Trends in prevalence of thyroid dysfunction and its associations with mortality among US participants, 1988-2012.
Open accessAbstract
CONTEXT: Various dynamic factors could influence the prevalence and distribution of thyroid dysfunction. OBJECTIVE: To provide national estimates and temporal trends in prevalence of thyroid dysfunction over the past 3 decades in United States and determine the impact of thyroid dysfunction on mortality in US adults. METHODS: A cross-sectional analysis of data from 33 117 participants aged 12 years or older in the National Health and Nutrition Examination Survey III (1988-1994), 1999-2002, and 2007-2012. RESULTS: The weighted mean age was 41.6 years, and 48.3% were men. In 2007 through 2012, the prevalence of subclinical and overt hypothyroidism, subclinical and overt hyperthyroidism was 4.3%, 0.33%, 3.2%, and 0.2% respectively. Eighty percent of individuals with thyroid dysfunction were previously undiagnosed. The prevalence of subclinical hypothyroidism and hyperthyroidism was stable, whereas overt hypothyroidism (0.54% [95% CI, 0.35-0.8] vs 0.33% [95% CI, 0.23-0.48]) and hyperthyroidism (0.8% [95% CI, 0.58-1.1] vs 0.2% [95% CI, 0.12-0.33]) were less prevalent in 2007-2012 compared to 1988-1994. Older age, White Americans, obesity, and positivity for thyroid peroxidase antibody and thyroglobulin antibody were risk factors for hypothyroidism, whereas older age, women, and Black Americans were risk factors for hyperthyroidism. Over a median follow-up of 17.2 years, no significant association was observed between any type of thyroid dysfunction with the risk of total or cardiovascular mortality. However, among individuals aged 65 years or older, subclinical hypothyroidism was associated with a higher risk of total mortality (hazard ratio, 1.17; 95% CI, 1.00-1.37; P = .05) and cardiovascular mortality (HR, 1.29; 95% CI, 1.04-1.62; P = .02). CONCLUSIONS: The prevalence of subclinical thyroid dysfunction remained relatively unchanged, whereas that of overt thyroid dysfunction decreased. Subclinical hypothyroidism was associated with a higher mortality among individuals aged 65 years or older.
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- Authors
- Zhang, X., Wang, Y., Wang, H., & Zhang, X.
- Affiliations
- Nanjing Drum Tower Hospital (CN)
- Nanjing University (CN)
- Corresponding author
- Zhang, Xiaowen
- Zhang, Xinlin
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2023-09-20
- Volume
- 109
- Issue
- 2
- Pages
- e657-e666
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W4386950914
- Cited by
- 29
- References
- 32
- Citations by year
- 2026: 9 · 2025: 15 · 2024: 5
- FWCI
- 5.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Affiliated Drum Tower Hospital, Nanjing University School of Medicine (2022-LCYJ-PY-06, 2022-381 YXZX-NFM-02)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- thyroid dysfunction, subclinical hypothyroidism, overt hypothyroidism, hyperthyroidism, prevalence trends, mortality, cardiovascular mortality, all-cause mortality, thyroid peroxidase antibodies, thyroglobulin antibodies, obesity, racial and ethnic differences, older adults, risk factors, United States adults, NHANES III
- MeSH terms
- Adult, Cardiovascular Diseases, Cross-Sectional Studies, Female, Humans, Hyperthyroidism, Hypothyroidism, Male, Nutrition Surveys, Thyroid Diseases, Thyrotropin, Prevalence
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