It's not at all uncommon for an older adult to develop hypothyroidism. It's also not uncommon for the condition to be undiagnosed or incorrectly diagnosed. In fact, according to the ATA, one in four patients in nursing homes may have undiagnosed hypothyroidism.
Symptoms of hypothyroidism in older adults are the same as they are for younger people — weight gain, dry skin, intolerance for the cold, depression, and fatigue, for instance. But older patients are less likely to have multiple symptoms. Many of the classic symptoms are often absent, and in some cases, they may have only one symptom, such as memory loss, which is easily dismissed as a sign of old age.
So when does a physician begin to consider the possibility of thyroid disease? That depends largely on the physician, his training, experience, and knowledge. Sometimes, an in-depth conversation with the patient will reveal a family history of thyroid disease. Or perhaps the patient will reveal a long-ago treatment for a bout of hyperthyroidism. Perhaps the conversation will uncover a distant memory of surgery or radiation performed on the neck. Once a physician suspects the thyroid, he will order a test to see whether there is an elevated TSH level.
Postmenopausal women who are taking hormone replacement therapy (HRT) may require higher doses of levothyroxine than women not taking HRT. The synthetic estrogen in HRT causes an increase in the production of thyroid binding globulin, which can cause a reduction in thyroid hormone in the bloodstream.
If your TSH levels are indeed high, and you're experiencing symptoms of hypothyroidism, your doctor will probably start treating you with thyroid hormone replacement. Older patients, especially those with heart disease, generally start on a lower dose so that the medication does not stress the heart. The lower dosage will give your body the time it needs to adjust to the medication. For more information on hypothyroidism, see Chapter 4.