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Thyroid for Every 1,000 Americans, up to Overt Overt THYROID FOR EVERY 1,000 AMERICANS, UP TO OVERT OVERT 8 HAVE HYPOTHYROIDISM 5 HAVE HYPERTHYROIDISM SUBCLINICAL SUBCLINICAL 130 HAVE HYPOTHYROIDISM 4 HAVE HYPERTHYROIDISM THYROID IN 2008, THYROID DISEASE CONDITIONS TREATMENT COSTS FOR US WOMEN OVER AGE 18 TOTALED OR $4.3 BILLION $343.00 / WOMAN RECEIVING TREATMENT3 92,931 UP 5 TO 10 x MORE COMMON THYROIDECTOMIES 39% IN WOMEN WERE PERFORMED FROM 1996 COMPARED TO MEN2 IN THE US IN 20064 1 Source: Hollowell et al. 2002 2 Source: Wang et al. 1997 3 Source: Soni. 2011 4 Source: Sun et al. 2013 © 2015 The Endocrine Society. All rights reserved. OVERT Endocrine Society 2055 L Street NW, Suite 600 HYPERTHYROIDISM Washington, DC 20036 USA Phone: 202.971.3636 Fax: 202.736.9705 endocrine.org Mission Statement of the Acknowledgements We also acknowledge the Endocrine Society The production of Endocrine Facts contributions of Nancy Chill, The mission of the Endocrine and Figures would not have been Wendy Sturley, Nikki Deoudes, Society is to advance excellence possible without the guidance of: Beryl Roda, Mary Wessling, in endocrinology and promote and Thomson Reuters. IN 2008, THYROID DISEASE its essential and integrative role Advisory Panel in scientific discovery, medical Robert A. Vigersky, MD (Chair) For More Information TREATMENT COSTS practice, and human health. Uniformed Services University of the For more information, updates, and FOR US WOMEN OVER AGE 18 TOTALED Health Sciences; Medtronic Diabetes the online version of this report, visit: About Endocrine Facts endocrinefacts.org and Figures Ursula B. Kaiser, MD OR Endocrine Facts and Figures is a Brigham and Women’s Hospital Suggested Citation $4.3 BILLION compendium of epidemiological The Endocrine Society requests that data and trends related to a Sherita H. Golden, MD, MHS this document be cited as follows: 3 $343.00 / WOMAN RECEIVING TREATMENT spectrum of endocrine diseases. Johns Hopkins University The Endocrine Society. Endocrine The data is organized into nine Facts and Figures: Thyroid. First chapters covering the breadth Joanna L. Spencer-Segal, MD, PhD Edition. 2015. of endocrinology: Adrenal, Bone University of Michigan and Calcium, Cancers and Disclaimer Neoplasias, Cardiovascular and R. Michael Tuttle, MD This publication summarizes Lipids, Diabetes, Hypothalamic- Memorial Sloan Kettering current scientific information Pituitary, Obesity, Thyroid, and Cancer Center about epidemiology and trends Reproduction and Development. data related to a spectrum of William F. Young, Jr., MD, MSc endocrine diseases. It is not a All data is sourced from peer- Mayo Clinic practice guideline or systematic reviewed publications, with an review. Except when specified, additional round of review by a Thyroid Expert Reviewers this publication does not represent group of world-renowned experts in Kenneth Burman, MD the official policy of the Endocrine the field. Additional oversight from MedStar Washington Society. the Endocrine Facts and Figures Hospital Center Advisory Panel ensured fair and © 2015 The Endocrine Society. balanced coverage of data across Anne Cappola, MD, MSc All rights reserved. This is an the therapeutic areas. University of Pennsylvania official publication of The Endocrine Society. No part of this publication The first edition ofEndocrine Facts Elizabeth Pearce, MD, MSc may be reproduced, translated, and Figures emphasizes data on the Boston University modified, enhanced, and/or United States. Future updates to the transmitted in any form or by report will include additional data for Endocrine Society Staff any means without the prior other countries. Alison M. Kim, PhD written permission of The Endocrine Society. To Lucia D. Tejada, PhD purchase additional reprints or obtain permissions, e-mail [email protected]. © 2015 The Endocrine Society. All rights reserved. prescription medications. In 2008, among females with I OVERVIEW any expenses for thyroid disease treatment, the average expenditure per female for the treatment of thyroid The thyroid is a component of the hypothalamic-pituitary- disease was $343; the mean expenditure for ambulatory thyroid axis, which is responsible for maintaining normal care visits was $409, and the mean expenditure for 21 levels of thyroid hormones (Figure 1).1 Thyroid hormones, prescription medications was $116. T3 and T4, play an essential role in the regulation of many 2,3,4 aspects of metabolism , with T4 being the predominant thyroid hormone in circulation and T3 being the most 5 active form. Interestingly, approximately 80% of T4 is converted to T3 in liver and other target organs, whereas 20% of T is synthesized in the thyroid.1 3 - Thyroid disease or dysfunction may result from structural HYPOTHALAMUS or functional abnormalities along any part of this complex network. This chapter presents epidemiological data on the following thyroid conditions: thyroid nodules and goiter; hypothyroidism; hyperthyroidism; thyroiditis; autoimmune thyroiditis (Hashimoto’s thyroiditis); and THYROTROPIN iodine deficiency — hereinafter collectively referred to as RELEASING thyroid disease. HORMONE (TRH) 1.1 EPIDEMIOLOGY Table 1 summarizes recently published data on the prevalence of thyroid disease, by condition, conducted in United States (US) and international-based studies.There are significant differences in the prevalence of thyroid ANTERIOR - disease based on factors that include sex, race and ethnicity. Differences in thyroid disease prevalence among PITUITARY major ethnic/racial groups in the US are summarized below (Table 2). THYROID As a group, thyroid conditions affect 5-10 times more STIMULATING 17,18 HORMONE females than males. Table 3 provides an example of (TSH) this sex difference as observed in the incidence of Graves’ disease and Hashimoto’s thyroiditis. 