BACKGROUND
Hypothyroidism had previously been estimated to occur in 4.6% of population in the United States, based on the data from the 1988-1994 National Health and Nutrition Examination Survey (NHANES). NHANES periodically surveys and records health and nutritional status of the U.S. population from interviews, exams, and laboratory tests in a sample of adults and children. A study of more recent data from 2009-2010 and 2011-2012 cycles of the NHANES and from a U.S. commercial insurance claims database in 2019 reported that hypothyroidism is now diagnosed much more frequently, in 9.6% and 11.7% of the populations studied, respectively.

With the increase in the number of patients with hypothyroidism in the U.S., this study aimed to describe treatment patterns of hypothyroidism across the United States using NHANES and the Optum Claims Database, a database of commercial insurance claims.

THE FULL ARTICLE TITLE
Tessnow AH et al. Treatment of hypothyroidism by age and sex in the United States: a NHANES and Optum Claims data analysis. Endocr Pract 2025;31(3):359-365; doi: 10.1016/j.eprac.2024.12.004. PMID: 39667670.

SUMMARY OF THE STUDY
The researchers used thyroid function test results from 2009-2010 and 2011-2012 NHANES cycles and medical diagnosis and pharmacy prescription data from the Optum Claims Database from 2012-2019 to determine the number of adults diagnosed with hyperthyroidism and the number of those who were treated for hypothyroidism. The proportion of patients who were treated was calculated by dividing the number of the participants treated by the number of those diagnosed. The proportion of participants treated based on age, sex, and insurance status (private insurance or Medicare vs other or no insurance) were also calculated to assess potential differences in patterns of hypothyroidism treatment.

In the NHANES database, about 19 million participants (72% female) had hypothyroidism. Among these patients, 78.3% of women were treated while only 56.3% of men were treated.

When divided by age, only 47.3% of women under 44 years of age were treated. About 21% of participants with hypothyroidism did not have insurance. Among the uninsured participants, only 57.3% of women and 26.4% of men were treated. When divided by age group, only 21.7% of women and 0% of men under the age of 44 years were treated.

In the 2012-2019 Optum Claims Database, approximately 2.2 million patients were diagnosed with overt hypothyroidism and all patients had insurance. More than 78% of these patients were treated, without significant differences between women and men and between younger and older patients.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
Treatment of hypothyroidism in the United States based on data from national survey showed different patterns based on age, sex, and insurance status. Younger patients and male patients were less likely to be treated for hypothyroidism, especially those without insurance. Although the data from Optum claims database showed similar treatment rates across sex and age groups, there were clear differences in the treatment patterns from the NHANES database based on sex, age, and insurance status. The findings suggest that treatment of hypothyroidism does not differ significantly when patients have equal access to medical care, as in the case of the patients in the Optum Claims Database. On the other hand, participants in the NHANES database are selected at random from the general population of the United States and may reflect potential disparities in treatment access more accurately. The NHANES data suggested that younger and male patients, especially those who are uninsured, have far lower rates of treatment for overt hypothyroidism. It is also notable that the proportion of young women of reproductive age (< 44 years old) was low, especially in the uninsured. Given potential health consequences of untreated severe overt hypothyroidism in general population and in pregnant women, more awareness of importance of hypothyroidism treatment in younger and male populations, as well as systematic improvement in treatment access to uninsured population may be needed to improve current state of hypothyroidism treatment in the United States.

— Sun Y. Lee, MD

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