Thyroid and Parathyroid Diseases in Elderly Patients

  • Silvestro Canonico
  • Massimo De Falco
  • Giuseppe Santangelo
Chapter

Abstract

Goiter size is likely to be larger in geriatric patients than in young people. If a hypothyroidism is recognized, symptoms can be characterized by bodyweight gain, asthenia and fatigue, hypersomnia, heat intolerance, myxedema, constipation, skin and appendages disorders, psychiatric depression, altered consciousness or impaired concentration ability and heart failure; in cases of regular functions, symptoms may only be mechanical, such as dyspnea, dysphagia and rarely dysphonia. To assess the thyroid function, the dosage of TSH, FT3 and FT4 is necessary together with the measurement of Ab-hTg and Ab-TPO. Instrumental diagnosis consists firstly of an US-scan; chest and thorax CT scan are required in cases of sub sternal widening. The diagnostic has to be completed by performing a needle biopsy, in cases of solid lumps with suspicious characteristics.

The definition of toxic goiter refers to a thyroid enlargement with overproduction of thyroid hormones. Even when dealing with geriatric patients, a surgical treatment of the multinodular goiter is considered best practice: surgical options, in the case of bilateral pathology, are total or subtotal thyroidectomy. A thyroid lobectomy may be performed in cases of monolateral pathology.

The cancers that can be generated from the follicular thyroid epithelium are papillary and follicular cancers, and anaplastic thyroid cancers. Other forms (lymphomas, miscellaneous tumors, metastatic tumors, non-classified tumors) are rare. Parafollicular cells can instead give rise to medullary cancer. Thyroid carcinoma is not always symptomatic and it can be accidentally diagnosed when other analyses are being carried out for other purposes. When symptomatic, the carcinoma reveals itself with a swelling in the iodine neck area that can be of higher consistency and hypomobile compared with superficial layers. Carcinomas should be treated with total thyroidectomy and therapeutic lymphadenectomy.

Keywords

Goiter Hypothyroidism Toxic goiter Cancers 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Silvestro Canonico
    • 1
  • Massimo De Falco
    • 1
  • Giuseppe Santangelo
    • 1
  1. 1.Department of Medical, Surgical, Neurological, Metabolic and Geriatric SciencesUniversity of Campania Region “Luigi Vanvitelli”CasertaItaly

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