Epidemiology of autoimmune thyroiditis


  • V.I. Кravchenko State Institution “V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine https://orcid.org/0000-0002-7758-6498
  • О.А. Тоvkay Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0002-1329-279X
  • О.V. Rakov State Institution “V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine https://orcid.org/0000-0002-0563-3961
  • М.D. Тronko State Institution “V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine https://orcid.org/0000-0001-7421-0981




thyroid gland, autoimmune thyroiditis, antithyroid antibodies, oxidative stress, epidemiology, postpartum thyroiditis, review


A review of the literature on the epidemiology of autoimmune thyroiditis (AT) is presented. This review examines the etiological factors of autoimmune thyroid damage. In case of damage to thyroid cells, the formation of antibodies and lymphoid infiltration of the gland is of great importance. It is noted that genetic factors precede the occurrence of pathological changes. Loss of immune tolerance to thyroid autoantigens such as thyroid pero­xidase (TPO), thyroglobulin underlies the development of AT. The role of oxidative stress and reactive oxygen species is important in the pathogenesis of the disease. It is shown that at the beginning, AT is asymptomatic and the formation of TPO and thyroglobulin antibodies precedes the onset of the disease and may indicate latent AT. The prevalence of latent AT varies from country to country and ranges from 2 to 20 %, and among women it was 4–6 times higher than among men. Subsequently, latent AT progresses to subclinical and overt thyroiditis with hypothyroidism. The incidence of mani­fest AT in various countries is from 27 to 273 per 100,000 population. Often, the disease began in childhood and adolescence. The frequency of pathology, including latent subclinical and manifest AT, in this cohort of the population according to different authors is from 0.3 to 9.6 %. Pregnancy was also accompanied by the pre­sence of TPO antibodies but with reduced aggression of cellular ele­ments and antibodies to the thyroid gland. The postpartum period was characterized by exacerbation of the disease. In Ukraine, the incidence of AT is 43.1 per 100,000, the prevalence is almost 10 times higher — 421.2 per 100,000. It is concluded that AT is the most common organ-specific autoimmune disease.


Download data is not yet available.


Unal E, Akın A, Yıldırım R, Demir V, Yildiz İ, Haspolat YK. Association of Subclinical Hypothyroidism with Dyslipidemia and Increased Carotid Intima-Media Thickness in Children. J Clin Res Pediatr Endocrinol. 2017 Jun 1;9(2):144-149. doi:10.4274/jcrpe.3719.

Vukovic R, Zeljkovic A, Bufan B, Spasojevic-Kalimanovska V, Milenkovic T, Vekic J. Hashimoto Thyroiditis and Dyslipidemia in Childhood: A Review. Front Endocrinol (Lausanne). 2019 Dec 10;10:868. doi:10.3389/fendo.2019.00868.

Głowinska-Olszewska B, Borysewicz-Sańczyk H, Sawicka B, et al. Does Hashimoto's Thyroiditis Increase the Risk of Cardiovascular Disease in Young Type 1 Diabetic Patients? Front Endocrinol (Lausanne). 2020 Jul 24;11:431. doi:10.3389/fendo.2020.00431.

Jeppesen R, Benros ME. Autoimmune Diseases and Psychotic Disorders. Front Psychiatry. 2019 Mar 20;10:131. doi:10.3389/fpsyt.2019.00131.

Sliwinska A, Fumuso P, Stringer B, Ansar M, Baldwin J. Hashimoto Encephalopathy With Status Epilepticus. Cureus. 2020 Dec 2;12(12):e11857. doi:10.7759/cureus.11857.

Hashimoto H. Zur kenntniss der lymphomatosen veranderung der Schilddruse (Struma lymphomatosa) [To know about lymphomatous changes in the thyroid gland (goiter lymphomatosa)]. Arch Klin Chir. 1912;97:219-248.

Zakharchenko TF, Kravchenko VI. Peculiarities of innate and adaptive immunity in the pathogenesis of thyroid autoimmune diseases. Immunocorrection (part 1). Mìžnarodnij endokrinologìčnij žurnal. 2020;16(7):564-576. doi:10.22141/2224-0721.16.7.2020.219011. (in Ukrainian).

Hwangbo Y, Park YJ. Genome-Wide Association Studies of Autoimmune Thyroid Diseases, Thyroid Function, and Thyroid Cancer. Endocrinol Metab (Seoul). 2018 Jun;33(2):175-184. doi:10.3803/EnM.2018.33.2.175.

