Diseases of the Thyroid (Contemporary Endocrinology)

Making Sense of Thyroid Disease: A Primary Care Approach
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Vanderpump MPJ. The epidemiology of thyroid disease Br Med Bull ;โ€” The thyroid gland and the process of aging; what is new? Thyroid Res ; Higher risk for thyroid diseases in physicians than in the general population: a Taiwan nationwide population-based secondary analysis study QJM-Int J Med ;โ€”8. No stress after hour on-call shifts? J Occup Health ; Chin Med J ; Adipocytokine correlations with thyroid function and autoimmunity in euthyroid sardinians. Cytokine ; Cytoplasmatic-nuclear shuttling of PER1 protein. Hypophysectomy abolishes rhythms in rat thyroid hormones but not in the thyroid clock.

J Endocrinol ; Cell Rep.

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Edited by: L. Braverman Humana Press Inc. Totowa NJ. An Update. Clock genes alterations and endocrine disorders. Eur J Clin Invest ;e Repercussions of hypo and hyperthyroidism on the heart circadian clock. Chronobiol Int ; Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association.

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Endocr Pract ; Home About us Subjects Contacts. Advanced Search Help. Entire Site De Gruyter Online. Sign in Register. The prevalence of undiagnosed total, overt, and subclinical hypothyroidism in females was 6.

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On the other hand, the prevalence of undiagnosed total, overt, and subclinical hyperthyroidism in the female population was 1. The mean prevalence of total thyroid dysfunction category 2 in Europe was 3. The prevalence of previously known and undiagnosed hypothyroidism and hyperthyroidism was 3. In this group, only 4 of 9 studies assessed subclinical disease.

Again, there was a clear female preponderance 6. In females, the prevalence of hyperthyroidism was 1. Regarding the prevalence of hypothyroidism, we found 5. Regarding those studies assessing subclinical disease 19 , 28 , 32 , 37 , the prevalence of overt and subclinical hyperthyroidism in women was 0. On the other hand, the prevalence of overt and subclinical hypothyroidism in females was 0. See Table 2. The incidence of total thyroid dysfunction category 3 in Europe was Once again, there was a clear female preponderance: The incidence rate of hypothyroidism was The incidence rate of hyperthyroidism was See Table 3.

To the best of our knowledge, this is the first meta-analysis of epidemiology of thyroid dysfunction. Our main objective was to better understand thyroid dysfunction epidemiology in Europe. We were also interested in identifying the percentage of undiagnosed thyroid dysfunction and providing information that could help future studies to find clues to better understand its etiology and association with iodine deficiency or thyroid cancer.

Our study provides extensive data on both prevalence and incidence of thyroid dysfunction in Europe, compares occult or undiagnosed disease with known disease, and classifies the parameters by sex and separates subclinical from clinical disease. We have compared our findings with the published information from other parts of the world. Unknown hypothyroidism and hyperthyroidism were found in 4.

Comparing these results with present meta-analysis results, the Europeans exceed the Americans by 0.

Only 6. In contrast, a similar comparison for the Europeans showed that the prevalence of unknown clinical hypothyroidism in Europe was double According to the Colorado survey, the number of Americans with subclinical disease surpasses the Europeans by 3. These conflicting results indicate that interpretation of studies about the frequency of thyroid dysfunction should take into account the study design and circumstances such as genetic background, race, environment, iodine consumption, age, and gender.

The information out of Asia is scarce. As usual, the leading cause of thyroid dysfunction among Japanese was subclinical hypothyroidism 5. In another study from this country, the investigators reported that the prevalence of unsuspected thyroid dysfunction was lower in Japan than in Europe with an age-related increase.

In China, the prevalence of hyperthyroidism varied between 1. The prevalence of thyroid dysfunction in Australia has been assessed in a sample of elderly people, but not in the general population The authors reported a prevalence of undiagnosed thyroid dysfunction of 3. In Brazil, as in Australia, its frequency was assessed among the elderly.

The authors reported a prevalence of 5. These results, however, are not comparable to the present meta-analysis results because the latter were estimated from studies in the general population. In addition, the Brazilian authors underlined that most participants were not aware of their thyroid dysfunction. As previously mentioned, comparing epidemiologic studies of thyroid dysfunction can be complicated because of the numerous differences between them.

The difficulties we have found involved disease definition and severity eg, overt and subclinical dysfunction , selection criteria of the studied population, and the influence of age, sex, and environmental factors. We also found differences in reference ranges and in the laboratory techniques used to measure serum thyroid hormone levels It was in when TSH second-generation assays were developed that provided a dramatic improvement in sensitivity.

