Thyroid Diseases – Symptoms, Treatment, and Importance for the Elderly

The thyroid gland plays a crucial role in the body's metabolism and affects several vital organs, including the heart, brain, liver, and intestines. Disorders in thyroid function can cause both physical and mental symptoms and can be difficult to detect in the elderly. In nursing homes, it's therefore important to pay attention to signs of thyroid disease and ensure the correct diagnosis and treatment are given.

Thyroid Function and Significance

The thyroid gland is a small but important gland located at the front of the neck. It produces hormones that affect the body's metabolism, energy production, and temperature regulation. When the production of these hormones is disrupted, it can lead to a range of symptoms that can be mistaken for normal age-related changes.

Elderly people might therefore have an undiagnosed thyroid disease contributing to symptoms such as fatigue, weight changes, depression, cognitive impairment, or heart problems. In nursing homes, thyroid function should always be considered during health assessments, especially if a resident exhibits unexplained symptoms.

Hypothyroidism – Lack of Thyroid Hormone

Hypothyroidism means that the thyroid does not produce enough hormones, leading to a slow metabolism. Common symptoms include:
- Fatigue and lack of energy  
- Weight gain  
- Feeling cold  
- Constipation  
- Dry skin and hair loss  
- Swelling in the body  
- Low mood and concentration difficulties  

In the elderly, hypothyroidism can sometimes manifest as confusion, low mood, or swelling, which can lead to misdiagnoses such as depression or dementia. The condition can be treated with thyroid hormones in tablet form, often leading to a significant improvement in symptoms.

Hypothyroidism is a common disease affecting about half a million people in Sweden. Women are at higher risk than men.

Hyperthyroidism – Excess of Thyroid Hormone

Hyperthyroidism means that the thyroid produces too many hormones, leading to an increased metabolism. Common symptoms include:
- Increased heart rate  
- Weight loss despite normal or increased appetite  
- Sweating and feeling hot  
- Sleep disturbances  
- Restlessness and anxiety  
- Feeling of pressure over the throat  

Elderly people with hyperthyroidism can sometimes only exhibit vague symptoms, such as fatigue, palpitations, or muscle weakness. The treatment can include medication that suppresses hormone production, radioiodine therapy, or surgical removal of parts of the thyroid.

In Sweden, there is a national healthcare program for hyperthyroidism to ensure consistent and safe care.

Thyroid Cancer and Benign Nodules

Thyroid nodules, i.e., lumps in the thyroid, can be either benign or malignant. Most nodules are harmless and need only be treated if they cause discomfort, such as a feeling of pressure or swallowing difficulties. If thyroid cancer is suspected, an investigation that can include ultrasound, blood tests, and tissue samples is conducted. Treatment may consist of surgery, radiation, or medication depending on the type and extent of the cancer.

Thyroid Diseases in the Elderly – Why is it Important to Pay Attention?

Since the symptoms of thyroid disease can be diffuse and resemble other age-related ailments, it's important to pay attention to whether:
- A resident with unexplained fatigue or depression has untreated hypothyroidism.  
- A resident who suddenly loses weight or has palpitations has untreated hyperthyroidism.
- A resident with neck swelling or swallowing difficulties has a thyroid nodule.  

If thyroid problems are suspected, a doctor should be contacted to perform necessary blood tests and establish the correct diagnosis.

How can Nursing Homes Ensure Proper Care?

In nursing homes, it's important to have routines for identifying and managing thyroid diseases.
- Regular health assessment – Thyroid tests should be considered at admission and at annual doctor's check-ups, especially if the resident has symptoms that may indicate thyroid disease.  
- Attention to symptoms – Nursing assistants and healthcare staff who notice changes in a resident's energy level, weight, or mood should report this to a nurse or doctor.  
- Follow-up of medication – For those already treated with thyroid hormones, the dosage should be checked regularly as the need can change with age.  
- Adjustment of care – A resident with hyperthyroidism may need adjusted diet and rest, while a person with hypothyroidism may need extra support for mobilization and to avoid low mood.  

Reflection Questions - Thyroid Diseases

Care staff:  
- Do you have residents being treated for any thyroid disease?  
- Have you noticed changes in a resident's energy, weight, or mood that may indicate a thyroid disorder?  

Manager, nurse, occupational therapist, and physiotherapist:  
- Are thyroid tests included in the health assessment at admission or at the annual doctor check-ups?  
- Are there routines for noticing and following up on thyroid-related symptoms in the residents?  

Residents and relatives:
- Have you or your relative been offered thyroid testing at admission or during regular health check-ups?
- Have you noticed any changes in your own or your relative's weight, energy level, or mood that you suspect may be due to the thyroid?
- Do you feel the staff at the nursing home pay attention to potential symptoms that may indicate thyroid disease?

Erland Olsson
Specialist nurse
Sofrosyne - Better Care Every Day