Journal List > J Korean Thyroid Assoc > v.6(1) > 1056542

TOOLS
Gi, Sun, and Jae: Incidence & Prevalence of Hyperthyroidism and Preference for Therapeutic Modalities in Korea
Original Article

J Korean Thyroid Assoc 2013;6(1):56-63.

Published online: 3 May 2013

DOI: https://doi.org/10.11106/jkta.2013.6.1.56

Incidence & Prevalence of Hyperthyroidism and Preference for Therapeutic Modalities in Korea

Hyeon Seo Gi, Wook Kim Sun, Hoon Chung Jae

1Health Insurance Review and Assessment Service, Seoul, Korea

2Division of Endocrinology & Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Address reprint requests to Jae Hoon Chung, MD, PhD, Division of Endocrinology & Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea Tel: 82-2-3410-3434, Fax: 82-2-3410-3849, E-mail: thyroid@skku.edu

Received 13 February 2013       Accepted 14 February 2013

Copyright © 2013, the Korean Thyroid Association. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background and Objectives

The incidence and prevalence of hyperthyroidism has been reported to be 0.2-0.9/1000 population/year and 5-10/1000 population in foreign countries, respectively. However, there has been no nationwide survey to evaluate them in Korea. Therefore, this study was conducted to investigate the incidence and prevalence of hyperthyroidism in Korea using medicare claims data provided by the Health Insurance Review and Assessment Service. Preference for its therapeutic modalities and its change were also analyzed.

Materials and Methods

This study was performed in 308,584 (men 86,460, women 222,124) Korean patients with hyperthyroidism treated from January 2006 to June 2012. Patients with past history of hyperthyroidism were not included.

Results

The incidence of hyperthyroidism was 0.72/1000 population/year (men 0.40, women 1.03), and its prevalence was 3.40/1000 population (men 2.09, women 4.70) in Korea. Its peak prevalence was detected between 45 and 49 years of age. Among 177,487 patients with hyperthyroidism treated from 2007 to 2011, anti-thyroid drugs were prescribed in 97.9%, and radioiodine therapy and surgery were finally performed in 8.2% and 0.9%, respectively. The prescription of propylthiouracil (PTU) has been reduced from 63.3% in 2007 to 42.9% in 2011, but the use of methimazole (MMI) increased from 33.9% in 2007 to 54.8% in 2011. Primary physicians preferred PTU to MMI, but physicians in general hospitals preferred MMI to PTU.

Conclusion

This is the first nationwide report to investigate the incidence and prevalence of hyperthyroidism in Korea.

