Acta Clinica Belgica International Journal of Clinical and Laboratory Medicine

ISSN: 1784-3286 (Print) 2295-3337 (Online) Journal homepage: http://www.tandfonline.com/loi/yacb20

Some Epidemiological Aspects Of Thyrotoxicosis In A Belgian Population F. Comhaire, R. Rubens & J. van Egmond To cite this article: F. Comhaire, R. Rubens & J. van Egmond (1975) Some Epidemiological Aspects Of Thyrotoxicosis In A Belgian Population, Acta Clinica Belgica, 30:5, 388-391, DOI: 10.1080/17843286.1975.11717027 To link to this article: http://dx.doi.org/10.1080/17843286.1975.11717027

Published online: 21 May 2016.

Submit your article to this journal

View related articles

Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=yacb20 Download by: [Australian Catholic University]

Date: 17 August 2017, At: 19:20

388

SOME EPIDEMIOLOGICAL ASPECTS OF THYROTOXICOSIS IN A BELGIAN POPULATION

Downloaded by [Australian Catholic University] at 19:20 17 August 2017

F. COMHAIRE•. R. RUBENS•, J. van EGMONo••

INTRODUCTION

As part of a systematic survey of Belgian patients with thyrotoxicosis, the epidemiological characteristics of 160 adult hyperthyroid patients are studied. The group consists of 130 patients with Graves' disease (GO) and 30 cases of toxic adenoma (T A) examined in the section of endocrinology of our department during 3 years. In these cases the sex ratio, age distribution , recurrence rate and some familial characteristics are studied. Whenever possible our results are compared to those of similar studies in the literature. Statistical analysis makes use of the chi square test.

of Horst (9), but contrasts to the ratio of 20/1 found by Wayne (23). The las t author however obtained his data before the systematic th yroid scanning which probably has greatly influenced the diag nosis, due to underestimation of toxic adenoma·(3). Malamos (13) quotes 10 % of his thyrotoxic patients to present an adenoma of the GRAVES DISEASE

Histogram women

15 - 19 20 - 24

MATERIAL AND METHODS

The same patients and methods are used as described in the preceding paper on the clinical aspects of thyrotoxicosis.

+ 10

A ge

11 I

~ in cidence

3. 7

2. 8 15 . 7

25 - 29

9. 3

30 - 34

12.0

35 - 39 4 0- 44

RESULTS AND DISCUSSION 9. 3

4 5 - 49

The ratio Graves' disease over toxic adenoma is 5.111 in men and 4.111 in women. The difference between men and women is not significant. The mean ratio for men and women combined, is 4.3/1 which is in accordance with the results

Acta C/inica Be/gica, 30, 5 (19 75)

3. 7

55 - 59

60 - 64

65 - 69

• Dept of Medici ne, sectio n of Endocri nology and Metabolic Diseases (Head Prof. Dr. A. Vermeulen) State University of Gent, Belgiu m. ** Dept. of Medical Informatics (Head Prof. Dr. Wieme) State University of Gent, Belgium.

6 .5

50 - 54

70 - 71

7 5 - 79

• I

~

II. I

6.5 3. 7

1. 9

EPIDEMIOLOGICAL ASPECTS OF THYROTOXICOSIS

TOXIC UN/NODULAR Histogram women + 10 1.

Downloaded by [Australian Catholic University] at 19:20 17 August 2017

Age

1•

incide nce

40 - 44

19 . 2

45 - 49

II . 5

50 - 54

II. 5

55 - 59

23. I

60 - 64

7. 7

65 - 69 70 - 74

-

19. 2

7.7

gland. It should be mentioned that about 1 out of 6 cases with a "hot nodule" on thyroid scanning presents hyperfunction (5).

GRAVES DISEASE

Histogram men -/. incidence

Age

20 - 24

' 13 . 6

25 - 29

13 . 6

30- H

35 - 39 40 - 44 45 - 49 50 - 54

--

18 .2

4.5 4. 5 4. 5 13 . 6

55 - 59

4. 5

60 - 64

18.2

65 - 69

4 .5

389 The sex ratio women I men is 108/22 or 511 in GD which is not different from that in TA: 26/4 or 6.1/1. lngbar(IO) found a 711 ratio for GD, Schneider (17) a 511 ratio and Ferri man (5) a 6/1 ratio forT A, all are fitting well with our results.

