Incidence of hyperthyroidism in Stockholm, Sweden, 2003–2005.

Objective: To investigate the long-term prognosis of patients with Graves' disease (GD) after antithyroid drug (ATD) treatment and follow-up outside of highly specialised care. Design and methods: Medical records of all patients diagnosed with first-time GD in 2000-2010 with at least 6 months ATD treatment at a central hospital and follow-up in primary health care in the county of Norrbotten in northern Sweden were retrospectively reviewed. Patients were followed for relapse until 31st December 2012. We included 219 patients (mean age 46 years, 82.5% women) with follow-up of maximum 10 years and 829 observed patient years. Data were analysed using Kaplan-Meier estimates and log-rank test. Results: During the observation period, 43.5% of the patients had relapsed into active GD. The cumulative relapse rates were 22.6, 30.2, 36.9 and 41.5% after 6 months, 1, 3 and 5 years respectively. The presence of goitre (PZ0.014) predicted relapse. Previous smoking was protective against relapse (PZ0.003). The levels of free thyroxine or free tri-iodothyronine, age, gender, current smoking and ophthalmopathy did not predict relapse. Agranulocytosis was found in 1.7% (95% CI 0.7-4.0%). Conclusion: A long-term remission of 56.5%, in an iodine-sufficient area where ATD is offered to most patients in the real world of central and district hospitals, is higher than in most studies. Relapse was most common during the first year, and prognosis was excellent after 4 years without relapse. The protective effect of previous smoking merits further research.

Section: Discussionmentioning

confidence: 71%

Long-term prognosis after medical treatment of Graves' disease in a northern Swedish population 2000–2010

Mohlin

Nyström

Eliasson

2014

“…The incidence of MNTG in Denmark (34.6 per 100 000 person-years) is higher than in most other countries studied, where the calculated SIRs spanned from 3.3 to 30.5 per 100 000 person-years (6,8). All these studies were performed in regions with a higher iodine intake in the population compared with Denmark.…”

Section: Subtypes Of Hyperthyroidismmentioning

confidence: 96%

“…Many studies not only included patients with biochemical overt hyperthyroidism, but also patients with subclinical hyperthyroidism (7), or may have identified patients by means of biochemical screening (2). Other studies only evaluated certain age groups (8). Most studies were based on patients referred to hospital departments (6,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), potentially leading to referral bias (19).…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of subtypes of hyperthyroidism in Denmark: a population-based study

Carlé

Pedersen

Knudsen

et al. 2011

176

125

Objective: Few population-based studies have described the epidemiology of subtypes of hyperthyroidism. Design: A prospective population-based study, monitoring two well-defined Danish cohorts in Aalborg with moderate iodine deficiency (nZ311 102) and Copenhagen with only mild iodine deficiency (nZ227 632). Methods: A laboratory monitoring system identified subjects with thyroid function tests suggesting overt hyperthyroidism (low s-TSH combined with high s-thyroxine or s-triiodothyronine). For all subjects, we collected information on medical history, thyroid scintigraphy and thyroid hormone receptor antibody (TRAb) measurement. Information was used to disprove or verify primary overt hyperthyroidism and to subclassify hyperthyroidism into nosological disorders. Results: From 1997 to 2000 (2 027 208 person-years of observation), we verified 1682 new cases of overt hyperthyroidism. The overall standardized incidence rate (SIR) per 100 000 person-years was 81.6, and was higher in Aalborg compared with Copenhagen (96.7 vs 60.0, P!0.001), giving an SIR ratio (SIRR (95% confidence interval (CI))) between moderate versus mild iodine-deficient areas of 1.6 (1.4-1.8). Nosological types of hyperthyroidism (percentage/SIRR (95% CI)): multinodular toxic goitre (MNTG) 44.1%/1.9 (1.6-2.2), Graves' disease (GD) 37.6%/1.2 (0.99-1.4), solitary toxic adenoma (STA) 5.7%/2.4 (1.3-3.5), 'mixed type' hyperthyroidism (TRAb-positive, scintigraphicly multinodular) 5.4%/6.0 (3.0-12), subacute thyroiditis 2.3%/0.9 (0.4-1.4), postpartum thyroid dysfunction 2.2%/1.6 (0.8-3.0), amiodarone-associated hyperthyroidism 0.8%/7.1 (1.1-65), hyperthyroidism after thyroid radiation 0.7%/12.3 (0.8-50), lithium-associated hyperthyroidism 0.7%/0.97 (0.4-4.8) and hyperthyroidism caused by various other factors 0.7%. Lifetime risk for overt hyperthyroidism was 10.5%/6.5%/2.4% (females/all/males). Conclusion: Hyperthyroidism was common in Denmark with MNTG and GD as dominating entities. The higher incidence of hyperthyroidism in the most iodine-deficient region was caused by higher frequency of MNTG, 'mixed-type', STA and amiodarone-associated hyperthyroidism.

“…The incidence of thyrotoxicosis has previously been determined in Sweden and studies showed a variation between 25.8 and 43.0 cases per 100 000 per year (1)(2)(3)(4). In other studies in Europe, outside Sweden, performed in Iceland, Denmark, and the UK the incidence varied between 9.7 and 56.5 per 100 000 and year (5)(6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 94%

Immigration and the incidence of Graves' thyrotoxicosis, thyrotoxic multinodular goiter and solitary toxic adenoma

Lantz¹,

Abraham-Nordling²,

Svensson³

et al. 2009

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