1
روان شناسی و مشاوره::
تیروییدیسم
The prevalence of hyper- thyroidism is estimated to be 0.5%-3% in the aging population.4,6-9 Toxic multinodular goiter is a common cause of hyperthyroidism in older adults living in areas of low iodine intake;10 Graves' disease is an impor- tant cause of hyperthyroidism in older adults living in regions of higher iodine intake.8 In aged patients, hyper- thyroidism may also be precipitated by excess iodine intake from drugs or radiographic contrast agents4; sub- acute thyroiditis can also be noted at an increased rate.
The classical symptoms of hyperthyroidism are often reduced in aging patients with Graves' disease, except for weight loss and atrial fibrillation.11 Although apathetic hyperthyroidism is more common, the classical symptoms of hyperthyroid- ism may be seen older patients with more severe hyper- thyroidism, and in smokers.12
Atrial fibrillation is an important age-related sign of hyper- thyroidism.13 In addition, older adults with hyperthy- roidism experience an increased rate of gastrointestinal symptoms, such as diarrhea, loss of appetite, nausea, persistent vomiting; and neurological symptoms such as mania, depression, and cognitive impairment, includ- ing dementia.14 Elevated T4 levels in the elderly are also associated with loss of bone density, increased fracture risk (e.g.
The most common cause of subclinical hyper- thyroidism is excessive replacement of thyroid hormone that is recognized as asymptomatic lower serum TSH levels <0.1 ng/dL.27 Subclinical hyperthyroidism can also result from Graves' disease and toxic multinodular goiter.
Although some studies suggest that subclinical hyper- thyroidism increases relative mortality risk, a larger number of studies do not seem to suggest increased car- diovascular and overall mortality risk.21,22,30,39-42 If one elects to treat subclinical hyperthyroidism in the elderly, the treatment options are similar to those in younger patients (e.g.
واژگان شبکه مترجمین ایران