DETECTION AND TREATMENT OF HYPOTHYROIDISM AND GRAVES-DISEASE

The clinical presentations of thyroid disorders are often subtle in ol der adults and may be confused with ''normal'' aging. To avoid delay i n diagnosis, we recommend, routine TSH screening of all patients age 6 0 and older in the primary care practice. With hypothyroidism, pursue treatment cautiously; start with small doses of levothyroxine and clos ely monitor serum TSH values. When hyperthyroidism is caused by Graves ' disease, begin symptomatic therapy with a beta blocker or antithyroi d drugs, followed by definitive thyroid ablation with radioiodine. Sur gical treatment may be indicated if a goiter causes compressive sympto ms.