Thyroid Research Thyroid Research Archive Hyperthyroidism

Multinodular goiter is the most common cause of hyperthyroidism in older people

(November 2003)

The background of the study. Multinodular goiter and Graves' disease are common causes of hyperthyroidism, and their frequency varies according to patient age. In this study the causes of hyperthyroidism in patients ≥55 years of age was studied.

How the study was done. The study subjects were 313 patients (246 women, 67 men) ≥55 years of age with overt or subclinical hyperthyroidism seen at a single clinic in Spain. The cause of hyperthyroidism was determined by the results of clinical, serologic, thyroid radionuclide uptake and imaging studies, and thyroid ultrasonography.

The results of the study. There were 263 patients with spontaneously occurring hyperthyroidism and 50 patients with hyperthyroidism caused by excessive thyroid hormone therapy; 167 patients had overt hyperthyroidism (high serum thyroid hormone and low serum thyrotropin [TSH] values) and 146 patients had subclinical hyperthyroidism (normal serum thyroid hormone and low serum TSH values). The most common causes of spontaneously occurring hyperthyroidism were multinodular goiter (135 patients [43 percent], Graves' disease (67 patients [21 percent]), and thyroid adenoma (37 patients [12 percent]).

Among the patients with previously diagnosed hyperthyroidism, all of the 93 patients with overt hyperthyroidism had been treated. Most patients with Graves' disease were treated with an antithyroid drug, whereas most of the patients with a multinodular goiter or thyroid adenoma were treated with radioiodine. Among the 72 patients with previously diagnosed subclinical hyperthyroidism, most of whom had a multinodular goiter, few had been treated. Whether overt hyperthyroidism developed during follow-up in any of these patients is not stated.

The conclusions of the study. Among elderly patients a multinodular goiter is the most common cause of hyperthyroidism.

The original article. Diez JJ. Hyperthyroidism in patients older than 55 years: an analysis of the etiology and management. Gerontology 2003:49:316-23.