Prevalence of Treated Hypothyroidism in the Community - analysis from General Practices in North-East England with implications for the UK

[helvella]

2,300,000 hypothyroid people in the UK.

If 15% don't do well on levothyroxine, that is about 345,000 who might need something else (yes, my code for T3!). That is an awful lot of unwell people. And voters.

Clin Endocrinol (Oxf). 2017 Aug 7. doi: 10.1111/cen.13440. [Epub ahead of print]

Prevalence of Treated Hypothyroidism in the Community - analysis from General Practices in North-East England with implications for the United Kingdom.

Ingoe L1, Phipps N2, Armstrong G3, Rajagopal A4, Kamali F5, Razvi S1,6.

Author information

1 Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, NE9 6SX.

2 Hadrian Primary Care Alliance, West Northumberland.

3 Pharmicus,CBC Health Ltd, Gateshead, NE11 0QD.

4 Netherfield House Surgery, Seghill, Northumberland, NE23 7EF.

5 Branch End Surgery, Stocksfield, Northumberland, NE43 7LL.

6 Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, NE1 3BZ.

Abstract

OBJECTIVE:

Hypothyroidism is more frequently diagnosed in women and older individuals. It has been suggested that the prevalence of hypothyroidism and the number of prescriptions for thyroid hormones are increasing. However, despite hypothyroidism being a common medical condition, contemporary data on prevalence, particularly across the various age groups, is limited.

DESIGN:

Information regarding number of individuals diagnosed with treated hypothyroidism (defined as patients prescribed levothyroxine) across ten General Practices (total population of 66,843) in the North-East of England in 2016 was obtained in an anonymised manner. Total as well as age group specific point prevalence rates were calculated. In addition, corresponding population data for the United Kingdom was acquired and national total and age-specific hypothyroidism prevalence rates were estimated.

RESULTS:

The overall prevalence of hypothyroidism in this community sample was 4.5% (n=3004). Prevalence increased across the age groups from 0.1% in children aged 0 - 10 years to 15.1% in those aged more than 90 years. After adjusting for demographic differences between the North-East England and UK populations, it is estimated that the total UK wide prevalence of hypothyroidism in 2016 is 3.6%; affecting more than 2.3 million individuals including nearly 800,000 individuals aged >70 years.

CONCLUSIONS:

Hypothyroidism affects millions of individuals in the UK and is currently a prevalent diagnosis in more than 1 in 10 individuals aged above 70 years. As the population ages this number is likely to increase. The clinical and economic effects of current management strategies for hypothyroidism, particularly in the older population, need to be evaluated. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

KEYWORDS:

Age groups; Hypothyroidism; Levothyroxine; Prevalence

PMID: 28782887

DOI: 10.1111/cen.13440

ncbi.nlm.nih.gov/pubmed/287...

[AngieAsh]

'The clinical and economic effects of current management strategies for hypothyroidism, particularly in the older population, need to be evaluated'

I don't like the sound of that. It sounds more like where can we save money than how can we help treat it better.( Or maybe I'm just getting more cynical as ai get older. )

[helvella Administrator Thyroid UK in reply to AngieAsh]

Always worries me when the talk is about strategies rather than patients.

For goodness sake, even changing to three-month prescriptions would save a lot of money. I don't know who makes the most out of 28-day prescribing but handling 12/13 prescriptions a year, with whatever costs there are to each piece of paper, surely must waste money?

[TSH110 in reply to AngieAsh]

AngieAsh I guess they could save a lot of money by just leaving us oldsters to die but if they had any sense they would abandon levothyroxine as the treatment of choice in favour of NDT that would soon save them a bomb in antidepressant etc prescriptions and allow a lot more of us to be able to contribute to the economy by being able to work effectively. Mind you anyone who likes Levo should be given the choice to stay on it not like the draconian situation we have now with treatments other than levo.

I wonder what the picture would be if patients were allowed to pick their medication - how many of the 2.3 million would take what.

[helvella Administrator Thyroid UK in reply to TSH110]

I think ignorance (of the options, of any understanding that ongoing symptoms are of thyroid issues, etc.) would keep the levothyroxine choosing percentage very high.

[AngieAsh in reply to TSH110]

@TSH110 and helvella Well as a vegetarian I would have still chosen Levo to try first anyway but would certainly want an option to add T3 if needed or as a very last resort add NDT if all else failed.

As someone just starting down the Thyroid road the removal of both leaving no NHS alternative is extremely worrying and as someone with many symptoms but classed as sub clinical Hashi's, so is any talk of looking into 'overprescribing' of Thyroid meds. I might never have even been considered if those people get their way.

