Endocrine Considerations in the Elderly Lecture Powerpoint

Question 1

Recall the hypothalamic pituitary thyroid axis

Answer 1

Hypothalamus secretes TRH, pituitary releases TSH, thyroid releases T4 mostly and a little T3

Question 2

Aging and the thyroid gland (4)

Answer 2

• thyroid gland becomes smaller and denser
• pituitary TSH doesn’t change
• T3 and T4 production declines
• thyroid hormone action decreases

Question 3

Most common thyroid disease in the elderly

Answer 3

Subclinical hypothyroid disease (elevated TSH with normal serum T4)

Question 4

Hypothyroidism common presentation in elderly (4)

Answer 4

• peaks in the 7th decade
• women 3-10x more than men
• cold intolerance
• mild symptoms that can take years

Question 5

Most common cause of hypothyroidism in the dlerly

Answer 5

Hashimoto’s disease (autoimmune destruction of thyroid tissue)

Question 6

Drugs that can cause hypothyroidism (5)

Answer 6

• amiodarone
• lithium
• phenytoin
• carbamezapine
• gleevac

Question 7

Myxedema coma in the elderly

Answer 7

Initial presentation of hypothyroidism more often in elderly populations but still relatively rare (sees frank psychosis, drop in mental status and associated CO2 retention following depressed respriatory drive, and coma) - is life threatening and rare

Question 8

Hypothyroidism sees a link with ___ and ___ in the elderly

Answer 8

dementia, carpal tunnel syndrome

Question 9

Overt hypothyoridism

Answer 9

Elevated TSH with low T4

Question 10

Thyroid replacement therapy

Answer 10

For overt hypothyroidism, 25 mcg initially of levothyroxine starting at a low dose (already at increased risk for cardiac complication) and increase in increments of 25 mcg

Question 11

When should subclinical hypothyroidism be treated?

Answer 11

If it becomes overt, or if TSH is consistently elevated above 10 uU per mL, or at provider discretion

Question 12

Most common causes (2) of hyperthyroidism in the elderly

Answer 12

Multinodular goiter and graves disease

Question 13

Most common hyperthyroidism in the elderly

Answer 13

Subclinical hyperthyroidism (low TSH with normal T4)

Question 14

Hyperthyroidism signs and symptoms (5)

Answer 14

• anxiety/depression
• tremors
• weight loss
• lid lag
• heat intolerance

Question 15

2 evals for hyperthyroidism

Answer 15

• Anti TSH receptor antibodies (rule out graves disease)

- radioactive iodine uptake

Question 16

Hyperthyroidism treatment options (3)

Answer 16

• medications (methimazole or propylthiouracil)
• radioactive iodine
• surgery as back up

Question 17

Thyroid storm

Answer 17

Acute hyperthyroidism, occurs after operation, trauma, infection or radiaoactive idoine therapy that causes fever, confusion, agitation and potentially coma or death, life threatening but low death rate compared to myxedema (not as common as myxedema either)

Question 18

3 most common presenting symptoms in elderly with diabetes

Answer 18

Incontinence and confusion, up to 50% may be asymptomatic

Question 19

Diabetes types and geriatric populations

Answer 19

Majority are type 2, but CAN see type 1 typically in thinner lean active geriatric patients

Question 20

Medication causes of diabetes (4)

Answer 20

• high dose or long term steroid use
• thiazide diuretics
• statins
• furosemide

Question 21

Most common 3 presenting symptoms in young with diabetes

Answer 21

Polyuria, polydipsia, polyphagia

Question 22

Renal threshold and the elderly

Answer 22

Value at which glucose is spilled into urine, typically 160-180 but is higher in the elderly therefore urinalysis not a good measure to check

Question 23

Why are elderly more susceptible to hypoglycemia

Answer 23

Glucose regulatory mechanisms are altered with age, such as glucagon and epinephrine, and might not present symptoms (diaphoresis, fatigue, etc) until exceptionally lower

Question 24

Complications of untreated hypoglycemia in elderly (3)

Answer 24

• may precipitate stroke
• MI
• injury from trauma during syncope

Question 25

Large and small vessel complications of untreated diabetes in the elderly (4)

Answer 25

• peripheral vascular dz
• retinopathy (cataracts)
• nephropathy
• neuropathy

Question 26

Hyperglycemic hyperosmolar nonketoic syndrome in geriatrics

Answer 26

More often seen in elderly (kids see diabetic ketoacidosis more often, has no ketones present and patient is NOT acidotic), associated with severe dehydration and severe electrolyte disturbances often due to underlying kidney problems, decreased sensation of thirst or access to water

Question 27

Diabetes screening guidelines USPTF

Answer 27

At risk adults 45 (obese or overweight) and repeat every 3 years
Diagnosis made on basis of fasting glucose >126, random value >200, or A1C >6.5%

Question 28

What HbA1C are geriatric patients treated at?

Answer 28

8% ( a little wiggle room)

Question 29

Sulfonyurea mechanism of action vs biguanides (metformin)

Answer 29

Sulfonyureas lower blood sugar by stimulating release of insulin, biguanides (metformin) decreases glucose release from the liver