The Philippine Thyroid Disorder Prevalence Survey (PhilTiDeS)

A project of the Philippine Society of Endocrinology and Metabolism in cooperation with the Food and Nutrition Research Institute-Department of Science and Technology and the Philippine Council on Health and Research Development

National Prevalence of Goiter

• • • • • • 1987 and 1993 National Nutrition Surveys National prevalence of goiter based on PE 1987 - 3.7% 1993 - 6.7% in 1993 Highest prevalence rate seen in pregnant women 13-20 yo - 27.4% This study will be the first national survey in the Philippines on the prevalence of thyroid disorder based on thyroid function tests. Phil. F&F, 2001

Significance of the study

• This study is the first national survey in the Philippines on the prevalence of thyroid disorders based on thyroid function tests. Phil. F&F, 2001

Objectives

• • • To determine the prevalence of: – Overt Hyperthyroid and subclinical hyperthyroid disorders – Overt Hypothyroid and subclinical hypothyroid disorders – Thyroid nodules – Iodine deficiency disorders To evaluate the sufficiency of iodine nutrition based on urinary iodine excretion To determine the relationship between abnormal thyroid function and: – Lipid levels – Clinical symptoms and signs as assessed by the modified Wayne's index

Population

• • • 7 th National Nutrition Survey 2008 National Statistics Office Labor Force Survey Sample Non-pregnant, non-lactating adults > 20 yo

Sampling design

• • stratified multi-stage sampling design 17 regions, 80 provinces

Primary sampling units (PSUs)

Barangays with > 500 households Enumeration areas 150-200 households

Household Household members N=5000

Methodology

• • PhilTiDeS questionnaire administered by trained field personnel – Demographics – Clinical history – PE for goiter grading Biochemical assays – Serum TSH (microparticle immunoassay Abott) • Ref range 0.47-4.64

– Serum free T4 (ELISA) • Ref range 0.71-1.85

– Urinary iodine – Total cholesterol, triglycerides, HDL, LDL

WHO-UNICEF-ICCIDD 2001 consensus

Median value (UIE ug/L)

< 20 20-49 50-99 100-199 200-299 >300

Iodine intake (ug/day) Iodine status

Insufficient Insufficient Insufficient Adequate Above requirements excessive Severe iodine deficiency Moderate IDD Mild IDD Adequate iodine Adequate for pregnant, lactating, more than adequate for others Risk of adverse health consequences

Thyroid Function Biochemical Status

Operational definition

Overt hypothyroidism Overt hyperthyroidism Subclinical hypothyroidism Subclinical hyperthyroidism Elevated TSH (>4.64) and low FT4 (<0.71) & no intake of meds On current LT4 therapy Any TSH, any FT4 and intake of LT4 and Post-thyroidectomy and Post-RAI Low TSH (<0.47) and elevated FT4 (>1.85) and no intake of meds Any TSH, any FT4 and current intake of ATD elevated TSH (>4.64) and normal FT4 and no intake of meds Low TSH (<0.47) and normal FT4 and no intake of meds

Classification based on thyroid status

Classification

Normal Current ATD Biochemical hyperthyroid Subclinical hyperthyroid Current LT4 Biochemical hypothyroid Subclinical hypothyroid Total N (with blood tests)

Count

4481 4 26 258 2 17 110 4898

Percentage

91.49

0.08

0.53

5.27

0.04

0.35

2.25

100

Goiter grading and thyroid status

Classification

Normal Biochemical hyperthyroid Subclinical hyperthyroid Biochemical hypothyroid Subclinical hypothyroid Total

Grade 0

Freq (%) 4025 (90.51) 14 (46.67)

Grade 1

Freq (%) 324 (7.29) 10 (33.3)

Grade 2

Freq (%) 98 (2.2) 6 (20)

Total

4447 30 216 (84.71) 16 (84.21) 96 (88.07) 20 (7.84) 2 (10.53) 10 (9.17) 19 (7.45) 1 (5.26) 3 (2.75) 255 19 109 4367 (89.86) 366 (7.53) 127 (2.61) 4868

Population with goiter by PE

Classification

Goiter Grade 0 Grade 1 Grade 2 Total

Count

675 7229

Percentage

9.34

100