Endocrinol Metab.  2018 Jun;33(2):260-267. 10.3803/EnM.2018.33.2.260.

Prevalence and Annual Incidence of Thyroid Disease in Korea from 2006 to 2015: A Nationwide Population-Based Cohort Study

• Kwon H
• Jung JH
• Han KD
• Park YG
• Cho JH
• Lee DY
• Han JM
• Park SE
• Rhee EJ
• Lee WY

• KMID: 2420495
• DOI: http://doi.org/10.3803/EnM.2018.33.2.260

Abstract

BACKGROUND
The incidence of thyroid nodules has increased worldwide in recent years. Thyroid dysfunction is a potential risk factor for hypercholesterolemia, cardiovascular disease, osteoporosis, arrhythmia, and neuropsychiatric disease. This study investigated the prevalence and annual incidence of thyroid nodules, hypothyroidism, and hyperthyroidism in Koreans.
METHODS
In this nationwide population-based cohort study, 51,834,660 subjects were included using the National Health Information database from 2006 to 2015, after the exclusion of subjects with thyroid cancer.
RESULTS
The prevalence in Korea in 2015 of thyroid nodules, hypothyroidism in patients taking thyroid hormone, and hyperthyroidism in patients undergoing treatment was 15.82/1,000 population, 15.94/1,000 population, and 2.76/1,000 population, respectively. All these diseases were more prevalent among women than among men. The number of incident cases of these three thyroid diseases steadily increased from 2006 to 2012, and then decreased through 2015. The incidence of thyroid nodules, hypothyroidism treated with thyroid hormone, and treated hyperthyroidism was 6.79/1,000 population, 1.76/1,000 population, and 0.55/1,000 population, respectively, in Korea in 2015. The use of methimazole continuously increased, from 33% of total antithyroid drug prescriptions in 2006 to 74.4% in 2015, and it became the most frequently prescribed antithyroid drug in Korea. In contrast, the use of propylthiouracil continuously decreased.
CONCLUSION
This was the first nationwide study of the prevalence and annual incidence of thyroid nodules, hypothyroidism, and hyperthyroidism to take into account recent changes and to include the current status of patients receiving treatment.

Keyword

Thyroid; Hypothyroidism; Hyperthyroidism; Prevalence; Incidence

MeSH Terms

Arrhythmias, Cardiac
Cardiovascular Diseases
Cohort Studies*
Drug Prescriptions
Female
Humans
Hypercholesterolemia
Hyperthyroidism
Hypothyroidism
Incidence*
Korea*
Male
Methimazole
Osteoporosis
Prevalence*
Propylthiouracil
Risk Factors
Thyroid Diseases*
Thyroid Gland*
Thyroid Neoplasms
Thyroid Nodule
Methimazole
Propylthiouracil

Figure

• 

  Fig. 1 Annual incidence of thyroid nodules in 2006 to 2015.

• 

  Fig. 2 Annual incidence of hypothyroidism in patients taking thyroid hormone in 2006 to 2015.

• 

  Fig. 3 Annual incidence of hyperthyroidism in patients undergoing treatment in 2006 to 2015.

• 

  Fig. 4 Changes in the prescription patterns of antithyroid drug in patients with hyperthyroidism. CAMZ, carbimazole; MMI, methimazole; PTU, propylthiouracil.

Reference

1. Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017; 390:1550–1562. PMID: 28336049.

2. De Leo S, Lee SY, Braverman LE. Hyperthyroidism. Lancet. 2016; 388:906–918. PMID: 27038492.

3. Mitchell J, Parangi S. The thyroid incidentaloma: an increasingly frequent consequence of radiologic imaging. Semin Ultrasound CT MR. 2005; 26:37–46. PMID: 15771264.

4. Moon JH, Hyun MK, Lee JY, Shim JI, Kim TH, Choi HS, et al. Prevalence of thyroid nodules and their associated clinical parameters: a large-scale, multicenter-based health checkup study. Korean J Intern Med. 2017; 7. 07. [Epub]. DOI: 10.3904/kjim.2015.273.

5. Shin J, Kim MH, Yoon KH, Kang MI, Cha BY, Lim DJ. Relationship between metabolic syndrome and thyroid nodules in healthy Koreans. Korean J Intern Med. 2016; 31:98–105. PMID: 26767863.

6. Liu Y, Lin Z, Sheng C, Zhu Y, Huang Y, Zhong N, et al. The prevalence of thyroid nodules in northwest China and its correlation with metabolic parameters and uric acid. Oncotarget. 2017; 8:41555–41562. PMID: 28107199.

