From the Research
For a 93-year-old patient, the normal TSH reference range is typically 0.4-4.0 mIU/L, but a slightly higher upper limit of normal (up to 7.0 mIU/L) may be acceptable without treatment if the patient is asymptomatic, as suggested by recent clinical guidelines 1. When evaluating TSH in a 93-year-old, consider the patient's clinical status rather than just the laboratory value.
- If the TSH is mildly elevated but the patient has no symptoms of hypothyroidism, watchful waiting with repeat testing in 3-6 months may be appropriate.
- For symptomatic hypothyroidism, start levothyroxine at a low dose (12.5-25 mcg daily) and increase gradually every 6-8 weeks while monitoring TSH and symptoms.
- For hyperthyroidism with suppressed TSH, begin with low-dose methimazole (5-10 mg daily) and adjust based on response, as supported by a study on hyperthyroidism treatment 2. Elderly patients are more sensitive to both thyroid hormone excess and replacement therapy, so a "start low, go slow" approach is essential to avoid cardiac complications, as emphasized in a review of thyroid hormone therapy 3. Always evaluate for medication interactions and consider non-thyroidal illness that may affect TSH levels in this age group, as highlighted in a study on thyroid-stimulating hormone stimulation 4. In general, the management of TSH levels in elderly patients should prioritize a patient-centered approach, taking into account the individual's clinical status, symptoms, and potential risks and benefits of treatment, as recommended by a recent review on hyperthyroidism treatment 1.