Nadczynność tarczycy – Epidemiologia

Nadczynność tarczycy
Epidemiologia

Nadczynność tarczycy (hipertyreoza) charakteryzuje się nadmiernym stężeniem hormonów tarczycy w tkankach i występuje globalnie z częstością od 0,2% do 1,4%. W Europie dotyka około 0,8% populacji, a w USA 1,3%, z podziałem na 0,5% jawnej i 0,7% subklinicznej postaci. Choroba Gravesa-Basedowa jest dominującą przyczyną nadczynności w krajach z wystarczającą podażą jodu, odpowiadając za 60-80% przypadków, z roczną zapadalnością około 50 na 100 000 osób. Wole guzkowe toksyczne i gruczolak toksyczny stanowią odpowiednio 15-20% i 3-5% przypadków. Subkliniczna nadczynność, definiowana jako obniżone TSH przy prawidłowych fT4 i T3, występuje u 1-2% populacji, a u osób powyżej 70. roku życia na obszarach z niedoborem jodu nawet do 15%. Ryzyko powikłań, takich jak migotanie przedsionków, złamania kości i zwiększona śmiertelność z powodu chorób sercowo-naczyniowych, jest szczególnie wysokie przy TSH <0,10 mIU/L.

Epidemiologia nadczynności tarczycy

Częstotliwość występowania na świecie
Roczna zachorowalność
Różnice demograficzne
Różnice geograficzne i wpływ jodu
Przyczyny nadczynności tarczycy
Subkliniczna nadczynność tarczycy

Nadzór nad nadczynnością tarczycy

Wykrywanie i diagnostyka
Badania przesiewowe
Obserwacja i leczenie
Implikacje dla zdrowia publicznego
Trendy i prognozy
Kolejne rozdziały

Epidemiologia nadczynności tarczycy

Nadczynność tarczycy (hipertyreoza) to stan kliniczny charakteryzujący się nadmiernym stężeniem hormonów tarczycy w tkankach organizmu. Częstość występowania tego schorzenia różni się w zależności od regionu geograficznego, zawartości jodu w diecie oraz badanej populacji.¹²

Częstotliwość występowania na świecie

Globalna częstość występowania nadczynności tarczycy wynosi od 0,2% do 1,4% populacji.¹ W Europie szacuje się, że nadczynność tarczycy dotyka około 0,8% mieszkańców, podczas gdy w Stanach Zjednoczonych odsetek ten wynosi około 1,3%.¹ Według badań przeprowadzonych w USA, rozpowszechnienie jawnej nadczynności tarczycy wynosi 0,5%, a subklinicznej nadczynności – 0,7%.¹²

Badanie The Whickham Survey przeprowadzone w 1977 roku w północno-wschodniej Anglii wykazało, że nadczynność tarczycy występuje około 10 razy częściej u kobiet niż u mężczyzn (2,7% kobiet vs 0,23% mężczyzn).¹ W Chinach częstość występowania jawnej nadczynności tarczycy jest podobna jak w krajach zachodnich i wynosi około 0,78%.¹²

W Australii szacuje się, że nadczynność tarczycy dotyka 3 na 1000 osób.¹ Natomiast w Europie średnia częstość występowania nadczynności tarczycy wynosi 0,75% według metaanaliz.¹

Roczna zachorowalność

Nowe przypadki nadczynności tarczycy pojawiają się z częstością około 20-50 na 100 000 osób rocznie w populacjach z wystarczającą podażą jodu.¹ Duże badanie przeprowadzone we Włoszech wykazało całkowitą zapadalność na nadczynność tarczycy wynoszącą 54 na 100 000 osobolat. W Europie średnia zapadalność wynosi około 51 na 100 000 osób rocznie.¹

W przypadku choroby Gravesa-Basedowa, która jest najczęstszą przyczyną nadczynności tarczycy, roczna zapadalność wynosi około 0,5 przypadków na 1000 osób (czyli 50 na 100 000) w populacji ogólnej.¹ W Szwecji odnotowano wzrost rocznej zachorowalności na chorobę Gravesa-Basedowa, z 15-30 nowych przypadków na 100 000 mieszkańców w latach 2000.¹

Różnice demograficzne

Nadczynność tarczycy występuje zdecydowanie częściej u kobiet niż u mężczyzn. Stosunek zachorowań kobiet do mężczyzn wynosi około 5:1, a w przypadku choroby Gravesa-Basedowa nawet 7-8:1.¹² Szczyt zachorowań przypada zazwyczaj między 30. a 60. rokiem życia.¹²

W badaniu obejmującym populację niemiecką oszacowano występowanie przełomu tarczycowego (najcięższej postaci nadczynności tarczycy) na 1,4 przypadku na 100 000 osób rocznie u kobiet i 0,7 przypadku na 100 000 osób rocznie u mężczyzn. Częstość występowania przełomu tarczycowego była trzykrotnie wyższa u osób powyżej 60. roku życia w porównaniu z młodszymi pacjentami.¹

Różnice geograficzne i wpływ jodu

Częstość występowania nadczynności tarczycy różni się w zależności od zawartości jodu w diecie populacji.¹ Na obszarach z niedoborem jodu częściej występuje wole guzkowe toksyczne, natomiast w regionach z wystarczającą podażą jodu dominującą przyczyną nadczynności jest choroba Gravesa-Basedowa.¹²

Częstość występowania subklinicznej nadczynności tarczycy jest wyższa na obszarach z niedoborem jodu niż na obszarach z wystarczającą podażą tego pierwiastka. Zauważono również, że wprowadzenie powszechnych programów jodowania soli prowadzi do zmniejszenia liczby przypadków nadczynności tarczycy.¹

Spożycie jodu ma związek z występowaniem zaburzeń tarczycy w kształcie litery U. Historycznie, regiony z niedoborem jodu obserwowały więcej przypadków nadczynności tarczycy u starszych dorosłych (z powodu wola guzkowego), zwłaszcza po wprowadzeniu programów jodowania (zjawisko, w którym nagłe uzupełnienie jodu „budzi” nadczynne guzki tarczycy). Obecnie trwałe suplementowanie jodem powoduje długoterminowy spadek liczby tych przypadków.¹

