Trends in Pharmacological, Radioactive Iodine, and Surgical Treatments for Hyperthyroidism in Japan: A Decade-Long Nationwide Claims-Based Analysis (2014-2023)
Abstract
OBJECTIVE: To investigate the nationwide trends in pharmacological, radioactive iodine (RAI), and surgical treatments for hyperthyroidism in Japan from 2014 to 2023. METHODS: Annual sex- and age-stratified data on methimazole (MMI), propylthiouracil (PTU), potassium iodide (KI), RAI therapy, and thyroidectomy were extracted from the National Database of Health Insurance Claims (NDB). Crude and age-adjusted counts and rates per 1,000 (drugs) or 100,000 (RAI and surgery) person-years were calculated for each year. The annual trends were analyzed using linear and Poisson regression models. RESULTS: The cross-sectional distributions strongly reflected the female reproductive life stages. Notably, RAI therapy charges exhibited a bimodal peak distribution in females (25-29 and 45-49 years), whereas thyroidectomy peaked at 30-34 years, coinciding with the intervening childbearing period. Longitudinally, age-adjusted MMI and KI prescriptions and surgeries increased significantly (P ＜0.0001), whereas PTU prescriptions and RAI therapy declined (P ＜0.0001). Subgroup analyses revealed distinct age-dependent shifts, with MMI and KI use increasing across most age groups, particularly among individuals aged ≥90 years. PTU use showed divergent trends by sex, decreasing among males, but increasing among older females, particularly those aged ≥90 years. Surgical interventions increased mainly among older adults, whereas RAI therapy declined across most age groups. CONCLUSION: Over the past decade, hyperthyroidism management in Japan has shifted toward MMI consolidation, expanded KI use in the super-elderly population, declining RAI therapy in broad-aged populations, and increasing surgery in older adults. These age-dependent treatment shifts reflect the evolving clinical practice and therapeutic challenges posed by a rapidly aging society.
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BibTeX
@article{kido2026trends,
title = {{Trends in Pharmacological, Radioactive Iodine, and Surgical Treatments for Hyperthyroidism in Japan: A Decade-Long Nationwide Claims-Based Analysis (2014-2023)}},
author = {Masamitsu Kido and Emi Ushigome and Hanako Nakajima and Takahiro Tsujikawa and Shigeyuki Mukudai and Motoki Nishimura and Yusuke Ichijo and Norihiro Aibe and Shinsuke Nagasawa and Yoshitaka Hashimoto and Kengo Yoshii and and Katsutoshi Shoda},
journal = {Internal Medicine},
year = {2026},
month = aug,
doi = {10.2169/internalmedicine.7746-26},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7746-26/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Trends in Pharmacological, Radioactive Iodine, and Surgical Treatments for Hyperthyroidism in Japan: A Decade-Long Nationwide Claims-Based Analysis (2014-2023)
AU - Masamitsu Kido
AU - Emi Ushigome
AU - Hanako Nakajima
AU - Takahiro Tsujikawa
AU - Shigeyuki Mukudai
AU - Motoki Nishimura
AU - Yusuke Ichijo
AU - Norihiro Aibe
AU - Shinsuke Nagasawa
AU - Yoshitaka Hashimoto
AU - Kengo Yoshii
AU - and Katsutoshi Shoda
PY - 2026
DA - 2026/08/19
JO - Internal Medicine
DO - 10.2169/internalmedicine.7746-26
UR - https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7746-26/_article
AB - OBJECTIVE: To investigate the nationwide trends in pharmacological, radioactive iodine (RAI), and surgical treatments for hyperthyroidism in Japan from 2014 to 2023. METHODS: Annual sex- and age-stratified data on methimazole (MMI), propylthiouracil (PTU), potassium iodide (KI), RAI therapy, and thyroidectomy were extracted from the National Database of Health Insurance Claims (NDB). Crude and age-adjusted counts and rates per 1,000 (drugs) or 100,000 (RAI and surgery) person-years were calculated for each year. The annual trends were analyzed using linear and Poisson regression models. RESULTS: The cross-sectional distributions strongly reflected the female reproductive life stages. Notably, RAI therapy charges exhibited a bimodal peak distribution in females (25-29 and 45-49 years), whereas thyroidectomy peaked at 30-34 years, coinciding with the intervening childbearing period. Longitudinally, age-adjusted MMI and KI prescriptions and surgeries increased significantly (P ＜0.0001), whereas PTU prescriptions and RAI therapy declined (P ＜0.0001). Subgroup analyses revealed distinct age-dependent shifts, with MMI and KI use increasing across most age groups, particularly among individuals aged ≥90 years. PTU use showed divergent trends by sex, decreasing among males, but increasing among older females, particularly those aged ≥90 years. Surgical interventions increased mainly among older adults, whereas RAI therapy declined across most age groups. CONCLUSION: Over the past decade, hyperthyroidism management in Japan has shifted toward MMI consolidation, expanded KI use in the super-elderly population, declining RAI therapy in broad-aged populations, and increasing surgery in older adults. These age-dependent treatment shifts reflect the evolving clinical practice and therapeutic challenges posed by a rapidly aging society.
SN - 1349-7235
SN - 0918-2918
ER -