Thyroid Disease and High Concentration of Serum Thyrotrophin in a Population Sample of Women

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Abstract
In a population study in Goteborg, Sweden, comprising women in the age strata 44, 52, 56, 60 and 66 yr, serum thyrotrophin (S-TSH) was determined in 1283 women representative of the general population of women of these ages. No women with previously unknown hypothyroidism were found at the clinical examination; 47 (3.7%) were on thyroxine treatment 9 (0.7%) because of spontaneous hypothyroidism. Sixteen women (1.2%) had markedly elevated S-TSH concentration (.gtoreq. 14 mU/l). They were studied further by determination of thyroid hormones and circulating antithyroid microsomal and thyroglobulin antibodies, and those with goiter were subjected to fine-needle biopsy of the thyroid gland. They were furthermore followed for 4 yr. Four euthyroid women were given thyroxine because of goiter and abnormal laboratory test results. Of 9 individuals with high S-TSH concentration and high titers of thyroid antibodies and/or biopsy evidence of autoimmune thyroiditis, 7 became hypothyroid within the 4 yr of follow-up. The other 2 women had consistently elevated basal S-TSH concentration and exaggerated S-TSH response after TRH administration. The majority of individuals without previously recognized thyroid disease who had S-TSH concentration above 14 mU/l with the assay will require thyroxine therapy within a few years. In 1 women with multinodular colloid goiter and high titer of antimicrosomal antibodies, the basal S-TSH concentration decreased during follow-up to a high normal value; the S-TSH response to TRH was high borderline. She remained euthyroid during follow-up. The results suggest an annual incidence of spontaneous hypothyroidism of 1-2 cases/1000 middle-aged females in a Swedish westcoast population.