Which of the following is inappropriate for older adults due to concerns about cardiac effects and safer alternatives available?

• A. Desiccated thyroid
• B. Megestrol
• C. Growth hormone
• D. Insulin sliding scale

Answer: (A)

Desiccated thyroid is avoided in older adults because it delivers both T4 and T3 with potency that can vary between batches. In the elderly, even small increases in thyroid hormone can raise heart rate and contractility, worsen cardiac conditions, and precipitate atrial fibrillation, angina, or heart failure. A safer, more predictable option is levothyroxine, a synthetic T4 with stable potency that allows careful, gradual titration and monitoring via TSH to achieve normal thyroid levels without triggering thyrotoxicosis. In older patients, starting at a low dose and slow uptitration helps minimize cardiac risk while reaching effective therapy. While other choices carry their own safety concerns in advanced age, the primary reason desiccated thyroid is inappropriate here is the cardiac risk from thyroid hormone excess and the existence of a safer, more controllable alternative.