Przyczyny nadczynności tarczycy

Choroba Gravesa-Basedowa jest najczęstszą przyczyną nadczynności tarczycy w krajach rozwiniętych i na obszarach z wystarczającą podażą jodu, odpowiadając za około 60-80% przypadków tyreotoksykozy w Stanach Zjednoczonych.¹² Choroba ta dotyka około 1 na 200 osób w USA, co czyni ją najczęstszą przyczyną nadczynności tarczycy w tym kraju.¹²

Wole guzkowe toksyczne jest drugą najczęstszą przyczyną nadczynności tarczycy w USA (15-20% przypadków tyreotoksykozy) i najczęstszą przyczyną u osób starszych, szczególnie na obszarach z niedoborem jodu.¹² Gruczolak toksyczny odpowiada za 3-5% przypadków tyreotoksykozy.¹

Tyreotoksykoza indukowana amiodaronem (AIT) występuje u około 6% osób przyjmujących ten lek na obszarach z wystarczającą podażą jodu i około 10% osób z obszarów z niedoborem jodu.¹

Subkliniczna nadczynność tarczycy

Subkliniczna nadczynność tarczycy definiowana jest jako niskie lub niewykrywalne stężenie hormonu tyreotropowego (TSH) w surowicy, przy prawidłowych stężeniach wolnej tyroksyny (fT4) i całkowitej lub wolnej trójjodotyroniny (T3). Częstość występowania subklinicznej nadczynności tarczycy w populacji ogólnej wynosi około 1-2%, ale może być wyższa na obszarach z niedoborem jodu.¹

U osób powyżej 70. roku życia częstość występowania endogennej subklinicznej nadczynności tarczycy może sięgać 15% na obszarach z niedoborem jodu.¹ Subkliniczna nadczynność tarczycy występuje najczęściej u pacjentów otrzymujących terapię hormonami tarczycy; częstość występowania u tych pacjentów może wynosić nawet 20%, szczególnie u osób przyjmujących wysuszony ekstrakt z tarczycy.¹

Subkliniczna nadczynność tarczycy wiąże się ze zwiększonym ryzykiem śmiertelności z powodu choroby wieńcowej i wystąpienia migotania przedsionków, przy czym najwyższe ryzyko występuje, gdy poziom TSH jest niższy niż 0,10 mIU/L. Związana jest również ze zwiększonym ryzykiem złamań biodra i innych złamań, szczególnie u osób z poziomem TSH poniżej 0,10 mIU/L.¹

Nadzór nad nadczynnością tarczycy

Wykrywanie i diagnostyka

Rozpoznanie nadczynności tarczycy opiera się na objawach klinicznych, badaniu fizykalnym oraz jest potwierdzane badaniami laboratoryjnymi mierzącymi stężenie hormonów tarczycy (tyroksyny, czyli T4, i trójjodotyroniny, czyli T3) oraz hormonu tyreotropowego (TSH) we krwi.¹

Wybór początkowych testów diagnostycznych zależy od kosztów, dostępności i lokalnej wiedzy specjalistycznej. Pomiar przeciwciał, takich jak TRAb (przeciwciała przeciwko receptorowi TSH) lub TSI (immunoglobulina stymulująca tarczycę), jest efektywny kosztowo i w przypadku dodatniego wyniku potwierdza rozpoznanie choroby Gravesa-Basedowa bez konieczności wykonywania dalszych badań.¹

Jeżeli poziom TSH we krwi jest niski (poniżej zakresu referencyjnego), a poziom T4 (fT4) jest wysoki (powyżej zakresu referencyjnego), zazwyczaj wskazuje to na nadczynność tarczycy.¹ Test wychwytu radioaktywnego jodu i scyntygrafia tarczycy pomagają określić przyczynę nadczynności tarczycy.¹

U osób z podejrzeniem choroby Gravesa-Basedowa obecność przeciwciał przeciwko receptorowi TSH i/lub przeciwciał przeciwko peroksydazie tarczycowej (anty-TPO) oznacza, że nadczynność tarczycy jest spowodowana tą chorobą.¹ Jeśli badanie scyntygraficzne wykazuje znaczny wzrost wychwytu znacznika radioaktywnego (tzw. gorący skan), potwierdza to chorobę Gravesa-Basedowa.¹

Badania przesiewowe

U.S. Preventive Services Task Force (USPSTF) i American Academy of Family Physicians stwierdziły w 2015 roku, że brakuje wystarczających dowodów, aby ocenić bilans korzyści i szkód z badań przesiewowych w kierunku dysfunkcji tarczycy u bezobjawowych, niebędących w ciąży dorosłych.¹

Mimo braku oficjalnych rekomendacji dotyczących powszechnych badań przesiewowych, częstość wykrywania niezdiagnozowanej nadczynności tarczycy pozostaje znacząca. W badaniu przeprowadzonym w Chorwacji stwierdzono, że 71,4% przypadków jawnej i 83% przypadków subklinicznej nadczynności tarczycy nie było wcześniej zdiagnozowanych, co wskazuje, że rutynowe badania przesiewowe często ujawniają ukryte przypadki choroby.¹

Obserwacja i leczenie

Po rozpoznaniu nadczynności tarczycy większość pacjentów powinna być, przynajmniej początkowo, oceniana przez specjalistę w zakresie zaburzeń tarczycy.¹ Leczenie będzie zależeć od kilku czynników, takich jak rodzaj nadczynności tarczycy i jej nasilenie.¹

Po jednorazowym cyklu leczenia lekami przeciwtarczycowymi nadczynność tarczycy może zostać wyleczona, jeśli przyczyną nadczynności tarczycy jest choroba Gravesa-Basedowa.¹ Jednak około 52% pacjentów z nadczynnością tarczycy leczonych lekami przeciwtarczycowymi doświadcza nawrotu choroby.¹

