Geriatric Medicine
General
Summary
- Elderly patient with abnormal thyroid levels and multiple comorbidities.
- PCP wanted to know how to proceed with care plan.
- Specialistic provided holistic education appropriate to management of patient avoiding referral while addressing disease burden.
eConsult Transcript
PCP submission
78-year-old female patient with multiple conditions has not had a blood test in over one year. Labs were checked and found to have TSH elevated 6.99, and T4 normal. hyroglobulin antibodies 35. HepC AB positive. Elevated glucose 124. Multiple abnormal labs. Elevated TSH and Normal T4, Hyperlipidemia, Hyperglycemia, and Hept C antibody Positive negative PCR, and non-detectable counts.
How to proceed with a 78-year-old female with multiple abnormal tests. Should be aggressive management.
Specialist response
Thanks for your question. I wouldn’t base any management decisions solely on age, but rather the overall health of the patient. I would try to understand if overall she is in the top quartile for health (very healthy, doing all her own ADLs, iADLs), bottom quartile or middle half. If in the top quartile I would be more aggressive, in the bottom quartile, perhaps less aggressive after having a discussion with her. As far as the elevated TSH with normal T4, first you want to ask about thyroid related symptoms (fatigue, weight gain, heat/cold intolerance). Often, we don’t treat until the TSH >10. So at this point, I would monitor her TSH every 6-12 months. Her hyperlipidemia treatment depends on her comorbidities and her ASCVD score. You can calculate it here: https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/ Based on this, you can decide whether to start a statin. Her elevated glucose should be followed up with an A1c. She may benefit from starting an oral antihyperglycemic agent if her renal function allows it. Lastly, her Hep C antibody with negative PCR means she was Hep C positive in the past, but does not have active disease.
