From the Guidelines
Yes, elderly individuals can develop Graves' disease, although it is less common in this age group compared to younger adults. Graves' disease is an autoimmune disorder that causes hyperthyroidism (overactive thyroid) and can occur at any age [(1, 2)]. In elderly patients, the presentation may be more subtle, often called "apathetic hyperthyroidism," with symptoms like unexplained weight loss, fatigue, and heart rhythm disturbances rather than the classic symptoms of anxiety, tremors, and heat intolerance seen in younger patients.
Risk Factors and Screening
The risk factors for hyperthyroidism, which includes Graves' disease, are female sex, advancing age, black race, low iodine intake, personal or family history of thyroid disease, and ingestion of iodine-containing drugs, such as amiodarone [(1, 2)]. The serum TSH test is the primary screening test for thyroid dysfunction, and multiple tests should be done over a 3- to 6-month interval to confirm or rule out abnormal findings [(1, 2)].
Treatment Options
Treatment options for elderly patients with Graves' disease include antithyroid medications like methimazole (typically starting at 5-10 mg daily) or propylthiouracil (rarely used in elderly due to higher risk of side effects), radioactive iodine therapy, or thyroid surgery [(1, 2)]. Beta-blockers such as propranolol (10-40 mg three to four times daily) or atenolol (25-50 mg daily) may be prescribed to control symptoms like rapid heart rate.
Special Considerations in the Elderly
Elderly patients often require careful monitoring due to increased risk of cardiovascular complications and potential drug interactions with other medications they may be taking 3. The underlying cause of Graves' disease is the production of antibodies that stimulate the thyroid gland to produce excess thyroid hormones, disrupting the body's normal metabolic processes. Some key points to consider in the management of Graves' disease in the elderly include:
- Atrial fibrillation occurs in 10% to 25% of patients with hyperthyroidism, more commonly in men and the elderly than in women or patients less than 75 years old 3.
- The presentation of Graves' disease in the elderly may be atypical, making diagnosis more challenging.
- Treatment should be tailored to the individual patient, taking into account their overall health, other medications, and potential risks and benefits of each treatment option.
From the Research
Graves' Disease in the Elderly
- There is no specific information in the provided studies that directly addresses the development of Graves' disease in elderly individuals.
- However, the studies suggest that Graves' disease can occur at any age, with one study stating that it "occurs at all ages but especially in women of reproductive age" 4.
- Another study mentions that the treatment of Graves' disease has not changed substantially for many years and remains a choice between antithyroid drugs, radioiodine, or surgery, without specifying any age-related differences in treatment or development of the disease 4.
- The studies primarily focus on the treatment options and pathogenesis of Graves' disease, rather than the age of onset or development of the disease.
Treatment Options for Graves' Disease
- The treatment options for Graves' disease include antithyroid drugs, radioactive iodine, and surgery, with the choice of treatment depending on the patient's preferences and situation 5, 6.
- Antithyroid drugs, such as carbimazole and its metabolite thiamazole, have been shown to be effective in controlling hyperthyroidism, but carry a risk of rare but serious adverse effects, including agranulocytosis and hepatitis 5.
- Radioactive iodine is administered as a single oral dose and can achieve permanent cure in about 80% of cases, but may exacerbate pre-existing ophthalmopathy or provoke its onset, especially among smokers 5.
- Surgical thyroidectomy may be total or subtotal, with the risk of complications, including hypoparathyroidism and permanent paralysis of the recurrent laryngeal nerve 5, 6.