Hypothyroidism Symptoms And Signs In An Older Person

Overview

Hypothyroidism (say: hy-po-THY-royd-ism) means your thyroid gland is underactive. The thyroid is a small, butterfly-shaped gland in the front of your neck. It makes thyroid hormones, which act like a thermostat for your body — they control how fast your body uses energy (this is called your metabolism). When the gland makes too little hormone, many body systems slow down. In older people, the signs can be gentle and easy to miss, because they often look like normal ageing or are put down to 'just getting older'.

Yes. An underactive thyroid is one of the more common hormone conditions, and it becomes more common as people get older. It is far more common in women than in men. Many cases in older people are picked up on a routine blood test before obvious symptoms appear.

Anyone can develop it, but it is most often seen in women, especially women over 60. Your risk is higher if a close relative has a thyroid or autoimmune condition, if you have another autoimmune illness (such as type 1 diabetes or coeliac disease), or if you have had thyroid surgery or radiotherapy to the neck.

Symptoms

Common symptoms

• Feeling very tired, or having less energy than usual
• Gaining weight without clearly eating more
• Feeling cold when others are comfortable
• Constipation (hard, less frequent bowel movements)
• Dry, rough or itchy skin
• Thinning hair, or hair that falls out more than usual
• A slow heart rate
• Low mood, low interest in things, or feeling flat
• Muscle aches, cramps or stiffness
• A hoarse or deeper voice
• Puffiness around the eyes or face
• Heavier periods than usual (in women still having periods)

Symptoms in children

• In children, an underactive thyroid is uncommon but important to spot early.
• Signs can include slower than expected growth, delayed puberty, poor school concentration, tiredness, constipation and dry skin.
• Babies can be born with an underactive thyroid; this is why newborn screening blood tests are done in many countries.
• If you are worried about a child's growth or development, speak to their doctor — this is a treatable condition.

Symptoms in older adults

• Symptoms are often quieter and easier to miss than in younger people.
• Memory problems, confusion or slowed thinking that may be mistaken for 'normal ageing' or early dementia
• Low mood or withdrawal that can look like depression
• Loss of appetite, or food simply not tasting as good
• Unexplained falls, unsteadiness or general weakness
• Feeling cold all the time, or a lower body temperature than usual
• Puffy face, puffy eyelids, or swelling of the hands and feet
• Constipation that does not respond to the usual fibre and water advice
• Breathlessness, ankle swelling or a slow, irregular heartbeat — sometimes the first clue
• Sometimes no symptoms at all, and the condition is found on a blood test done for another reason
• A word of caution: in older people the signs can also come from too much replacement hormone, so never change your dose on your own — get a blood test first

Causes

Main causes

• An autoimmune problem, where the body's own immune system slowly damages the thyroid gland (the most common cause in countries where iodine is plentiful)
• Treatment for an overactive thyroid, such as surgery or radioactive iodine, which can leave the gland making too little hormone
• Surgery to remove part or all of the thyroid
• Radiotherapy to the neck or head
• Some medicines — for example certain treatments for heart rhythm problems, mood disorders or cancer — can affect the thyroid; ask your doctor or pharmacist whether yours is one of them
• Not getting enough iodine in the diet (rare in many countries because iodine is added to salt and found in dairy and seafood)
• A problem with the pituitary gland (a small gland in the brain that tells the thyroid what to do) — this is much less common
• Inflammation of the thyroid after pregnancy, or after a viral illness

Risk factors

• Being over 60
• Being female
• A family history of thyroid disease or autoimmune disease
• Having another autoimmune condition, such as type 1 diabetes, coeliac disease, vitiligo or rheumatoid arthritis
• Previous thyroid surgery or radiotherapy to the neck
• Taking certain long-term medicines that affect the thyroid
• Down syndrome or Turner syndrome
• Having had thyroid problems during or after a pregnancy

When to see a doctor

See a doctor urgently if:

• New confusion, drowsiness or difficulty waking someone up
• Chest pain, fainting, or a heartbeat that feels very slow or irregular
• Breathlessness that is getting worse, or rapid swelling of the ankles or abdomen
• Severe constipation with a swollen, painful abdomen and vomiting
• Any thoughts of harming yourself

Book a routine appointment if:

• You feel persistently tired and low in energy for more than a few weeks and cannot explain why
• You are feeling the cold much more than others, or your skin, hair or nails have changed
• You have constipation that is not helped by fibre, fluids and movement
• Your memory or concentration has changed, or family notice you are 'not yourself'
• You have gained weight without changing how you eat
• You have a family history of thyroid disease, or another autoimmune condition, and want to be checked
• You are already on thyroid treatment and your symptoms have changed

Diagnosis

Your doctor will ask about your symptoms, look at your medical history and any medicines you take, and may examine your neck to feel the thyroid gland. The key step is a blood test. Sometimes the result is borderline, so the test is repeated after a few weeks before any decision is made. If your doctor thinks another condition could explain your symptoms — such as anaemia, low vitamin levels or depression — they may check for those too.

Tests that may be done

• Thyroid stimulating hormone (TSH) — a hormone from the brain that tells the thyroid to work; a high level usually means the thyroid is underactive
• Free T4 — the main thyroid hormone measured in the blood
• Thyroid antibodies — to see whether the immune system is attacking the gland
• A repeat blood test after a few weeks if the first result is borderline
• General blood tests such as a full blood count, vitamin levels and cholesterol, to look for other causes of tiredness
• Occasionally, an ultrasound scan of the neck if the gland feels enlarged or lumpy

What to expect at your appointment

The blood test is quick and only needs a small sample. Results usually come back within days. If treatment is started, you will have follow-up blood tests to make sure the level is right for you — this is especially important in older people. Nothing about the testing is painful beyond the small needle scratch, and you do not usually need to fast.

