Hyperthyroidism Linked to Work Absenteeism

Ricki Lewis, PhD

June 30, 2014

Work absenteeism in people with hyperthyroidism peaks during the first year after diagnosis and then attenuates, remaining at twice the level for healthy control patients, according to findings published online June 17 in the Journal of Clinical Endocrinology & Metabolism.

Thyroid disease affects quality of life, but little information is available on its effect on job absenteeism, return to work, and disability pensioning (government compensation because of medical inability to work). Graves' disease with ocular involvement has been reported as being particularly disabling in terms of return to work.

Mette Andersen Nexø, MA, from the National Research Centre for the Working Environment and the University of Copenhagen in Denmark, and colleagues conducted a longitudinal register-based cohort study. They compared disability pension and sick leave claims for 862 people in Denmark who received treatment for thyroid disorders in either of 2 university outpatient clinics in 2007 with the claims for 7043 control patients. Diagnoses occurred between 1994 and 2011.

The researchers matched patients with those in the control group according to age, sex, and geography, accounting for comorbidities. National and municipal records of work absenteeism are available because in Denmark, local government compensates people who miss work for more than 3 weeks because of illness.

The study stratified patients by diagnosis: nontoxic goiter, hyperthyroidism, Graves' orbitopathy, autoimmune hypothyroidism, or other thyroid diseases (postpartum thyroiditis, subacute thyroiditis, or other congenital or chronic thyroid diseases). The researchers measured the workplace effect, using adjusted hazard ratios (HRs). They assessed risk during the first year after diagnosis, as well as subsequent years, when the disease is assumed to have been in remission or controlled.

In the first year after diagnosis, patients with Graves' disease with eye complications were nearly 7 times (HR, 6.94) more likely to miss work long-term than control patients, and patients with other forms of hyperthyroidism were about twice as likely (HR, 1.96 ) to do so. In subsequent years, the risk for patients with hyperthyroidism remained double that for controls (HR, 2.08), mainly because of a higher risk for long-term absence for those with Graves’ orbitopathy. People with hyperthyroidism were more than 4 times as likely (HR, 4.40) to retire on a disability pension after the first year compared with healthy control patients.

The analysis revealed a significantly lower likelihood of returning to work for patients with hyperthyroidism (HR, 0.62) or autoimmune hypothyroidism (HR, 0.56), presumably reflecting extended sick leave. Hyperthyroidism accounted for the lower probability of return to work after the first year.

Limitations of the study include small sample sizes for some indications, consideration of patients only up to age 60 years (retirement age in Denmark), use of hospital populations that may have excluded less severely affected individuals, and clinical data recorded only at the time of study entry. Results may not be representative of the situation in other countries.

The Novo Nordisk Foundation and the Danish Council for Strategic Research supported the investigation. The authors have disclosed no relevant financial relationships.

J Clin Endocrinol Metabol. Published online June 17, 2014. Abstract

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