormones and thyroid-stimulating hormone assays can establish the diagnosis quickly. Antithyroid medication can be used in medically unstable older hyperthyroid patients to quickly suppress the hormones. When the patient is stable, definitive therapies such as radioactive iodine or surgery should be considered. Radioactive iodine therapy is well tolerated and effective. Surgery is indicated in patients who fail to respond to radioactive iodine therapy and patients with multinodular goiter.
Key words: thyrotoxicosis, older adults, hyperthyroidism, Graves’ disease, T3 toxicosis.

Nariman Malik, BSc

Hyperthyroidism is defined as an excess of circulating thyroid hormones, either thyroxine (T4) or triiodothyronine (T3).¹ In Canada, its prevalence is approximately 1.9% and it is ten times more common in women than in men.² The disease can present at any age but is less common before the age of 15.3

Hyperthyroidism is an important cause of morbidity in the elderly. The clinical manifestations of hyperthyroidism vary from one patient to another and no single clinical manifestation is a specific indicator of the condition. Hyperthyroidism classically presents with symptoms that affect almost every organ system.³ The typical features include: weight loss with preserved appetite, heat intolerance, nervousness, anxiety, insomnia, proximal muscle weakness, fatigue, tremor, heart palpitations, and increased frequency of bowel movements. Other general signs include hyperactivity, tachycardia, atrial fibrillation, systolic hypertension, hyperreflexia, lid lag, and eyelid retraction.

Elderly persons may present with these classic symptoms or more usually, their presentation is atypical (please refer to table 1).