Older Subjects with Hyperthyroidism Present with a Paucity of Symptoms and Signs: A Large Cross-Sectional Study
Abstract
CONTEXT: The absence of classical symptoms and signs of hyperthyroidism often results in delayed diagnosis and treatment. OBJECTIVES: The objective of the study was to determine the prevalence of symptoms and signs of hyperthyroidism according to patients' age and gender as well as severity and type of hyperthyroidism. DESIGN, PARTICIPANTS AND SETTING: This was a cross-sectional study of 3049 consecutive patients with hyperthyroidism presenting to a single secondary/tertiary care clinic. MAIN OUTCOME MEASURES: Calculation of adjusted odds ratios for presence/absence of symptoms/signs of hyperthyroidism simultaneously analyzing the influence of patients' age/gender, disease etiology/severity, symptom duration, and smoking. RESULTS: The majority of patients older than 61 yr had two or more symptoms. The lowest proportion of subjects reporting five or more symptoms was found in those older than 61 yr. Increasing age was associated with reduced adjusted odds ratio for the presence of most classical symptoms except for weight loss and shortness of breath, independent of disease severity. Those with more severe hyperthyroidism and smokers had increased odds ratios for most symptoms. Older age, higher serum free T(4) concentrations at diagnosis, male gender, and toxic nodular hyperthyroidism were independently associated with risk of atrial fibrillation. Signs of ophthalmopathy were associated with increasing age, smoking, longer symptom duration, and female gender. CONCLUSIONS: Classical symptoms and signs of hyperthyroidism are significantly less prevalent in older patients and more prevalent in smokers and subjects with higher free T(4) concentrations. We propose a lower threshold for performing thyroid function tests in patients older than 60 yr, especially in those presenting with atrial fibrillation, weight loss, or shortness of breath.
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The absence of specific symptoms of hyperthyroidism does not exclude the diagnosis of overt and subclinical hyperthyroidism in the elderly because symptoms are often masked.
“However, the absence of specific symptoms of hyperthyroidism does not exclude the diagnosis of overt and subclinical hyperthyroidism in the elderly because symptoms are often masked [50,51] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [50]
The lack of a link between subclinical hyperthyroidism and left ventricular mass in elderly subjects is almost certainly because subclinical hyperthyroidism has not been associated with symptoms of adrenergic overactivity in the elderly.
“On the other hand, two recent prospective studies did not find a link between SHyper and left ventricular mass in elderly subjects [69,70] , almost certainly because SHyper has not been associated with symptoms of adrenergic overactivity in the elderly [50] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [50]
The importance of age as a determinant of the prevalence and severity of hyperthyroid symptoms has recently been confirmed.
“The importance of age as a determinant of the prevalence and severity of hyperthyroid symptoms has recently been confirmed (30).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [30]
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- Authors
- Boelaert, K., Torlinska, B., Holder, R. L., & Franklyn, J. A.
- Affiliations
- University of Birmingham (GB)
- School of Clinical and Experimental Medicine (K.B., B.T., J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom
- Corresponding author
- Franklyn, J. A.
- ORCID
- Boelaert, K.
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2010-06-01
- Volume
- 95
- Issue
- 6
- Pages
- 2715-2726
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2000504772
- Cited by
- 196
- References
- 44
- Citations by year
- 2026: 8 · 2025: 9 · 2024: 15 · 2023: 18 · 2022: 10 · 2021: 22 · 2020: 17 · 2019: 10 · 2018: 12 · 2017: 9 · 2016: 13 · 2015: 12 · 2014: 11 · 2013: 13 · 2012: 7
- FWCI
- 7.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Funders
- Medical Research Council
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Keywords
- hyperthyroidism, older adults, atypical presentation, delayed diagnosis, smoking, atrial fibrillation, Graves' ophthalmopathy, free thyroxine, weight loss, dyspnea
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Cross-Sectional Studies, Female, Goiter, Nodular, Humans, Hyperthyroidism, Male, Middle Aged, Sex Factors, Smoking, Socioeconomic Factors, Thyroid Function Tests, Thyrotoxicosis, Thyroxine, Triiodothyronine, Odds Ratio, Young Adult
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