Schilddrüsenfunktionsstörungen gehören zu den häufigsten endokrinologischen Krankheitsbildern.
Mit zunehmender Lebenserwartung steigt auch die Zahl der betroffenen älteren Patienten.
Gleichzeitig sind Veränderungen der Schilddrüsenhormonphysiologie Teil des Alterungsprozesses,
sodass Diagnostik und Therapie in Abhängigkeit vom Lebensalter variieren. Der Beitrag
beleuchtet die Besonderheiten bei älteren Patienten mit Schilddrüsenfehlfunktionen.
Abstract
Thyroid dysfunctions are common endocrine disorders. With an increasing number of
older persons in European societies, the number of older patients affected will also
rise. The physiology of thyroid hormones and their regulation change with increasing
age. The age-dependent increase of thyroid stimulating hormone (TSH) is clinically
most relevant, but many laboratories do not provide age-specific reference ranges.
Older patients also have more comorbidities and thyroid dysfunctions will have a negative
impact on many of these, in particular on cardiovascular disorders. While there are
clear indications to treat overt hyperthyroidism and hypothyroidism, treatment recommendations
for subclinical thyroid dysfunctions differ depending on the patient’s age. The European
Thyroid Association suggests a TSH level of 0.1 mU/l for patients with subclinical
hyperthyroidism older than 65 years as threshold. A TSH level < 0.1 mU/l is a clear
indication for treatment while concentrations > 0.1 mU/l are relative treatment indications.
Patients older than 65 years with subclinical hypothyroidism and a TSH level > 10
mU/l should also be treated, in particular when cardiovascular comorbidities are present.
Levothyroxine treatment has to be monitored on a regular basis, as overdosing is also
harmful. For patients with TSH concentrations between 7 and 10 mU/l there is no clear
indication to initiate a levothyroxine treatment, as they do not have a clearly elevated
mortality and morbidity, also quality of life does not improve.
Schlüsselwörter
Hypothyreose - Hyperthyreose - Therapie im Alter
Key words
hypothyroidism - hyperthyroidism - therapy in old age
