HYPERTHYROIDISM IN ELDERLY PATIENTS AND HYPERTHYROID MYOPATHY: CASE REPORT AND LITERATURE REVIEW
DOI:
https://doi.org/10.17501/24246735.2022.7107Keywords:
hyperthyroidism, senile hyperthyroidism, Graves' disease, hyperthyroid myopathy, mitochondrial myopathy, elderly patientsAbstract
Hyperthyroidism is the excessive production of thyroid hormone causing
palpitation, hypertension, weight loss, heat intolerance, tremor, anxiety, etc.
Hyperthyroidism in elderly patients does not display typical features, making diagnosis
difficult. Hyperthyroid myopathy in elders is often mistaken for normal aging. It involves
mostly proximal muscles for unclear reasons. This case reports hyperthyroidism in an
elderly patient. A 70-year-old female was presented with chest discomfort intermittently
for over 10 years and exacerbated for 10 days. This discomfort was described as chest
tightness and palpitation. She also experienced shortness of breath. On physical
examination, an enlarged thyroid was palpated. Thyroid ultrasound revealed diffuse
thyroid nodules. Thyroid function tests showed increased free and total triiodothyronine,
free thyroxine, thyrotropin receptor antibodies, as well as a decreased thyroid-stimulating
hormone. Her clinical findings and lab tests were consistent with Graves’ disease, a
condition of hyperthyroidism. Her condition was well managed with an antithyroid drug
and beta-blocker. Hyperthyroidism in elderly patients may present only with
cardiovascular disorders such as atrial fibrillation. In this case, the patient only displayed
chest tightness and palpitation. Diagnosing hyperthyroidism in elders requires vigilance
and we should not dismiss any diagnostic hint. Through literature review, a potential link
between hyperthyroid myopathy and mitochondrial pathology is observed, which can be
further investigated using mitochondrial histochemistry and beta-blockade experiment.
This study hopes to promote awareness of thyroid diseases in the elderly population and
address the issue of myopathy in elders due to thyroid diseases.
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References
American Thyroid Association. (n.d.). Older patients and thyroid diseases. Retrieved August 17, 2022, from https://www.thyroid.org/thyroid-disease-older-patient/
Atmis, V., Bülbül, B., Bahşi, R., Gümüşsoy, M., Yalçin, A., Doğan, Z., Demir, Ö., Erdoğan, M., & Atli, T. (2021). Iodine concentration and prevalence of thyroid disease in older people after salt iodization in Turkey. Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit, 27(2), 151–158. doi: 10.26719/2021.27.2.151
Bhalla, N. S., Vinales, K. L., Li, M., Bhattarai, R., Fawcett, J., & Harman, S. M. (2021). Low TSH Is Associated With Frailty in an Older Veteran Population Independent of Other Thyroid Function Tests. Gerontology & geriatric medicine, 7, 2333721420986028. doi: 10.1177/2333721420986028
Cakir, M., Samanci, N., Balci, N., & Balci, M. K. (2003). Musculoskeletal manifestations in patients with thyroid disease. Clinical endocrinology, 59(2), 162–167. doi: 10.1046/j.1365-2265.2003.01786.x
Cappola, A. R., Fried, L. P., Arnold, A. M., Danese, M. D., Kuller, L. H., Burke, G. L., Tracy, R. P., & Ladenson, P. W. (2006). Thyroid status, cardiovascular risk, and mortality in older adults. JAMA, 295(9), 1033–1041. doi: 10.1001/jama.295.9.1033
D'Aurizio, F. (2021). The role of laboratory medicine in the diagnosis of the hyperthyroidism. The quarterly journal of nuclear medicine and molecular imaging : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of..., 65(2), 91–101. doi: 10.23736/S1824-4785.21.03344-6
de Jongh, R. T., Lips, P., van Schoor, N. M., Rijs, K. J., Deeg, D. J., Comijs, … Dekkers, O. M. (2011). Endogenous subclinical thyroid disorders, physical and cognitive function, depression, and mortality in older individuals. European journal of endocrinology, 165(4), 545–554. doi: 10.1530/EJE-11-0430
Hughes, K., & Eastman, C. (2021). Thyroid disease: Long-term management of hyperthyroidism and hypothyroidism. Australian journal of general practice, 50(1-2), 36–42. doi: 10.31128/AJGP-09-20-5653
Jiménez-Blanco, S., Pla-Peris, B., & Marazuela, M. (2021). COVID-19: a cause of recurrent Graves' hyperthyroidism?. Journal of endocrinological investigation, 44(2), 387–388. doi: 10.1007/s40618-020-01440-0
Kahaly G. J. (2020). Management of Graves Thyroidal and Extrathyroidal Disease: An Update. The Journal of clinical endocrinology and metabolism, 105(12), 3704–3720. doi: 10.1210/clinem/dgaa646
Kennedy, J. W., & Caro, J. F. (1996). The ABCs of managing hyperthyroidism in the older patient. Geriatrics, 51(5), 22–32.
