There was a steady rise in the number of endocrine procedures being performed in the United States over the past decade, according to a new publication from the Endocrine Society.
Thyroid disease treatment costs in U.S. women alone totaled $4.3 billion in 2008, representing a cost of $343 per patient, according to the report, authored by the Endocrine Society under the guidance of an advisory committee chaired by Dr. Robert A. Vigersky, head of the Diabetes Institute at Walter Reed National Military Medical Center in Bethesda, Md.
The number of endocrine procedures also has increased steadily, mainly because of new and improved surgical techniques, but the annual case number is predicted to go as high as 173,000 by 2020.
Thyroid conditions affect five times as many women as men, particularly in the case of Hashimoto’s disease – the incidence in women is more than eight times that in men – and Graves’ disease, where women have a nearly sixfold higher incidence than men, according to the report, which is available online.
The most common thyroid disease is thyroid nodules, which international studies estimate affect up to 60% of the population. In the United States, findings from a study using chest radiography found nearly one in four adult outpatients had thyroid nodules.
The diagnosis of thyroid nodules has increased as imaging technologies such as CT scanning, ultrasound, and MRI improve on the traditional diagnostic method of physical examination. The increase in thyroid surgery for this condition has raised questions about whether this has led to improved outcomes.
Hyperthyroidism and hypothyroidism have a lower prevalence, although estimates suggest as much as 13% of the U.S. population has subclinical hypothyroidism.
This has implications particularly in pregnancy, as subclinical hypothyroidism may increase the risk of pregnancy complications, including preeclampsia, placental abruption, preterm birth, and neonatal mortality.
One study found that 12.4% of healthy pregnant women with no known thyroid disease had subclinical hypothyroidism. Overt hypothyroidism affects around 0.8% of adults, while overt hyperthyroidism affects just 0.5% of adults, the report stated.
Graves’ disease is one form of hyperthyroidism, and it has a prevalence in the U.S. population of 0.63%-1.49%, mostly affecting women, African Americans, and Asian/Pacific Islanders.
This condition is most commonly treated with antithyroid drugs or radioactive iodine therapy, although around 0.7% of patients undergo thyroidectomies.
Another group of thyroid diseases, grouped under the umbrella term of thyroiditis, includes a common element of inflammation of the thyroid gland. Among them is the autoimmune condition Hashimoto’s thyroiditis, which is thought to affect around 4.6% of the population.
Postpartum thyroiditis – an inflammatory autoimmune condition that develops in the first year after delivery – is estimated to have a prevalence around 4.5%, according to one review.
“Evidence is emerging that as women age subclinical hypothyroidism – as a sequel of postpartum thyroiditis – predisposes them to cardiovascular disease,” wrote Dr. Vigersky, also of the Uniformed Services University of the Health Sciences, and the other panel members.
“Hence, postpartum thyroiditis is no longer considered a mild and transient disorder.”
The report was produced by the Endocrine Society. There were no conflicts of interest declared.
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