Leczenie jodem radioaktywnym jest najczęstszą metodą leczenia nadczynności tarczycy w Stanach Zjednoczonych, a badania potwierdzają jego stosowanie od ponad 70 lat.¹² Poza USA preferowane jest początkowo leczenie lekami przeciwtarczycowymi (ATD), natomiast leczenie definitywne (tj. leczenie jodem radioaktywnym lub chirurgiczne) jest zarezerwowane tylko dla pacjentów z przetrwałą lub nawracającą nadczynnością tarczycy.¹

Po leczeniu jodem radioaktywnym lub chirurgicznym, pacjenci powinni mieć częste badania krwi w celu sprawdzenia czynności tarczycy, aż do osiągnięcia stabilizacji, a następnie raz w roku, ponieważ istnieje długoterminowe ryzyko rozwoju niedoczynności tarczycy.¹

Implikacje dla zdrowia publicznego

Nieleczona nadczynność tarczycy może prowadzić do poważnych powikłań, w tym problemów z sercem. Do najczęstszych powikłań sercowo-naczyniowych należą: zaburzenia rytmu serca (np. migotanie przedsionków), które zwiększają ryzyko udaru mózgu, oraz niewydolność serca.¹²

Nadczynność tarczycy zwiększa również ryzyko osteoporozy – stanu powodującego osłabienie kości i zwiększającego ryzyko złamań. Może wpływać na kości jeszcze przed wystąpieniem innych objawów choroby. Dotyczy to szczególnie kobiet, które przeszły menopauzę lub które są już w grupie wysokiego ryzyka osteoporozy.¹²

Nadczynność tarczycy może również utrudniać zajście w ciążę zarówno kobietom, jak i mężczyznom. Jest to spowodowane tym, że problemy z hormonem tarczycy mogą zaburzyć równowagę hormonów powodujących owulację. Niedoczynność tarczycy może również powodować, że organizm wytwarza więcej prolaktyny, hormonu, który informuje organizm o produkcji mleka matki. Zbyt dużo prolaktyny może zapobiegać owulacji.¹

W przypadku wojskowego personelu aktywnego, nadczynność i niedoczynność tarczycy mogą prowadzić do okresów niezdolności do służby, tymczasowego profilu służby lub potrzeby zwolnienia lekarskiego w momencie diagnozy lub w przypadku przerwania leczenia. Cięższe przypadki nadczynności tarczycy mogą wymagać do 1 roku na stabilizację, co skutkuje znacznymi okresami ograniczonej zdolności do służby.¹²

Trendy i prognozy

Zapadalność i wskaźniki hospitalizacji z powodu nadczynności tarczycy wykazały pewien spadek w ostatnich dziesięcioleciach, prawdopodobnie ze względu na lepsze odżywianie jodem i ulepszone leczenie ambulatoryjne. Na przykład w regionie Veneto we Włoszech, charakteryzującym się niedoborem jodu, wprowadzenie jodowania soli od 2005 roku doprowadziło do znacznego spadku liczby nowych przypadków nadczynności tarczycy, zwłaszcza tych spowodowanych wolem guzkowym.¹

W Stanach Zjednoczonych liczba hospitalizacji z powodu nadczynności tarczycy spadła o 28% w latach 2008-2018 (z 12 689 do 9 110 rocznych pobytów szpitalnych). Prawdopodobnie odzwierciedla to wcześniejszą diagnozę i leczenie ambulatoryjne, zapobiegając ciężkim przypadkom wymagającym hospitalizacji.¹

W związku ze starzeniem się populacji na całym świecie, obciążenie nadczynnością tarczycy może się zmieniać. Ponieważ toksyczne wole guzkowe ma tendencję do atakowania osób starszych, wzrost liczby osób starszych może utrzymać znaczącą liczbę przypadków nadczynności guzkowej (chociaż przeciwdziała temu suplementacja jodu).¹

Trend w kierunku wcześniejszego wykrywania (poprzez rutynowe badania krwi) prawdopodobnie będzie się utrzymywał, co oznacza, że więcej przypadków zostanie wykrytych na etapie subklinicznym. W gospodarkach rozwiniętych częstość występowania niezdiagnozowanych chorób tarczycy spada dzięki powszechnym badaniom przesiewowym.¹

Oczekuje się, że w przyszłości będzie mniej ciężkich, niewykrytych przypadków, a większość pacjentów otrzyma leczenie przed rozwinięciem się powikłań. Niektóre prognozy sugerują, że jeśli obecne trendy się utrzymają, hospitalizacje i kryzysy, takie jak przełom tarczycowy, pozostaną rzadkie lub będą nadal spadać wraz z poprawą opieki ambulatoryjnej.¹

