Department of Medicine and Surgical Sciences, Geriatrics Division, University of Padua, Via Giustiniani 2, 35128 Padova, Italy.
Arch Gerontol Geriatr. 2012 Jul-Aug;55(1):82-4. doi: 10.1016/j.archger.2011.05.003. Epub 2011 Jun 2.
A diagnosis of hypothyroidism in the elderly can easily be overlooked if we rely exclusively on its clinical presentation because this may be highly non-specific, since the signs and symptoms of the disease are common to other diseases typical of old age, and even to the normal aging process. Imaging diagnostics (ultrasound or CT), when considered alone, are also of little use for the purpose of clarifying thyroid gland function. We report here on a case of primary hypothyroidism that was diagnosed late because the correlated signs and symptoms (asthenia, bradycardia, pleural effusions, hyponatremia, worsening renal and respiratory insufficiency, hoarseness) had previously been attributed to the normal aging process and to the patient's other health conditions (Parkinson's disease, PD; chronic obstructive pulmonary disease, COPD). After a couple of weeks of treatment with levothyroxine and liothyronine, there were clinical and laboratory evidences of an improvement in the patient's condition. She became more reactive, with a shriller voice. The pleural effusion disappeared, and so did the bradycardia. Laboratory tests showed normal sodium levels, and the renal insufficiency had improved. The lack of specificity of the clinical presentation of hypothyroidism in the elderly might justify the routine measurement of thyroid-stimulating hormone in these patients.
如果我们仅仅依靠其临床表现来诊断老年人的甲状腺功能减退症，那么很容易被忽视，因为该疾病的体征和症状与老年的其他典型疾病甚至正常的衰老过程高度相似，特异性并不高。影像学诊断（超声或 CT）单独考虑时，对于澄清甲状腺功能也没有太大用处。我们在此报告一例原发性甲状腺功能减退症，由于相关的体征和症状（乏力、心动过缓、胸腔积液、低钠血症、肾功能和呼吸功能恶化、声音嘶哑）以前归因于正常的衰老过程和患者的其他健康状况（帕金森病、PD；慢性阻塞性肺疾病、COPD），因此被诊断得很晚。在接受左甲状腺素和三碘甲状腺原氨酸治疗几周后，患者的病情有了临床和实验室改善的证据。她变得更加活跃，声音更尖锐。胸腔积液消失，心动过缓也消失了。实验室检查显示钠水平正常，肾功能不全有所改善。老年人甲状腺功能减退症临床表现缺乏特异性，可能证明在这些患者中常规测量促甲状腺激素是合理的。
