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Cited by 142Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryOphthalmology and Eye Disorders

Morbidity before and after the diagnosis of hyperthyroidism: a nationwide register-based study

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Brandt, Frans, Thvilum, Marianne, Almind, Dorthe, Christensen, Kaare, Green, Anders, Hegedüs, Laszlo, Brix, Thomas Heiberg·2013·PLoS ONE
DOI 10.1371/journal.pone.0066711PMC PMC3688572
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Abstract

BACKGROUND: Hyperthyroidism has been linked with different morbidities, like atrial fibrillation, stroke and diabetes mellitus. However, our knowledge regarding the extent and temporal relation between hyperthyroidism and other diseases is fragmented. Here, we aimed at evaluating various morbidities before and after the diagnosis of hyperthyroidism. METHODS: Observational cohort study. From nationwide Danish health registers 2631 hyperthyroid singletons and 375 twin pairs discordant for hyperthyroidism were identified and followed for an average of 6 years (range 0-13). Data on the occurrence of cardiovascular diseases, lung diseases, diabetes mellitus, rheumatic diseases and malignant diseases was obtained by person-to-person record linkage with the National Danish Patient Register and/or the Danish National Prescription Registry (lung diseases and diabetes mellitus). Logistic and Cox regression models were used to assess the risk of morbidity before and after the diagnosis of hyperthyroidism, respectively. All Cox regression analyses were adjusted for the degree of co-morbidity preceding the diagnosis of hyperthyroidism, using the Charlson score. RESULTS: Hyperthyroid individuals had a significantly higher risk of being diagnosed with cardiovascular diseases (odds ratio (OR) 1.65; 95% confidence interval (CI): 1.45-1.87), lung diseases (OR 1.53; 95% CI: 1.29-1.60), and diabetes mellitus (OR 1.43, 95% CI: 1.20-1.72), but not with malignant diseases (OR 1.16, 95% CI: 0.99-1.36) prior to the diagnosis of hyperthyroidism. After the diagnosis of hyperthyroidism, subjects had a significantly higher risk of being diagnosed with cardiovascular diseases (hazard ratio (HR) 1.34; 95% CI: 1.15-1.56), lung diseases (HR 1.28; 95% CI: 1.10-1.49), and diabetes mellitus (HR 1.46; 95% CI: 1.16-1.84), but not with rheumatic diseases (HR 1.39, 95% CI: 0.92-2.09) or malignant diseases (HR 1.18, 95% CI 0.97-1.42). CONCLUSIONS: We demonstrate a significantly increased burden of morbidity, both before and after the diagnosis of hyperthyroidism.

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  • An elevated risk of T2DM in patients with hyperthyroidism has been documented.

    “An elevated risk of T2DM in patients with hyperthyroidism has been documented (6, 7).”

    From The progression of secondary diabetes: A review of modeling studies (2022) · cites this paper as [6]

    The Results report a significantly higher risk of diabetes mellitus diagnosis after a hyperthyroidism diagnosis. However, the Methods define diabetes mellitus as a combined outcome without separating type 2 from type 1, so the paper does not establish the claim specifically for T2DM. (LLM, conf=0.88)

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  • A number of studies have reported rising incidence of diabetes mellitus in patients with thyroid hormone dysregulation and vice versa.

    “A number of studies have reported the rising incidence of diabetes mellitus in patients with thyroid hormone dysregulation and vice versa (6, 7).”

    From The progression of secondary diabetes: A review of modeling studies (2022) · cites this paper as [6]

    The Discussion reports an increased risk of diabetes diagnosis both before and after a hyperthyroidism diagnosis, supporting an association in both temporal directions. It does not establish a rising incidence over time or extend the finding to thyroid hormone dysregulation generally; it also cautions that the temporal association does not establish direction of effect. (LLM, conf=0.84)

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  • Overtreatment of hypothyroidism most likely carries a similar risk of increased morbidity and mortality as shown for hyperthyroidism.

    “Thus, overtreatment of hypothyroidism most likely carries a similar risk of increased morbidity (39,40) and mortality, (41) as shown for hyperthyroidism.”

    From The Excess Risk of Major Osteoporotic Fractures in Hypothyroidism Is Driven by Cumulative Hyperthyroid as Opposed to Hypothyroid Time: An Observational Register-Based Time-Resolved Cohort Analysis (2015) · cites this paper as [39]

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1 of the 44 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [32]Rothman XJ, Greenland S, Lash TL (2008) Modern Epidemiology: Case Control studies. Lippincott Williams & Wilkins. Philadelphia 2008.

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Authors
Brandt, F., Thvilum, M., Almind, D., Christensen, K., Green, A., Hegedüs, L., & Brix, T. H.
Affiliations
  • Odense University Hospital (DK)
  • University of Southern Denmark (DK)
Corresponding author
Brandt, Frans
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2013-06-20
Volume
8
Issue
6
Pages
e66711
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0066711
PMC
PMC3688572
OpenAlex
W2044489693
Cited by
142
References
44
Citations by year
2026: 1 · 2025: 7 · 2024: 10 · 2023: 15 · 2022: 17 · 2021: 13 · 2020: 17 · 2019: 6 · 2018: 12 · 2017: 11 · 2016: 8 · 2015: 9 · 2014: 15 · 2013: 1
FWCI
8.67
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion)
Funders
  • Novo Nordisk
  • Syddansk Universitet
  • Novo Nordisk Fonden
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
Keywords
hyperthyroidism, comorbidities, cardiovascular disease, lung disease, diabetes mellitus, rheumatic diseases, cancer, atrial fibrillation, stroke, hyperthyroidism diagnosis, twin discordance, Charlson Comorbidity Index, Denmark, patient registry, data linkage
MeSH terms
Aged, Cardiovascular Diseases, Denmark, Diabetes Mellitus, Female, Humans, Hyperthyroidism, Lung Diseases, Male, Middle Aged, Morbidity, Registries, Time Factors, Cohort Studies, Logistic Models, Proportional Hazards Models

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