Hyperthyroidism : a chronic disease?

Sammanfattning: During 2003-2005, approximately 3,000 de novo hyperthyroid patients were collected in Sweden and became one of the world's largest hyperthyroidism studies. This dissertation shows that many people diagnosed with hyperthyroidism live with its impacts even after excess of thyroid hormone has ended. These include repeated recurrences, multiple treatments, replacement therapy, little sense of recovery, and reduced Quality Of life(QoL). Patients were categorised into two groups, Graves' disease (GD) and toxic nodular goitre (TNG), studied separately. Overall, just over 1,400 patients, or 60% of dispatches, answered the questionnaires. 1186 GD, 237 TNG. Most patients were women and GD's mean age was around 40 years, while TNG patients were 20 years older, reflecting the same patternas previous studies. The incidence of 27/100,000 persons per year might not seem large, but considering the proposed chronic nature of hyperthyroidism, prevalence is high (0.7%). Around two in three people diagnosed with hyperthyroidism will live with thyroid hormone replacement. This could be attributed, that GD patients over time receive more ablative treatment, despite the fact that less receive it as the first treatment. Another explanation the recurrence risk of ATD-treated patients exceeds 50%. Levothyroxine treatment did not vary between TNG treatments. Repeated, often multiple, treatments in TNG patients are rarely described. This implies TNG may be more complex than anticipated. Hyperthyroid patients have worse QoL 6-10 years following diagnosis than the general public. RAI treated patients with GD had more affected long-term thyroid-specific and generic QoL than ATD and surgical patients. Surprisingly, there was no clear QoL difference between GD and TNG. GD is often seen as a severe condition than TNG, as TNG has a milder course of disease. Hyperthyroidism has long-term impacts, affecting a relatively large population. This dissertation's findings indicate a chronic nature of hyperthyroidism.