JAMDA
Volume 9, Issue 1 , Pages 9-17 , January 2008

Diagnosing and Managing Thyroid Disease in the Nursing Home

  • Ligia J. Dominguez, MD

      Affiliations

    • Geriatric Unit, Institute of Internal Medicine and Geriatrics, University of Palermo, Italy
    • Corresponding Author InformationAddress correspondence to Ligia J Dominguez, MD, University of Palermo, Italy, Viale F. Scaduto 6/c 90144, Palermo, Italy.
    • ,
  • Maurizio Bevilacqua, MD

      Affiliations

    • Endocrine and Diabetes Unit, Department of Internal Medicine, L. Sacco Hospital (Vialba)-University of Milan, Italy.
    • ,
  • Giovanna DiBella, MD

      Affiliations

    • Geriatric Unit, Institute of Internal Medicine and Geriatrics, University of Palermo, Italy
    • ,
  • Mario Barbagallo, MD, PhD

      Affiliations

    • Geriatric Unit, Institute of Internal Medicine and Geriatrics, University of Palermo, Italy

References 

  1. Levy EG. Thyroid disease in the elderly. Med Clin North Am. 1991;75:151–167
  2. Mariotti S, Franceschi C, Cossarizza A, Pinchera A. The aging thyroid. Endocr Rev. 1995;16:686–715
  3. Mohandas R, Gupta KL. Managing thyroid dysfunction in the elderly (Answers to seven common questions). Postgrad Med. 2003;113:54–5665–68, 100
  4. Toft AD. Clinical practice (Subclinical hyperthyroidism). N Engl J Med. 2001;345:512–516
  5. Cooper DS. Clinical practice (Subclinical hypothyroidism). N Engl J Med. 2001;345:260–265
  6. Wilson S, Parle JV, Roberts LM, et al. Prevalence of subclinical thyroid dysfunction and its relation to socioeconomic deprivation in the elderly: a community-based cross-sectional survey. J Clin Endocrinol Metab. 2006;91:4809–4816
  7. Muller GM, Levitt NS, Louw SJ. Thyroid dysfunction in the elderly. S Afr Med J. 1997;87:1119–1123
  8. Ayala C, Cozar MV, Rodriguez JR, et al. Subclinical thyroid disease in institutionalised healthy geriatric population. Med Clin. 2001;117:534–535
  9. Ania Lafuente BJ, Suarez Almenara JL, Fernandez-Burriel Tercero M, et al. Thyroid function in the aged admitted to a nursing home. An Med Interna. 2000;17:5–8
  10. Drinka PJ, Nolten WE. Prevalence of previously undiagnosed hypothyroidism in residents of a midwestern nursing home. South Med J. 1990;83:1259–12611265
  11. Thong H, Rahimi AR. Prevalence of hypothyroidism in a southeastern nursing home. J Am Med Dir Assoc. 2000;1:25–28
  12. Szabolcs I, Podoba J, Feldkamp J, et al. Comparative screening for thyroid disorders in old age in areas of iodine deficiency, long-term iodine prophylaxis and abundant iodine intake. Clin Endocrinol. 1997;47:87–92
  13. Surks MI, Ortiz E, Daniels GH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA. 2004;291:228–238
  14. Coll PP, Abourizk NN. Successful withdrawal of thyroid hormone therapy in nursing home patients. J Am Board Fam Pract. 2000;13:403–407
  15. Laurberg P, Andersen S, Bulow Pedersen I, Carle A. Hypothyroidism in the elderly: Pathophysiology, diagnosis and treatment. Drugs Aging. 2005;22:23–38
  16. Biondi B, Palmieri EA, Klain M, et al. Subclinical hyperthyroidism: Clinical features and treatment options. Eur J Endocrinol. 2005;152:1–9
  17. Drinka PJ, Nolten WE, Voeks SK, Langer EH. Follow-up of mild hypothyroidism in a nursing home. J Am Geriatr Soc. 1991;39:264–266
  18. Gussekloo J, van Exel E, de Craen AJ, et al. Thyroid status, disability and cognitive function, and survival in old age. JAMA. 2004;292:2591–2599
  19. Sawka AM, Fatourechi V, Boeve BF, Mokri B. Rarity of encephalopathy associated with autoimmune thyroiditis: A case series from Mayo Clinic from 1950 to 1996. Thyroid. 2002;12:393–398
  20. Fatourechi V. Hashimoto’s encephalopathy: Myth or reality? (An endocrinologist’s perspective). Best Pract Res Clin Endocrinol Metab. 2005;19:53–66
  21. Stockigt JR. Guidelines for diagnosis and monitoring of thyroid disease: nonthyroidal illness. Clin Chem. 1996;42:188–192
  22. Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002;87:489–499
  23. Singh S, Duggal J, Molnar J, et al. Impact of subclinical thyroid disorders on coronary heart disease, cardiovascular and all-cause mortality: A meta-analysis. Int J Cardiol. 2007;[Epub ahead of print]
  24. Rodondi N, Aujesky D, Vittinghoff E, Cornuz J, Bauer DC. Subclinical hypothyroidism and the risk of coronary heart disease: A meta-analysis. Am J Med. 2006;119:541–551
  25. Biondi B, Palmieri EA, Lombardi G, Fazio S. Effects of subclinical thyroid dysfunction on the heart. Ann Intern Med. 2002;137:904–914
  26. Yun KH, Jeong MH, Oh SK, et al. Relationship of thyroid stimulating hormone with coronary atherosclerosis in angina patients. Int J Cardiol. 2007;[Epub ahead of print].
  27. Cappola AR, Fried LP, Arnold AM, et al. Thyroid status, cardiovascular risk, and mortality in older adults. JAMA. 2006;295:1033–1041
