What testing is required for a 70-year-old patient with a history of Hashimoto's (Autoimmune) Thyroiditis?

From the Guidelines

For a 70-year-old patient with Hashimoto's thyroiditis, regular monitoring of thyroid function through serum TSH testing is crucial, with follow-up testing of serum T4 levels if TSH levels are persistently abnormal, as recommended by the USPSTF 1. The primary goal of this monitoring is to prevent complications of both under- and over-treatment, which can have significant impacts on morbidity, mortality, and quality of life.

• Key aspects of management include:
  • Monitoring TSH levels at least annually, with more frequent testing if symptoms change or if the patient is experiencing side effects from treatment
  • Adjusting levothyroxine doses as necessary, taking into account the patient's age and changing metabolism
  • Considering bone density testing due to the increased risk of osteoporosis associated with hypothyroidism
  • Regular lipid panels to monitor the potential effects of thyroid dysfunction on cholesterol levels These recommendations prioritize the prevention of cardiovascular and cancer-related morbidity and mortality, as well as falls, fractures, and declines in functional status and quality of life, which are critical considerations in the management of elderly patients with Hashimoto's thyroiditis 1.
• It is also important to note that while detection and treatment of abnormal TSH levels are common practices, evidence that these interventions improve important health outcomes is lacking, highlighting the need for long-term randomized controlled trials to inform clinical decision-making 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Testing for a 70-year-old patient with Hashimoto's thyroiditis

To determine the necessary testing for a 70-year-old patient with a history of Hashimoto's thyroiditis, several factors should be considered:

• The patient's current thyroid function status
• The presence of any symptoms suggestive of hypothyroidism or hyperthyroidism
• The patient's medical history and presence of any comorbidities

Laboratory Tests

The following laboratory tests may be useful in evaluating a patient with Hashimoto's thyroiditis:

• Thyroid-stimulating hormone (TSH) levels to assess the functional status of the thyroid gland 2
• Free thyroxine (FT4) and free triiodothyronine (FT3) levels to evaluate the patient's thyroid hormone levels 2
• Thyroid peroxidase antibodies (TPO-Ab) to confirm the diagnosis of Hashimoto's thyroiditis 3, 2
• Thyroglobulin (Tg) and thyroglobulin antibodies (Tg-Ab) to assess for the presence of thyroid cancer or other thyroid disorders 2

Clinical Considerations

When interpreting laboratory results, it is essential to consider the clinical context, including:

• The patient's symptoms and medical history 2
• The presence of any comorbidities that may affect thyroid function 2
• The potential for assay interferences or effects of concurrent medications on laboratory results 2

Additional Testing

In some cases, additional testing may be necessary, such as:

• Thyroid ultrasound to evaluate the thyroid gland for nodules or other abnormalities
• Fine-needle aspiration biopsy to assess for thyroid cancer
• Radioactive iodine uptake scan to evaluate thyroid function and detect any abnormalities in thyroid hormone production 4

Management

The management of Hashimoto's thyroiditis typically involves:

• Levothyroxine (LT4) replacement therapy to normalize thyroid hormone levels 3, 5, 6
• Regular monitoring of TSH and free thyroid hormone levels to adjust LT4 doses as needed 3, 5, 6
• Consideration of liothyronine (LT3) therapy in patients with persistent symptoms despite adequate LT4 treatment 5, 6