Primary Hypothyroidism in Older Adults: Do Current Guidelines Need an Update?

Abstract

Purpose of research. This review evaluates the current knowledge regarding primary hypothyroidism in patients aged 65 and older, focusing on the oldest-old, to determine if recent scientific evidence warrants updating prevailing clinical guidelines.

Research materials and methods. A narrative review of current medical literature was conducted. The analysis encompassed guidelines from international endocrine societies (ETA, ATA, AACE), observational studies, meta-analyses, and pivotal multicenter randomized controlled trials assessing the efficacy and safety of levothyroxine (L-T4) therapy in the geriatric population.

Basic results. Mildly elevated serum TSH levels in older adults frequently normalize spontaneously and may represent an adaptive physiological mechanism promoting longevity. Large-scale randomized controlled trials demonstrate that routine L-T4 treatment for subclinical hypothyroidism (SCH) in older patients yields no clinically significant benefits regarding symptom alleviation, quality of life, or cardiovascular outcomes. Furthermore, inappropriate hormone replacement significantly increases the risk of iatrogenic complications.

Conclusions. Current evidence does not justify the routine pharmacological treatment of SCH in the elderly. The preferred clinical strategy is watchful waiting and strict adherence to the "start low and go slow" principle. There is an urgent need to update guidelines and implement age-specific serum TSH reference ranges to prevent overdiagnosis.