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Background

Hypothyroidism results from lack of sufficient thyroid hormone being produced by the thyroid gland. Older adults may have subclinical hypothyroidism, in which the TSH (thyroid-stimulating hormone) is elevated and the T4 (thyroxine or thyroid hormone) is normal; 4.3–9.5% of the general population has this problem (Woolever & Beutler, 2007). In this condition, the body is trying to stimulate production of more thyroid hormone. Some older adults with this condition will progress to have primary or overt hypothyroidism. This is when the TSH is elevated and T4 is decreased. Hashimoto’s disease is the most common cause and represents 90% of all patients with hypothyroidism (American Association of Clinical Endocrinologists [AACE], 2005; Woolever & Beutler, 2007), though certain pituitary disorders, medications, and other hormonal imbalances may be causal factors.

Warning Signs

Older adults may present an atypical picture, but the most common presenting complaints are fatigue and weakness.

Diagnosis

Diagnosis should include a thorough history and physical. Bradycardia and heart failure are often associated factors. Lab tests should include thyroid and thyroid antibody levels (common to Hashimoto’s), and lipids, because hyperlipidemia is also associated with this disorder.

Treatment

Treatment centers on returning the thyroid ¬hormone level to normal. This is done through oral thyroid replacement medication, usually L-thyroxine. In older adults with coexisting cardiovascular disease, starting with the usual doses may exacerbate angina and worsen the underlying heart disease, so it is important to start low and go slow. Titration should be done cautiously, with close monitoring of the older adult’s response to the medication. The does should be adjusted on 6- week intervals until normal levels of thyroid hormone are achieved. Once the TSH is within normal limits, then checking the TSH should be done every 6 to 12 months to monitor effectiveness and blood levels, because hyperthyroidism is a side effect of this therapy and can have serious implications on the older person’s health.

Patients need to learn the importance of taking thyroid medication at the same time each day without missing doses. Sometimes older adults have other problems associated with hypothyroidism, such as bowel dysfunction and depression. Any signs of complicating factors should be reported to the physician, and doctors’ appointments for monitoring should be religiously kept. Strategies for managing fatigue and weakness should also be addressed, because some lifestyle modifications may need to be made as treatment is initiated.

Adapted from Mauk, K. L., Hanson, P., & Hain, D. (2014). Review of the management of common illnesses, diseases, or health conditions. In K. L.
Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Sudbury, MA: Jones and Bartlett Publishers. Used with permission.

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Research indicates that Americans are living longer than any other period in history. The best way to ensure your quality of life in your senior years is by addressing mental and physical health. Here are some tactics that can help make your golden years even more exciting.

Be Active in Your Healthcare
Not only do you need to make sure you have a primary care physician familiar with your health history, you also need to make sure you stay up to date on how you’ll pay for regular checkups, appointments with specialists, and medication. This includes keeping an eye on your Medicare plan and making changes to it as necessary. You may want to consider signing up for a Medicare Advantage plan, which offers perks that regular plans don’t cover. For instance, a Humana Medicare Advantage Plan offers benefits like a Nurse Advice Line, which saves you from the time and hassle of visiting your doctor for every little ache and pain, and enrollment in SilverSneakers, which will help you stay active throughout your golden years — another critical component of your quality of life.

Exercise Regularly
The body isn’t able to repair itself as quickly when we become older — not to mention, the loss of muscle mass contributes to mobility issues. Not only can regular exercise improve both of these concerns, but it can also regulate blood pressure and sugar management, boost mood, strengthen the immune system, improve gastrointestinal function, enhance cognitive ability, prevent heart disease and diabetes, and make it easier to manage weight. There’s no need to push yourself too hard. Even simple walking for 30 minutes four times a week is enough to get going. Seniors can also work out at home with exercise videos, fitness apps, and Wii games.

Eat Well
Eating a healthy diet is crucial at every stage of life, but takes on an even more important role as our bodies change with age. Your doctor may recommend a specific diet that tailors to your unique health needs — if you need to consume more protein or calcium, for example — but in general, you’ll need to eat foods that make your microbiome happy. Not only will eating probiotic-packed and fermented foods help you stay regular, you’ll actually feel happier and more energized overall by taking care of your gut health, since doing so ramps up your body’s production of the feel-happy chemical serotonin.

Improve Quality of Sleep
Research suggests that seniors can benefit from quality and quantity of sleep more than they did in their younger years. There are several tactics that can make it easier to get ample shuteye, since it can be a challenge for the elderly. This includes increasing daytime light exposure, ditching caffeine and alcohol in the evening hours, exercising early in the day, making your bedroom a cool and dark respite, unplugging from electronics at least one hour before bed, and consistent bed- and wake-up times.

Stay Social
It’s important to stay social in order to keep your mental health in check. Some easy ways to stay socially engaged include connecting with friends via social media, joining a club or senior center, volunteering, helping out your family (such as babysitting the grandkids so your adult children can enjoy a date night), and taking up a part-time job.

It’s important that you have an established primary care physician and that you visit him or her regularly. You’re more likely to prevent illness and disease when you’ve got a health care schedule in place (as well as a plan to pay for it). A pro can also direct you to other specialists and help guide you through the financial side of care, too.

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