Overt and Subclinical Hypothyroidism in the Elderly: When to Treat
Open accessAbstract
Hypothyroidism is characterized by increased thyrotropin (TSH) levels and reduced free thyroid hormone fractions while, subclinical hypothyroidism (sHT) by elevated serum TSH in the face of normal thyroid hormones. The high frequency of hypothyroidism among the general population in Western Countries made levothyroxine (LT4) one of the 10 most prescribed drugs. However, circulating TSH has been demonstrated to increase with ageing, regardless the existence of an actual thyroid disease. Thus, when confronting an increase in circulating TSH levels in the elderly, especially in the oldest old, it is important to carry an appropriate diagnostic path, comprehensive of clinical picture as well as laboratory and imaging techniques. In the current review, we summarize the recommendations for a correct diagnostic workup and therapeutic approach to older people with elevated TSH value, with special attention to the presence of frailty, comorbidities and poly-therapy. The treatment of choice for hypothyroid patients is hormone replacement with LT4 but, it is important to consider multiple factors before commencing the therapy, from the age dependent TSH increase to the presence of an actual thyroid disease and comorbidities. When treatment is necessary, a tailored therapy should be chosen, considering poly-pharmacy and frailty. A careful follow-up and treatment re-assessment should be always considered to avoid the risk of over-treatment. It is important to stress the need of educating the patient for a correct administration of LT4, particularly when poly-therapy is in place, and the importance of a tailored therapeutic approach and follow-up, to avoid overtreatment.
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The frail elderly are vulnerable to drug side effects, overtreatment and poor compliance.
“The frail elderly are vulnerable to drugs side effects, overtreatment and poor compliance (54).”
From Levothyroxine therapy in elderly patients with hypothyroidism (2021) · cites this paper as [54]
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- Authors
- Calsolaro, V., Niccolai, F., Pasqualetti, G., Calabrese, A. M., Polini, A., Okoye, C., Magno, S., Caraccio, N., & Monzani, F.
- Affiliations
- University of Pisa (IT)
- Corresponding author
- Calsolaro, Valeria
- ORCID
- Venue
- Frontiers in Endocrinology
- Publisher
- Frontiers Media SA
- Published
- 2019-03-22
- Volume
- 10
- Pages
- 177-177
- ISSN
- 1664-2392 (ISSN-L)
- PMC
- PMC6438852
- OpenAlex
- W2920265483
- Cited by
- 68
- References
- 78
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 9 · 2023: 9 · 2022: 9 · 2021: 8 · 2020: 11 · 2019: 4
- FWCI
- 1.23
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Endocrinology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- subclinical hypothyroidism, overt hypothyroidism, older adults, levothyroxine, TSH elevation, frailty, comorbidities, polypharmacy, overtreatment, thyroid hormone replacement, treatment follow-up, patient education
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