SAT-352 Successful Medical Management Of Graves' Disease In A 99-year-old Patient: Navigating Hyperthyroidism In The Very Elderly

Abstract Disclosure: A. khan: None. F. Shah: None. Z. Ilyas: None. Introduction: We report a case of Graves' disease in a 99-year-old woman, the oldest known patient with this condition, managed successfully with medical therapy alone. Hyperthyroidism in the very elderly presents unique challenges due to its rarity and associated comorbidities, which will be covered in this article. Case Presentation: The patient, with chronic kidney disease, anemia, and frailty, presented with atypical symptoms of hyperthyroidism, including significant weight loss. Laboratory tests confirmed thyrotoxicosis and strongly positive Graves' disease markers. Methimazole was initiated and carefully adjusted to maintain euthyroidism, considering her declining renal function and anemia. Due to high surgical risks, alternative treatments were not pursued. By late 2023, she was weaned off methimazole, maintaining stable thyroid function through early 2025. Discussion: Overt hyperthyroidism, marked by low TSH and high T3/FT4 levels, affects 0.2-1.4% globally and raises risks for cardiac issues and osteoporosis, requiring prompt management. Graves' disease is the leading cause, impacting 2% of women and 0.5% of men. In the elderly, hyperthyroidism prevalence is 0.5-4%, often due to overtreatment. Older adults typically show atypical symptoms like weight loss and tachycardia. Treatment for Graves' includes antithyroid drugs (ATD), thyroidectomy, and radioiodine therapy, with methimazole preferred for elderly patients due to lower risks. ATD therapy should last 12-18 months, adjusting methimazole based on thyroid levels. Long-term methimazole is safe and cost-effective. Remission is achieved when thyroid levels remain normal for a year post-treatment. In our case, the patient maintained normal thyroid function and symptom-free status a year after stopping methimazole, highlighting the importance of vigilant monitoring and shared decision-making. Conclusion: This case demonstrates effective management of Graves' disease in a 99-year-old using methimazole, emphasizing individualized care and monitoring. It emphasizes the need to consider hyperthyroidism in the elderly, who often show atypical symptoms and are typically screened for hypothyroidism, not hyperthyroidism. At age 103, the patient remains stable, illustrating that tailored medical therapy is a safe and effective option for managing Graves' disease in older adults. Presentation: Saturday, July 12, 2025