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Materiały źródłowe

#1 Hyperthyroidism: Diagnosis and Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2016/0301/p363.html
Hyperthyroidism is an excessive concentration of thyroid hormones in tissues causing a characteristic clinical state. In the United States, the overall prevalence of hyperthyroidism is 1.2%, and the prevalences of overt hyperthyroidism and subclinical hyperthyroidism are 0.5% and 0.7%, respectively. […] Toxic multinodular goiter is the second most common cause of hyperthyroidism in the United States and the most common cause in older persons living in iodine-deficient areas. […] In a Danish study, its prevalence among patients with thyrotoxicosis was 0.5%, as evaluated by scintigraphy. […] The clinical presentation of hyperthyroidism ranges from asymptomatic to thyroid storm. […] Signs that are pathognomonic for Graves disease include orbitopathy, pretibial myxedema (thyroid dermopathy), and thyroid acropachy, which occur in 25%, 1.5%, and 0.3% of patients, respectively. […] Clinical suspicion of hyperthyroidism should prompt laboratory testing. […] A radioactive iodine uptake test and thyroid scan help determine the cause of hyperthyroidism. […] Radioactive iodine ablation of the thyroid gland is the most common treatment of Graves disease in the United States.
#1 Disorders that cause hyperthyroidism – UpToDate
https://www.uptodate.com/contents/disorders-that-cause-hyperthyroidism
Several different disorders can cause hyperthyroidism. It is essential that the correct cause be identified because appropriate therapy depends upon the underlying mechanism of the hyperthyroidism. […] The global prevalence of hyperthyroidism is 0.2 to 1.4 percent. In the United States, the overall prevalence of hyperthyroidism is approximately 1.3 percent, and it increases to 4 to 5 percent in older women. Hyperthyroidism is more common in women than men (5:1 ratio), and in smokers. Graves’ disease is seen most often in younger women and in regions of iodine sufficiency, while toxic nodular goiter is more common in older women and in regions of mild to moderate iodine deficiency.
#1 Hyperthyroidism
https://pmc.ncbi.nlm.nih.gov/articles/PMC5014602/
Prevalence of hyperthyroidism is 08% in Europe, and 13% in the USA. Hyperthyroidism increases with age and is more frequent in women. The prevalence of overt hyperthyroidism is 0508% in Europe, and 05% in the USA. Data for ethnic differences are scarce, but hyperthyroidism seems to be slightly more frequent in white people than in other races. The incidence of mild hyperthyroidism is also reported to be higher in iodine-deficient areas than in iodine-sufficient areas, and to decrease after introduction of universal salt iodisation programmes. […] The most common cause of hyperthyroidism in iodine-sufficient areas is Graves disease. In Sweden, the annual incidence of Graves disease is increasing, with 1530 new cases per 100 000 inhabitants in the 2000s. […] The choice of treatment for Graves disease differs depending upon geographical regions. Radioactive iodine therapy is frequently used as the first therapy in North America. Outside of the USA, ATDs are preferred as primary treatment, whereas definitive therapy is reserved only for patients with persistent or recurrent hyperthyroidism.
#1 Hyperthyroidism – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK537053/
Hyperthyroidism is a common thyroid disorder with multiple underlying etiologies. This disease is characterized by excess thyroid hormone production. Hyperthyroidism is more common in women compared to men. Other risk factors associated with the development of hyperthyroidism include smoking, iodine deficiency, iodine excess, selenium deficiency, genetic factors, and the use of certain drugs. The prevalence of hyperthyroidism varies worldwide, based on dietary iodine content. Graves disease is typically seen in younger patients and is the most common cause of hyperthyroidism in this demographic. The incidence of Graves disease is highest between the age group of 30 to 50 years. Toxic multifocal goiter is typically seen in older individuals and is the most common cause of hyperthyroidism in this demographic. The 1977 Whickham Survey evaluated the spectrum of thyroid disorders in County Durham in northeastern England. The Whickham Survey demonstrated a prevalence of hyperthyroidism in women, approximately 10 times more than that of men (2.7% versus 0.23%). The prevalence of hyperthyroidism in the United States was 1.3% in the general population, with 0.5% cases of overt hyperthyroidism and 0.7% cases of subclinical hyperthyroidism. A meta-analysis found the prevalence of hyperthyroidism in Europe to be 0.75%. The prevalence of overt hyperthyroidism is similar in China at 0.78%. Amiodarone-induced thyrotoxicosis (AIT) is seen in about 6% of the individuals taking the medication in iodine-sufficient areas and about 10% in individuals taking the medication from iodine-deficient areas.
#1 Hyperthyroidism – Hormones Australia
https://www.hormones-australia.org.au/endocrine-diseases/hyperthyroidism/
Hyperthyroidism is a condition where the thyroid gland becomes overactive and produces too much thyroid hormone. […] In Australia, it is estimated that hyperthyroidism affects 3 in 1000 people. […] Your doctor may ask you questions about your personal health and your family’s health history. This will include questions about any thyroid disease, autoimmune disorders, current and previous medications, other medical conditions or concerns and, for women, your pregnancy history. […] If symptoms suggest hyperthyroidism, your doctor will order a blood test to measure the level of thyroid hormones (T4 T3) and thyroid stimulating hormone (TSH). […] The presence of TSH-receptor antibodies and/or TPO antibodies means the hyperthyroidism is caused by Graves disease. […] If the scan shows a marked increase in uptake of the radioactive tracer (i.e. is a hot scan) Graves disease is confirmed.
#1 Hyperthyroidism Statistics: Global and U.S. Overview, Types, Trends, and Complications â Broken English MD
https://brokenenglishmd.com/hyperthyroidism-statistics-global-and-u-s-overview-types-trends-and-complications/
Annual Incidence: New cases of hyperthyroidism occur at an annual rate of roughly 20â50 per 100,000 people in iodine-sufficient populations. Gravesâ disease (autoimmune hyperthyroidism) has an incidence around 0.5 cases per 1,000 per year (i.e. 50 per 100,000) in the general population, with peaks in younger adults. A large study in Italy found an overall hyperthyroidism incidence of 54 per 100,000 person-years. In Europe, the average incidence is reported around 51 per 100,000 per year. These rates indicate that for every 100,000 people, roughly 50 will be diagnosed with hyperthyroidism each year. Subclinical hyperthyroidism is more frequently detected: it affects an additional 1â2% of people per year in some cohorts, though many cases may be transient or mild. […] Historical Trends: The incidence and hospitalization rates for hyperthyroidism have shown some declines in recent decades, likely due to better iodine nutrition and improved outpatient management. For example, in the iodine-deficient Veneto region of Italy, the introduction of salt iodization since 2005 led to a significant drop in new hyperthyroidism cases, especially those due to nodular goiter. Similarly, in the U.S., hospitalizations for hyperthyroidism fell by 28% from 2008 to 2018 (from 12,689 to 9,110 annual hospital stays). This likely reflects earlier diagnosis and treatment on an outpatient basis, preventing severe cases that require admission.
