Warning Signs of a Thyroid Disorder

Most thyroid problems happen because the immune system mistakenly attacks the thyroid gland, Via adds. In what’s known as Hashimoto’s disease, “cells of the immune system damage the tissues of the thyroid gland, ultimately causing an underactive thyroid, or hypothyroidism,” Via says. “At the other end of the thyroid function spectrum, cells of the immune system may produce antibodies that stimulate the thyroid gland, leading to excess thyroid activity, or hyperthyroidism.”  

An autoimmune condition known as Graves’ disease is the most common cause of hyperthyroidism. Hashimoto’s and Graves’ diseases can show up at any point in life, but treatment approaches often vary depending on the patient’s age and other health conditions, Via says.  

Getting older also raises the risk of nodules, or lumps, in the thyroid. More than half of people over 60 have thyroid nodules, compared with around 10 to 15 percent of people in their 20s, Via says.

Though these nodules are almost always benign, some produce excess levels of thyroid hormone, causing hyperthyroidism. “These nodules are known as toxic nodules,” Via says. “The majority of toxic nodules are seen in people between the ages of 50 and 80.” 

Signs and symptoms of a thyroid disorder

Up to 6 in 10 people with a thyroid disorder don’t realize they have it, according to the American Thyroid Association. It’s easy to see why.

Common warning signs include changes in heart rate, mood shifts, sensitivity to temperature and weight changes — all of which can also be symptoms of other common age-related health conditions like cardiovascular disease, osteoporosis, cognitive impairment and depression.

For example, “symptoms of hyperthyroidism have significant overlap with menopause and perimenopausal symptoms, including hot flashes, insomnia, palpitations, irritability and anxiety,” says Dr. Maria Brito, an endocrinologist specializing in thyroid disorders at UT Southwestern Medical Center. “Hyperthyroidism can also exacerbate cardiac arrhythmia like atrial fibrillation,” she adds.

With hypothyroidism, common symptoms include dry skin, brittle hair and nails, listlessness, fatigue, muscle weakness, cold intolerance, weight gain, constipation and reduced concentration or cognition.

A person with hypothyroidism might also notice that other underlying medical conditions worsen. “This is commonly seen in conditions such as type 2 diabetes, depression, heart disease and many others that are exacerbated when a person has untreated hypothyroidism,” Via says.

Further complicating things, some people over age 60 have few, if any, symptoms of hypothyroidism.

How is a thyroid disorder diagnosed and treated?

If you show up for your annual checkup complaining of these symptoms, your doctor will likely order a blood test to check thyroid hormone levels and how well the thyroid is working.

If there is swelling or a lump, they may order an ultrasound. “Most physicians readily screen for thyroid conditions either routinely or early on when exploring differential diagnoses for these symptoms,” Brito says. 

Hypothyroidism is usually treated with a medication (levothyroxine) that basically takes over where your underactive thyroid left off, restoring hormone levels to where they should be.  

“The difference in treating older individuals is that we will typically start with a lower dose,” Schulman says. “Excess thyroid hormone levels — either produced by the thyroid or resulting from excess levothyroxine doses — increase the risk of heart arrhythmias and osteoporosis, particularly in older adults. It’s safest to begin with lower levothyroxine doses and increase the dose if needed.”

Treatment for hyperthyroidism includes anti-thyroid medications, surgery to remove the thyroid and treating the thyroid with radioactive iodine, Schulman says. The goal is to calm an overactive thyroid.

“As far as lifestyle modifications, we typically recommend that older adults with hyperthyroidism avoid strenuous exercise until their thyroid condition is treated,” Schulman adds. “Hyperthyroidism increases the risk of adverse cardiac effects in older individuals, and this risk would be exacerbated by the effects of strenuous exercise.”