• Antonio Maria Borzì, Antonio Biondi, Francesco Basile, and Marco Vacante.
• Department of General Surgery and Medical-Surgical Specialties, University of Catania, Via S. Sofia,78, 95123, Catania, Italy.
• Wien. Klin. Wochenschr. 2020 Mar 1; 132 (5-6): 161-167.

PurposeTo review the diagnosis and the treatment of both subclinical and overt hypothyroidism in old people, which could represent a challenge for the clinicians.MethodsNarrative literature review. An extensive literature search was performed using the databases of Scopus, Medline through PubMed, and Google Scholar from January 1975 to May 2019. The search terms were "hypothyroidism," "older adults," "elderly," and "myxedema."ResultsHypothyroidism is more common among older subjects in comparison to the younger counterparts. The hypothalamic-pituitary-thyroid axis and its hormones undergo significant changes due to the physiological aging process. For a correct diagnosis of hypothyroidism in old people clinicians must take such age-related changes into account.ConclusionsThe administration of replacement therapy in older adults should consider frailty, polypharmacy and a high risk to develop overtreatment symptoms. On the other hand, older patients with untreated or undertreated hypothyroidism may develop a state of myxedema coma.

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