SAT-327 - Graves' Dise Ase: A Paradigm Shift in the 21St Century for Elderly Patients

It is recognized that in elderly subjects with Graves’ disease (GD), cardiovascular symptoms and signs predominate. Other features may include apathy, weight loss, and decline in cognitive function. However, with widespread screening of thyroid disorders, early diagnosis and prompt treatment are possible and thus GD, especially in elderly subjects, can be managed before significant cardiovascular or severe neurological disorders manifest. We report 3 patients aged 80–92 years old who were managed successfully with a low dose of methimazole.
Case 1
A 92-year-old female presented to the Endocrinology clinic with a history of 15-lb weight loss, palpitations, and heat intolerance. Examination: HR 89/min, BP 120/88 mmHg, patient had no evidence of thyroid eye disease (TED), thyroid gland diffusely enlarged (40 gms). The rest of the examination was normal. Labs: TSH < 0.01 μU/mL (ref 0.4–4.4); Free T4 2.9 ng/dL (ref 0.8–1.9); T3 387 ng/dL (ref 76–193); Thyroid stimulating immunoglobulin (TSI) 2.9 IU/L (ref < 0.55). Ultrasound showed a diffusely enlarged thyroid with hypervascularity. I131 uptake at 24 hours: 54% with I131 scan diffuse uptake. A diagnosis of GD was made. Patient was treated with 20 mg of methimazole/day initially then tapered down to 2.5mg/day after 9 months. . Patient requested continued treatment with methimazole.

Case 2
An 84-year-old female presented with a history of 22- lbs. weight loss and palpitations. Physical examination: HR 92/min, BP 134/86 mmHg, no evidence of TED, thyroid gland was diffusely enlarged. The rest of the examination was normal. Laboratory: TSH < 0.001 μU/mL; Free T4 3.1 ng/dL; Total T3 289 ng/dL; TSI 3.8 IU/L. I131 uptake at 24 hours: 48% with I131 thyroid scan diffuse uptake. The patient was treated with 25 mg methimazole and tapered down to 2.5mg/day over 8 months. . Patient requested continued treatment with methimazole.
Case 3
An 88-year-old female was referred to the Endocrinology clinic for evaluation of hyperthyroidism. She had a history of 19-lbs weight loss, insomniainsomnia, and heat intolerance. Examination: HR 90/min, BP 112/74 mmHg, no evidence of TED, thyroid gland was diffusely enlarged. The rest of the examination was normal. Laboratory: TSH < 0.01 μU/mL; Free T4 3.1 ng/dL; Total T3 368ng/dL; TSI 4.2 IU/L. I131 uptake at 24 hours: 62% with thyroid diffuse uptake. The patient was treated with 20 mg methimazole which was tapered down to 2.5 mg/day over the course of 8 months. Patient requested continued treatment with methimazole.

Conclusion: Early diagnosis and prompt treatment of GD in elderly subjects are effective in restoring a euthyroid status. These strategies can avoid the cardiovascular and neurological manifestations associated with hyperthyroidism seen in the past in this population.

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