National Trends in US Hospitalizations and Outcomes of Thyrotoxicosis With and Without Thyrotoxic Storm, 2016 to 2020

Abstract

Context: Thyrotoxicosis, a potentially life-threatening endocrine disorder, can result in severe complications, particularly when it progresses to thyroid storm. Analyzing hospitalization trends, outcomes, and the healthcare burden associated with thyrotoxicosis is essential for enhancing management strategies and optimizing resource allocation.

Objective: We analyzed trends in thyrotoxicosis hospitalizations with and without thyroid storm in the United States between 2016 and 2020.

Methods: We analyzed data from the national inpatient database using International Classification of Diseases, Tenth Revision (ICD-10) codes for thyrotoxicosis (E05). We compared demographics using χ2 tests. Trends in hospitalization outcomes were assessed using the Cuzick test. Hospital costs were adjusted for inflation using the 2020 consumer price index. Odds of mortality and secondary outcomes were analyzed using multivariable logistic regression. Hospital stay in the 95th percentile was considered prolonged.

Results: A total of 33 430 hospitalizations were analyzed. Hospitalization rates declined from 7444 in 2016 to 5424 in 2020 (Ptrend = .002). Mortality rates increased both for hospitalizations without storm (10 [0.17%] in 2016 to 55 [1.30%] in 2020; Ptrend < .001) and with thyroid storm (10 [0.62%] in 2016 to 50 [4.15%] in 2020; Ptrend = .051). There was an uptrend in prolonged hospitalization rates in the total study cohort (11.9% [3978] to 14.6% [4881]; Ptrend = .030). Total hospital costs increased from $36 408 to 49 031 (Ptrend < .001). A similar uptrend was observed with ($45 343 to $69 321; Ptrend < .001) and without storm ($34 066 to $42 703; Ptrend < .001). Thyroid storm was correlated with higher odds of major adverse cardiovascular events (adjusted odds ratio [aOR]: 1.05; 95% CI, 1.02-1.17; P = .002), including acute heart failure (aOR: 1.15; 95% CI, 1.03-1.78; P < .001), sudden cardiac death (aOR: 1.23; 95% CI, 1.04-2.17; P = .041), and atrial fibrillation (aOR: 1.17; 95% CI, 1.05-2.06; P < .001).

Conclusion: In the present study, we examined trends in hospilization and outcomes of thyrotoxicosis across the United States. Hospitalization rates for thyrotoxicosis were reduced while mortality rates significantly increased. There was an uptrend in health care costs, prolonged hospitalization, and the incidence of MACEs.

Keywords: cardiovascular diseases; cerebrovascular disorders; clinical outcomes; health care costs; hospitalization; longitudinal studies; mortality; thyroid storm; thyrotoxic crises; thyrotoxicosis.