Treatment

An underactive thyroid is treated by replacing the hormone your gland is not making. This is usually a single tablet taken once a day. The aim is to bring your hormone level back into the normal range so you feel like yourself again. In older people, treatment often starts gently and is adjusted slowly, particularly if you have heart disease, because the body needs time to get used to the hormone.

Self-care at home

• Take your tablet every day, at the same time, as your doctor or pharmacist has advised
• Do not stop or change your dose on your own, even if you feel better or worse
• Go for your follow-up blood tests — they are how your dose is kept right
• Keep a short note of your symptoms so you can tell your doctor what has changed
• Tell any doctor, nurse or pharmacist that you take thyroid medicine, especially before starting a new medicine
• Ask your pharmacist before taking supplements containing calcium or iron, or indigestion remedies, as some can affect how the tablet is absorbed
• Eat a balanced diet with enough fibre and fluids to help with constipation
• Keep warm in cold weather, and let someone know if you feel unusually cold or drowsy

Medical treatments

The standard treatment is daily hormone replacement — a tablet that gives your body the thyroid hormone it is missing. Your doctor will usually start with a modest dose and check your blood after about six to eight weeks, adjusting the dose in small steps until your level is comfortable for you. Once settled, blood tests are usually needed about once a year, or sooner if your symptoms change or you start a new medicine. Older people are checked carefully because both under-treatment and over-treatment can cause problems: too little hormone leaves symptoms and raises heart and cholesterol risks, while too much can strain the heart and thin the bones. If you ever take too many tablets by mistake, contact your doctor or a poison information service straight away.

When is surgery considered?

Surgery is rarely needed for an underactive thyroid itself. It may be considered if the thyroid is very enlarged and presses on the windpipe or food pipe, causing trouble breathing or swallowing, or if there are lumps (nodules) that need to be removed or checked. Your specialist team would discuss this with you in detail.

Living with this condition

Most people settle into a simple routine: one tablet a day, a blood test once a year, and a bit of attention to how you feel. It can help to take the tablet at the same point in your daily routine, and to use a pill organiser or phone reminder if memory is a concern. Family or carers can help by noticing changes in your energy, mood or alertness — sometimes others spot a shift before you do. If you live alone, consider a system so someone checks in on you during very cold weather.

Lifestyle tips

• Stay active in a way that suits you — regular gentle movement helps energy, mood and bowels
• Eat a varied diet with plenty of fibre, fruit, vegetables and fluids to ease constipation
• Keep to a regular sleep routine and pace yourself on low-energy days
• Limit alcohol, which can disturb sleep and mood
• Stay warm at home in cold months and dress in layers
• Keep your home safe to reduce falls — good lighting, no loose rugs, grab rails if needed
• Keep up with other health checks, such as blood pressure and cholesterol

Diet and exercise

No special diet is needed. A balanced, varied diet gives you the iodine and nutrients your body needs. Very large amounts of certain raw vegetables, kelp or iodine supplements are not helpful and can upset thyroid balance — ask your pharmacist or doctor before taking supplements. Regular movement — walking, swimming, gardening, chair-based exercise or whatever you enjoy — supports energy levels, heart health, mood and digestion. Start gently if you have been tired for a while, and build up as you feel able. If exercise causes chest pain or severe breathlessness, stop and seek medical advice.

Mental health and emotional wellbeing

An underactive thyroid can genuinely affect mood. Low mood, anxiety, poor concentration and a sense of 'slowing down' are common, and in older people they are sometimes mistaken for depression or dementia. This is not a sign of weakness, and it usually improves once hormone levels are corrected. If low mood lingers, tell your doctor — talking therapies and other support can help alongside thyroid treatment. If you ever have thoughts of ending your life or harming yourself, please contact your local emergency number or a crisis support line straight away, or tell someone you trust and ask them to stay with you.

Prevention

Most cases cannot be prevented, because the usual cause is the immune system affecting the thyroid, which is not something you can control. What you can do is have it checked early if you have symptoms or risk factors, and take any thyroid medicine exactly as prescribed. If you have had thyroid surgery or radiotherapy, your team will monitor you so that treatment can start promptly if levels drop.

Screening programmes

There is no routine screening programme for thyroid problems in most countries. Testing is usually done when you have symptoms, when another blood test hints at it, or when you have a strong risk factor such as a family history or another autoimmune condition. If you are pregnant or planning a pregnancy and have thyroid risk factors, ask your doctor whether testing is right for you.

Complications

If left untreated

• Continuing tiredness, low mood and poor concentration that affect daily life
• Raised cholesterol and a higher long-term risk of heart disease
• Heart problems, including a slow heartbeat and, in some cases, heart failure
• Nerve problems causing numbness or tingling, especially in the hands and feet
• Worsening constipation and, rarely, a blocked bowel
• Memory and thinking changes that can be mistaken for dementia
• In women, problems with periods and fertility
• Rarely, a life-threatening emergency called myxoedema coma, with severe drowsiness, confusion and dangerously low body temperature — this is why sudden confusion or drowsiness in an older person with thyroid problems needs urgent help

Long-term outlook

The outlook is good. Once the hormone level is corrected, most people notice real improvement within a few weeks, though it can take a few months to feel fully back to normal — and older people often need to be adjusted more slowly. Treatment is usually lifelong, but it is simple, well understood, and monitored with a yearly blood test. Many people with an underactive thyroid live full, active lives. If you do not feel better despite treatment, tell your doctor — the dose may need adjusting, or something else may be going on, and that is worth exploring.

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