Treatment Concerns for Older Adults
Treating thyroid disease in older people is more challenging than it is in younger adults. For starters, many older adults are on other medications, making it more likely that there will be a drug interaction. Older adults may also wrestle with memory problems, which make it a challenge to ensure that they take their thyroid drugs consistently. In addition, some drugs seem to have a more powerful effect on older patients. In this section, we'll take a look at some particular concerns that affect older people with thyroid disease.
Amiodarone (Cordarone) is an antiarrhythmic medication used to treat life-threatening ventricular arrhythmias when other therapies have failed. The medication works by slowing the nerve impulses of the heart. Problem is, amiodarone can cause many problems with thyroid function, including hypo- or hyperthyroidism.
The primary problem with amiodarone is that it contains iodine. In people who have undetected Hashimoto's disease, the excess iodine can bring on symptoms of hypothyroidism. In other people, the medication seems to trigger the release of stored thyroid hormone, which causes hyperthyroidism.
Stopping the medication may seem like a logical option, but amiodarone is currently one of only two drugs that can treat ventricular arrhythmias in people who have heart failure. The other drugs that can help are beta-blockers. But if your heart hasn't responded to beta-blockers, then your only option may be amiodarone.
To keep you on amiodarone, your doctor may give you thyroid hormone replacement, beta-blockers, or other medications to help control your thyroid problem. Less commonly, you may need surgery to remove the thyroid and become hypothyroid to stay on amiodarone. Treatment will depend on the individual patient, the severity of the heart problem, and the challenges of the thyroid disease.
Start Low, Go Slow
When it comes to treating hypothyroidism in the elderly, it's best to start on a low dose of thyroid hormone replacement. Dosages may be as low as 12.5 or 25 micrograms. Subsequent increases, if necessary, should be equally slow and gradual to ensure that the medication doesn't affect your heart. It might also take longer for the medicine to have its full effect since these drugs tend to remain in the body longer in older people.
Older people take a disproportionately large number of medications and account for approximately 30 percent of all prescriptions sold in the United States, according to the U.S. Food and Drug Administration. That's because many older people have medical conditions that require ongoing maintenance, such as arthritis, high blood pressure, diabetes, and heart disease.
Older adults who have Alzheimer's may need help remembering to take their thyroid hormone medication. Some people may also stop complying with proper drug use. If someone you know is wrestling with Alzheimer's, take steps to make sure she still gets her thyroid medication.
When you add thyroid disease to the mix, it often means taking yet another medication. That's why older adults who develop thyroid disease should be extra vigilant about telling their doctors about existing medical conditions and the medications they take. Consuming levothyroxine with anticoagulants, for instance, can make the anticoagulant more potent. It can also render insulin less effective. You should also talk to your doctor or pharmacist about the impact of certain foods.