I would appreciate your input on the following case: a 103 yrsold white female, was first diagnosed with hyperthyroidism 6 month ago, but she was followed up w/t therapy. There is no known thyroid disorder in the family.Thyroid was normal in size. Since the beginning of January are clinicallypresent diarrhea,nervousness, palpitations, breathlessness. Geriatric physician gave her beta blockers with a partial resolution of symptoms.
Thyroid tests are as follow: FT3 —–4.14 pg/ml (1.45-3.48), FT4——2.45 ng/dl (0.71-1.85) , TSH 0.007 micro IU/L (0.4-2.8 ), Anti TPO antibody 41 IU/ml ( 0.0-12), Anti TG antibody 15.1 IU/ml (0.0-34).
How do I best manage the patient? Do I start methimazole?
Prof. Daniele Danese
Università “La Sapienza” Roma
You do not mention the thyroid, or eye symptoms, but everything seems to fit with Graves’ disease of moderate severity. I can not speak based on a string of cases in 103 year old patients! However, I may offer the following. In general her life would be simpler with definitive treatment, rather than continued antithyroid drugs. Thus if she seems fairly well, and to have expectancy to live on another year(s), I would choose therapy with RAI over continued ATD. Usually therapy is intended to effectively ablate the thyroid. If she has no eye symptoms, it might be sensible to use a lower dose intended to reduce function to normal, but not ablate. That might, or might not work, but little would be lost in the effort, except the possible need to retreat at a later date.
L De Groot, MD