1.2 COST BURDEN OF DISEASE National surveillance data report a steady rise in case THYROID volume of endocrine procedures in the US over the last decade, mainly attributable to new and improved imaging and surgical techniques.20 It is estimated that the number of endocrine procedures performed in the US in 2020 may be as high as 173,509.20 T3, T4 In 2008, overall thyroid disease treatment costs in the US for females over age 18 totaled $4.3 billion, including $2.2 billion for ambulatory visits, and $1.4 billion for Figure 1. Hypothalamic-pituitary-thyroid axis feedback loop. © 2015 The Endocrine Society. All rights reserved. ENDOCRINE SOCIETY | 1 Table 1 Estimated prevalence of thyroid disease by condition. CONDITION METHOD DATA SOURCE POPULATION PREVALENCE REFERENCE Thyroid nodules Autopsy Review article International 13% – 60% Stanicic et al, 20096 population Palpation Whickham Survey Adults, Whickham, 0.5% – 26% Vanderpump et al, 19957 (1972) UK Ultrasonography Review article International 13.4% – 46% Stanicic et al, 20096 population Enhanced chest Johns Hopkins Adult outpatients, US 25.1% Ahmed et al, 20128 radiography Hospital Hyperthyroidism Overt NHANES III Subjects age 0.1% – 0.5% Hollowell et al, 20029 (1988-1994) 12 years and older, US (n=17,353) Subclinical NHANES III Subjects age 0.75% – 4.3% Hollowell et al, 20029 (1988-1994) 12 years and older, US (n=17,353) Graves’ disease Literature review US population 0.63% – 1.49% Hayter et al, 201210 Hypothyroidism Overt NHANES III Subjects age 0.3% – 0.8% Hollowell et al, 20029 (1988–1994) 12 years and older, US (n=17,353) Subclinical NHANESIII Subjects age 0.7% – 13% Hollowell et al, 20029 (1988-1994) 12 years and older, US (n=17,353) Gestational Quest diagnostics Pregnant women, US 15.5% Blatt et al, 201211 data (2005-2008) (n=117,892) Congenital (incidence) NNSGRC dataset Newborns, US 0.04% Hinton et al, 201012 (1991-2000) Autoimmune Hashimoto’s Thyroid 811 consecutive 4.6% – 13.4% Staii et al, 201013 thyroiditis thyroiditis Multidisciplinary patients who Clinic, Wisconsin received fine needle (2006-2008) application biopsies, US Goiter Sporadic diffuse Literature review International 1% – 10% Lind et al, 199814 population Sporadic nodular Literature review International 5% – 9% Lind et al, 199814 population School-aged children Research study Children age 9-16 6.8% Trowbridge et al, 197515 years, US (n=7,785) Iodine deficiency Low urinary iodine NHANES Non-pregnant, non- 17% Perrine et al, 201016 concentrations (2001-2006) lactating women age (<50 mcg/L) 15-44 years, US Note: Differences in diagnostic criteria and analytical techniques account for ranges of prevalence of thyroid disease reported in the literature. 2 | THYROID © 2015 The Endocrine Society. All rights reserved. Importantly, in the time period reported in Table 4 (1996 In addition to costs related to treatment expenses and to 2006), there was only a 19.5% increase in inpatient hospitalization, costs also involve work absence, and thyroidectomies, whereas outpatient thyroidectomies unemployment. Indeed, certain forms of disease have increased 60.9%. In 2006, the difference in unit charge a higher cost in terms of work disability. For example, between inpatient and outpatient (i.e. length of stay in a recent Danish study found that patients with Graves’ hospital <24 hours) thyroidectomy ($15,315) yielded orbitopathy had the highest risk of work disability, estimated yearly savings of $63.6 million by reducing with this being most pronounced in the first year after length of stay to less than 24 hours.22 diagnosis.23 Table 2 Prevalence of thyroid disease by race/ethnicity in the US. HYPOTHYROIDISM HYPERTHYROIDISM RACE/ETHNICITY OVERALL OVERT SUBCLINICAL OVERALL OVERT SUBCLINICAL All 4.6% 0.3% 4.3% 1.3% 0.55% 0.75% White, 5.1% 0.4% 4.8% 1.4% 0.6% 0.8% non-Hispanic Black, 1.7% 0.1% 1.6% 1.1% 0.5% 0.6% non-Hispanic Mexican American 4.1% 0.2% 3.9% 0.7% 0.2% 0.5% All other races/ 4.2% 0.2% 4.0% 0.7% 0.4% 0.3% ethnicities Source: Hollowell et al. 20029 Table 3 Sex differences in incidence of thyroid disease (per 1000 person-years). DATA SOURCE POPULATION CONDITION MALES FEMALES Comprehensive analysis of medical diagnoses of US adults age 20-57 years Hashimoto’s 0.03 0.26 active US Military Personnel (1997-2011) thyroiditis Graves’ disease 0.08 0.47 Source: McLeod et al.
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