Graves' disease. Influence of age on clinical findings

Thyroid hormone in health and disease

“…While these are present in the majority of subjects with overt thyroid hormone excess, their clinical importance is overshadowed by the challenges posed by atrial fibrillation (AF), which occurs in 5-15% of patients with thyrotoxicosis and may be the presenting problem (Sandler & Wilson 1959, Forfar et al 1979, Sawin et al 1994, Gilligan et al 1996. Higher prevalence rates are found in older patients and in those with known or suspected underlying organic heart disease (Forfar et al 1979, Nordyke et al 1988. Despite this clear association between thyrotoxicosis and AF, when subjects with new onset of AF have been investigated, overt hyperthyroidism has been reported to be an uncommon cause (<1%) (Krahn et al 1996), so although hyperthyroidism is a risk factor for AF, this association is uncommon in the absence of additional symptoms and signs of thyrotoxicosis.…”

“…In those with new-onset AF complicating thyrotoxicosis, spontaneous reversion to sinus rhythm may occur in up to 50%, and typically does so within a few months of restoration of euthyroidism (Nakazawa et al 1982). Restoration of normal rhythm is, however, much less likely in those with underlying heart disease or AF of longer duration (Sandler & Wilson 1959, Nakazawa et al 1982, Nordyke et al 1988). In those not returning to normal rhythm spontaneously, pharmacological or electrical cardioversion should be attempted only after the patient has been rendered euthyroid (Nakazawa et al 1982, Klein & Ojamaa 2001.…”

Slowly Progressive Insulin-dependent Diabetes Mellitus in an Elderly Patient with Graves' Disease.

“…The percentage of patients over 70 years old with Graves' disease is 6% (12). The clinical symptoms of thyroid disease are different in older patients than in younger patients ( 1 2-14).…”

“…Patients with IDDMare well known to frequently have coexisting autoimmune thyroid disease (AITD) (6-1 1). Clinically, Graves' disease in the elderly is characterized by the presence of apathetic thyrotoxicosis without typical hyperthyroidism and is considered difficult to diagnose (12)(13)(14)(15). Weexperienced a rare case of SPIDDMwith Graves' disease that first presented as weight loss and apathetic thyrotoxicosis in an elderly patient.…”

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“…Atrial fibrillation is a well-known complication of overt hyperthyroidism, and has been found in 2-30 % at the time of diagnosis of overt hyperthyroidism [43,44]. Although only a low percentage of subjects with AF has a functional disorder of the thyroid gland [45], European Society of Cardiology suggests to evaluate thyroid function in all patient with a recent diagnosis of AF [46].…”