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theses

BACKGROUND:
Hypo- and hyperthyroidism are the most common types of autoimmune diseases of the thyroid gland. Although the prevalence of overt hypo- and hyperthyroidism is 0.3% and 0.5%, respectively, the majority of patients with these disorders suffer from cardiovascular complications, which are considered to be a significant risk of mortality. The thyroid disorders and their complications affect patient quality of life and life spans, and elevate the government’s economic burdens regarding health care. The objective of the present study is to highlight the similarities and differences of hypo- and hyperthyroidism in terms of risk factors related to hospitalization outcomes such as mortality, length of stay, and total medical charges when there is a presence of cardiovascular and other complications.
METHOD:
The study implemented a cross-sectional design to achieve the primary objectives. Data were downloaded and extracted, with permission, from Nationwide Inpatient Sample (NIS). A total of 721,958 patients with hypo- and hyperthyroidism were admitted to hospitals in the United States in 2012. The collected data included patient demographic characteristics, such as age, gender, race, insurance type, and income. Patient medical information included the number of medical procedures, chronic diseases, co-morbidities, and the type of thyroid disorder. Statistical Package for the Social Sciences (SPSS) version 22 was used to analyze the data of the present study, and all outcomes with a p-value less than 0.05 were found to be significant. Multinomial logistic regression and multiple linear regressions (the dummy method) were the appropriate statistical tests to determine the predictors of the study outcomes.
RESULTS:
A descriptive analysis of the present study revealed the highest incidences of thyroid disorders to be in those who were older than 80 years of age (29.3%), white (76.7%), female (74.9%), on Medicare (68.2%), and who had a household income in the 25th percentile (27.1%). Patient medical information showed the highest comorbidities to be hypertension (63.8%), fluid-electrolyte disorders (29.1%) and uncomplicated diabetes (24.4%). The incidence of mortality for patients with thyroid diseases was 2.4%. The mean (± SD) length of hospital stay and total medical charges were 5.06 (±6.113) days and $41829.47 (±60920.47), respectively. There was a higher prevalence of hypothyroidism than hyperthyroidism (97% vs. 3%). Overall mortality showed a higher incidence of hypothyroidism than of hyperthyroidism (2.4% vs. 1.75%). The incidence of mortality increased with cardiovascular complications, to 5.42% vs. 4.87% for congestive heart failure (CHF) and 2.47% vs. 1.99% for hypertension (HT), for patients with hypo- and hyperthyroidism, respectively. Risk factors for patients with hyperthyroidism related to length of stay were paralysis, weight loss, pulmonary circulation, fluid and electrolyte disorders, age, neurological disorders, coagulopathy, psychosis, and the number of procedures. Risk factors of length of stay for patients with hypothyroidism patients were weight loss, paralysis, fluid and electrolyte disorders, age, the number of procedures, and insurance type.
Risk factors of total charges for hyperthyroidism patients were Hispanic or Asian-Pacific Islander descent, younger than 30 years of age, paralysis, the number of procedures, weight loss, fluid and electrolyte disorders, coagulopathy, and neurological disorders. In patients with hypothyroidism of Hispanic or Asian-Pacific Islander descent who were younger than 30 years of age, risk factors related to total medical charges of patients with were the number of procedures, weight loss, coagulopathy, paralysis, and fluid and electrolyte disorders. Risk factors for patients with hyperthyroidism related to mortality were the number of procedures, age, metastasis, fluid and electrolyte disorders, insurance type, and renal failure. Risk factors for patients with hypothyroidism related to mortality were the number of procedures, age, fluid and electrolyte disorders, metastasis, weight loss, and coagulation.
CONCLUSION:
Several factors were observed to increase the risk of mortality, the total medical charges, and the length of stay for patients included in the present study. Comorbidities can increase cost and mortality, which are considered to be serious risks for patient outcomes. Similarities found in risk factors between hypo- and hyperthyroidism were attributed to the physiological changes of thyroid function, which worsened the patients’ health statuses; however, differences were found depending on the strength of each risk factor in relation to each type of thyroid disorder. These risks also increased the cost and mortality for patients with cardiovascular diseases. The government and researchers are required to manage preventable risk factors to minimize incidences of mortality and to control the costs of therapy and health services administered to patients with thyroid diseases.
 

ETD_9534

Ph.D.

Includes bibliographical references

by Samah Ismail

doi:10.7282/t3-2bh5-yr75

ETD doctoral

The author owns the copyright to this work.