You're never too old to have an underactive thyroid

When a person's thyroid hormone level gets too low nearly every system in the body is affected. An underactive thyroid (hypothyroidism) can set off a wide range of symptoms that can include fatigue, depression, weight gain, constipation, and dry skin.

While typical of an underactive thyroid, all those symptoms could be easily attributed to other medical problems. And in people over 60, symptoms of hypothyroidism can be more confusing. Any of the following health issues in a person over 60, alone or in combination, could mean an underlying thyroid problem. 

• Unexplained high cholesterol. High cholesterol is sometimes the only evidence of an under active thyroid in an older person. Because this may be the only symptom, a high cholesterol level warrants a thyroid evaluation.

• Heart failure. Some of the effects of low thyroid hormone levels — for example, reduced blood volume, weaker contractions of the heart muscle, and a slower heart rate — may contribute to heart failure. (Heart failure describes a condition in which the heart doesn't pump blood effectively to the muscles and organs of the body). Symptoms of heart failure include breathlessness, swelling in the ankles, weakness, and fatigue.

• Bowel movement changes. An older person with hypothyroidism might have constipation because of decreased movement of stool through the bowels. Less often, an older person will have frequent bouts of diarrhea, which is more typically a symptom of an overactive thyroid. Persistent or severe diarrhea in an older person always warrants a call to the doctor.

• Joint or muscle pain. Vague joint pain is a classic symptom of hypothyroidism. It sometimes is the only symptom of hypothyroidism in an older patient, although many experience an overall muscular aching, particularly in large muscle groups.

• Mental health concerns. As with younger people, depression is common among older people with an underactive thyroid. The difference is that in older people it can be the only symptom. An older person could also develop other psychiatric symptoms including delusions or hallucinations.

• Dementia. Debilitating memory loss — often but not always, accompanied by depression or some kind of psychosis — can also occur as the only symptom of hypothyroidism. If you or a loved one is being evaluated for dementia, be sure that thyroid tests are part of the work up.

• Problems with balance. Abnormalities in the cerebellum at the back of the brain that occur with an underactive thyroid may lead to walking problems in older people.

If you or someone you love is living with thyroid disease, learn how to take control of your condition and be an active participant in your care by purchasing Thyroid Disease, a Special Health Report from Harvard Medical School.