Modern studies since generally use third-generation assays that represent an extra fold increase in sensitivity over the former. Therefore, differences between TSH assays makes it difficult to compare TSH values between studies that have used different assays because a TSH reported as being slightly elevated on one assay could be reported to be normal on another assay. All these circumstances help to explain the differences in the figures between the original Whickham survey 13 and the Vanderpump study 14 despite the fact that the latter was conducted 20 years later on the same population.

The initial study was carried out from July to June ; therefore, TSH was measured using a first-generation assay and the investigators derived a free T 4 index from their data. Additionally Vanderpump et al 14 point out that there is an important difference between the 2 Whickham studies: although the population was theoretically the same, in reality, the population of the second study was 20 years older than that of the first study. The fact that thyroid dysfunction especially hypothyroidism increases dramatically after age 40 could also partially explain the differences between the 2 studies, as has been previously noted by others It should be also taken into account that the problem inherent to studying a large number of individuals is the difficulty in carrying out epidemiologic investigations in the general population.

Surveys aimed at revealing incidence are even more limited because they are complex to carry out. We have found that most cross-sectional studies have focused on middle-aged subjects, pregnant women, or the elderly. In addition, it should be noted that not all of the studies used the same measures of frequency. We dealt with this issue by dividing the selected studies into 3 separate categories: 1, prevalence of undiagnosed thyroid dysfunction; 2, prevalence of thyroid dysfunction; and 3, incidence of thyroid dysfunction. Eventually taking into account all these variables, we used an empirical Bayesian random-effects model that adjusts for heterogeneity.

The random-effects approach assumes that true prevalence differs across studies. In recent years, there has been an increasing amount of data suggesting that any degree clinical and subclinical of thyroid dysfunction is associated with deleterious health effects. Most these patients approximately 4.

Given the mildness of the clinical manifestations of subclinical hypothyroidism, the diagnosis is often overlooked. Whether healthy individuals could benefit from a universal screening program for thyroid disease is a subject of controversy. On its face, the benefits of a screening program should outweigh any potential drawbacks Usually, the only test needed for thyroid dysfunction screening is a serum TSH level, which is inexpensive and free from side effects.

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The guidelines presented here principally address the management of ambulatory patients with biochemically confirmed primary hypothyroidism whose thyroid status has been stable for at least several weeks. Short-term time trends in prescribing therapy for hypothyroidism: results of a survey of american thyroid association members. Patients with thyroid nodules should have an ultrasensitive TSH assay performed to assess the possible presence of either hyperthyroidism or hypothyroidism. N Engl J Med โ€” Plasma fetuin-A levels are reduced in patients with hypothyroidism. In progress issue alert. New York: Plenum Medical;

In the era of preventive medicine, regular screening of TSH blood levels would be extremely cost-effective. The goal of thyroid screening should be to identify and treat patients with thyroid dysfunction. Early diagnosis would prevent the development of complications. In recent years, mounting evidence has made universal screening for thyroid dysfunction ever more compelling. Nowadays, we know that complications associated with either overt or subclinical thyroid dysfunction cannot be neglected.

These complications could be especially severe in patients with cardiovascular diseases, in postmenopausal women, or in women antedating pregnancy. A brilliant example in support of the advisability of the thyroid dysfunction screening program was provided by Vaidya et al The authors prospectively illustrate that testing only women with high-risk pregnancies, as the consensus guidelines recommend 40 , would fail to identify about one-third of women with hypothyroidism.

We conclude that a large proportion of the European population unknowingly has laboratory evidence of thyroid dysfunction. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search.

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Endocrine l Thyroid Hyperthyroidism vs. Hypothyroid NCLEX

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1. Introduction: clinical problem

Google Preview. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Search ADS. Subclinical thyroid dysfunction: a joint statement on management from the American Association of Clinical Endocrinologists, the American Thyroid Association, and the Endocrine Society. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Quality of Reporting of Meta-analyses. Predicting the extent of heterogeneity in meta-analysis, using empirical data from the Cochrane Database of Systematic Reviews.

The confidence profile method: a Bayesian method for assessing health technologies. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. The prevalence of thyroid dysfunction in a population with borderline iodine deficiency. Thyroid function abnormalities and cognitive impairment in elderly people: results of the Invecchiare in Chianti study. The thyroid epidemiology, audit, and research study: thyroid dysfunction in the general population.

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Thyroid function and prevalence of anti-thyroperoxidase antibodies in a population with borderline sufficient iodine intake: influences of age and sex. Incidence of different forms of thyroid dysfunction and its degrees in an iodine sufficient area. Low incidence rate of overt hypothyroidism compared with hyperthyroidism in an area with moderately low iodine intake.

Thyroid function in Japanese adults as assessed by a general health checkup system in relation with thyroid-related antibodies and other clinical parameters. Epidemiological survey on the relationship between different iodine intakes and the prevalence of hyperthyroidism.