Lin, S. H., & Huang, C. L. (2012). Mechanism of thyrotoxic periodic paralysis. Journal of the American Society of Nephrology : JASN, 23(6), 985–988. doi: 10.1681/ASN.2012010046
Liu, Y., Shan, Z., Endocrine Metabolic Diseases Group of the Chinese Geriatrics Society, & Thyroid Group of the Chinese Society of Endocrinology, Chinese Medical Association (2021). Expert consensus on diagnosis and treatment for elderly with thyroid diseases in China (2021). Aging medicine (Milton (N.S.W)), 4(2), 70–92. doi: 10.1002/agm2.12165
Maugeri, D., Salvatore Russo, M., Carnazzo, G., Di Stefano, F., Catanzaro, S., Campagna, S., … Panebianco, P. (1996). Altered laboratory thyroid parameters indicating hyperthyroidism in elderly subjects. Archives of gerontology and geriatrics, 22(2), 145–153. doi: 10.1016/0167-4943(95)00689-3
Muscular Dystrophy Association. (n.d.). Hyperthyroid and hypothyroid myopathies. Retrieved August 17, 2022, from https://www.mda.org/disease/inherited-and-endocrine-myopathies/types/hyperthyroid-hypothyroid
Nelson, J. S., Mena, H., Parisi, J. E., & Schochet, S. S. (2003). Principles and Practice of Neuropathology (2nd ed). Oxford University Press.
Olson, B. R., Klein, I., Benner, R., Burdett, R., Trzepacz, P., & Levey, G. S. (1991). Hyperthyroid myopathy and the response to treatment. Thyroid : official journal of the American Thyroid Association, 1(2), 137–141. doi: 10.1089/thy.1991.1.137
O’Neill, P., Dornan, T., & Denning, D. (2007). Master Medicine: Medicine (3rd ed.). Churchill Livingstone.
Paravati, S., Rosani, A., & Warrington, S. J. (2021). Physiology, Catecholamines. In StatPearls. StatPearls Publishing.
Pimstone, N., Marine, N., & Pimstone, B. (1968). Beta-adrenergic blockade in thyrotoxic myopathy. Lancet (London, England), 2(7580), 1219–1220. doi: 10.1016/s0140-6736(68)91697-8
Rehman, S. U., Cope, D. W., Senseney, A. D., & Brzezinski, W. (2005). Thyroid disorders in elderly patients. Southern medical journal, 98(5), 543–549. doi: 10.1097/01.SMJ.0000152364.57566.6D
Riek A. E., Zhang R. M., & Clutter W. E. (2020). Endocrine Disease. In Z. Crees (Ed.), The Washington Manual of Medical Therapeutics (36th ed.) (pp. 830). Lippincott Williams & Wilkins.
Salvatore, D., Simonides, W. S., Dentice, M., Zavacki, A. M., & Larsen, P. R. (2014). Thyroid hormones and skeletal muscle--new insights and potential implications. Nature reviews. Endocrinology, 10(4), 206–214. doi: 10.1038/nrendo.2013.238
Svensson, J., Ohlsson, C., Karlsson, M. K., Lorentzon, M., Lewerin, C., & Mellström, D. (2021). Subclinical hyperthyroidism is associated with increased risk of vertebral fractures in older men. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 32(11), 2257–2265. doi: 10.1007/s00198-021-05964-w
Takizawa, P. (n.d.). Red ragged fibers. Histology at Yale. Retrieved August 17, 2022, from http://medcell.med.yale.edu/histology/cell_lab/red_ragged_fibers.php
Vidili, G., Delitala, A., & Manetti, R. (2021). Subclinical hyperthyroidism: the cardiovascular point of view. European review for medical and pharmacological sciences, 25(8), 3264–3271. doi: 10.26355/eurrev_202104_25735
Wang, C., Li, Y., Teng, D., Shi, X., Ba, J., Chen, B., … Teng, W. (2021). Hyperthyroidism Prevalence in China After Universal Salt Iodization. Frontiers in endocrinology, 12, 651534. doi: 10.3389/fendo.2021.651534
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