Panicker V. Genetics of thyroid function and disease. Clin Biochem Rev. 2011 Nov;32(4):165-75.

Wellcome Trust Case Control Consortium. Genome-wide association study of 14,000 cases of seven common diseases and 3,000 shared controls. Nature. 2007 Jun 7;447(7145):661-78. doi:10.1038/nature05911.

Simmonds MJ, Gough SC. The search for the genetic contribution to autoimmune thyroid disease: the never ending story? Brief Funct Genomics. 2011 Mar;10(2):77-90. doi:10.1093/bfgp/elq036.

Brown RS. Autoimmune thyroid disease: unlocking a complex puzzle. Curr Opin Pediatr. 2009 Aug;21(4):523-8. doi:10.1097/MOP.0b013e32832cf824.

Jacobson EM, Tomer Y. The genetic basis of thyroid autoimmunity. Thyroid. 2007 Oct;17(10):949-61. doi:10.1089/thy.2007.0153.

Teft WA, Kirchhof MG, Madrenas J. A molecular perspective of CTLA-4 function. Annu Rev Immunol. 2006;24:65-97. doi:10.1146/annurev.immunol.24.021605.090535.

Ajjan RA, Kemp EH, Waterman EA, et al. Detection of binding and blocking autoantibodies to the human sodium-iodide symporter in patients with autoimmune thyroid disease. J Clin Endocrinol Metab. 2000 May;85(5):2020-7. doi:10.1210/jcem.85.5.6526.

Yoshida A, Hisatome I, Taniguchi S, et al. Pendrin is a novel autoantigen recognized by patients with autoimmune thyroid diseases. J Clin Endocrinol Metab. 2009 Feb;94(2):442-8. doi:10.1210/jc.2008-1732.

Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmun Rev. 2014 Apr-May;13(4-5):391-7. doi:10.1016/j.autrev.2014.01.007.

Weetman AP. The immunopathogenesis of chronic autoimmune thyroiditis one century after hashimoto. Eur Thyroid J. 2013 Jan;1(4):243-50. doi:10.1159/000343834.

Dong YH, Fu DG. Autoimmune thyroid disease: mechanism, genetics and current knowledge. Eur Rev Med Pharmacol Sci. 2014;18(23):3611-8.

Cogni G, Chiovato L. An overview of the pathogenesis of thyroid autoimmunity. Hormones (Athens). 2013 Jan-Mar;12(1):19-29. doi:10.1007/BF03401283.

Brent GA. Environmental exposures and autoimmune thyroid disease. Thyroid. 2010 Jul;20(7):755-61. doi:10.1089/thy.2010.1636.

Eschler DC, Hasham A, Tomer Y. Cutting edge: the etiology of autoimmune thyroid diseases. Clin Rev Allergy Immunol. 2011 Oct;41(2):190-7. doi:10.1007/s12016-010-8245-8.

Belin RM, Astor BC, Powe NR, Ladenson PW. Smoke exposure is associated with a lower prevalence of serum thyroid autoantibodies and thyrotropin concentration elevation and a higher prevalence of mild thyrotropin concentration suppression in the third National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2004 Dec;89(12):6077-86. doi:10.1210/jc.2004-0431.

Carlé A, Bülow Pedersen I, Knudsen N, et al. Smoking cessation is followed by a sharp but transient rise in the incidence of overt autoimmune hypothyroidism - a population-based, case-control study. Clin Endocrinol (Oxf). 2012 Nov;77(5):764-72. doi:10.1111/j.1365-2265.2012.04455.x.

Effraimidis G, Strieder TG, Tijssen JG, Wiersinga WM. Natural history of the transition from euthyroidism to overt autoimmune hypo- or hyperthyroidism: a prospective study. Eur J Endocrinol. 2011 Jan;164(1):107-13. doi:10.1530/EJE-10-0785.

Effraimidis G, Tijssen JG, Wiersinga WM. Discontinuation of smoking increases the risk for developing thyroid peroxidase antibodies and/or thyroglobulin antibodies: a prospective study. J Clin Endocrinol Metab. 2009 Apr;94(4):1324-8. doi:10.1210/jc.2008-1548.

Caturegli P, Ruggere C. Karl Hürthle! Now, who was he? Thyroid. 2005 Feb;15(2):121-3. doi:10.1089/thy.2005.15.121.

Shawky M, Sakr M. Hurthle Cell Lesion: Controversies, Challenges, and Debates. Indian J Surg. 2016 Feb;78(1):41-8. doi:10.1007/s12262-015-1381-x.

