Bradypnea, diminished vital capacity and total lung capacity, dyspnea
Hypoactive bowel sounds and abdominal bloating
Swollen hands, swollen feet and leg edema
Dementia, paranoid ideation, slow delayed reflexes and cerebellar ataxia
Dry skin, pale, course dry hair, brittle nails, hair loss, and temporal thinning of eyebrows
Differential diagnosis for hypothyroidism includes:
Coronary heart disease
Congestive heart failure
Chronic kidney disease
Diagnostic tests to order if you suspect hypothyroidism include:
Thyroid panel (TSH, Free T4)-
Overt hypothyroidism will demonstrate an increase in TSH and a decrease in T3 and T4 levels
Subclinical hypothyroidism may show an increased but normal level of TSH with normal levels of free T4
CBC for anemia
Daily thyroid replacement.
Thyroid replacement doses are based on laboratory results.
Older adults may metabolize T4 more slowly than younger persons. Dosage adjustment may be necessary.
When prescribing a daily thyroid replacement remember a few points:
Prescribe with caution in older adults with cardiovascular co-morbidities.
Educate patients about how to take medications – same time each day, on an empty stomach, full glass of water.
Avoid concomitant use with aluminum hydroxide antacids as it prevents absorption of the thyroid replacement.
Avoid calcium supplements within 4 hours of thyroid replacement due to decrease in absorption of thyroid replacement.
Thyroid replacement may interfere with the MOA of the following medications: tricyclic antidepressants, aminophylline, theophylline, warfarin, phenytoin, carbamazepine, beta blockers, digoxin and testosterone (DeLong, 2012).
Agency for Healthcare Research and Quality (2010). Thyroid function tests: Diagnoses and monitoring of thyroid function disorders in adults. Retrieved from:
http://www.guideline.gov/content.aspx?id=38907&search=hypothyroidism Last accessed November 1, 2013. Carroll, P. (2009). Hypothyroid disease. Evidence –based nursing monographs. Retrieved from http://www.nursingconsult.com/das/news/body/206944645-2/ebnm/0/214405/1.htm Last accessed June 23, 2010.
DeLong, M.F. (2012). Thyroid dysfunction. CME Resource. Retrieved from www.NetCE.com June 23, 2010.
The American Thyroid Association. (2012). Thyroid Disease in the Older Patient. Retrieved from http://www.thyroid.org/patients/patient_brochures/older_patient.html. Last accessed November 1, 2013.