#1 Hyperthyroidism and Thyrotoxicosis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/767130-overview
Graves disease is the most common form of hyperthyroidism in the United States, causing approximately 60-80% of cases of thyrotoxicosis. The annual incidence of Graves disease was found to be 0.5 cases per 1000 population during a 20-year period, with the peak occurrence in people aged 20-40 years. […] Toxic multinodular goiter (15-20% of thyrotoxicosis) occurs more frequently in regions of iodine deficiency. Most persons in the United States receive sufficient iodine, and the incidence of toxic multinodular goiter in the US population is lower than that in areas of the world with iodine deficiency. Toxic adenoma is the cause of 3-5% of cases of thyrotoxicosis. […] The incidences of Graves disease and toxic multinodular goiter change with iodine intake. Compared with regions of the world with less iodine intake, the United States has more cases of Graves disease and fewer cases of toxic multinodular goiters.
#1 Graves’ Disease
https://www.thyroid.org/graves-disease/
Graves disease is an autoimmune disease that leads to a generalized overactivity of the entire thyroid gland (hyperthyroidism). It is the most common cause of hyperthyroidism in the United States. It is 7-8 times more common in women than men. […] The diagnosis of hyperthyroidism is made on the basis of your symptoms and findings during a physical exam and it is confirmed by laboratory tests that measure the amount of thyroid hormones (thyroxine, or T4, and triiodothyronine, or T3) and thyroid-stimulating hormone (TSH) in your blood. […] The choice of initial diagnostic testing depends on cost, availability and local expertise. Measurement of antibodies, such as TRAb or TSI, is cost effective and if positive, confirms the diagnosis of Graves disease without further testing needed. […] If your hyperthyroidism due to Graves disease persists after 6 months, then your doctor may recommend definitive treatment with either radioactive iodine or surgery. […] Hyperthyroidism due to Graves disease is, in general, controllable and safely treated and treatment is almost always successful.
#1 How common is thyroid storm and which groups have the highest rates of death from this condition?
https://www.thyroid.org/patient-thyroid-information/ct-for-patients/september-2023/vol-16-issue-9-p-12-13/
HYPERTHYROIDISM How common is thyroid storm and which groups have the highest rates of death from this condition? […] Thyroid Storm is the most severe form of hyperthyroidism. […] So far, only 3 research studies have looked into the epidemiology of thyroid storm, and they estimate an incidence of 0.20 to 0.76 cases per 100,000 people per year. […] The estimated occurrence of thyroid storm was 1.4 cases per 100,000 people per year in females and 0.7 cases per 100,000 people per year in males. […] This is the first study reporting population-based data on diagnosis and death rate of thyroid storm in Germany. […] However, the diagnosis rate strongly varies with age and sex since the rate of thyroid storm was two times higher in females than in males and it was 3 times higher in persons 60 years compared with younger individuals.
#1 Hyperthyroidism Statistics: Global and U.S. Overview, Types, Trends, and Complications â Broken English MD
https://brokenenglishmd.com/hyperthyroidism-statistics-global-and-u-s-overview-types-trends-and-complications/
Impact of Iodine Intake: Iodine intake has a U-shaped relationship with thyroid disorders. Historically, regions with iodine deficiency saw more hyperthyroidism in older adults (due to nodular goiters), especially after iodization programs (a phenomenon where sudden iodine repletion âwakes upâ overactive thyroid nodules). Now, sustained iodine supplementation is causing a long-term decrease in those cases. In formerly deficient areas, overt hyperthyroidism from toxic nodular goiter has diminished over time as goiter rates fall. Conversely, very high iodine intake (as seen in some coastal regions with kelp-rich diets) can slightly increase autoimmune thyroid disease, but studies in China and Japan did not find major differences in hyperthyroid rates between iodine-sufficient vs. high-excess areas. Overall, iodine sufficiency programs have reduced hyperthyroid incidence in many parts of the world, a public health success.
#1 Graves’ Disease (Overactive Thyroid) Market â Global Market Size, Share, and Trends Analysis Report â Industry Overview and Forecast to 2032 | Data Bridge Market Research
https://www.databridgemarketresearch.com/reports/global-graves-disease-overactive-thyroid-market?srsltid=AfmBOor5JEIBYU6cRKxiXmBvCBDhoVDEXwlag5mGdpezOkRfDlu_hD-z
Graves’ disease is an immune system condition characterized by excessive thyroid hormone production (hyperthyroidism). […] Graves’ disease affects one in every 200 people in the United States, making it the most common cause of hyperthyroidism. […] The rising prevalence of Graves’ disease (overactive thyroid) across the globe is estimated to enhance the market’s growth. […] Another significant factor influencing the growth rate of Graves’ disease (overactive thyroid) market is the rising healthcare expenditure which helps in improving its infrastructure. […] The changing lifestyle of people such as high alcohol consumption and addiction of smoking will result in the expansion of Graves’ disease (overactive thyroid) market. […] Furthermore, rising initiatives by public and private organizations to spread awareness and increasing incidences of autoimmune diseases such as diabetes and others will expand the Graves’ disease (overactive thyroid) market.
#1 Subclinical Hyperthyroidism: When to Consider Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2017/0601/p710.html
Subclinical hyperthyroidism is defined by a low or undetectable serum thyroid-stimulating hormone level, with normal free thyroxine and total or free triiodothyronine levels. The prevalence of subclinical hyperthyroidism in the general population is about 1% to 2%; however, it may be higher in iodine-deficient areas. […] The prevalence of endogenous subclinical hyperthyroidism can be as high as 15% in patients older than 70 years who live in iodine-deficient regions. […] Subclinical hyperthyroidism is most common in patients receiving thyroid hormone replacement therapy; the prevalence in these patients may be as high as 20%, particularly in those taking desiccated thyroid hormone. […] The U.S. Preventive Services Task Force found insufficient evidence to assess the balance of benefits and harms of screening for thyroid dysfunction in asymptomatic persons. […] In 2015, the U.S. Preventive Services Task Force (USPSTF) and the American Academy of Family Physicians concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for thyroid dysfunction in non-pregnant, asymptomatic adults.
