American Surgical Association

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Hyperthyroidism is Under-Diagnosed and Under-Treated in 174,011 Patients: An Opportunity for Improvement and Intervention
Ammar Asban*, Sebastian K. Chung*, Margaret A. Tresler*, Priyanka Huilgol*, Rongbing Xie*, James K. Kirklin, Courtney J. Balentine*, Brenessa M. Lindeman*, Herbert Chen
University of Alabama at Birmingham, Birmingham, AL

OBJECTIVE(S):
When undiagnosed and untreated, hyperthyroidism significantly diminishes quality of life and increases the financial burden on patients and health systems. We hypothesized that many patients with hyperthyroidism remain untreated because physicians fail to recognize and evaluate the first indication of disease: a suppressed thyroid stimulating hormone (TSH).METHODS: We reviewed administrative data on 174,011 patients with TSH measured at a tertiary referral center between 2011-2017 to identify individuals with hyperthyroidism (TSH <0.05 mU/L). We evaluated whether patients underwent evaluation of hyperthyroidism (measurement of thyroxine T4, T3, radioactive iodine uptake scan, thyroid stimulating immunoglobulin, thyroid peroxidase antibodies), had documentation of hyperthyroidism, or were treated. RESULTS: We found 3,379 patients with hyperthyroidism. The mean age of our cohort was 52 17 years, with 79% females and 59% Caucasians. Only 1236 patients (37%) received any further laboratory or imaging work up, and hyperthyroidism remained undiagnosed in 53% of patients who had the appropriate workup. Despite meeting criteria for intervention, only 9% were referred for surgery and 8% received radioactive iodine. Predictors for hyperthyroidism diagnosis include being African American (hazard ration (HR) 1.28 vs. Caucasian, 95% CI 1.12-1.47, p=0.0003), lower TSH 0.01u/L (HR 2.3, 95% CI 2.09-2.55, p=<.0001) and younger age (10 years) (HR 1.17, 95% CI, 0.25-1.21, p=<.0001). CONCLUSIONS: Hyperthyroidism is frequently unrecognized and untreated, which can lead to adverse outcomes and increased costs. Improved systems for detection and treatment of hyperthyroidism are needed to address this gap in care.


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