Incidence and Clinical Presentation of Moderate to Severe Graves' Orbitopathy in a Danish Population before and after Iodine Fortification of Salt
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CONTEXT: Population-based data on the incidence and clinical presentation of moderate to severe Graves' orbitopathy (GO) are scarce, and virtually nothing is known on the effect of an iodization program on the incidence and presentation of GO. OBJECTIVE: The objective of the study was to characterize incident moderate to severe GO in North Jutland County, Denmark, during the period 1992-2009, before and after the Danish salt iodization program. DESIGN AND PATIENTS: The design of the study was a prospective register of patients with incident moderate to severe GO in a population during 8.9 million persons × years of observation. SETTING: The study was conducted at a thyroid-eye clinic of university hospital. MAIN OUTCOME MEASURES: Clinical presentation and incidence before and after the year 2000 initiation of the mandatory Danish iodization of salt were measured. The incidence of GO was related to the incidence of Graves' hyperthyroidism (GH) in the same population. RESULTS: The incidence rate of moderate to severe GO was 16.1/million per year (women: 26.7; men: 5.4), with no change associated with iodization of salt. The moderate to severe GO incidence was 4.9% of the incidence of GH. The incidence rate ratio between women and men with GO (4.9) was not different from the ratio in GH. Compared with GH, only a few patients (<2%) suffered from moderate and severe GO below the age of 40 yr, whereas GO was relatively common in age groups 40-60 yr (∼8%). CONCLUSIONS: Approximately 5% of the patients with Graves' disease develop moderate to severe GO, with a similar risk in women and men with Graves' disease. The risk of GO is much higher in patients aged 40-60 yr than in young patients with Graves' disease. Salt iodization was not associated with a change in the incidence of GO.
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More recent studies do not identify a clear sex-related risk for GO, while some older studies point to a possible slightly increased risk for men.
“More recent studies do not identify a clear sex-related risk for GO (517,518), while some older studies point to a possible slightly increased risk for men (519,520).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [517]
Approximately a third of patients with Graves' hyperthyroidism have some signs and/or symptoms of GO, while only 5% have moderate-to-severe disease.
“Approximately a third of patients with Graves' hyperthyroidism have some signs and/or symptoms of GO, while only 5% have moderate-to-severe disease (517,518).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [517]
GO peaks in incidence in the fifth and sixth decade of life, with a higher prevalence of severe cases in the elderly population.
“The disease peaks in incidence in the fifth and sixth decade of life (517,518,521,522) with a higher prevalence of severe cases in the elderly population (517).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [517]
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- Authors
- Laurberg, P., Berman, D. C., Bülow Pedersen, I., Andersen, S., & Carlé, A.
- Affiliations
- Aalborg University Hospital (DK)
- Corresponding author
- Laurberg, Peter
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2012-07
- Volume
- 97
- Issue
- 7
- Pages
- 2325-2332
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC3387399
- OpenAlex
- W2137293941
- Cited by
- 133
- References
- 36
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 17 · 2023: 9 · 2022: 7 · 2021: 11 · 2020: 11 · 2019: 9 · 2018: 12 · 2017: 9 · 2016: 7 · 2015: 10 · 2014: 6 · 2013: 6 · 2012: 2
- FWCI
- 5.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Aarhus Universitet
- Aarhus Universitetshospital
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Neurology › Myasthenia Gravis and Thymoma
- Keywords
- Graves' ophthalmopathy, Graves' hyperthyroidism, salt iodization, iodine fortification, incidence, clinical features, sex differences, age distribution
- MeSH terms
- Adolescent, Adult, Aged, Child, Denmark, Female, Graves Disease, Humans, Iodine, Male, Middle Aged, Phenotype, Population, Severity of Illness Index, Time Factors, Incidence, Sodium Chloride, Dietary, Graves Ophthalmopathy, Young Adult
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