#1 Hyperthyroidism (overactive thyroid) | Doctor
https://patient.info/doctor/hyperthyroidism
Subclinical hyperthyroidism is associated with increased risks of coronary heart disease (CHD) mortality and incident atrial fibrillation, with highest risks of CHD mortality and atrial fibrillation when thyrotropin level is lower than 0.10 mIU/L. […] Subclinical hyperthyroidism is also associated with an increased risk of hip and other fractures, particularly among those with TSH levels of less than 0.10 mIU/L.
#1 Become a member
https://www.btf-thyroid.org/hyperthyroidism-leaflet
Hyperthyroidism is a condition where the thyroid gland produces more thyroid hormones than is needed by the body. It is also referred to as thyrotoxicosis, or an overactive thyroid. The majority of patients with hyperthyroidism should be assessed, at least initially, by a specialist in thyroid disorders. […] Graves disease is the most common cause of hyperthyroidism in the UK and is much more common in women than in men. […] Graves disease is an autoimmune condition. The bodys immune system turns against the thyroid gland, which in response becomes over-active. […] By a physical examination and blood tests. If the thyroid-stimulating hormone (TSH) blood level is low – below the reference range – and the thyroxine (FT4) blood level is high – above the reference range – this usually indicates an over-active thyroid.
#1 Hyperthyroidism Statistics: Global and U.S. Overview, Types, Trends, and Complications â Broken English MD
https://brokenenglishmd.com/hyperthyroidism-statistics-global-and-u-s-overview-types-trends-and-complications/
Hyperthyroidism â often called an overactive thyroid â is a common endocrine disorder with significant health impacts. This comprehensive report compiles all key statistics and data on hyperthyroidism including how widespread it is in the U.S. and globally, historical trends and future projections, demographic patterns, pediatric vs adult differences, geographic variations, normal vs abnormal lab values, associated health risks, mortality rates, treatment outcomes, and the economic burden on healthcare. […] United States Prevalence: About 1 in 100 Americans (1%) over age 12 has hyperthyroidism. This equates to roughly 1.2â1.3% of the U.S. population when both overt and subclinical cases are included. In large U.S. surveys, overt hyperthyroidism (clear symptoms with abnormal labs) is found in ~0.5% of people, while subclinical hyperthyroidism (mild or no symptoms but low TSH hormone) affects ~0.7%. In total, that means an estimated 3â4 million Americans have an overactive thyroid at any given time. Notably, many cases are undiagnosed â a study in Croatia found 71.4% of clinical (overt) and 83% of subclinical hyperthyroid cases were previously undiagnosed, indicating that routine screening often uncovers hidden disease.
#1 Become a member
https://www.btf-thyroid.org/hyperthyroidism-leaflet
Your treatment will depend on several factors, such as the type of hyperthyroidism you have, and the severity. […] After a single course of antithyroid drug treatment, your hyperthyroidism may be cured if the cause of the thyroid overactivity is Graves disease. […] If you have had radioactive iodine or surgery, you should have frequent blood tests to check your thyroid function until you are stable, and once a year after that, as there is a long-term risk of developing hypothyroidism. […] Thyroid problems often run in families and if family members are unwell they should be encouraged to discuss with their own GP whether thyroid testing is warranted.
#1 Hyperthyroidism – Life Extension
https://www.lifeextension.com/protocols/metabolic-health/hyperthyroidism?srsltid=AfmBOoqe5r5_zD9AKQJXZp2voJtJFFqtBEeJr0J2_0JLWkgpXl-m2MyH
In a long-term randomized trial, 179 people with Graves disease received treatment with either anti-thyroid medications, radioiodine, or surgery. […] About 52% of hyperthyroidism patients treated with anti-thyroid drugs relapse. […] Radioactive iodine is the most common treatment for hyperthyroidism in the United States, and research has supported its use for over 70 years. […] Hyperthyroidism can lead to nervousness and irritability, weight loss, a racing heart, sleep disturbances, and vision issues among other concerns.
#1 Hyperthyroidism – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/symptoms-causes/syc-20373659
Hyperthyroidism happens when the thyroid gland makes too much thyroid hormone. This condition also is called overactive thyroid. Hyperthyroidism speeds up the body’s metabolism. […] After a diagnosis of hyperthyroidism, most people need regular follow-up visits with their health care provider to monitor the condition. […] Hyperthyroidism can be caused by several medical conditions that affect the thyroid gland. […] Conditions that can lead to hyperthyroidism include: Graves’ disease is the most common cause of hyperthyroidism. […] Risk factors for hyperthyroidism include: A family history of thyroid disease, particularly Graves’ disease. […] Hyperthyroidism can lead to the following complications. […] Some of the most serious complications of hyperthyroidism involve the heart, including: A heart rhythm disorder called atrial fibrillation that increases the risk of stroke. […] Hyperthyroidism raises the risk of thyrotoxic crisis.
#1 Thyroid disease
https://womenshealth.gov/a-z-topics/thyroid-disease
Hyperthyroidism, (hy-pur-THY-roi-diz-uhm) or overactive thyroid, causes your thyroid to make more thyroid hormone than your body needs. This speeds up many of your body’s functions, like your metabolism and heart rate. […] The most common cause of hyperthyroidism is Graves’ disease. Graves’ disease is a problem with the immune system. […] Hyperthyroidism raises your risk for osteoporosis, a condition that causes weak bones that break easily. In fact, hyperthyroidism might affect your bones before you have any of the other symptoms of the condition. This is especially true of women who have gone through menopause or who are already at high risk of osteoporosis. […] About three times as many women get thyroid cancer as men. The number of women with thyroid cancer is also going up. By 2020, the number of women with thyroid cancer is expected to double, from 34,000 women to more than 70,000 women.
#1 Thyroid disease
https://womenshealth.gov/a-z-topics/thyroid-disease