In women G.D. occurs predominantly in the age groups from 25 to 45 years and there is a second peak in the ages 60 to 69 years (histogram 1). Toxic adenoma (histogram 2) does not occur in women before the age of 40 years, but from then on the incidence is almost constant up to 69 years. The mean age for GD in women is 43.6 years (95 % limits : 16-72 years) against 55.3 years (95 % limits 39-70 years) for TA. In men G.D. (histogram 3) occurs more frequently in the ages 20-34 and 50-64 years (mean 42.2 years, 95 % limits : 19-64 years). The distribution is similar to that of G.D. in women. Toxic adenoma seems to be more frequent in the older age, however the number of observations is small (mean 56 years, 95 % limits : 33-65 years). Data in the literature concerning the age distribution of patients with hyperthyroidism are discordant. lngbar (1 0) finds T A to occur more frequently in patients in the 3th and 4th decade, whereas GD is observed to occur mainly in the third to fifth decade, being unusual in the elderly; this is confirmed by Furszyfer (6). Wayne (23) quotes 60 % of his hyperthyroid cases to occur between 41 and 60 years. Schneider (17) finds most cases ofT A in the age group 40 to 65 years, with a high frequency in women at menopausal age, Ferriman (5) also records most of his T A cases in the age group 35-65 years. Our data suggest GD mainly to occur, as well in men as in women, in two age groups: from 25 to 45 years and in the sixth decade. The incidence of T A is equally distributed over the fourth, fifth and sixth decade. About 40 % (51 out of 160) of our patients mention thyrotoxic antecedents and consult for recurrence of hyperthyroidism. One third of these have more than one thyrotoxic episode, which has occurred most often within the last 5 years before the present consultation. Acra Clinica Belgica. 30, 5 (1975)

Downloaded by [Australian Catholic University] at 19:20 17 August 2017

390 Our data are in accordance with those of Solomon (21) who points to a high frequency of recurrence of hyperthyroidism in the first months after withdrawal of medical therapy . In his material the percentage of GO patients still in remission 4 years after cessation of drug therapy is about 60 %. Lowry (12) observes 55 % of his carbimazole treated patients to remain in remission after 2 years; Shizume (19) records a higher recurrence rate, however his group uses a shorter treatment regimen. In order to detect the heriditary characteristics of thyroid disease we use the patients memory as a source of information. Thus, 39 cases of thyroid disorders (including as well euthyroid goiter as hypo- or hyperthyroidism) are traced in the families of 28 patients (22 %) among the 130 cases with GD, and 13 cases in the relatives of 9 patients (30 %) among the 30 T A cases. Our data suggest the familial incidence of thyroid disease to be similar in the relatives of patients with either G.O. or T A. This finding gives rise to some considerations on the possible etiological mechanism involved in the pathogenesis of both conditions. Whereas Bartels (1) finds 8.2 % of the sisters and 2.7 % of the aunts of the GD patients to suffer from that disease, Martin (14) suggests the frequency of " thyroid disorders" in the relatives of GO patients to be about 60 %. A high incidence of " abnormal iodine handl ing " is detected in the euthyroid relatives of GO patients by Jngbar (I 0). Bonnyns (2) finds LA TS in 22 % of the relatives of GD patients. These and other data (16, 24) point to a familial incidence of GD, probably due to a genetic factor (20). The ethiopathogenesis of GD is still controversial (7, 22). The disease is thought to result from an inherited defect in the immunological surveillance, which could result in the survival, rather than the destruction, of a forbidden clone and in a disorder of the cell-mediated immunity (8, 15). This clone could produce abnormal immunoglobulins, such as LA TS (the long acting thyroid stimulator) which is a IgG directly influencing the thyroid gland function. LA TS is however not the sole cause of hyperthyroidism in GD patients. The existance of a Acta C/inica Belgica , 30, 5 (19 75)

EPIDEMIOLOGICA L ASPECTS OF THYROTOXICOSIS

permissive factor, that facilitates its action on the thyroid , is postulated (4, 11, 18). The pathogenesis of T A in the contrary is unknown , the condition belonging to the neoplastic disorders (follicular adenoma). It is noteworthy that the incidence of thyroid disturbances in the families of our patients with T A is of the same order of mag nitude as in the rel atives of GD patients , however our data do not allow the differentiation of the type of thyroid disease among the affected rel atives . Knowing the frequency of thyroid disorders in the ge neration before the patients (P 1) and in the generation of the patients (P0 ) we calculated the P/P0 ratio ; this is identical in GO (20/i 1) to that in T A (7 I 4). These preliminary data should encourage more detailed investigation of the families ofT A patients. AKNOWLEDGMENT This work was s upported in part by a gran t o f the inte rm inistrial commiss ion for scientific policy, project 20-2 1 (Brussels, Belgium).