Keywords: Hyperthyroidism, Incidence, Prevalence, Propylthiouracil, Methimazole

References

1. Tunbridge WM, Evered DC, Hall R, Appleton D, Brewis M, Clark F, et al. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol (Oxf). 1977; 7(6):481–93.
crossref
2. Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf). 1995; 43(1):55–68.
crossref
3. dos Remedios LV, Weber PM, Feldman R, Schurr DA, Tsoi TG. Detecting unsuspected thyroid dysfunction by the free thyroxine index. Arch Intern Med. 1980; 140(8):1045–9.
crossref
4. Mogensen EF, Green A. The epidemiology of thyrotoxicosis in Denmark. Incidence and geographical variation in the Funen region 1972-1974. Acta Med Scand. 1980; 208(3):183–6.
5. Barker DJ, Phillips DI. Current incidence of thyrotoxicosis and past prevalence of goitre in 12 British towns. Lancet. 1984; 2(8402):567–70.
crossref
6. Haraldsson A, Gudmundsson ST, Larusson G, Sigurdsson G. Thyrotoxicosis in Iceland 1980-1982. An epidemiological survey. Acta Med Scand. 1985; 217(3):253–8.
7. Berglund J, Christensen SB, Hallengren B. Total and age-specific incidence of Graves’ thyrotoxicosis, toxic nodular goitre and solitary toxic adenoma in Malmo 1970-74. J Intern Med. 1990; 227(2):137–41.
8. Berglund J, Ericsson UB, Hallengren B. Increased incidence of thyrotoxicosis in Malmo during the years 1988-1990 as compared to the years 1970-1974. J Intern Med. 1996; 239(1):57–62.
crossref
9. Galofre JC, Garcia-Mayor RV, Fluiters E, Fernandez-Calvet L, Rego A, Paramo C, et al. Incidence of different forms of thyroid dysfunction and its degrees in an iodine sufficient area. Thyroidology. 1994; 6(2):49–54.
10. Bulow Pedersen I, Knudsen N, Jorgensen T, Perrild H, Ovesen L, Laurberg P. Large differences in incidences of overt hyper- and hypothyroidism associated with a small difference in iodine intake: a prospective comparative register-based population survey. J Clin Endocrinol Metab. 2002; 87(10):4462–9.
11. Flynn RW, MacDonald TM, Morris AD, Jung RT, Leese GP. The thyroid epidemiology, audit, and research study: thyroid dysfunction in the general population. J Clin Endocrinol Metab. 2004; 89(8):3879–84.
crossref
12. Holm IA, Manson JE, Michels KB, Alexander EK, Willett WC, Utiger RD. Smoking and other lifestyle factors and the risk of Graves’ hyperthyroidism. Arch Intern Med. 2005; 165(14):1606–11.
crossref
13. Chung JH, Kim BJ, Choi YH, Shin MH, Kim SH, Min YK, et al. Prevalence of thyrotoxicosis and hypothyroidism in the subjects for health check-up. J Korean Soc Endocrinol. 1999; 14(2):301–13.
14. Oh MK, Cheon KS, Jung SM, Ryu DS, Park MS, Cheong SS, et al. Prevalence of thyroid diseases among adult for health check-up in a Youngdong area of Kwangwon province. J Korean Acad Fam Med. 2001; 22(9):1363–74.
15. Park JE, Cho HC. Clinical review of thyroid dysfunction in the subjects for health check-up. J Korean Thyroid Assoc. 2012; 5(1):52–9.
crossref
16. Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002; 87(2):489–99.
crossref
17. Golden SH, Robinson KA, Saldanha I, Anton B, Ladenson PW. Clinical review: Prevalence and incidence of endocrine and metabolic disorders in the United States: a comprehensive review. J Clin Endocrinol Metab. 2009; 94(6):1853–78.
18. Vanderpump MP. The epidemiology of thyroid disease. Br Med Bull. 2011; 99:39–51.
crossref
19. Aghini-Lombardi F, Antonangeli L, Martino E, Vitti P, Maccherini D, Leoli F, et al. The spectrum of thyroid disorders in an iodine-deficient community: the Pescopagano survey. J Clin Endocrinol Metab. 1999; 84(2):561–6.
crossref
20. Knudsen N, Jorgensen T, Rasmussen S, Christiansen E, Perrild H. The prevalence of thyroid dysfunction in a population with borderline iodine deficiency. Clin Endocrinol (Oxf). 1999; 51(3):361–7.
crossref
21. Cho BY, Koh CS. Current trends in the diagnosis and treatment of Graves’ disease in Korea. J Korean Soc Endocrinol. 1992; 7(3):216–27.
22. Rivkees SA, Mattison DR. Ending propylthiouracil-induced liver failure in children. N Engl J Med. 2009; 360(15):1574–5.
crossref
23. Bahn RS, Burch HS, Cooper DS, Garber JR, Greenlee CM, Klein IL, et al. The Role of Propylthiouracil in the Management of Graves’ Disease in Adults: report of a meeting jointly sponsored by the American Thyroid Association and the Food and Drug Administration. Thyroid. 2009; 19(7):673–4.
crossref
24. Bahn Chair RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011; 21(6):593–646.
crossref

Table 1.
Incidence of hyperthyroidism in Korea according to age and gender (2011)
Age Men Women Total
Incidence Number Incidence Number Incidence Number
≤4 0.00 1 0.01 11 0.01 12
5-9 0.01 17 0.05 63 0.03 80
10-14 0.05 83 0.27 408 0.15 491
15-19 0.14 258 0.55 891 0.33 1,149
20-24 0.20 322 0.77 1,108 0.47 1,430
25-29 0.36 654 1.17 2,036 0.76 2,690
30-34 0.53 980 1.42 2,594 0.97 3,574
35-39 0.59 1,220 1.28 2,613 0.94 3,833
40-44 0.64 1,325 1.31 2,699 0.97 4,024
45-49 0.62 1,271 1.42 2,874 1.02 4,145
50-54 0.65 1,226 1.76 3,361 1.21 4,587
55-59 0.65 878 1.63 2,287 1.14 3,165
60-64 0.57 600 1.33 1,496 0.96 2,096
65-69 0.50 418 1.05 1,023 0.80 1,441
70-74 0.34 229 0.89 794 0.65 1,023
75-79 0.29 118 0.68 459 0.53 577
80-84 0.22 40 0.48 197 0.40 237
≥85 0.15 14 0.28 76 0.25 90
Total 0.40 9,654 1.03 24,990 0.72 34,644

