Comparing Clinical Presentation Of Hyperthyroidism In Elderly and Younger Patients.

When comparing middle-aged patients with hyperthyroidism to elderly patients with hyperthyroidism, elderly patients are more likely to have

A) Restlessness
B) Hyperactive appearance
C) Atrial fibrillation
D) Weight gain
E) Goiter

Answer and Discussion

The answer is C.  Atrial fibrillation

The most common cause of hyperthyroidism in the elderly is Graves’ disease or toxic diffuse goiter. Graves’ disease is an autoimmune disorder resulting from the action of a thyroid-stimulating antibody on thyroid-stimulating hormone receptors. Thyroid-stimulating hormone receptor antibodies are detectable in the serum of approximately 80% to 100% of untreated patients with Graves’ disease. Hyperthyroidism in the elderly is often more difficult to diagnose than in younger patients.
Only 25% of those affected present with symptoms typical in younger patients, such as restlessness and hyperactive appearance.

Elderly patients are more likely to show

• weight loss, 
• new-onset atrial fibrillation, and
• withdrawal or depression. 
• Other complications include cardiac failure, angina, MI, and osteoporosis with an increased risk of bone fractures. 

Older patients have a lower incidence of goiter.

Behavioral changes in younger patients include anxiety, emotional lability, insomnia, lack of concentration, restlessness, and tremulousness. In contrast, elderly patients show apathy, lethargy, pseudodementia, and depressed moods.