Thyroid cancer is more common in women who: Are between the ages of 25 and 65, Had radiation therapy to the head or neck, especially in childhood, to treat cancer, Have a history of goiter, Have a family history of thyroid cancer. […] Both hyperthyroidism and hypothyroidism can make it harder for you to get pregnant. This is because problems with the thyroid hormone can upset the balance of the hormones that cause ovulation. Hypothyroidism can also cause your body to make more prolactin, the hormone that tells your body to make breastmilk. Too much prolactin can prevent ovulation. […] Pregnancy-related hormones raise the level of thyroid hormones in the blood. Thyroid hormones are necessary for the baby’s brain development while in the womb. […] It can be harder to diagnose thyroid problems during pregnancy because of the change in hormone levels that normally happen during pregnancy. But it is especially important to check for problems before getting pregnant and during pregnancy. Uncontrolled hyperthyroidism and hypothyroidism can cause problems for both mother and baby.
#1 Thyroid Disorders, Active Component, U.S. Armed Forces, 2008â2017 | Health.mil
https://health.mil/News/Articles/2018/12/01/Thyroid-Disorders?page=3
Between 2008 and 2017, the most common incident thyroid disorder among male and female service members was primary/NOS hypothyroidism and the least common were thyroiditis and other disorders of thyroid. […] More than 40,000 cases of thyroid disorders were diagnosed during the 10-year surveillance period among active component service members. […] Although thyroid disorders are treatable, hypothyroidism and hyperthyroidism can result in periods of non-deployability, temporary duty profile, or need for medical waiver at the time of diagnosis or if there is a disruption in treatment. More severe cases of hyperthyroidism can take up to 1 year to stabilize, resulting in significant periods of limited deployability. […] The prevalence of hyperthyroidism in the U.S. is estimated to be 1.3% according to data from the NHANES-III, with the lowest prevalence observed among Mexican Americans and the highest among non-Hispanic whites.
#1 Hyperthyroidism Statistics: Global and U.S. Overview, Types, Trends, and Complications â Broken English MD
https://brokenenglishmd.com/hyperthyroidism-statistics-global-and-u-s-overview-types-trends-and-complications/
Future Projections: With aging populations worldwide, the burden of hyperthyroidism may shift. Because toxic multinodular goiter tends to affect older individuals, an increase in elderly population could keep nodular hyperthyroidism cases significant (though counteracted by iodine supplementation). Meanwhile, the trend toward earlier detection (through routine blood tests) is likely to continue, meaning more cases will be caught at subclinical stages. In advanced economies, the prevalence of undiagnosed thyroid disease has been falling due to widespread screening. Thus, we expect fewer severe, undetected cases in the future, and most patients will receive treatment before complications develop. Some projections suggest that if current trends hold, hospitalizations and crises like thyroid storm will remain rare or decline as outpatient care improves. However, continued vigilance is needed in regions with limited healthcare access â many developing countries still lack comprehensive thyroid epidemiology data, and iodine deficiency or environmental factors could influence future incidence there.
#2 Hyperthyroidism – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK537053/
Hyperthyroidism is a common thyroid disorder with multiple underlying etiologies. This disease is characterized by excess thyroid hormone production. Hyperthyroidism is more common in women compared to men. Other risk factors associated with the development of hyperthyroidism include smoking, iodine deficiency, iodine excess, selenium deficiency, genetic factors, and the use of certain drugs. The prevalence of hyperthyroidism varies worldwide, based on dietary iodine content. Graves disease is typically seen in younger patients and is the most common cause of hyperthyroidism in this demographic. The incidence of Graves disease is highest between the age group of 30 to 50 years. Toxic multifocal goiter is typically seen in older individuals and is the most common cause of hyperthyroidism in this demographic. The 1977 Whickham Survey evaluated the spectrum of thyroid disorders in County Durham in northeastern England. The Whickham Survey demonstrated a prevalence of hyperthyroidism in women, approximately 10 times more than that of men (2.7% versus 0.23%). The prevalence of hyperthyroidism in the United States was 1.3% in the general population, with 0.5% cases of overt hyperthyroidism and 0.7% cases of subclinical hyperthyroidism. A meta-analysis found the prevalence of hyperthyroidism in Europe to be 0.75%. The prevalence of overt hyperthyroidism is similar in China at 0.78%. Amiodarone-induced thyrotoxicosis (AIT) is seen in about 6% of the individuals taking the medication in iodine-sufficient areas and about 10% in individuals taking the medication from iodine-deficient areas.
#2 Hyperthyroidism: Diagnosis and Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2016/0301/p363.html
Hyperthyroidism is an excessive concentration of thyroid hormones in tissues causing a characteristic clinical state. In the United States, the overall prevalence of hyperthyroidism is 1.2%, and the prevalences of overt hyperthyroidism and subclinical hyperthyroidism are 0.5% and 0.7%, respectively. […] Toxic multinodular goiter is the second most common cause of hyperthyroidism in the United States and the most common cause in older persons living in iodine-deficient areas. […] In a Danish study, its prevalence among patients with thyrotoxicosis was 0.5%, as evaluated by scintigraphy. […] The clinical presentation of hyperthyroidism ranges from asymptomatic to thyroid storm. […] Signs that are pathognomonic for Graves disease include orbitopathy, pretibial myxedema (thyroid dermopathy), and thyroid acropachy, which occur in 25%, 1.5%, and 0.3% of patients, respectively. […] Clinical suspicion of hyperthyroidism should prompt laboratory testing. […] A radioactive iodine uptake test and thyroid scan help determine the cause of hyperthyroidism. […] Radioactive iodine ablation of the thyroid gland is the most common treatment of Graves disease in the United States.
#2 Hyperthyroidism Statistics: Global and U.S. Overview, Types, Trends, and Complications â Broken English MD
https://brokenenglishmd.com/hyperthyroidism-statistics-global-and-u-s-overview-types-trends-and-complications/
Global Prevalence: Hyperthyroidism is a worldwide condition, but rates vary with iodine nutrition and population factors. Globally, prevalence ranges roughly from 0.2% up to 1â2% of the population. In iodine-sufficient regions (e.g. North America, Western Europe), about 0.5â1% of people are hyperthyroid at a given time. For example, a European meta-analysis estimated 0.75% prevalence (~ of 1%). In China, after universal salt iodization, overt hyperthyroidism prevalence is similar â about 0.78%. In areas with chronic iodine deficiency, rates can be higher: small communities in iodine-poor regions have reported hyperthyroidism in 2â3% of residents, mostly due to toxic nodular goiter. Overall, experts estimate tens of millions of people worldwide are affected by hyperthyroidism at any time. […] Lifetime Risk: Over a lifetime, the cumulative risk of developing some thyroid disorder is fairly high (over 12% of Americans will develop a thyroid condition in their lifetime). For hyperthyroidism specifically, women have about a 3% lifetime risk of developing Gravesâ disease (the most common cause) and men about a 0.5% risk. When all causes are included, lifetime risk of hyperthyroidism may be on the order of 2â5% (higher for women). In one long-term U.K. study (Whickham survey), 2.7% of women and 0.23% of men had evidence of hyperthyroidism, highlighting the strong female predominance.