[TSH110 in reply to AngieAsh]

AngieAsh

Please don't guilt trip me 😢AA!

I was delighted when I started Levo that there was a synthetic treatment having been a veggie for over 30 years.

Imagine how dire I was feeling to resort to NDT I still feel bad for all those poor piggies dying so I can live.

I would have done T4/T3 if it had been an option. I may even do that now NDT is becoming so difficult to pay for. I know a bit more now and I am less of a scaredy cat so would feel more confident to try T3 too.

Now there's a thought.....,

[AngieAsh in reply to TSH110]

Sorry. It wasn't my intention to guilt trip you TSH110 and I didn't know you were veggie when I wrote this. Like I said I would have still liked the option of NHS NDT myself as a last resort if all else failed. End of the day if it came down to the piggies who would be killed for meat anyway or me feeling ill for the rest of my life the piggies would lose. I just would want to try the other routes first.

[TSH110 in reply to AngieAsh]

AngieAsh it was a tad tongue in cheek 😊 Tho I do regret having to use piggies which I agree are killed primarily for other things, with NDT being a side line.

Now I hear they are breeding pigs for organs for humans. Ironic that NDT is effectively banned but it will eventually be ok to put bits of pig in us. I wonder if the thyroid gland will be on the list of pig replacement parts in the future.

[crimple]

wonder if the figures should be doubled to take into account those who have not been diagnosed but actually have hypothyroidism?! Was there any info available about TSH levels at diagnosis which then led to patients getting Levo? Just thinking about all those poor patients who have to reach TSH 10 before getting treated. Shouldn't the powers that be take a look at what is lacking in our diets re Iodine?

[helvella Administrator Thyroid UK in reply to crimple]

I too have wondered how many people there are between "no thyroid issue" and "diagnosed hypothyroid" at any one time. Suspect even an optimistic answer is going to be a large number.

[TSH110 in reply to helvella]

helvella it is a pity we cannot collate all tests from labs for thyroid function to catch some of that number. But say in my case I never got a test till my TSH was completely haywire so there must' be many who never even get tested. Do other countries with more enlightened treatment protocol shed any light on possible percentages in the whole population I wonder? Is such information even in the public domain and possible to find?

[SlowDragon Administrator]

Damn I was too conservative (with a small c) in my reply to NHS England consultation

I under-estimated that approx 200,000 minimum in need of T3 as ESSENTIAL (not optional) medication.

I mean basically probably a minimum of 50% of hypo patients on T4, in reality would have benefit of some T3 ........that would be over a million people

[Marz]

It is a start - but then we must remember that as the FT4 is rarely tested with the FT3 then probably another million are missed. Scanning other fora on HU - loads of posts scream HYPO .....

[Kitten1978 in reply to Marz]

Yeap, e.g. fibromyalgia and chronic fatigue forums, also ME, depression and anxiety and many others

[Fruitandnutcase]

I can't help but wonder why when

"Hypothyroidism affects millions of individuals in the UK and is currently a prevalent diagnosis in more than 1 in 10 individuals aged above 70 years. As the population ages this number is likely to increase."

No one is doing any research to try and find out why this is happening? There must be some reason that so many people have underactive thyroids.

I mean it has been found that a low carb, high fat diet can in a lot of cases reduce T2 diabetes but that is taking a while filter down to GPs even though a lot of patients already know that and follow a LCHF lifestyle.

Metformin and insulin etc may deal with the problem quickly but (and I've got no medical training) surely if a patient can be given support to alter their diet and lifestyle and thereby make themselves no longer T2 even though it could take time at the beginning it would ultimately save the NHS money in the long run.

I also wonder how so many doctors and endocrinologists can stick their head in the sand and pretend the problem doesn't exist. I wonder if the 1 in 10 figure includes all the people we read about on here who are being fobbed off and either being told there is nothing wrong with them or are being offered antidepressants instead of having their thyroids treated.

Equally I know of two people who are both taking thyroxine, neither of them felt they had a problem, both were given the levo after routine blood tests, both are thin as rakes, both are extremely active and both take theirs with their breakfast and swallow the levo down with a cup of milky coffee and both were most surprised when I suggested that they were really supposed to take levo with water and to leave some time before eating!

Having been a thyroid patient and temporarily a T2 diabetes patient it almost feels like endocrinology is a 'Cinderella' field of medicine but then it's probably only one of many.

[TSH110]

Fruitandnutcase judging by all the investigations I was sent for to other disciplines in the NHS the ignorance of hypo seems widespread as not one suggested that might be my reason for symptoms.

I should think chemicals must have something to do with the increase if it is real.

I goes back generations in my family - probably a genetic thing.