Risks of Thyroid Disease in Elderly
It isn't easy to detect thyroid disease in the elderly. But left untreated, thyroid disease can have serious ramifications for older adults, especially women in their postmenopausal years. Inadequate or excess amounts of thyroid hormone can speed the rate of bone loss, promote the buildup of cholesterol, and raise your risk of heart disease.
Bones naturally weaken with age, especially in women who lose the protective effects of estrogen after menopause. But some people develop a condition called osteoporosis, which is low bone density. Osteoporosis is a silent disease that produces no symptoms, and most people won't know they have it unless they suffer a fracture. Approximately 10 million people in the United States have osteoporosis, 8 million of them women. Each year, approximately 1.5 million American adults suffer an osteoporosis-related fracture.
Throughout life, our bones are in the constant process of breaking down and rebuilding. This process is achieved through the activity of osteoclasts, which break down the bone, and osteoblasts, which restore the bone. Having too much thyroid hormone accelerates the breakdown of bone by stimulating the osteoclasts. As a result, the osteoclasts go into overdrive without any activity from the osteoblasts, which are not affected by the excess thyroid hormone and so will not compensate for the bone loss.
Women over age sixty-five should get 1,500 mg of calcium a day. If you're postmenopausal, regardless of whether you are taking HRT, you should also aim for 1,500 mg. Women between the ages of twenty-five and fifty should get 1,000 mg a day. Ideally, you should break up your calcium intake through the day since your body can absorb only about 600 mg at a time. Good dietary sources include low-fat milk, yogurt, and cheese.
Proper treatment of hyperthyroidism to reduce the amount of thyroid hormone in your body puts an end to this destructive process. You can also take measures to minimize bone loss by eating adequate amounts of calcium and vitamin D. If you don't think you're getting enough calcium in your diet, consider taking calcium supplements. Antacids such as Tums are a good option, but remember to wait at least one hour after taking your thyroid hormone before taking calcium. You can supplement your vitamin D by taking two multivitamins (each with 400 IU of vitamin D) a day.
Another bone-boosting strategy is doing weight-bearing exercises three to five times a week, for twenty to thirty minutes at a time. It's also helpful to give up cigarette smoking and to drink alcoholic beverages in moderation. If necessary, you can take medications that help slow bone loss.
Heart disease is the leading cause of death in the United States, accounting for 29 percent of all deaths in the country in 2001, according to the Centers for Disease Control and Prevention. Having hypo-or hyperthyroidism can make any pre-existing heart disease worse or put you at risk for heart problems that you don't normally have. Fortunately, prompt treatment can usually put a halt to these problems. But it's important to understand the risks of heart disease caused by thyroid disorders since heart disease is more prevalent among older adults.
Hypothyroidism affects the heart in several ways. It can cause elevated cholesterol levels in the blood by increasing the amount of cholesterol the body naturally produces in the liver. An underactive thyroid also increases the amount of cholesterol absorbed into the bloodstream and makes it harder for the liver to eliminate cholesterol.
Hypothyroidism also can cause hypertension or high blood pressure, which occurs when constricted blood vessels are forced to work harder to pump blood through the body. In people with hypothyroidism, the heart rate may be slowed significantly, which lowers the heart's ability to pump enough blood and causes hypertension. Having high blood pressure raises your risk for heart attack, heart failure, and stroke. The presence of high cholesterol compounds that risk.
Older people with hyperthyroidism may develop heart problems, too. Hyperthyroidism can cause abnormal heart rhythms, such as atrial fibrillations, which can worsen existing heart problems. Hyperthyroidism can also cause tachycardia, in which the heartbeat is rapid, at a rate above 100 beats per minute. In some cases, hyperthyroidism can bring about heart failure, in which the heart becomes damaged or is forced to work too hard. Anyone with underlying heart problems who develops hyperthyroidism is at greater risk for heart attack or stroke.
Older adults who have suffered from untreated hypothyroidism for a long time are at risk for a rare life-threatening condition called myxedema coma. The condition may be triggered by a variety of factors, including infection, the use of certain drugs, severe stress, extremely cold temperatures, stroke, trauma, and heart failure.
When myxedema coma occurs, the patient's body temperature plummets, causing hypothermia. The patient may also experience delirium, a loss of lung function, a slowing of the heart rate, constipation, urine retention, stupor, and swelling. In addition, the condition causes the patient to become disoriented and suffer seizures. Eventually, the patient may fall into a coma and die.
Thanks to advances in medical care, which include better diagnostic tools and treatment, both myxedema coma and thyroid storm have become extremely rare. Nonetheless, they can occur and always should be treated as medical emergencies.
A myxedema coma is a medical emergency that warrants immediate attention and treatment. Treatment often involves intravenous injections of thyroid hormone. Because the condition can impair the body's ability to convert T4 into T3, patients are often treated with Cytomel (T3) as well. Unfortunately, death from myxedema coma is common, especially among older patients who have heart problems. The best treatment for myxedema coma is prevention, which means treating hypothyroidism before it becomes a serious problem.
Elderly people who have hyperthyroidism are more likely to experience thyroid storm, a rare condition that affects a small percentage of people with an overactive thyroid. In people who have thyroid storm, the heart rate becomes uncontrollably fast, and blood pressure rises to extreme highs. Other symptoms include a high fever, shortness of breath, chest pain, confusion, weakness, and extreme nervousness and mood swings. Some people have nausea and vomiting as well as profuse sweating. In severe cases, the patient may fall into a coma.
Like myxedema coma, a thyroid storm is a medical emergency that needs immediate treatment. Untreated, thyroid storm can quickly progress to a stroke or heart attack. The condition usually requires treatment with high doses of antithyroid medications, followed by iodine-containing compounds and therapy for any underlying condition that may be causing or contributing to the problem.
In addition to untreated hyperthyroidism, thyroid storm is more likely in people who develop infections, changes in blood sugar, and severe emotional stress.