MON-415 Unexpected New Onset of Grave’s Disease in an 80 Year Old Female

Abstract Disclosure: A.C. Lopez: None. M. Shahid: None. J.M. Chehade: Abbvie. Introduction: Grave’s disease (GD) is by far the most common etiology for hyperthyroidism across all age groups. Geriatric patients often have a subclinical presentation without the classical signs of thyrotoxicosis, one third of this population may present with apathetic hyperthyroidism, requiring careful elucidation from the diligent clinician. Case presentation: An 80-year-old female, with a past medical history of hypertension, osteoporosis, 3rd degree heart block and heart failure with pacemaker placement, and cataracts, who presented with 8lb weight loss over few months and feeling down. She denied chest pain, shortness of breath, tremors, palpitations, vision change, cold/heat intolerance, mood changes, diaphoresis, and throat pain. She denied exposure to amiodarone, iodine, or recent viral illnesses. She denied compressive symptoms and reported no family history of thyroid or other autoimmune disease. On physical examination, Hertel exophtalmometer measurements were recorded as follows: base 119mm, right eye 17mm, and left eye 17mm (normal values are 12-21 mm). No thyromegaly or bruit appreciated, no hand tremors, reflexes 2+ throughout and heart rate 84. Thyroid functions studies were performed. TSH < 0.005, FT3 8.1 FT4 2.1, elevated TSI ab 10, TPO ab 71. TSH from 2 years prior was 1.08. She was started on methimazole 5 mg TID. Thyroid ultrasound reported an heterogenous highly vascular gland, consistent with GD. After 4 weeks, methimazole was reduced to 5 mg daily with normalization of her FT3 and FT4. Discussion: Our case further illustrates the unexpected diagnosis of late-onset GD, given the patient’s advanced age. Its prevalence is estimated up to 0.5% to 3% of geriatric patients. GD incidence peaks at age 40-60, though toxic adenomas and toxic multinodular goiters usually arise in those older than age 70. Due to this change in prevalence, autonomy is more common than GD in older adults with thyrotoxicosis. GD manifestations in the elderly can be subtle, presenting a unique challenge in diagnosis and management. The most common symptoms when compared to younger patients include emaciation, weight loss, anorexia, and arrhythmia. Less common symptoms are goiter, exophthalmos, and increased appetite. Complications can include congestive heart failure (HF) and atrial fibrillation. The paucity of clinical signs of hyperthyroidism in older adults (age≥70) has been confirmed by several studies. Laboratory findings are often significant for lower FT3, FT4, and antibodies when compared to younger patients. GD in the elderly may accelerate the occurrence of cataracts, age-related hearing impairment, COPD, and sarcopenia. The absence of classical symptoms and signs in older adults presents a diagnostic challenge and may lead to delay in treatment and poor outcome if not recognized. Ref: J Clin Endocrinol Metab, June 2010, 95(6):2715–2726 Presentation: Monday, July 14, 2025