FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 338:712-718 March 12, 1998 Number 11 Next

	Full Text PDF Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Hyperthyroidism affects many organ systems, but the effects are usually considered reversible. The long-term effects of hyperthyroidism on mortality are not known.

Methods We conducted a population-based study of mortality in a cohort of 7209 subjects with hyperthyroidism who were treated with radioactive iodine in Birmingham, United Kingdom, between 1950 and 1989. The vital status of the subjects was determined on March 1, 1996, and causes of death were ascertained for those who had died. The data on the causes of death were compared with data on age-specific mortality in England and Wales. The standardized mortality ratio was used as a measure of relative risk, and the effect of covariates on mortality was assessed by regression analysis.

Results During 105,028 person-years of follow-up, 3611 subjects died; the expected number of deaths was 3186 (standardized mortality ratio, 1.1; 95 percent confidence interval, 1.1 to 1.2; P<0.001). The risk was increased for deaths due to thyroid disease (106 excess deaths; standardized mortality ratio, 24.8; 95 percent confidence interval, 20.4 to 29.9), cardiovascular disease (240 excess deaths; standardized mortality ratio, 1.2; 95 percent confidence interval, 1.2 to 1.3), and cerebrovascular disease (159 excess deaths; standardized mortality ratio, 1.4; 95 percent confidence interval, 1.2 to 1.5), as well as fracture of the femur (26 excess deaths; standardized mortality ratio, 2.9; 95 percent confidence interval, 2.0 to 3.9). The excess mortality was most evident in the first year after radioiodine therapy and declined thereafter.

Conclusions Among patients with hyperthyroidism treated with radioiodine, mortality from all causes and mortality due to cardiovascular and cerebrovascular disease and fracture are increased.

Source Information

From the Department of Medicine, University of Birmingham, United Kingdom (J.A.F., M.C.S., J.B.); and the Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy (P.M., P.B.).

Address reprint requests to Dr. Franklyn at the Department of Medicine, University of Birmingham, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom.

Full Text of this Article

This article has been cited by other articles:

