5 Thyroiditis

Suggested citation: Endocrine Society. Endocrine Facts and Figures: Thyroid. First Edition. 2015.

Thyroiditis is a broad term encompassing a group of conditions whose primary symptom is inflammation of the thyroid gland. These conditions include Hashimoto’s thyroiditis, postpartum thyroiditis, painless thyroiditis, subacute thyroiditis, drug-induced and radiation-induced thyroiditis, and acute or infectious thyroiditis. Hashimoto’s thyroiditis is considered the most common autoimmune disease, at 46 cases per 1000 when measured by levels of circulating thyroid antibodies.133

5.1    Prevalence and Incidence

5.1.1        Hashimoto’s Thyroiditis

Tables 27, 28, and 29 present data related to epidemiology of Hashimoto’s thyroiditis. Please note that in these tables, disease-free population is defined as those not reporting thyroid disease, goiter, or taking thyroid medication at the time of the study.

Table 27. Incidence and prevalence of Hashimoto’s thyroiditis.
POPULATION METHOD INCIDENCE PER 100,000/YEAR PREVALENCE REFERENCE
Rochester, Olmsted County, Minnesota, US (1935–1967)* Tissue sample; clinical manifestations 1935-1944, 6.5 (F);
1945-1954, 21.4 (F)
1955-1964, 67.0 (F)1965-1967, 69.0 (F)
Overall, 246/2336 (10.53%);
F, 240 (10.27%);
M, 6 (0.26%)
Furszyfer et al. 1972113
Whickham, UK (1972), adults age ≥ 20 years (n=2779) Hemagglutination, TgAb immunoreactivity F, 16.2% ; M, 4.3% Tunbridge et al. 197748; McLeod et al. 2012134
Whickham, UK (1972-1992)(n=1877) Serum TSH, free T4 350 (F), 60 (M) F, 10.3%; M, 2.7% Vanderpump et al. 19957; McLeod et al. 2012134
7 towns (n=719) England and Wales previously characterized in terms of past and present iodine intake TPOAb immunoreactivity 15 (F) F, 20.2% McLeod et al. 2012134; Prentice et al.  1990135
Tayside, Scotland (1994-2001) TEARS database (n=390,000) Serum TSH 448 (F), 92 (M) Increased from 1.83% to 3.01% over 1994-2001 Leese et al. 200869
US active-duty military personnel, age 20–54 years, (1997-­2011) Diagnosis per ICD-9-CM code 245.2 26.3 (F), 3.2 (M) McLeod et al. 201419
761 patients, U. Wisconsin Thyroid Clinic, 2006-2008 FNA, cytological diagnosis 13.4% Staii et al. 201013
NHANES III (1988-1004) (n= 17,353; 8,043 (M) and 9,310 (F)), age ≥ 12 years ** Serum TSH, T4,  thyroid antibodies (TPOAb and TgAb) Hollowell et al. 20029
Total population(n = 17,353) TPOAb 13.0%
TgAb 11.5%
Disease-free population(n = 16,533) TPOAb 11.3%
TgAb 10.4%
Abbreviations: F, females; M, males; TPOAb, antithyroid peroxidase; TgAb, antithyroglobulin; TSH, thyroid stimulating hormone.
Notes: *The detailed analysis for the incidence of Hashimoto’s was done only for the female population; **Positive TPOAb ≥0.5 IU/mL; positive TgAb ≥1.0 IU/mL
Table 28. Antibody prevalence by thyroid status, antibody prevalence, all ethnic groups by age (%) in the US, NHANES III (1988-1994).
 AGE TPOAb TgAb
TOTAL POPULATION DISEASE-FREE POPULATION TOTAL POPULATION DISEASE-FREE POPULATION
All ages 13.0 11.3 11.5 10.4%
12-19 4.8 4.8 6.3 6.3
20-29 8.5 7.9 7.2 6.7
30-39 11.9 10.5 11.2 10.1
40-49 14.7 13.1 12.0 11.3
50-59 16.0 13.5 13.9 12.0
60-69 20.2 16.7 16.9 14.7
70-79 22.3 19.6 18.8% 17.0
80-89 23.9 20.4 21.6% 19.4
Abbreviations: F, females; M, males. TPOAb, antithyroid peroxidase; TgAb, antithyroglobulin.
Definition: positive TPOAb; ≥0.5 IU/mL; positive TgAb; ≥1.0 IU/mL

Source: Hollowell et al. 20029

Table 29. Antibody prevalence by thyroid status, gender, and ethnicity in the US, NHANES III (1988-1994)
TPOAb TgAb
TOTAL POPULATION DISEASE-FREE POPULATION TOTAL POPULATION DISEASE-FREE POPULATION
Total M F Total M F Total M F Total M F
All ethnic groups 13.0 8.7 17.0 11.3 8.0 14.6 11.5 7.6 15.1 10.4 6.9 13.8
White non-Hispanic 14.3 10.0 18.4 12.3 9.1 15.6 12.9 8.9 16.6 11.5 8.1 15.0
Black non-Hispanic 5.3 2.5 7.6 4.5 6.2 6.4 3.0 2.2 4.4 2.7 1.1 4.1
Mexican American 10.9 16.2 15.9 10.1 5.9 14.7 8.8 4.7 13.1 8.2 4.6 12.3
Abbreviations: F, females; M, males. TPOAb, antithyroid peroxidase; TgAb. antithyroglobulin.

