Treatment of Hypothyroidism by Age and Sex in the United States: A NHANES and Optum Claims Data Analysis

Objective

Recent data using NHANES and Optum Claims data (OCD) showed an increase in primary hypothyroidism (HT) prevalence in the United States following the 2002 NHANES III report. Using these data, we characterized treatment patterns of overt HT (OHT) in the United States.

Methods

Data on adults with OHT were collected from NHANES (2009-2012) and OCD (2012-2019). Disease status was determined from laboratory results or evidence of HT treatment (levothyroxine or liothyronine). OHT was defined as thyroid-stimulating hormone > 4.0 mIU/L and free thyroxine < 0.8 ng/dL or evidence of OHT treatment. Results were stratified by age group and sex. NHANES data were further stratified by insurance status (private/Medicare vs neither).

Results

Overall, > 72% received treatment, with > 80% of the OCD cohorts receiving treatment. Among the NHANES cohort, treatment rates increased with advancing age and were consistently higher in females than in males (age 18–44: 47.3% vs 39.9%; 45–59: 76.8% vs 51.1%; ≥ 60: 91.9% vs 65.6%, respectively). Among the OCD cohorts, treatment patterns were similar across age group and sex (> 78% treated). Among the NHANES cohort that were not privately/Medicare insured, overall treatment rates were 50%, with those ≥ 60 having highest treatment rates (> 75%). Moreover, < 50% of reproductive-aged women in the NHANES dataset received treatment, which was reduced to 22% among uninsured patients.

Conclusions

This study provides important updates regarding treatment of OHT and highlights treatment disparities, especially among men and women of reproductive age, using both total and insured population estimates.