• Haentjens, P., Van Meerhaeghe, A., Poppe, K., Velkeniers, B. (2008). Subclinical thyroid dysfunction and mortality: an estimate of relative and absolute excess all-cause mortality based on time-to-event data from cohort studies. Eur J Endocrinol 159: 329-341 [Abstract] [Full Text]  
• Biondi, B., Cooper, D. S. (2008). The Clinical Significance of Subclinical Thyroid Dysfunction. Endocr. Rev. 29: 76-131 [Abstract] [Full Text]  
• Homoncik, M., Gessl, A., Ferlitsch, A., Jilma, B., Vierhapper, H. (2007). Altered Platelet Plug Formation in Hyperthyroidism and Hypothyroidism. J. Clin. Endocrinol. Metab. 92: 3006-3012 [Abstract] [Full Text]  
• Bassett, J. H. D., Nordstrom, K., Boyde, A., Howell, P. G. T., Kelly, S., Vennstrom, B., Williams, G. R. (2007). Thyroid Status during Skeletal Development Determines Adult Bone Structure and Mineralization. Mol. Endocrinol. 21: 1893-1904 [Abstract] [Full Text]  
• Volzke, H., Schwahn, C., Wallaschofski, H., Dorr, M. (2007). The Association of Thyroid Dysfunction with All-Cause and Circulatory Mortality: Is There a Causal Relationship?. J. Clin. Endocrinol. Metab. 92: 2421-2429 [Abstract] [Full Text]  
• Gammage, M. D., Osman, F., Sheppard, M. C., Franklyn, J. A. (2007). Reply. J Am Coll Cardiol 49: 2229-2230 [Full Text]  
• Vanderpump, M. (2007). Cardiovascular and Cancer Mortality after Radioiodine Treatment of Hyperthyroidism. J. Clin. Endocrinol. Metab. 92: 2033-2035 [Full Text]  
• Metso, S., Jaatinen, P., Huhtala, H., Auvinen, A., Oksala, H., Salmi, J. (2007). Increased Cardiovascular and Cancer Mortality after Radioiodine Treatment for Hyperthyroidism. J. Clin. Endocrinol. Metab. 92: 2190-2196 [Abstract] [Full Text]  
• Bassett, J. H. D., O'Shea, P. J., Sriskantharajah, S., Rabier, B., Boyde, A., Howell, P. G. T., Weiss, R. E., Roux, J.-P., Malaval, L., Clement-Lacroix, P., Samarut, J., Chassande, O., Williams, G. R. (2007). Thyroid Hormone Excess Rather Than Thyrotropin Deficiency Induces Osteoporosis in Hyperthyroidism. Mol. Endocrinol. 21: 1095-1107 [Abstract] [Full Text]  
• Lee, J. A., Grumbach, M. M., Clark, O. H. (2007). The Optimal Treatment for Pediatric Graves' Disease Is Surgery. J. Clin. Endocrinol. Metab. 92: 801-803 [Full Text]  
• Iagaru, A., McDougall, I. R. (2007). Treatment of Thyrotoxicosis. JNM 48: 379-389 [Abstract] [Full Text]  
• Osman, F., Franklyn, J. A., Holder, R. L., Sheppard, M. C., Gammage, M. D. (2007). Cardiovascular Manifestations of Hyperthyroidism Before and After Antithyroid Therapy: A Matched Case-Control Study. J Am Coll Cardiol 49: 71-81 [Abstract] [Full Text]  
• Cuthbertson, D. J, Davidson, J. (2006). What to tell patients about radioiodine therapy.. BMJ 333: 271-272 [Full Text]  
• Flynn, R. W. V., MacDonald, T. M., Jung, R. T., Morris, A. D., Leese, G. P. (2006). Mortality and Vascular Outcomes in Patients Treated for Thyroid Dysfunction. J. Clin. Endocrinol. Metab. 91: 2159-2164 [Abstract] [Full Text]  
• Cann, S. A. H. (2006). Hypothesis: dietary iodine intake in the etiology of cardiovascular disease.. J. Am. Coll. Nutr. 25: 1-11 [Abstract] [Full Text]  
• Riis, A. L. D., Hansen, T. K., Thiel, S., Gravholt, C. H., Gjedde, S., Gormsen, L. C., Jorgensen, J. O. L., Weeke, J., Moller, N. (2005). Thyroid hormone increases mannan-binding lectin levels. Eur J Endocrinol 153: 643-649 [Abstract] [Full Text]  
• Boelaert, K, Franklyn, J A (2005). Thyroid hormone in health and disease. J Endocrinol 187: 1-15 [Abstract] [Full Text]  
• Kahaly, G. J., Dillmann, W. H. (2005). Thyroid Hormone Action in the Heart. Endocr. Rev. 26: 704-728 [Abstract] [Full Text]  
• Franklyn, J. A., Sheppard, M. C., Maisonneuve, P. (2005). Thyroid Function and Mortality in Patients Treated for Hyperthyroidism. JAMA 294: 71-80 [Abstract] [Full Text]  
• Heijckmann, A C., Huijberts, M. S P, Geusens, P., de Vries, J., Menheere, P. P C A, Wolffenbuttel, B. H R (2005). Hip bone mineral density, bone turnover and risk of fracture in patients on long-term suppressive L-thyroxine therapy for differentiated thyroid carcinoma. Eur J Endocrinol 153: 23-29 [Abstract] [Full Text]  
• Biondi, B., Palmieri, E. A., Klain, M., Schlumberger, M., Filetti, S., Lombardi, G. (2005). Subclinical hyperthyroidism: clinical features and treatment options. Eur J Endocrinol 152: 1-9 [Abstract] [Full Text]  
• Horne, M. K. III, Singh, K. K., Rosenfeld, K. G., Wesley, R., Skarulis, M. C., Merryman, P. K., Cullinane, A., Costello, R., Patterson, A., Eggerman, T., Bernstein, D. M., Pucino, F., Csako, G. (2004). Is Thyroid Hormone Suppression Therapy Prothrombotic?. J. Clin. Endocrinol. Metab. 89: 4469-4473 [Abstract] [Full Text]  
• Ginsberg, J. (2003). Diagnosis and management of Graves' disease. CMAJ 168: 575-585 [Abstract] [Full Text]  
• Irving, R. J., Carson, M. N., Webb, D. J., Walker, B. R. (2002). Peripheral Vascular Structure and Function in Men with Contrasting GH Levels. J. Clin. Endocrinol. Metab. 87: 3309-3314 [Abstract] [Full Text]  
• Osman, F., Gammage, M. D., Sheppard, M. C., Franklyn, J. A. (2002). Cardiac Dysrhythmias and Thyroid Dysfunction - The Hidden Menace?. J. Clin. Endocrinol. Metab. 87: 963-967 [Abstract] [Full Text]  
• Sheppard, M. C., Holder, R., Franklyn, J. A. (2002). Levothyroxine Treatment and Occurrence of Fracture of the Hip. Arch Intern Med 162: 338-343 [Abstract] [Full Text]  
• Siddiqi, A., Parsons, M. P., Lewis, J. L., Monson, J. P., Williams, G. R., Burrin, J. M. (2002). TR Expression and Function in Human Bone Marrow Stromal and Osteoblast-Like Cells. J. Clin. Endocrinol. Metab. 87: 906-914 [Abstract] [Full Text]  
• Klein, I., Ojamaa, K. (2001). Thyroid Hormone and the Cardiovascular System. NEJM 344: 501-509 [Full Text]  
• Weetman, A. P. (2000). Graves' Disease. NEJM 343: 1236-1248 [Full Text]  
• Biagi, J., MacKenzie, R. G., Lim, M. S., Sapp, M., Berinstein, N. (2000). Primary Hodgkin's disease of the CNS in an immunocompetent patient: A case study and review of the literature. Neuro Oncol 2: 239-243 [Abstract]  
• Toft, A D, Boon, N A (2000). GENERAL CARDIOLOGY: Thyroid disease and the heart. Heart 84: 455-460 [Full Text]  
• Nygaard, B., Hegedus, L., Ulriksen, P., Nielsen, K. G., Hansen, J. M. (1999). Radioiodine Therapy for Multinodular Toxic Goiter. Arch Intern Med 159: 1364-1368 [Abstract] [Full Text]  
• (1998). Hyperthyroidism and Long-Term Mortality. JWatch Women's Health 1998: 19-19 [Full Text]