7. Guo H, Sun M, He W, Chen H, Li W, Tang J, et al. The prevalence of thyroid nodules and its relationship with metabolic parameters in a Chinese community-based population aged over 40 years. Endocrine. 2014; 45:230–235. PMID: 23720025.

8. Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002; 87:489–499. PMID: 11836274.

9. Suk JH, Kim TY, Kim MK, Kim WB, Kim HK, Jeon SH, et al. Prevalence of ultrasonographically-detected thyroid nodules in adults without previous history of thyroid disease. J Korean Endocr Soc. 2006; 21:389–393.

10. Kim WJ, Kim JH, Park DW, Lee CB, Park YS, Kim DS, et al. Prevalence of thyroid nodules detected by ultrasonography in adults for health check-ups and analysis of fine needle aspiration cytology. J Korean Endocr Soc. 2008; 23:413–419.

11. Kim JH, Park SJ, Kim SE, Lee KH, Cho IK, Jang SI, et al. Prevalence of thyroid nodules detected by ultrasonography in adult men attending health check-ups. J Korean Endocr Soc. 2007; 22:112–117.

12. Peeters RP. Subclinical hypothyroidism. N Engl J Med. 2017; 376:2556–2565. PMID: 28657873.

13. Smith TJ, Hegedus L. Graves' disease. N Engl J Med. 2016; 375:1552–1565. PMID: 27797318.

14. Garmendia Madariaga A, Santos Palacios S, Guillen-Grima F, Galofre JC. The incidence and prevalence of thyroid dysfunction in Europe: a meta-analysis. J Clin Endocrinol Metab. 2014; 99:923–931. PMID: 24423323.

15. Asvold BO, Vatten LJ, Bjoro T. Changes in the prevalence of hypothyroidism: the HUNT Study in Norway. Eur J Endocrinol. 2013; 169:613–620. PMID: 23975540.

16. Kim WG, Kim WB, Woo G, Kim H, Cho Y, Kim TY, et al. Thyroid stimulating hormone reference range and prevalence of thyroid dysfunction in the Korean population: Korea National Health and Nutrition Examination Survey 2013 to 2015. Endocrinol Metab (Seoul). 2017; 32:106–114. PMID: 28116874.

17. Seo GH, Chung JH. Incidence and prevalence of overt hypothyroidism and causative diseases in Korea as determined using claims data provided by the Health Insurance Review and Assessment Service. Endocrinol Metab (Seoul). 2015; 30:288–296. PMID: 25559717.

18. Seo GH, Kim SW, Chung JH. Incidence & prevalence of hyperthyroidism and preference for therapeutic modalities in Korea. J Korean Thyroid Assoc. 2013; 6:56–63.

19. Chang MY, Han DH, Moon IJ, Kim ST, Kim DY, Lee CH, et al. Assessment of allergic rhinitis websites in Korea. Clin Exp Otorhinolaryngol. 2010; 3:32–36. PMID: 20379400.

20. Seong SC, Kim YY, Khang YH, Park JH, Kang HJ, Lee H, et al. Data resource profile: the National Health Information database of the National Health Insurance Service in South Korea. Int J Epidemiol. 2017; 46:799–800. PMID: 27794523.

21. Yi KH, Park YJ, Koong SS, Kim JH, Na DG, Ryu JS, et al. Revised Korean Thyroid Association management guidelines for patients with thyroid nodules and thyroid cancer. Endocrinol Metab. 2010; 25:270–297.

22. Ahn HS, Welch HG. South Korea's thyroid-cancer “epidemic”: turning the tide. N Engl J Med. 2015; 373:2389–2390. PMID: 26650173.

23. Rivkees SA, Mattison DR. Ending propylthiouracil-induced liver failure in children. N Engl J Med. 2009; 360:1574–1575.

24. Bahn RS, Burch HS, Cooper DS, Garber JR, Greenlee CM, Klein IL, et al. The role of propylthiouracil in the management of Graves' disease in adults: report of a meeting jointly sponsored by the American Thyroid Association and the Food and Drug Administration. Thyroid. 2009; 19:673–674. PMID: 19583480.

25. Bahn Chair RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011; 21:593–646. PMID: 21510801.

26. Moon JH, Yi KH. The diagnosis and management of hyperthyroidism in Korea: consensus report of the Korean Thyroid Association. Endocrinol Metab (Seoul). 2013; 28:275–279. PMID: 24396691.