Objective

An improvement in iodine status in Veneto Region has been documented in the last decade. We aimed at estimating the incidence of hyperthyroidism in the Veneto Region (Italy) over the period 2013–2022.

Methods

Retrospective population-based study conducted in Veneto (4.9 million people) using the population registry, an administrative health database. Between 2012 and 2022, hyperthyroidism incidence was defined thank to a health-care co-payment exemption for hyperthyroidism or any hospital diagnosis of hyperthyroidism. Incident hyperthyroidism was defined from 2013 to 2022 to exclude prevalent cases. Standardized incidence rates (IRs) were reported by age, sex, and etiology of thyroid hyperfunction too.

Results

We identified 26,602 incident cases (IR of 54.38 per 100,000 person-years, 2.47-fold higher in females than in males). IR decreased from 69.87 (95% CI: 67.49, 72.25) in 2013 to 42.83 (95% CI: 40.99, 44.66) in 2022. In 2020, an out-of-trend decrease in hyperthyroidism incidence was documented, corresponding to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic outbreak, with a realignment to the trend in the subsequent years. The annual percentage change according to the cause of hyperthyroidism was as follows: −6.62% (95% CI: 8.47, 4.73) (P < 0.0001) in toxic multinodular goiter, −7.56% in toxic uninodular goiter (95% CI: 10.54, 4.48) (P < 0.001) and −4.70% (95% CI: 6.33, 3.04) in toxic diffuse goiter (Graves’ disease) (P < 0.001).

Conclusions

We documented a decline in the incidence of hyperthyroidism in Veneto Region, paralleling the improvement of the iodine status, thanks to a long and sustained iodine prophylaxis campaign. SARS-CoV-2 pandemic and vaccination campaign did not change the declining trend of hyperthyroidism incidence in our study region.

Significance statement

An improvement in iodine status in the population residing in the Veneto region has been documented in the last decade, thanks to a nationwide voluntary iodine prophylaxis program running since 2005, but its impact on the epidemiology of thyroid disease has never been documented. This is the largest study on the incidence rates of hyperthyroidism carried out in Italy and covers the longest observation period among all regionwide population-based studies of hyperthyroidism in our country. We documented a reduction in the incidence of hyperthyroidism, which was more pronounced in nodular goiter diagnosis but involved also toxic diffuse goiter. The decline in the incidence of hyperthyroidism in Veneto Region shows the efficacy and safety of the iodine prophylaxis campaign.

中文翻译：

---

意大利东北部一项大型人群研究中甲状腺功能亢进症的发病率

客观的

过去十年，威尼托大区的碘状况有所改善。我们的目的是估算 2013 年至 2022 年期间威尼托大区（意大利）甲状腺功能亢进症的发病率。

方法

使用人口登记处（一个行政健康数据库）在威尼托（490 万人）进行了基于人口的回顾性研究。2012 年至 2022 年间，甲状腺功能亢进发病率的定义得益于甲状腺功能亢进的医疗保健自付费用豁免或任何医院诊断的甲状腺功能亢进。甲亢事件的定义为 2013 年至 2022 年，以排除流行病例。标准化发病率（IR）也按年龄、性别和甲状腺功能亢进的病因报告。

结果

我们发现了 26,602 起事故案例（IR 为每 10 万人年 54.38 起，女性是男性的 2.47 倍）。IR 从 2013 年的 69.87 (95% CI: 67.49, 72.25) 下降到 2022 年的 42.83 (95% CI: 40.99, 44.66)。2020 年，甲亢发病率出现异常下降，对应于严重急性甲亢呼吸综合征冠状病毒 2 (SARS-CoV-2) 大流行爆发，并在随后几年重新调整了趋势。根据甲亢病因的年度百分比变化如下：毒性多结节性甲状腺肿为-6.62%（95% CI：8.47, 4.73）（ P < 0.0001），毒性单结节性甲状腺肿为-7.56%（95% CI：10.54，毒性弥漫性甲状腺肿（格雷夫斯病）（P < 0.001）中为-4.48） （ P < 0.001）和-4.70%（95% CI：6.33，3.04）。

结论

我们记录了威尼托地区甲状腺功能亢进症发病率的下降，同时碘状况的改善，这得益于长期持续的碘预防运动。SARS-CoV-2 大流行和疫苗接种运动并没有改变我们研究地区甲状腺功能亢进症发病率下降的趋势。

意义陈述

由于自 2005 年以来实施的全国性自愿碘预防计划，威尼托地区居民的碘状况在过去十年中有所改善，但其对甲状腺疾病流行病学的影响从未有记录。这是在意大利进行的最大规模的甲状腺机能亢进发病率研究，也是我国所有地区性甲状腺机能亢进研究中观察期最长的。我们记录了甲状腺功能亢进症发病率的降低，这在结节性甲状腺肿诊断中更为明显，但也涉及毒性弥漫性甲状腺肿。威尼托地区甲状腺功能亢进症发病率的下降表明了碘预防运动的有效性和安全性。