  28. Rodondi N, Newman AB, Vittinghoff E, et al. Subclinical hypothyroidism and the risk of heart failure, other cardiovascular events, and death. Arch Intern Med. 2005;165:2460–2466
  29. Arem R, Patsch W. Lipoprotein and apolipoprotein levels in subclinical hypothyroidism (Effect of levothyroxine therapy). Arch Intern Med. 1990;150:2097–2100
  30. Kung AW, Pang RW, Janus ED. Elevated serum lipoprotein(a) in subclinical hypothyroidism. Clin Endocrinol. 1995;43:445–449
  31. Walsh JP, Bremner AP, Bulsara MK, et al. Subclinical thyroid dysfunction as a risk factor for cardiovascular disease. Arch Intern Med. 2005;165:2467–2472
  32. Chueire VB, Romaldini JH, Ward LS. Subclinical hypothyroidism increases the risk for depression in the elderly. Arch Gerontol Geriatr. 2007;44:21–28
  33. Fountoulakis KN, Kantartzis S, Siamouli M, et al. Peripheral thyroid dysfunction in depression. World J Biol Psychiatry. 2006;7:131–137
  34. Roberts LM, Pattison H, Roalfe A, et al. Is subclinical thyroid dysfunction in the elderly associated with depression or cognitive dysfunction?. Ann Intern Med. 2006;145:573–581
  35. Auer J, Eber B. Subclinical hyperthyroidism and atrial fibrillation. Acta Med Austria. 2003;30:98–99
  36. Sawin CT, Geller A, Wolf PA, et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med. 1994;331:1249–1252
  37. Foldes J, Tarjan G, Szathmari M, et al. Bone mineral density in patients with endogenous subclinical hyperthyroidism: is this thyroid status a risk factor for osteoporosis?. Clin Endocrinol. 1993;39:521–527
  38. Kumeda Y, Inaba M, Tahara H, et al. Persistent increase in bone turnover in Graves’ patients with subclinical hyperthyroidism. J Clin Endocrinol Metab. 2000;85:4157–4161
  39. Drinka PJ, Amberson J, Voeks SK, et al. Low TSH levels in nursing home residents not taking thyroid hormone. J Am Geriatr Soc. 1996;44:573–577
  40. Parle JV, Maisonneuve P, Sheppard MC, Boyle P, Franklyn JA. Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: A 10-year cohort study. Lancet. 2001;358:861–865
  41. Chopra IJ. Clinical review 86: Euthyroid sick syndrome: Is it a misnomer?. J Clin Endocrinol Metab. 1997;82:329–334
  42. DeGroot LJ. ”Non-thyroidal illness syndrome” is functional central hypothyroidism, and if severe, hormone replacement is appropriate in light of present knowledge. J Endocrinol Invest. 2003;26:1163–1170
  43. Fliers E, Alkemade A, Wiersinga WM. The hypothalamic-pituitary-thyroid axis in critical illness. Best Pract Res Clin Endocrinol Metab. 2001;15:453–464
  44. Van den Berghe GH. Acute and prolonged critical illness are two distinct neuroendocrine paradigms. Verh K Acad Geneeskd Belg. 1998;60:487–520
  45. Utiger RD. Altered thyroid function in nonthyroidal illness and surgery (To treat or not to treat?). N Engl J Med. 1995;333:1562–1563
  46. Boelen A, Platvoet-ter Schiphorst MC, Bakker O, Wiersinga WM. The role of cytokines in the lipopolysaccharide-induced sick euthyroid syndrome in mice. J Endocrinol. 1995;146:475–483
  47. Davies PH, Black EG, Sheppard MC, Franklyn JA. Relation between serum interleukin-6 and thyroid hormone concentrations in 270 hospital in-patients with non-thyroidal illness. Clin Endocrinol. 1996;44:199–205
  48. Heinen E, Herrmann J, Konigshausen T, Kruskemper HL. Secondary hypothyroidism in severe non thyroidal illness?. Horm Metab Res. 1981;13:284–288
  49. Kabadi UM. Thyrotropin dysregulation during a non-thyroidal illness: Transient hypothalamic hypothyroidism?. J Endocrinol Invest. 2001;24:178–182
  50. Karga H, Papaioannou P, Venetsanou K, et al. The role of cytokines and cortisol in the non-thyroidal illness syndrome following acute myocardial infarction. Eur J Endocrinol. 2000;142:236–242
  51. Lim CF, Docter R, Krenning EP, et al. Transport of thyroxine into cultured hepatocytes: Effects of mild non-thyroidal illness and calorie restriction in obese subjects. Clin Endocrinol. 1994;40:79–85
  52. Young R, Worthley LI. Diagnosis and management of thyroid disease and the critically ill patient. Crit Care Resusc. 2004;6:295–305
  53. Amberson J, Drinka PJ. Medication and low serum thyroxine values in nursing home residents. South Med J. 1998;91:437–440
  54. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi. Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract. 2006;12:63–102
  55. Castro MR, Gharib H. Thyroid fine-needle aspiration biopsy: Progress, practice, and pitfalls. Endocr Pract. 2003;9:128–136

 None of the authors have any conflicts of interest, and there is no funding support pertaining to this study.

PII: S1525-8610(07)00350-7

doi: 10.1016/j.jamda.2007.07.011

JAMDA
Volume 9, Issue 1 , Pages 9-17 , January 2008

Article Tools

* Image Usage & Resolution