Kure S, Ohashi R. Thyroid Hürthle Cell Carcinoma: Clinical, Pathological, and Molecular Features. Cancers (Basel). 2020 Dec 23;13(1):26. doi:10.3390/cancers13010026.

Thieblemont N, Wright HL, Edwards SW, Witko-Sarsat V. Human neutrophils in auto-immunity. Semin Immunol. 2016 Apr;28(2):159-73. doi:10.1016/j.smim.2016.03.004.

Pankiv VI, Yuzvenko TYu, Pankiv IV. Type 2 diabetes mellitus and subclinical hypothyroidism: focusing on the role of cholecalciferol. Problems of Endocrine Pathology. 2019;2:46-51. doi:10.21856/j-PEP.2019.2.07.

Rodríguez Y, Rojas M, Monsalve DM, et al. Latent autoimmune thyroid disease. J Transl Autoimmun. 2020 Jan 8;3:100038. doi:10.1016/j.jtauto.2020.100038.

Tomer Y, Menconi F. Type 1 diabetes and autoimmune thyroiditis: the genetic connection. Thyroid. 2009 Feb;19(2):99-102. doi:10.1089/thy.2008.1565.

Hwang GB, Yoon JS, Park KJ, Lee HS, Hwang JS. Prevalence of autoimmune thyroiditis in patients with type 1 diabetes: a long-term follow-up study. Ann Pediatr Endocrinol Metab. 2018 Mar;23(1):33-37. doi:10.6065/apem.2018.23.1.33.

Staii A, Mirocha S, Todorova-Koteva K, Glinberg S, Jaume JC. Hashimoto thyroiditis is more frequent than expected when diagnosed by cytology which uncovers a pre-clinical state. Thyroid Res. 2010 Dec 20;3(1):11. doi:10.1186/1756-6614-3-11.

Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmun Rev. 2014 Apr-May;13(4-5):391-7. doi:10.1016/j.autrev.2014.01.007.

Thomsen H, Li X, Sundquist K, Sundquist J, Försti A, Hemminki K. Familial risks between Graves disease and Hashimoto thyroiditis and other autoimmune diseases in the population of Sweden. J Transl Autoimmun. 2020 Jun 1;3:100058. doi:10.1016/j.jtauto.2020.100058.

Ragusa F, Fallahi P, Elia G, et al. Hashimotos' thyroiditis: Epidemiology, pathogenesis, clinic and therapy. Best Pract Res Clin Endocrinol Metab. 2019 Dec;33(6):101367. doi:10.1016/j.beem.2019.101367.

McLeod DS, Cooper DS. The incidence and prevalence of thyroid autoimmunity. Endocrine. 2012 Oct;42(2):252-65. doi:10.1007/s12020-012-9703-2.

Teng W, Shan Z, Teng X, et al. Effect of iodine intake on thyroid diseases in China. N Engl J Med. 2006 Jun 29;354(26):2783-93. doi:10.1056/NEJMoa054022.

Sun X, Shan Z, Teng W. Effects of increased iodine intake on thyroid disorders. Endocrinol Metab (Seoul). 2014 Sep;29(3):240-7. doi:10.3803/EnM.2014.29.3.240.

Burek CL, Talor MV. Environmental triggers of autoimmune thyroiditis. J Autoimmun. 2009 Nov-Dec;33(3-4):183-9. doi:10.1016/j.jaut.2009.09.001.

Dragin N, Bismuth J, Cizeron-Clairac G, et al. Estrogen-mediated downregulation of AIRE influences sexual dimorphism in autoimmune diseases. J Clin Invest. 2016 Apr 1;126(4):1525-37. doi:10.1172/JCI81894.

Thompson EE, Nicodemus-Johnson J, Kim KW, et al. Global DNA methylation changes spanning puberty are near predicted estrogen-responsive genes and enriched for genes involved in endocrine and immune processes. Clin Epigenetics. 2018 May 9;10:62. doi:10.1186/s13148-018-0491-2.

Bliddal S, Nielsen CH, Feldt-Rasmussen U. Recent advances in understanding autoimmune thyroid disease: the tallest tree in the forest of polyautoimmunity. F1000Res. 2017 Sep 28;6:1776. doi:10.12688/f1000research.11535.1.

