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
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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
• 7th 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)
Iodine intake (ug/day)
Iodine status
< 20
Insufficient
Severe iodine deficiency
20-49
Insufficient
Moderate IDD
50-99
Insufficient
Mild IDD
100-199
Adequate
Adequate iodine
200-299
Above requirements
Adequate for pregnant,
lactating, more than adequate
for others
>300
excessive
Risk of adverse health
consequences
Thyroid Function Biochemical Status
Operational definition
Overt hypothyroidism
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
Overt hyperthyroidism
Low TSH (<0.47) and elevated FT4
(>1.85) and no intake of meds
Any TSH, any FT4 and current intake of
ATD
Subclinical hypothyroidism
elevated TSH (>4.64) and normal FT4
and no intake of meds
Subclinical hyperthyroidism
Low TSH (<0.47) and normal FT4 and no
intake of meds
Classification based on thyroid status
Classification
Count
Percentage
Normal
Current ATD
Biochemical hyperthyroid
Subclinical hyperthyroid
4481
4
26
258
91.49
0.08
0.53
5.27
Current LT4
Biochemical hypothyroid
Subclinical hypothyroid
2
17
110
0.04
0.35
2.25
Total N (with blood tests)
4898
100
Goiter grading and thyroid status
Classification
Grade 0
Grade 1
Grade 2
Total
Freq (%)
Freq (%)
Freq (%)
Normal
4025 (90.51)
324 (7.29)
98 (2.2)
4447
Biochemical
hyperthyroid
14 (46.67)
10 (33.3)
6 (20)
30
Subclinical
hyperthyroid
216 (84.71)
20 (7.84)
19 (7.45)
255
Biochemical
hypothyroid
16 (84.21)
2 (10.53)
1 (5.26)
19
Subclinical
hypothyroid
96 (88.07)
10 (9.17)
3 (2.75)
109
Total
4367 (89.86)
366 (7.53)
127 (2.61) 4868
Population with goiter by PE
Classification
Count
Percentage
Goiter
675
9.34
7229
100
Grade 0
Grade 1
Grade 2
Total
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The Philippine Thyroid Disorder Prevalence Survey (PhilTiDeS)