#2 Graves’ disease – Wikipedia
https://en.wikipedia.org/wiki/Graves%27_disease
Graves’ disease occurs in about 0.5% of people. Graves’ disease data has shown that the lifetime risk for women is around 3% and 0.5% for men. It occurs about 7.5 times more often in women than in men and often starts between the ages of 40 and 60. It is the most common cause of hyperthyroidism in the United States (about 50 to 80% of cases). […] It is the most common cause of hyperthyroidism.
#2 Graves disease | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/graves-disease?lang=us
Graves disease, also known as Basedow disease in mainland Europe, is an autoimmune thyroid disease and is the most common cause of hyperthyroidism. […] There is a strong female predilection (F:M = 5:1), and is most common between 30 and 60 years. The incidence is 20 per 100,000 people. […] Pediatric Graves disease accounts for 5% of all cases (incidence 5 per 100,000 children). It is more common in older adolescents. Children have a lower female prediction (F:M = 3.5:1).
#2 Disorders that cause hyperthyroidism – UpToDate
https://www.uptodate.com/contents/disorders-that-cause-hyperthyroidism
Several different disorders can cause hyperthyroidism. It is essential that the correct cause be identified because appropriate therapy depends upon the underlying mechanism of the hyperthyroidism. […] The global prevalence of hyperthyroidism is 0.2 to 1.4 percent. In the United States, the overall prevalence of hyperthyroidism is approximately 1.3 percent, and it increases to 4 to 5 percent in older women. Hyperthyroidism is more common in women than men (5:1 ratio), and in smokers. Graves’ disease is seen most often in younger women and in regions of iodine sufficiency, while toxic nodular goiter is more common in older women and in regions of mild to moderate iodine deficiency.
#2 Hyperthyroidism (overactive thyroid) | Doctor
https://patient.info/doctor/hyperthyroidism
Hyperthyroidism is overactivity of the thyroid gland, which results in a number of symptoms and signs. It can be primary or secondary: […] In Europe, thyrotoxicosis affects around 1 in 2,000 people annually. […] There is a global prevalence of 0.2 – 2.5%. […] Thyrotoxicosis is still under-diagnosed however – it has been shown that in people older than 65 years, undiagnosed hyperthyroidism occurs in 0.3% of people and around 2% of people aged over 65 years have subclinical hyperthyroidism. […] Graves’ disease in adults affects approximately 2% of women and 0.2% of men. […] Graves’ disease accounts for around 75% of cases. […] Subclinical hyperthyroidism occurs in around 2% of the elderly population. […] The most common cause of true subclinical hyperthyroidism is toxic nodular goitre, especially in the elderly.
#2 Graves’ disease: MedlinePlus GeneticsLock
https://medlineplus.gov/genetics/condition/graves-disease/
Graves’ disease affects about 1 in 200 people. The disease occurs more often in women than in men, which may be related to hormonal factors. Graves’ disease is the most common cause of thyroid overactivity (hyperthyroidism) in the United States. […] Graves’ disease is classified as an autoimmune disorder, one of a large group of conditions that occur when the immune system attacks the body’s own tissues and organs. In people with Graves’ disease, the immune system creates a protein (antibody) called thyroid-stimulating immunoglobulin (TSI). TSI signals the thyroid to increase its production of hormones abnormally. The resulting overactivity of the thyroid causes many of the signs and symptoms of Graves’ disease. […] People with Graves’ disease have an increased risk of developing other autoimmune disorders, including rheumatoid arthritis, pernicious anemia, systemic lupus erythematosus, Addison disease, celiac disease, type 1 diabetes, and vitiligo.
#2 Hyperthyroidism and Thyrotoxicosis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/767130-overview
Graves disease is the most common form of hyperthyroidism in the United States, causing approximately 60-80% of cases of thyrotoxicosis. The annual incidence of Graves disease was found to be 0.5 cases per 1000 population during a 20-year period, with the peak occurrence in people aged 20-40 years. […] Toxic multinodular goiter (15-20% of thyrotoxicosis) occurs more frequently in regions of iodine deficiency. Most persons in the United States receive sufficient iodine, and the incidence of toxic multinodular goiter in the US population is lower than that in areas of the world with iodine deficiency. Toxic adenoma is the cause of 3-5% of cases of thyrotoxicosis. […] The incidences of Graves disease and toxic multinodular goiter change with iodine intake. Compared with regions of the world with less iodine intake, the United States has more cases of Graves disease and fewer cases of toxic multinodular goiters.
#2
https://www.nhs.uk/conditions/overactive-thyroid-hyperthyroidism/complications/
Several complications can develop if you have an overactive thyroid (hyperthyroidism), particularly if the condition is not treated. […] An overactive thyroid can also increase your chances of developing: atrial fibrillation a heart condition that causes an irregular and often abnormally fast heart rate, weakened bones (osteoporosis) a condition that makes your bones fragile and more likely to break, heart failure where the heart is unable to pump blood around your body properly.
#2 Thyroid Disorders, Active Component, U.S. Armed Forces, 2008â2017 | Health.mil
https://health.mil/News/Articles/2018/12/01/Thyroid-Disorders
Although thyroid disorders are treatable, hypothyroidism and hyperthyroidism can result in periods of non-deployability, temporary duty profile, or need for medical waiver at the time of diagnosis or if there is a disruption in treatment. […] Hyperthyroidism and hypothyroidism can significantly degrade the military operational capabilities of affected service members due to the various symptoms of the disorders. […] The prevalence of hyperthyroidism in the U.S. is estimated to be 1.3% according to data from the NHANES-III, with the lowest prevalence observed among Mexican Americans and the highest among non-Hispanic whites. […] In the U.S., thyrotoxicosis is more common among women, those with other thyroid conditions, and people over 60 years old. […] It is most commonly caused by Graves’ disease, an autoimmune disorder affecting the thyroid. […] The finding that higher incidence of all thyroid disorders was observed among health care personnel is likely related to increased medical awareness, easier access to care, and, perhaps, older age compared to their respective counterparts in other occupations.