Tiredness, cold intolerance, dry skin and hair, and bowel problems are just some of the complaints that might indicate a thyroid condition. A simple blood test can often confirm that diagnosis if it shows increased levels of thyroid-stimulating hormone (TSH). However, correctly diagnosing a person over the age of 70 with a thyroid condition may not be so simple.

The symptoms associated with underactive thyroid—called hypothyroidism—also are commonly associated with normal aging. This includes elevated TSH levels. Johns Hopkins endocrinologist Jennifer Mammen, M.D., has been studying why TSH naturally increases with age, as well as the increasing mistreatment of hypothyroidism in older individuals. The risks associated with over-treatment of thyroid hormone replacement therapy can accumulate over time. “It can lead to atrial fibrillation and increased risk of stroke, as well as lower bone density, osteoporosis and fractures,” she explains. “These are serious health risks, especially for older adults.”

Dr. Mammen recommends working closely with your physician. “If you’re not feeling better after an appropriate trial of thyroid hormone replacement therapy, your diagnosis and treatment should be reconsidered.”