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Hyperthyroidism, Hypothyroidism, and Cause-Specific Mortality in a Large Cohort of Women



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  • Personal Author:
  • Description:
    Background: The prevalence of hyperthyroidism and hypothyroidism is 0.5-4% in iodine-replete communities, but it is 5-10 times higher in women than in men. Those conditions are associated with a broad range of metabolic disorders and cardiovascular diseases. Biological evidence of a role of thyroid hormones in carcinogenesis also exists. However, the association between thyroid dysfunction and cardiovascular disease or cancer mortality risk remains controversial. In a large cohort of women, the associations of hyperthyroidism and hypothyroidism with cause-specific mortality were evaluated after nearly 30 years of follow-up. Methods: The prospective study included 75,076 women aged 20-89 years who were certified as radiologic technologists in the United States in 1926-1982, completed baseline questionnaires in 1983-1998 from which medical history was ascertained, and reported no malignant disease or benign thyroid disease except thyroid dysfunction. A passive follow-up of this cohort was performed through the Social Security Administration database and the National Death Index-Plus. Cause-specific mortality risks were compared according to self-reported thyroid status, with proportional hazards models adjusted for baseline year and age, race/ethnicity, body mass index, family history of breast cancer, and life-style and reproductive factors. Results: During a median follow-up of 28 years, 2609 cancer, 1789 cardiovascular or cerebrovascular, and 2442 other non-cancer deaths were recorded. Women with hyperthyroidism had an elevated risk of breast cancer mortality after 60 years of age (hazard ratio [HR] = 2.04 [confidence interval (CI) 1.16-3.60], 13 cases in hyperthyroid women) compared to women without thyroid disease. Hypothyroid women had increased mortality risks for diabetes mellitus (HR = 1.58 [CI 1.03-2.41], 27 cases in hypothyroid women), cardiovascular disease (HR = 1.20 [CI 1.01-1.42], 179 cases), and cerebrovascular disease (HR = 1.45 [CI 1.01-2.08], 35 cases, when restricting the follow-up to >=10 years after baseline). Other causes of death were not associated with hyperthyroidism or hypothyroidism, though there was a suggestion of an elevated risk of ovarian cancer mortality in hyperthyroid women based on very few cases. Conclusion: The excess mortality risks observed in a large, prospective 30-year follow-up of patients with thyroid dysfunction require confirmation, and, if replicated, further investigation will be needed because of the clinical implications. [Description provided by NIOSH]
  • Subjects:
  • Keywords:
  • ISSN:
    1050-7256
  • Document Type:
    Text
  • Funding:
    Grant
  • Genre:
    Journal Article
  • Place as Subject:
  • CIO:
    National Institute for Occupational Safety and Health (NIOSH)
  • Topic:
    Workplace Safety & Health
  • Location:
    North America
  • Volume:
    27
  • Issue:
    8
  • NIOSHTIC Number:
    nn:20064320
  • Citation:
    Thyroid 2017 Aug; 27(8):1001-1010
  • Contact Point Address:
    Cari M. Kitahara, PhD, Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, MSC 9778, 9609 Medical Center Drive, Bethesda, MD 20892
  • Email:
    kitaharac@mail.nih.gov
  • Federal Fiscal Year:
    2017
  • Performing Organization:
    University of Minnesota Twin Cities
  • Peer Reviewed:
    True
  • Start Date:
    20050701
  • Source Full Name:
    Thyroid
  • End Date:
    20250630
  • Collection(s):
  • Main Document Checksum:
    urn:sha-512:0f922e476d4d839b4b27f00ce3e1d26278ad4294d5737e3398cb5bc2e3c9b21fc0344d963bed8414fe6cee8d013de4e179fc86cbd70ce04c3b6e2225f9ba76b8
  • Download URL:
  • File Type:
    Filetype[PDF - 271.18 KB ]
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