Trends in treatments of thyroid disease following iodine fortification in Denmark: a nationwide register-based study

Abstract

Line Tang Møllehave,1 Allan Linneberg,1–3 Tea Skaaby,1 Nils Knudsen,4 Torben Jørgensen,1,5,6 Betina Heinsbæk Thuesen1 1Center for Clinical Research and Disease Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark; 2Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; 3Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark; 4Department of Endocrinology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, Denmark; 5Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; 6Faculty of Medicine, Aalborg University, Aalborg, Denmark Background: Long-term iodine exposure may influence the frequency of thyroid disease treatments through fluctuations in thyroid diseases. Yet, the long-term fluctuations in thyroid disease treatments upon iodine fortification (IF) are not fully known. We aimed to examine the development in thyroid disease treatments in Denmark before and following the implementation of IF in 2000. Methods: Nationwide data on antithyroid medication, thyroid hormone therapy, thyroid surgery, and radioiodine treatment were obtained from Danish registries. Negative binominal regression was applied to analyze annual changes in treatment rates adjusted for region of residence, sex, and age. Results: Incidence of antithyroid medication transiently increased but fell and reached steady state from 2010 at an incidence rate ratio (RR) of 0.72 (95% confidence interval [CI] 0.67–0.77) compared to year 2000. Thyroid hormone therapy increased and reached steady state in 2010 at an incidence RR of 1.75 (95% CI 1.62–1.89) compared to year 2000. Thyroid surgery was constant except for higher rates in 2014–2015, and radioiodine treatment fluctuated with no apparent pattern. Conclusion: Ten years after IF, a steady state was observed for incident antithyroid medication below the level at IF, and thyroid hormone therapy above the level at IF. Only small changes were observed in thyroid surgery and radioiodine treatment. In the same period, changes in diagnostic and treatment practices and lifestyle factors are likely to have occurred and should be considered when evaluating the effects of IF on treatment of thyroid diseases. Keywords: iodine, pharmacoepidemiology, thyroid diseases

Keywords

• iodine
• pharmacoepidemiology
• thyroid diseases