Thyroid underactive living in older adults

Overview

An underactive thyroid, also called hypothyroidism, is when your thyroid gland doesn't make enough thyroid hormone. Thyroid hormone helps control your body's energy use. When levels are too low, many body processes slow down.

Yes, underactive thyroid becomes more common with age. About 1 in 10 people over 60 have it, though many don't know it.

It affects older adults, especially women over 60. People with a family history of thyroid problems or certain autoimmune conditions are also at higher risk.

Symptoms

Common symptoms

• Feeling tired or sluggish
• Feeling cold more easily
• Weight gain without trying
• Dry skin and hair
• Constipation
• Muscle aches and cramps
• Feeling down or depressed

Symptoms in older adults

• Symptoms may be subtle and come on slowly
• Memory problems or feeling confused
• Slower movements or thinking
• Hoarse voice
• Puffiness around the eyes
• Hearing loss

Causes

Main causes

• The most common cause is an autoimmune condition called Hashimoto's disease, where your immune system attacks your thyroid gland.
• Treatment for an overactive thyroid (such as radioactive iodine or surgery) can sometimes lead to an underactive thyroid.
• Certain medications, like amiodarone or lithium, can affect thyroid function.
• Rarely, problems with the pituitary gland in the brain can cause underactive thyroid.

Risk factors

• Being older than 60
• Being female
• Having a family history of thyroid disease
• Having another autoimmune disease, such as type 1 diabetes or rheumatoid arthritis
• Previous neck or thyroid surgery or radiation treatment

When to see a doctor

See a doctor urgently if:

• If you have chest pain, difficulty breathing, or fainting spells, seek emergency care immediately.

Book a routine appointment if:

• If you have any of the common symptoms listed above and they are affecting your life, make an appointment with your doctor.

Diagnosis

Your doctor will ask about your symptoms, medical history, and do a physical exam. They will also check for a goiter (swelling in the neck). The main test is a blood test.

Tests that may be done

• Blood test to measure thyroid-stimulating hormone (TSH) – a high level usually means the thyroid is underactive.
• Blood test to measure thyroid hormones (free T4) – a low level confirms hypothyroidism.
• Sometimes an antibody test to check for Hashimoto's disease.

What to expect at your appointment

Diagnosis is straightforward with a simple blood test. If results show an underactive thyroid, your doctor will discuss treatment options. You may need to repeat the test after starting treatment to adjust the dose.

Treatment

Treatment replaces the missing thyroid hormone with a daily tablet. This is a lifelong treatment, but it is safe and effective. The dose is adjusted carefully, especially in older adults, to avoid side effects.

Self-care at home

• Take your thyroid medication at the same time each day, usually in the morning on an empty stomach.
• Do not skip doses – if you miss one, take it as soon as you remember, but do not double up.
• Keep a log of your symptoms and any changes.

Medical treatments

The main treatment is a daily dose of thyroid hormone (levothyroxine). Your doctor will start with a low dose and increase gradually based on your blood tests. Regular blood tests are needed to monitor your levels.

When is surgery considered?

Surgery is not used to treat underactive thyroid. If you had surgery for another thyroid condition, you may already be on thyroid hormone replacement.

Living with this condition

Most people with underactive thyroid lead normal, active lives once treatment is stabilized. It's important to take your medication daily and see your doctor for regular check-ups.

Lifestyle tips

• Take your medication every day as prescribed.
• Eat a balanced diet, but avoid large amounts of soy, iron, or calcium supplements at the same time as your medication (they can affect absorption).
• Get regular exercise – it can help with energy and mood.
• Manage stress with relaxation techniques like deep breathing or gentle yoga.

Diet and exercise

A healthy diet rich in fruits, vegetables, and whole grains is good for overall health. Exercise, even light walking, can help boost your energy. Avoid extreme dieting or very low-calorie diets, as they can affect thyroid levels.

Mental health and emotional wellbeing

An underactive thyroid can cause depression, brain fog, and low mood. These symptoms often improve with treatment. If you continue to feel sad or anxious, tell your doctor – you may need additional support.

Prevention

In most cases, underactive thyroid cannot be prevented. However, if you have risk factors, regular check-ups can catch it early, which prevents complications.

Screening programmes

Routine screening for thyroid problems is not recommended for everyone. However, if you have symptoms or risk factors, talk to your doctor about getting tested.

Complications

If left untreated

• Heart problems, such as an enlarged heart or heart failure
• High cholesterol
• Peripheral neuropathy (nerve damage causing pain or numbness in hands and feet)
• Myxedema coma – a rare, life-threatening condition (severe hypothyroidism with confusion, hypothermia, and slowed breathing)
• Mental decline that may be mistaken for dementia

Long-term outlook

With proper treatment, the outlook is excellent. Most people feel much better within a few weeks to months. Lifelong medication is easy to manage, and you can expect to live a full, healthy life.

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