When I was in medical practice, a reasonably common complaint in my older patients was shaking hands. Because I am now a representative of the 70-plus club, shaking hands are a complaint of my similarly aged friends. The shaking usually is a benign condition, but can also be part of a number of underlying health conditions. This article will discuss the more common possible causes of hand-shaking, but this complaint needs to be discussed with your doctor.

Essential tremor

This type of tremor is present in about 20 percent of individuals aged 65 and up. It comes on gradually—often starting in one hand and then moving on to both. 

The tremor can be suppressed by the person when doing a task. People notice this tremor when carrying a cup of coffee or plate in one hand. 

It is also associated with voice tremor, a decline in handwriting legibility and an inability to catch items with one hand. 

It may have a genetic cause. 

Treatment is very basic. Most experts start with advising the person to cut down or stop caffeinated drinks and to cut back on alcohol intake. For many, this is enough. 

There is a surgical procedure for severe essential tremors.

Parkinson’s disease (PD)

One of the common concerns when a person develops a tremor is whether this is parkinsonism. It is the second most common neurologic disease after Alzheimer’s. It is estimated that there are over 500,000 U.S. citizens with this condition. 

Most PD patients are diagnosed by the age of 60. Generally, the tremor of this condition occurs with involuntary or uncontrolled body movement, especially the hands. 

PD is accompanied by other early symptoms, aside from a tremor of the hand. They include slowing movement, rigidity and changes in facial expressions. 

It can start on one side, but the signs progress more rapidly, affecting other parts of the body. 

There are a number of treatment options open to people with PD. Again, if you notice a tremor, check it out with your doctor.

Overactive thyroid disease—thyroiditis

A common condition seen in general practice is people presenting with overactive thyroid. The thyroid gland is the master organ that controls most bodily functions. Usually there is a feedback mechanism that releases just enough hormone to control one’s metabolism. If this gland becomes inflamed, it will dump its stored hormone into the system, causing a number of problems. Common problems include increased blood pressure, increased appetite, rapid heartbeat at rest, sleep disturbance and in some cases weight loss.

The tremor associated with this condition can be barely noticeable but may be severe enough that the person cannot hold anything, The tremor is usually fine in frequency and cannot be suppressed. 

Hyperthyroidism is associated with a family history, Type 1 diabetes, female gender, age over 60, and pernicious anemia. 

Treatment of tremor due to hyperthyroidism is centered on the use of thyroid-suppressing drugs, beta blockers and eventually surgery or radio-ablation of the gland. 

Other causes of shaking of the hands:

Multiple sclerosis (MS): Tremors of the hands and lower extremities can be controlled with medication.

Excessive caffeine can either exacerbate essential tremors or cause a tremor due to excessive stimulation.

Lack of sleep can indirectly cause shaking hands but is addressed by returning to a normal sleep cycle.

Alcohol withdrawal in people who are addicted. 

It is also associated with liver disease and damage to liver cells regardless of cause. 

Excessive stress that you are experiencing might first show as a tremor and high blood pressure. Sometimes controlled breathing exercises will reduce this.

Persons who are diabetic and undergoing a period of reduced blood-sugar levels will sometimes experience shaking of the hands. 

Other conditions associated with a tremor include smoking, lack of B12, and pheochromocytoma (rare), tardive dyskinesia and post-traumatic brain injury or stroke.

Medications such as antidepressants can cause shaking hands too. If a medication lists hand tremors as a side effect, an alternative medication should be tried. 

The observation of shaking hand(s) should always be shared with your doctor because it is associated with a number of potentially serious underlying conditions.