Prevalence and Prevention of Thyroid Disease in the USA
Editor’s note: Dr. Cooper clearly demonstrates that the prevalence
of thyroid dysfunction both as unrecognized thyroid illness and
improperly treated thyroid conditions are far greater than previously
suspected. 4.1 million men and 8 million women have either hyper-
or hypothyroidism that is unrecognized and untreated.
Of even greater concern is the fact that only 60% percent of individuals
taking thyroid hormone have thyroid levels, including TSH levels,
in the normal range. This may reflect patients who are purposely
being given high levels to suppress the growth of cancer, nodules,
or goiters. Those who are hypothyroid are at risk of increases in
blood cholesterol and other lipids, fatigue, depression, constipation,
and changes in skin and hair. Health risks are even greater for
those taking too much thyroid hormone. As Dr. Cooper points out
28% of those over sixty will develop the very dangerous cardiac
arrhythmia known as atrial fibrillation over the next ten years
and risk heart attack and stroke.
The Thyroid Foundation of America would like to work with members
of the media, government agencies, and other groups to increase
public awareness of these unrecognized and high-risk problems.
Lawrence C. Wood, MD, FACP
Preventive medicine focuses on avoiding or lessening the impact
of disease in a susceptible population. There are three distinct
types of prevention:
Primary prevention is the prevention
of new disease in previously healthy individuals. This typically
includes public health measures, such as eating a healthy diet,
getting vaccinations, and wearing seat belts. In the realm of thyroid
disease, ensuring an adequate iodine intake is the major way to
prevent thyroid disease in iodine-deficient areas of the world.
Secondary prevention is the prevention
of progression of mild or latent disease to more severe disease.
A prime example of secondary prevention would be the use of mammography
screening to detect the earliest stages of breast cancer. In the
case of thyroid disease, secondary prevention involves screening
of individuals for mild or "subclinical" hypothyroidism;
if mild hypothyroidism is detected, secondary prevention would also
entail treatment with thyroxine to prevent progression to a more
advanced degree of thyroid failure.
Tertiary prevention is
the term used to describe the prevention of worsening of already
present disease. This involves monitoring for disease progression
with clinical and laboratory assessment, and, theoretically, avoiding
iatrogenic disease (inadvertent illness induced by the doctor),
such as thyroid hormone overdose.