Schilddrüsenfunktionsstörungen im Alter

Schilddrüsenfunktionsstörungen gehören zu den häufigsten endokrinologischen Krankheitsbildern. Mit zunehmender Lebenserwartung steigt auch die Zahl der betroffenen älteren Patienten. Gleichzeitig sind Veränderungen der Schilddrüsenhormonphysiologie Teil des Alterungsprozesses, sodass Diagnostik und Therapie in Abhängigkeit vom Lebensalter variieren. Der Beitrag beleuchtet die Besonderheiten bei älteren Patienten mit Schilddrüsenfehlfunktionen.

Abstract

Thyroid dysfunctions are common endocrine disorders. With an increasing number of older persons in European societies, the number of older patients affected will also rise. The physiology of thyroid hormones and their regulation change with increasing age. The age-dependent increase of thyroid stimulating hormone (TSH) is clinically most relevant, but many laboratories do not provide age-specific reference ranges. Older patients also have more comorbidities and thyroid dysfunctions will have a negative impact on many of these, in particular on cardiovascular disorders. While there are clear indications to treat overt hyperthyroidism and hypothyroidism, treatment recommendations for subclinical thyroid dysfunctions differ depending on the patient’s age. The European Thyroid Association suggests a TSH level of 0.1 mU/l for patients with subclinical hyperthyroidism older than 65 years as threshold. A TSH level < 0.1 mU/l is a clear indication for treatment while concentrations > 0.1 mU/l are relative treatment indications. Patients older than 65 years with subclinical hypothyroidism and a TSH level > 10 mU/l should also be treated, in particular when cardiovascular comorbidities are present. Levothyroxine treatment has to be monitored on a regular basis, as overdosing is also harmful. For patients with TSH concentrations between 7 and 10 mU/l there is no clear indication to initiate a levothyroxine treatment, as they do not have a clearly elevated mortality and morbidity, also quality of life does not improve.

Schlüsselwörter

Hypothyreose - Hyperthyreose - Therapie im Alter

Key words

hypothyroidism - hyperthyroidism - therapy in old age

Publication History

Article published online:
22 September 2021

• Literatur

• 1 Ortiga-Carvalho TM, Chiamolera MI, Pazos-Moura CC. et al. Hypothalamus-Pituitary-Thyroid Axis. Compr Physiology 2016; 6: 1387-1428
• 2 Weitzel JM, Iwen KA. Coordination of mitochondrial biogenesis by thyroid hormone. Mol Cell Endocrinol 2011; 342: 1-7
• 3 Iwen KA, Oelkrug R, Brabant G. Effects of thyroid hormones on thermogenesis and energy partitioning. J Mol Endocrinol 2018; 60: R157-r1703
• 4 Biondi B, Cappola AR, Cooper DS. Subclinical Hypothyroidism: A Review. Jama 2019; 322: 153-160
• 5 Iwen KA, Brabant G. Therapie mit Schilddrüsenhormonen im Alter. Der Internist 2020; 61: 541-548
• 6 Burch HB. Drug Effects on the Thyroid. N Engl J Med 2019; 381: 749-761
• 7 Biondi B, Cooper DS. Subclinical Hyperthyroidism. N Engl J Med 2018; 378: 2411-2419
• 8 Jasim S, Gharib H. THYROID AND AGING. Endocrine practice: official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists 2018; 24: 369-374
• 9 Boucai L, Hollowell JG, Surks MI. An approach for development of age-, gender-, and ethnicity-specific thyrotropin reference limits. Thyroid: official journal of the American Thyroid Association 2011; 21: 5-11
• 10 Iwen KA. Schilddrüsensonografie – Schritt für Schritt. Dtsch Med Wochenschr 2020; 145: 260-267
• 11 Selmer C, Olesen JB, Hansen ML. et al. Subclinical and overt thyroid dysfunction and risk of all-cause mortality and cardiovascular events: a large population study. J Clin Endocrinol Metabol 2014; 99: 2372-2382
• 12 Biondi B, Bartalena L, Cooper DS. et al. The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism. Eur Thyr J 2015; 4: 149-163
• 13 Ross DS, Burch HB, Cooper DS. et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid: official journal of the American Thyroid Association 2016; 26: 1343-1421
• 14 Wiersinga WM, Duntas L, Fadeyev V. et al. 2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism. Eur Thyr J 2012; 1: 55-71
• 15 Taylor PN, Iqbal A, Minassian C. et al. Falling threshold for treatment of borderline elevated thyrotropin levels-balancing benefits and risks: evidence from a large community-based study. JAMA Internal Med 2014; 174: 32-39
• 16 Zulewski H, Muller B, Exer P. et al. Estimation of tissue hypothyroidism by a new clinical score: evaluation of patients with various grades of hypothyroidism and controls. J Clin Endocrinol Metabol 1997; 82: 771-776
• 17 Stott DJ, Rodondi N, Bauer DC. Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism. N Engl J Med 2017; 377: e20
• 18 de Montmollin M, Feller M, Beglinger S. et al. L-Thyroxine Therapy for Older Adults With Subclinical Hypothyroidism and Hypothyroid Symptoms: Secondary Analysis of a Randomized Trial. Ann Internal Med 2020; 172: 709-716
• 19 Lillevang-Johansen M, Abrahamsen B, Jorgensen HL. et al. Duration of over- and under-treatment of hypothyroidism is associated with increased cardiovascular risk. Eur J Endocrinol 2019; 180: 407-416