Definition: positive TPOAb ≥0.5 IU/mL); positive TgAb ≥1.0 IU/mL

Source: Hollowell et al. 20029

 5.1.2        Subacute Thyroiditis

Subacute thyroiditis is an acute painful inflammatory disorder of the thyroid gland, most likely due to viral infection.2 According to data collected between 1960 and 1997 from the residents of Olmsted County, Minnesota, the total incidence of subacute thyroiditis in the 1990’s was 3.6 per 100,000. Incidence was 2.8 per 100,000 among males and 4.6 among females.136 The data indicated a decrease in incidence from 8.7 per 100,000 in the 1960s to 5.6 during the 1970s and 3.2 in the 1980s, followed by a period of stability during the 1990s.136

A recent study examined a large cohort from two cities in Denmark, one with moderate iodine deficiency (Aalborg) and another with only mild iodine deficiency (Copenhagen). 2.3% of the cases of subacute thyroiditis presented in subjects from the moderate iodine deficiency area and 0.9% from the area with only mild iodine deficiency.109

 5.1.3        Postpartum Thyroiditis

Postpartum thyroiditis is an inflammatory autoimmune disorder of the thyroid gland that occurs in the first year following delivery. A review of 21 studies prospectively performed in women without another autoimmune disease estimated that the average incidence of postpartum thyroiditis was 5.4%; and it is increased in individuals with autoimmune diseases such as type 1 diabetes. Long-term follow-up of women after an episode of postpartum thyroiditis showed a 20% to 40% incidence of permanent hypothyroidism.137 A study of Japanese women stated that postpartum thyroid dysfunction occurs in in 5% to 10% of women, mostly thyrotoxicosis that appears early in the postpartum period and is usually followed by transient hypothyroidism.138

In a study of Iranian women with subclinical and overt postpartum thyroid dysfunction, after treatment with T4 for 23 months and subsequent withdrawal of treatment, 59% of women with subclinical thyroid dysfunction and 64% of women with overt hypothyroidism became hypothyroid. The author concluded that a high percentage of patients with subclinical postpartum thyroid dysfunction will proceed to permanent hypothyroidism.139 In a review of studies on postpartum thyroiditis, the authors found a wide range of permanent hypothyroidism, from 12% to 61%. They also stated that postpartum thyroiditis is an acute stage of autoimmune thyroid destruction, frequently leading to permanent thyroid failure.140

 

5.2    Demographic Differences

The Defense Medical Surveillance System reported the number of Hashimoto’s thyroiditis cases among all US active duty military personnel aged 20 to 54 years from January 1, 1997 to December 31, 2011. Hashimoto’s thyroiditis incidence was highest in whites and lowest in black women (IRR, 0.33) and men (IRR, 0.22) and Asian/Pacific Islander women (IRR, 0.31) and men (IRR, 0.23). 19

 

5.3    Life Expectancy and Mortality

Among pregnant women, thyroid autoimmunity in euthyroid women is associated with preterm delivery and miscarriage.141 Evidence is emerging that as women age subclinical hypothyroidism-as a sequel of postpartum thyroiditis-predisposes them to cardiovascular disease. Hence, postpartum thyroiditis is no longer considered a mild and transient disorder.140

 

5.4    Diagnosis, Treatment, and Prescription Trends

Postpartum thyroiditis is typically self-limited and does not always require treatment. However, postpartum thyroiditis may persist for up to 4 or more years in 25% of cases.142 Women who are symptomatic in the thyrotoxic phase may be treated with beta blockers. In the hypothyroid phase, T4 may be required if women are symptomatic or if the serum TSH is higher than 10 mIU/L.

Selenium supplementation for Hashimoto’s thyroiditis  has yielded non-definitive results, due to significant bias in four clinical trials reviewed in 2013.27

A retrospective review of the records of 72 patients with subacute thyroiditis found that 92% of the patients presented with local symptoms such as tenderness, pain, and dysphagia. 57% of patients showed symptoms of hyperthyroidism. Within 6 months after onset, subclinical hyperthyroidism was found in 15% and overt hyperthyroidism in 1.3% of patients. Long-term hormone replacement was deemed necessary if the TSH was higher than 3.5 mU/L. After a 12 month follow-up, 95.5% of patients were free of symptoms. At the endpoint of the study the thyroid gland volume was lower in the long term hormone replacement group compared with patients without need of T4 (41.7% vs 57.2% of sex-adjusted upper norm, respectively).143

 

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