Incidence: per 1000 population/year

Table 2.
Annual change of incidence of hyperthyroidism in Korea from 2007 to 2011
2007 2008 2009 2010 2011
Men 0.42 0.40 0.40 0.41 0.40
Women 1.12 1.08 1.04 1.06 1.03
Total 0.77 0.74 0.72 0.74 0.72

Incidence: per 1000 population/year

Table 3.
Prevalence of hyperthyroidism In Korea according to age and gender (2011)
Age Men Women Total
Prevalence Number Prevalence Number Prevalence Number
≤4 0.01 7 0.03 28 0.02 35
5-9 0.06 75 0.29 336 0.17 411
10-14 0.31 511 1.47 2,238 0.87 2,749
15-19 0.69 1,251 2.72 4,390 1.64 5,641
20-24 1.18 1,911 4.24 6,070 2.61 7,981
25-29 2.18 3,924 5.61 9,739 3.86 13,663
30-34 3.04 5,670 5.94 10,859 4.47 16,529
35-39 3.27 6,735 5.71 11,650 4.49 18,385
40-44 3.28 6,793 5.69 11,723 4.48 18,516
45-49 3.46 7,071 6.54 13 264 4.99 20,335
50-54 3.08 5,809 6.87 13,118 4.98 18,927
55-59 2.90 3,949 6.81 9,579 4.89 13,528
60-64 2.62 2,774 6.45 7,253 4.59 10,027
65-69 2.28 1,901 6.13 5,997 4.36 7,898
70-74 1.44 969 4.57 4,080 3.22 5,049
75-79 0.98 401 3.14 2,112 2.32 2,513
80-84 0.61 114 1.98 810 1.55 924
≥85 0.31 29 0.87 236 0.72 265
Total 2.09 49,894 4.70 113,482 3.40 163,376

Prevalence: per 1000 population/year

Fig. 1.
Annual change of prescription rate of anti-thyroid drugs from 2007 to 2011. The prescription of propylthiouracil (PTU) has been reduced from 63% in 2007 to 43% in 2011, but the use of methimazole (MMI) increased from 34% in 2007 to 55% in 2011. CAMZ: carbimazole, MMI: methimazole, PTU: propylthiouracil.
jkta-6-56f1.tif
Table 4.
Annual change of actual prescription number of anti-thyroid drugs from 2007 to 2011 according to the hospital size
Hospital Drug 2007 2008 2009 2010 2011 Total
University PTU 2,377 2,139 1,558 1,088 742 7,904
hospital Methimazole 3,231 3,026 3,803 4,252 4,148 18,460
Carbimazole 593 477 298 354 317 2,039
Total 6,201 5,642 5,659 5,694 5,207 28,403
General PTU 4,936 4,632 3,923 3,431 2,905 19,827
hospital Methimazole 4,053 4,117 4,331 5,208 5,560 23,269
Carbimazole 239 211 133 162 190 935
Total 9,228 8,960 8,387 8,801 8,655 44,031
Hospital PTU 2 353 2,308 2,371 2,230 2,094 11,356
Methimazole 592 670 913 1,118 1,416 4,709
Carbimazole 0 0 0 13 26 39
Total 2,945 2,978 3,284 3,361 3,536 16,104
Private clinic PTU 12,980 12,232 10,923 10,270 8,799 55,204
Methimazole 4,233 4,473 5,057 6,095 7,401 27,259
Carbimazole 182 221 221 254 247 1,125
Total 17,395 16,926 16,201 16,619 16,447 83,588

PTU: propylthiouracil

TOOLS
Similar articles