KEYWORDS Hyperth yroidism, thyrotoxi cosis, th yroid gland , epide mio logy, Graves disease, toxic adenom a.

SUMMARY A systematic survey of epide miological data co ncerning 160 patients suffering from thyrotoxicos is, indicates a ratio of 4.3 cases of Graves' disease (GD) agai nst I case of toxic adeno ma (T A). The sex ratio is not different for GD and T A cases, and clearly in favour of women (5 11), whereas age distribution is no t different in men and women. GD occurs prefere nti all y in the age gro up of 25 to 45 years and in th e sixth decade, T A is exclusively fo und in patients over 35 years with an equ al di stribut ion over the fourth , fifth and sixth decade. Thyro-· toxic antecedents are present in about 40 % of the patie nts under investigation , poi nt ing to a hi gh recu rrence rate of th e disease. The incidence of thyroid disorders in the re lati ves o f patients with T A seems not to be di fferent from that in patients with GD.

SAMENV ATTING Systematisc h onderzoek naar de epidemiol ogische kenmerken bij 160 patienten met hyperthyreose heeft aangetoo nd

EPIDEMIOLOGICAL ASPECTs OF THYROTOXICOSIS dat 4.3 maal vaker ziekte van Graves voorkomt dan toxisch adenoom . De geslachtsverhouding in beide ziekten is evenwel gelijk met name 5 vrouwen voor I man. De leeftijdsverdeling is dezelfde voor vrouwen als voor mannen, doch verschillend voor ziekte van Graves en toxisch adenoom. Thyreotoxische antecedenten werden geregistreerd bij 40 96 van onze patienten, wat wijst op een hoge frequentie van de recidieven. De incidentie van thyroidlijden was even groot in de families van patienten met ziekte van Graves als met lijden; aan toxisch adenoom .

Downloaded by [Australian Catholic University] at 19:20 17 August 2017

RESUME L'examen systematique des caracteristiques epidemiologiques chez 160 malades souffrant d'hyperthyreo'idie a demontre une -frequence 4.3 fois plus elevee de maladie. de Graves compare al'adenome toxique. Les deux maladies sont plus frequentes chez Ia femme que chez I' hom me (5 contre I). La distribution selon l'iige est Ia meme dans les deux sexes, cependant nettement difTerente dans Ia maladie de Graves compare a l'adenome toxique. La frequence d'antecedents thyreotoxiques chez nos malades etait 40 96 , indiquant une grande tendance aux recidives. L'incidence de maladies thyro'idiennes fut egale parmi les membres de famille de rnalades sou!Trants de maladie de Graves ou d'adenome toxique.

REFERENCES I. BARTELS, E.D. (1941)- Heridity in Graves' disease,

edit. E. Munksgaard, Copenhagen, cited by lngbar. 2. BONNYNS, M., VAN HAELST, L.(I972)-Familial incidence of long acting thyroid stimulator - LATS - in Graves Disease. Horm. Metab. Res., 4, 132. 3. BORNER, W., MOLL, E., RAUCH, E., POHNER, A., GREHNS, S., RUPPERT, G. (1971)- Diagnostik des autonomen Adenomas der Schilddrtise. Dtsch. med. Wschr., 96, 1707. 4. CHOPRA, 1.1., SOLOMON, D.H. (1970)- Graves Disease with delayed Hyperthyroidism. Ann. intern. Med. , 73, 985. 5. FERRIMAN, D., HENNEBRY, T.M., TASSOPOUWS, C.N. (1972)- Thrue Thyroid Adenoma. Quart. J. Med., 162, 127. 6. FURSZYFER, KURAND, L.T., McCONAHEY, N.M., WOOLNER, L.B., EL VERBACK, l.R. (1972)- Epidemiological Aspects of Hashimoto's Thyroiditis and Graves' Disease in Rochester, Minnesota (1935-1967), With special Reference to temporal Trends. Metabolism, 21, 197. 7. HALL, R. (1970)- Hyperthyroidism, Pathogenesis and Diagnosis. Brit. med. J.. 1, 743.