Eaton WW, Pedersen MG, Atladóttir HO, Gregory PE, Rose NR, Mortensen PB. The prevalence of 30 ICD-10 autoimmune diseases in Denmark. Immunol Res. 2010 Jul;47(1-3):228-31. doi:10.1007/s12026-009-8153-2.

Eaton WW, Rose NR, Kalaydjian A, Pedersen MG, Mortensen PB. Epidemiology of autoimmune diseases in Denmark. J Autoimmun. 2007 Aug;29(1):1-9. doi:10.1016/j.jaut.2007.05.002.

Kaloumenou I, Mastorakos G, Alevizaki M, et al. Thyroid autoimmunity in schoolchildren in an area with long-standing iodine sufficiency: correlation with gender, pubertal stage, and maternal thyroid autoimmunity. Thyroid. 2008 Jul;18(7):747-54. doi:10.1089/thy.2007.0370.

Mariotti S, Prinzis A, Ghiani M, et al. Puberty is associated with a marked increase of the female sex predominance in chronic autoimmune thyroiditis. Horm Res. 2009;72(1):52-6. doi:10.1159/000224341.

Kyritsi EM, Kanaka-Gantenbein C. Autoimmune Thyroid Disease in Specific Genetic Syndromes in Childhood and Adolescence. Front Endocrinol (Lausanne). 2020 Aug 19;11:543. doi:10.3389/fendo.2020.00543.

Kiyaev AV, Savelyev LI, Gerasimova LYu, Koroleva NP, Boyarsky SN, Tsvirenko SV. The Prevalence of Thyroid Disease in the Children and Teenagers in Iodine-Deficient Region. Clinical and experimental thyroidology. 2007;3(2):33-38. doi:10.14341/ket20073233-38. (in Russian).

Wasniewska M, Corrias A, Salerno M, et al. Thyroid function patterns at Hashimoto's thyroiditis presentation in childhood and adolescence are mainly conditioned by patients' age. Horm Res Paediatr. 2012;78(4):232-6. doi:10.1159/000343815.

Aversa T, Corrias A, Salerno M, et al. Five-Year Prospective Evaluation of Thyroid Function Test Evolution in Children with Hashimoto's Thyroiditis Presenting with Either Euthyroidism or Subclinical Hypothyroidism. Thyroid. 2016 Oct;26(10):1450-1456. doi:10.1089/thy.2016.0080.

Negro R, Formoso G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab. 2006 Jul;91(7):2587-91. doi:10.1210/jc.2005-1603.

Andersen SL, Olsen J. Early Pregnancy Thyroid Function Test Abnormalities in Biobank Sera from Women Clinically Diagnosed with Thyroid Dysfunction Before or After Pregnancy. Thyroid. 2017 Mar;27(3):451-459. doi:10.1089/thy.2016.0542.

Tingi E, Syed AA, Kyriacou A, Mastorakos G, Kyriacou A. Benign thyroid disease in pregnancy: A state of the art review. J Clin Transl Endocrinol. 2016 Nov 23;6:37-49. doi:10.1016/j.jcte.2016.11.001.

Okosieme OE, Marx H, Lazarus JH. Medical management of thyroid dysfunction in pregnancy and the postpartum. Expert Opin Pharmacother. 2008 Sep;9(13):2281-93. doi:10.1517/14656566.9.13.2281.

Stagnaro-Green A, Roman SH, Cobin RH, el-Harazy E, Alvarez-Marfany M, Davies TF. Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies. JAMA. 1990 Sep 19;264(11):1422-5.

Feldt-Rasmussen U, Høier-Madsen M, Rasmussen NG, Hegedüs L, Hornnes P. Anti-thyroid peroxidase antibodies during pregnancy and postpartum. Relation to postpartum thyroiditis. Autoimmunity. 1990;6(3):211-4. doi:10.3109/08916939009041041.

Negro R, Mestman JH. Thyroid disease in pregnancy. Best Pract Res Clin Endocrinol Metab. 2011 Dec;25(6):927-43. doi:10.1016/j.beem.2011.07.010.

Yang H, Shao M, Chen L, et al. Screening strategies for thyroid disorders in the first and second trimester of pregnancy in China. PLoS One. 2014 Jun 12;9(6):e99611. doi:10.1371/journal.pone.0099611.

Yang H, Shao M, Chen L, et al. Screening strategies for thyroid disorders in the first and second trimester of pregnancy in China. PLoS One. 2014 Jun 12;9(6):e99611. doi:10.1371/journal.pone.0099611.

