目的：本研究旨在利用健保資料庫探討台灣本土甲狀腺機能亢進症之全國性流行病學資料。
材料與方法：由2000年台灣健保承保資料檔中隨機選取100萬人，擷取其各年度所有就醫資料建置而成的2000年承保抽樣歸人檔中，以診斷碼、抗甲狀腺藥物的使用、放射性碘治療、及甲狀腺切除術處置為條件，篩選出甲狀腺機能亢進症個案，分別探討其盛行率、發生率、與其治療。
結果：經資料清洗，由原始資料庫中得到共999,494人之族群。其中女性佔486,877人（48.61%），男性佔513,617人（51.39%）。在1997年至2008年間，此族群中有94%的人至少使用過一次健保就醫。甲狀腺機能亢進症的盛行率為1.92%（女性2.95%，男性0.94%）。自2000年1月1日至2008年12月31日止，共有7,749位新發生個案，且女性/男性比例為3：1。在2000年至2008年間甲狀腺機能亢進症發生率為96.1人/100,000人/年，女性與男性的發生率分別為145.3人/100,000人/年及48.8人/100,000人/年。女性個案的平均發病年紀較男性年輕（女性40.4 ± 16.8歲，男性41.2 ± 17.5歲，p值0.0152）。無論在女性或男性，發生率在30至39歲達到最高，分別為女性199.9人/100,000人/年，男性65.9人/100,000人/年。若以開放進口未加碘食鹽的2004 - 2005年區分，年紀30歲以上的女性族群，發生率在2005年後似有下降趨勢。在新發生的甲狀腺機能亢進症個案中，99.68%的人在初診斷時接受抗甲狀腺藥物治療，有3.51%的個案在被診斷的第一年接受甲狀腺切除術的處置，少於0.1%的個案以放射性碘作為初始治療。
結論：甲狀腺機能亢進症在台灣是女性患者居多，相較於先前的研究報告，女性/男性患病比例較西方國家小。平均發病年紀女性較男性年輕。發生率最高的年齡層在男性和女性皆為30歲至39歲。年紀30歲以上的女性族群，發生率在2005年後似有下降趨勢。在台灣，抗甲狀腺藥物是新診斷甲狀腺機能亢進症之首選治療方式，放射線碘治療在非甲狀腺癌之甲狀腺機能亢進症最少被使用。

Purpose: The study aims to find out the nationwide epidemiological data of hyperthyroidism in Taiwan from the national health insurance database.
Materials and Methods: From the Longitudinal Health Insurance Database 2000 that contains claims data of 1,000,000 beneficiaries random sampling from the population in 2000, prevalent case was identified by diagnosis of thyrotoxicosis, antithyroid drug use, radioiodine therapy, or management of thyroidectomy. Prevalence, incidence, and the treatment are analyzed.
Results: A population of 999,494 is obtained after data cleansing, with 485,877 (48.61%) female and 513,617 (51.39%) male. About 94% of the population have utilized the insurance coverage at least once during 1997 – 2008. The prevalence of hyperthyroidism is 1.92% (female 2.95%, male 0.94%). There are 7,749 incident cases identified during 2000/01/01-2008/12/31, the female/male ratio is 3:1. The overall incidence during the observation period 2000 – 2008 is 96.1 cases/100,000/year, and the gender-specific incidence is 145.3 cases/100,000/year in female and 48.8 cases/100,000/year in male. The age of diagnosis is younger in female than in male (40.4 ± 16.8 years and 41.2 ± 17.5 years, respectively, p=0.0152). The incidence peaks at 30 – 39 years in both female and male, with 199.9 cases/100,000/year in female and 65.9 cases/100,000/year in male, respectively. When using the year that salt without iodization could be imported (2004 – 2005) as a cut-point, the incidence seems decreased after 2005 in the female group over 30 years of age. Among the incident cases, 99.68% have received antithyroid drug when diagnosed. Thyroidectomy is performed in 3.51% of the incident cases within the first year of diagnosis. Less than 0.1% of the incident cases receive I-131 as the initial therapy.
Conclusions: Hyperthyroidism is female-predominant in Taiwan, and the female/male ratio is smaller than previously reported in western countries. The onset age of thyrotoxicosis is younger in female than in male. The peak incidence is noted at 30 – 39 years in both female and male. The incidence decreases after 2005 in the female group over 30 years of age. ATD is the treatment of choice in newly-diagnosed hyperthyroidism patients in Taiwan, and radioiodine is rarely used for treatment of hyperthyroidism without thyroid cancer.

1.Bahn Chair, R.S., H.B. Burch, D.S. Cooper, J.R. Garber, M.C. Greenlee, I. Klein, P. Laurberg, I.R. McDougall, V.M. Montori, S.A. Rivkees, D.S. Ross, J.A. Sosa, and M.N. Stan Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 21:593-646. 2011.
2.Werner & Ingbar's the thyroid : a fundamental and clinical text, 9th ed.
3.Cooper, D.S. Hyperthyroidism. The Lancet 362:459-468. 2003.
4.Brent, G.A. Clinical practice. Graves' disease. N Engl J Med 358:2594-2605. 2008.
5.Lechpammer, M., J. Lukac, S. Lechpammer, and Z. Kusic Antithyroid drug-induced immunomodulation in Graves' disease patients. Acta medica Croatica : casopis Hravatske akademije medicinskih znanosti 56:21-26. 2002.