391 8. VAN HERLE, A.J ., CHOPRA, I.J. (1971) - Thymic Hyperplasia in Graves' Disease, J. c/in. Endocrin. , 32. 140. 9. HORST, W., ROSLER, H., SCHNEIDER, C., LABHART, A. (1965)- J. nuc/. Med .. 25, 515. 10. INGBAR, S.H., WOEBER, K.A. (1968)- In : Textbook of Endocrinology (Williams) edit. Saunders Cy, 195. II . McKENZIE (1972)- Does LA TS cause Hyperthyroidism in Graves' Disease? (A Review biased towards the AtT:cmative). Metabolism , 21. 883. 12. WWRY, R.C., WWE, D., HADDEN, R.D., MONTGOMERY, D.A.D., WEAVER, J.A. (1971)- Thyroid Suppressibility : follow-up for two years of Antithyroid Treatment. Brit. med. J .. 2, 19. 13. MALAMOS, B., KOUTRAS, D.A. , FRINGELI, D., T ASSAPOULOS, C.N. (1969)- Toxic Adenoma of the Thyroid. Horm. Merab . Res. , I. 19. 14. MARTIN, L. (1945)- The hereditary and familial Aspects ofexophtalmic Goiter and nodular Goiter. Quart. J. Med., 14, 207. 15. NILSSON, G. (1972) - Lymphoid Infiltration in toxic Goitres studied with fine Needle Aspiration Biopsy. Acta Endocrin., (Kbh), 71 , 480. 16. PARE, C., DEMERS, P.P. (1972)- Hyperthyroidie neonatale, lnsuffisance cardiaque et LA TS. L 'Union med. Ca nada , /01, 1307. 17. SCHNEIDER, C., THIEMANN, K.J ., BAY, V. (1970)Die Symptomatik des toxischen Adenoms der SchilddrOse in verschiedenen Lebensaltern. Dtsch. med. Wschr., 95, 387. 18. SHISHIBA, Y., SHIMIZU, T., YOSHIMURA, S., SHIZUME, K. (I 972)- Discrepancy between Inactivation by Thyroid Particulate Fraction of Thyroid Stimulating Activity of Long-Acting Thyroid-Stimulator (LATS). J. c/in. Endocrin., 34, 7. 19. SHIZUME,K.,1RIE,M .,NAGATAKI,S.,MATSUZAKI, F., SHISHIBA, Y., SUEMATSU, H., TSUSHIMA, T. (1970)- Long-term Results of Antithyroid Drug Therapy for Graves' Disease: Follow-up after more than 5 Years. Endocrin . Jap., 17, 327. 20. SKILLERN, P.G. (1972)- Genetics of Graves' Disease. Mayo Clin . Proc.. 47. 848. 21 . SOWMON, D.H., BECK, J.C., VANDERLAAN, W.P., ASTWOOD, E.B. (1953)- Prognosis of Hyperthyroidism treated by antithyroid Drugs. J. Amer. med. Ass. , 152, 201. 22 . VOLPE, R., EDMONDS, M., LAMKI, L., CLARKE, P., ROW, V. (1972)- The Pathogenesis of Graves' Disease. Mayo Clin. Proc., 47, 824. 23. WAYNE, E.J. (I 954)- The Diagnosis of Thyrotoxicosis. Brit. med. J., I, 411. 24. WILROY, R.S., ETTELOORF, J.N. (1971)- Familial Hyperthyroidism including two Siblings with neonatal Graves' Disease. J. Pediat. (St. -Louis). 78, 625.

Acta Cfinica Befgica , 30, 5 (1975)

Some epidemiological aspects of thyrotoxicosis in a Belgian population.

Acta Clinica Belgica International Journal of Clinical and Laboratory Medicine ISSN: 1784-3286 (Print) 2295-3337 (Online) Journal homepage: http://ww...
3MB Sizes 0 Downloads 0 Views