Thyroid Problems Over 50
As we age, the thyroid gland often functions less well, particularly
in producing less thyroid hormone than we need. And because it just
seems like "we are getting older" thyroid testing is often
overlooked. In addition, some of us may not get the right thyroid
treatment, which can help.
DON'T let your doctor skip your TSH test (for thyroid stimulating
hormone) at least once every five years if you are over 50 or more
often if you have symptoms.
- By age 50, 10% of women have signs of thyroid failure (TSH is
high).
- By age 60, 17% of women and 8% of men have a high TSH (thyroid
function will be below normal).
Testing is particularly important if you have these signs
indicating possible hypothyroidism (too little hormone):
- fatigue
- chilliness
- constipation
- forgetfulness
- muscle cramps
- hair loss
- depression
—or these signs indicating possible hyperthyroidism
(too much hormone)
- weight loss (not always present in the elderly)
- hyperactivity
- weakness
- palpitations
- tremor
- nervousness
- insomnia
Obviously all these problems can have a dozen causes-only the
correct blood tests will make sure.
DON'T decide you "just can't cope" unless you know for
sure it's not an easily treatable thyroid problem that's making
things so difficult for you.
Thyroid Treatment
Treatment to balance your hormone levels is simple and not very
expensive. Initiation of treatment, however, should be done gradually,
because older hearts may overreact to the changes and the treatment
could cause irregular heart beats or even chest pains.
If you make too little thyroid hormone, you can take the missing
thyroxine in pill form, often beginning with a very small dose of
0.025 mg (25 micrograms) or 0.05 mg (50 micrograms) and going up
gradually guided by your thyroid tests, done usually at six to eight
week intervals. Your doctor may find that you need very little thyroid
hormone to normalize your blood tests. Try to insist that your doctor
prescribes brand name thyroid hormone whenever possible. Not that
generics are bad, it’s just that they sometimes vary from
manufacturer to manufacturer, which would require extra office visits
and blood testing each time you get a new refill. Also, shop around
for your medication. Sometimes, an HMO will allow only 30 days of
medication to be dispensed. Your co-payment required may be more
than it would cost you to buy the pills yourself, as well as costing
you the inconvenience of going to the pharmacy once a month. Just
take an extra minute to price things when you are at your pharmacy
next time.
If you make too much hormone, there are drugs to control your symptoms
and make the gland stop over-producing. Often, however, these medications
only are a temporary measure and the hyperthyroid state may return
once the pills are stopped. Therefore, many doctors will opt for
definitive treatment right away. The overproducing cells can be
disabled by radioactive iodine, almost always given just one time
in your doctor’s office or in a radiology center. Then, if
necessary, you can receive thyroid hormone in pill form. Your doctor
will continue to follow you also to make sure the dose of thyroid
hormone is correct.
Screening
You must be tested properly if:
- You had a goiter or other thyroid problem when younger.
- You had childhood neck irradiation for conditions such as acne,
tonsillitis, or a big thymus gland.
- Your family has thyroid problems or other autoimmune problems
like rheumatoid arthritis, Type I diabetes, and pernicious anemia
or a skin condition called vitiligo.
- You have lumpiness or soreness in the thyroid gland at the
lower front of the neck.
- You have had extra radiation such as exposure to nuclear fallout,
or X-ray treatments on or near the neck for a medical condition
like Hodgkin's Disease.
Cancer
Thyroid cancer is rare. Fortunately, these tumors are often easier
to treat successfully than other kinds of cancer. However, you don't
want to get careless about it.
Thyroid cancer almost always presents with a lump in your neck
area. If your doctor feels a lump or nodule in your gland, or if
an ultrasound, CAT scan or MRI scan shows you have one or more lumps,
you may need further tests, perhaps including a biopsy, to rule
out cancer. And even if tests indicate a harmless nodule, your doctor
will likely recheck your thyroid every few months until it is clear
that the nodules aren’t growing larger, harder, or changing
in other ways that might suggest they contain cancer after all.
If you already have this problem or your doctor discovers a lump
in your neck, you might ask to be referred to an endocrinologist
for the most effective evaluation and treatment.
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