6.Corrales, J.J., A. Lopez, J. Ciudad, M.T. Mories, J.M. Miralles, and A. Orfao Methimazole therapy in Graves' disease influences the abnormal expression of CD69 (early activation antigen) on T cells. The Journal of endocrinology 155:491-500. 1997.
7.Wartofsky, L., D. Glinoer, B. Solomon, S. Nagataki, R. Lagasse, Y. Nagayama, and M. Izumi Differences and Similarities in the Diagnosis and Treatment of Graves' Disease in Europe, Japan, and The United States. Thyroid 1:129-135. 1991.
8.Bulow Pedersen, I., N. Knudsen, T. Jorgensen, H. Perrild, L. Ovesen, and P. Laurberg Large differences in incidences of overt hyper- and hypothyroidism associated with a small difference in iodine intake: a prospective comparative register-based population survey. J Clin Endocrinol Metab 87:4462-4469. 2002.
9.Golkowski, F., M. Buziak-Bereza, M. Trofimiuk, A. Baldys-Waligorska, Z. Szybinski, and B. Huszno Increased prevalence of hyperthyroidism as an early and transient side-effect of implementing iodine prophylaxis. Public Health Nutr 10:799-802. 2007.
10.Vanderpump, M.P.J. The epidemiology of thyroid disease. British Medical Bulletin 99:39-51. 2011.
11.Tunbridge, W.M.G., D.C. Evered, R. Hall, D. Appleton, M. Brewis, F. Clark, J.G. Evans, E. Young, T. Bird, and P.A. Smith The Spectrum of Thyroid Disease in A Community: The Whickham Surver. Clinical Endocrinology 7:481-493. 1977.
12.Vanderpump, M.P.J., W.M.G. Tunbrldge, J.M. French, D. Appleton, D. Bates, F. Clark, J.G. Evans, D.M. Hasan, H. Rodgers, F. Tunbridge, and E.T. Young The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clinical Endocrinology 43:55-68. 1995.
13.Hollowell, J.G., N.W. Staehling, W.D. Flanders, W.H. Hannon, E.W. Gunter, C.A. Spencer, and L.E. Braverman Serum TSH, T4, and Thyroid Antibodies in the United States Population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 87:489-499. 2002.
14.Haraldsson, A., S.T. Gudmundsson, G. Larusson, and G. Sigurdsson Thyrotoxicosis in Iceland 1980-1982. An epidemiological survey. Acta Med Scand 217:253-258. 1985.
15.Akamizu, T., Y. Nakamura, A. Tamaoki, Y. Inaba, N. Amino, and Y. Seino Prevalence and clinico-epidemiology of familial Graves' disease in Japan based on nationwide epidemiologic survey in 2001. Endocr J 50:429-436. 2003.
16.Weetman, A.P. Graves' Disease. N Engl J Med 343:1236-1248. 2000.
17.Chen, K.P., T.Y. Lee, P.Y. Hsu, C.C. Sung, C.Y. Chen, H.M. Chou, and H.C. Hung Studies on the effect of salt iodization on endemic goiter, Taiwan. I. Mass survey on goiter of school children. Taiwan Yi Xue Hui Za Zhi 75:471-482. 1976.
18.Chuang, C.C., S.T. Wang, P.W. Wang, and M.L. Yu Prevalence study of thyroid dysfunction in the elderly of Taiwan. Gerontology 44:162-167. 1998.
19.Lee, T.-C., and R.-S. Lin A Study on Hyperthyroidism Treatment Patterns in Taiwan. 2009.
20.Wu, E.L., I.C. Chien, C.H. Lin, Y.J. Chou, and P. Chou Increased risk of hypothyroidism and hyperthyroidism in patients with major depressive disorder: a population-based study. Journal of psychosomatic research 74:233-237. 2013.
21.Bureau of National Health Insurance, D.o.H., Executive Yuan National Health Insurance in Taiwan 2010. 2010.
22.Data subsets, National Health Insurance Research Database
http://w3.nhri.org.tw/nhird//date_cohort.htm.
23.Cerqueira, C., N. Knudsen, L. Ovesen, H. Perrild, L.B. Rasmussen, P. Laurberg, and T. Jorgensen Association of iodine fortification with incident use of antithyroid medication--a Danish Nationwide Study. J Clin Endocrinol Metab 94:2400-2405. 2009.
24.Bulow Pedersen, I., P. Laurberg, N. Knudsen, T. Jorgensen, H. Perrild, L. Ovesen, and L.B. Rasmussen Increase in incidence of hyperthyroidism predominantly occurs in young people after iodine fortification of salt in Denmark. J Clin Endocrinol Metab 91:3830-3834. 2006.
25.Galofre, J.C., L. Fernandez-Calvet, M. Rios, and R.V. Garcia-Mayor Increased incidence of thyrotoxicosis after iodine supplementation in an iodine sufficient area. J Endocrinol Invest 17:23-27. 1994.
26.行政院衛生署食品藥物管理局 市售鹽品碘含量監測暨健康風險評估. 101 年度研究成果報告.
27.Yamashita, S., N. Amino, and Y.K. Shong The American Thyroid Association and American Association of Clinical Endocrinologists hyperthyroidism and other causes of thyrotoxicosis guidelines: viewpoints from Japan and Korea. Thyroid 21:577-580. 2011.