1. 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

2. National Prevalence of Goiter 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

3. 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

4. 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

5. Population 7 th National Nutrition Survey 2008 National Statistics Office Labor Force Survey Sample Non-pregnant, non-lactating adults > 20 yo

6. Sampling design stratified multi-stage sampling design 17 regions, 80 provinces Household members N=5000 Household Primary sampling units (PSUs) Barangays with > 500 households Enumeration areas 150-200 households

7. 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

8. WHO-UNICEF-ICCIDD 2001 consensus Median value (UIE ug/L) Iodine intake (ug/day)Iodine status < 20InsufficientSevere iodine deficiency 20-49InsufficientModerate IDD 50-99InsufficientMild IDD 100-199AdequateAdequate iodine 200-299Above requirementsAdequate for pregnant, lactating, more than adequate for others >300excessiveRisk of adverse health consequences

9. 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 ( 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

10. Classification based on thyroid status ClassificationCountPercentage Normal448191.49 Current ATD40.08 Biochemical hyperthyroid260.53 Subclinical hyperthyroid2585.27 Current LT420.04 Biochemical hypothyroid170.35 Subclinical hypothyroid1102.25 Total N (with blood tests)4898100

11. Goiter grading and thyroid status ClassificationGrade 0Grade 1Grade 2Total Freq (%) Normal4025 (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 Total4367 (89.86)366 (7.53)127 (2.61)4868

12. Population with goiter by PE ClassificationCountPercentage Goiter6759.34 Grade 0 Grade 1 Grade 2 Total7229100