Shahbazian HB, Sarvghadi F, Azizi F. Prevalence and characteristics of postpartum thyroid dysfunction in Tehran. Eur J Endocrinol. 2001 Oct;145(4):397-401. doi:10.1530/eje.0.1450397.

Stagnaro-Green A. Approach to the patient with postpartum thyroiditis. J Clin Endocrinol Metab. 2012 Feb;97(2):334-42. doi:10.1210/jc.2011-2576.

Walfish PG, Meyerson J, Provias JP, Vargas MT, Papsin FR. Prevalence and characteristics of post-partum thyroid dysfunction: results of a survey from Toronto, Canada. J Endocrinol Invest. 1992 Apr;15(4):265-72. doi:10.1007/BF03348726.

Fung HY, Kologlu M, Collison K, et al. Postpartum thyroid dysfunction in Mid Glamorgan. Br Med J (Clin Res Ed). 1988 Jan 23;296(6617):241-4. doi:10.1136/bmj.296.6617.241.

Payenok OS, Vdovychenko YuP, Pankiv VI, et al. Thyroid pathology and pregnancy. Lviv: LSUOPC; 2020. 264 p. (in Ukrainian).

Kaminskyi OV, Pankiv VI, Pankiv IV, Afanasyev DE. Vitamin D Content In Population Of Radiologically Contaminated Areas In Chernivtsi Oblast (pilot project). Probl Radiac Med Radiobiol. 2018 Dec;23:442-451. doi:10.33145/2304-8336-2018-23-442-451. (in Ukrainian).

Kravchenko VI, Andrusyshyna IM, Luzanchuk IA, Polumbryk MO, Tarashchenko YM. Association Between Thyroid Hormone Status and Trace Elements in Serum of Patients with Nodular Goiter. Biol Trace Elem Res. 2020 Aug;196(2):393-399. doi:10.1007/s12011-019-01943-9.

Rostami R, Nourooz-Zadeh S, Mohammadi A, Khalkhali HR, Ferns G, Nourooz-Zadeh J. Serum Selenium Status and Its Interrelationship with Serum Biomarkers of Thyroid Function and Antioxidant Defense in Hashimoto's Thyroiditis. Antioxidants (Basel). 2020 Oct 31;9(11):1070. doi:10.3390/antiox9111070.

Mehl S, Sun Q, Görlich CL, et al. Cross-sectional analysis of trace element status in thyroid disease. J Trace Elem Med Biol. 2020 Mar;58:126430. doi:10.1016/j.jtemb.2019.126430.

Luzanchuk A, Kravchenko VI, Polumbryk MO, Tarachenko YM. Thyroid status, major and trace elements content in patients with autoimmune thyroiditis living in Chernobyl-affected areas of Zhytomyr region. Problems of Endocrine Pathology. 2020;3:54-62. doi:10.21856/j-PEP.2020.3.07.

Zimmermann MB, Boelaert K. Iodine deficiency and thyroid disorders. Lancet Diabetes Endocrinol. 2015 Apr;3(4):286-95. doi:10.1016/S2213-8587(14)70225-6.

Erdal M, Sahin M, Hasimi A, Uckaya G, Kutlu M, Saglam K. Trace element levels in hashimoto thyroiditis patients with subclinical hypothyroidism. Biol Trace Elem Res. 2008 Summer;123(1-3):1-7. doi:10.1007/s12011-008-8117-8.

Rasic-Milutinovic Z, Jovanovic D, Bogdanovic G, Trifunovic J, Mutic J. Potential Influence of Selenium, Copper, Zinc and Cadmium on L-Thyroxine Substitution in Patients with Hashimoto Thyroiditis and Hypothyroidism. Exp Clin Endocrinol Diabetes. 2017 Feb;125(2):79-85. doi:10.1055/s-0042-116070.

Feske S, Wulff H, Skolnik EY. Ion channels in innate and adaptive immunity. Annu Rev Immunol. 2015;33:291-353. doi:10.1146/annurev-immunol-032414-112212.

Wang K, Wei H, Zhang W, et al. Severely low serum magnesium is associated with increased risks of positive anti-thyroglobulin antibody and hypothyroidism: A cross-sectional study. Sci Rep. 2018 Jul 2;8(1):9904. doi:10.1038/s41598-018-28362-5.



How to Cite

Кravchenko V., Тоvkay О., Rakov О., & Тronko М. (2021). Epidemiology of autoimmune thyroiditis. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), 17(2), 136–144. https://doi.org/10.22141/2224-0721.17.2.2021.230568



Literature Review