From the Research
For an 82-year-old male with hypothyroidism, the target TSH level should generally be between 4.0-7.5 mIU/L, as older adults often benefit from slightly higher TSH levels, with the upper limit of normal being 7.5 mIU/L for patients over age 80 1.
Key Considerations
- Treatment typically involves levothyroxine (T4) replacement, starting at a lower dose of 25-50 mcg daily for elderly patients, with gradual increases every 6-8 weeks based on TSH monitoring.
- Dose adjustments should be made cautiously in this age group to avoid overtreatment, which can increase risk of atrial fibrillation, osteoporosis, and falls.
- Morning administration on an empty stomach (30-60 minutes before breakfast) with water is recommended for optimal absorption.
- Certain medications like calcium supplements, iron, and proton pump inhibitors can interfere with absorption, so separate timing by at least 4 hours is advised.
Monitoring and Management
- Regular TSH monitoring every 6-8 weeks during dose adjustments and then annually once stable is important.
- In elderly patients, symptoms of hypothyroidism may be subtle or attributed to aging, so clinical assessment alongside laboratory values is essential for proper management.
- The goal of treatment is to normalize signs and symptoms, as well as to achieve thyroid-stimulating hormone (TSH) concentrations within the reference range, on an individual basis, with consideration of age-dependent TSH goals 1.