Editing Hashimoto's thyroiditis (section)

==Epidemiology==
Hashimoto's Disease is estimated to affect 2% of the world's population.<ref name="Ramos-Levi2023" /><ref name="Chistiakov-2005">{{cite journal | vauthors = Chistiakov DA | title = Immunogenetics of Hashimoto's thyroiditis | journal = Journal of Autoimmune Diseases | volume = 2 | issue = 1 | pages = 1 | date = March 2005 | pmid = 15762980 | pmc = 555850 | doi = 10.1186/1740-2557-2-1 | doi-access = free }}</ref> About 1.0 to 1.5 in 1000 people have this disease at any time.<ref name="Maitra 2014 The Endocrine System" />

=== Sex ===
Anyone may develop this disease, but it occurs between 8<ref name=":6" /> and 15 times more often in women than in men. Some research suggests a connection to the role of the [[placenta]] as an explanation for the sex difference.<ref>{{cite journal | vauthors = Natri H, Garcia AR, Buetow KH, Trumble BC, Wilson MA | title = The Pregnancy Pickle: Evolved Immune Compensation Due to Pregnancy Underlies Sex Differences in Human Diseases | journal = Trends in Genetics | volume = 35 | issue = 7 | pages = 478–488 | date = July 2019 | pmid = 31200807 | pmc = 6611699 | doi = 10.1016/j.tig.2019.04.008 }}</ref>  Other research suggests the difference in [[prevalence]] amongst genders is due to the effects of [[sex hormone]]s.<ref name="Weetman2021"/>

=== High iodine consumption ===
Autoimmune thyroiditis has a higher prevalence in societies that have a higher intake of [[iodine]] in their diet, such as the United States and Japan, and among people who are [[Genetic predisposition|genetically susceptible]].<ref name="Monaco">{{cite book |title=Thyroid Diseases |vauthors=Monaco F |publisher=Taylor and Francis |year=2012 |isbn=978-1-4398-6839-3 |page=78}}</ref> It is the most common cause of hypothyroidism in areas of sufficient iodine.<ref name="Mincer2022" /> Also, the rate of lymphocytic infiltration increased in areas where the iodine intake was once low, but increased due to iodine supplementation.<ref name="Dayan96"/><ref name="Khattak-2016">{{cite journal | vauthors = Khattak RM, Ittermann T, Nauck M, Below H, Völzke H | title = Monitoring the prevalence of thyroid disorders in the adult population of Northeast Germany | journal = Population Health Metrics | volume = 14 | pages = 39 | date = 2016 | pmid = 27833458 | pmc = 5101821 | doi = 10.1186/s12963-016-0111-3 | doi-access = free }}</ref>

[[Iodine deficiency|Iodine deficiency disorder]] is combated using an increase in iodine in a person's diet. When a dramatic change occurs in a person's diet, they become more at-risk of developing hypothyroidism and other thyroid disorders. Treating iodine deficiency disorder with high salt intakes should be done carefully and cautiously as risk for Hashimoto's may increase.<ref name="Khattak-2016" />

=== Geographic influence of dietary trends ===
Geography plays a large role in which regions have access to diets with low or high iodine. Iodine levels in both water and salt should be heavily monitored in order to protect at-risk populations from developing hypothyroidism.<ref>{{cite journal | vauthors = Katagiri R, Yuan X, Kobayashi S, Sasaki S | title = Effect of excess iodine intake on thyroid diseases in different populations: A systematic review and meta-analyses including observational studies | journal = PLOS ONE | volume = 12 | issue = 3 | pages = e0173722 | date = 2017-03-10 | pmid = 28282437 | pmc = 5345857 | doi = 10.1371/journal.pone.0173722 | bibcode = 2017PLoSO..1273722K | doi-access = free }}</ref> Geographic trends of hypothyroidism vary across the world as different places have different ways of defining disease and reporting cases. Populations that are spread out or defined poorly may skew data in unexpected ways.<ref name="Chistiakov-2005" />

=== North America ===
Hashimoto's thyroiditis may affect up to 5% of the United States' population.<ref name=":3a">{{Cite book | vauthors = Biddinger PW |title=Diagnostic Pathology and Molecular Genetics of the Thyroid: A Comprehensive Guide for Practicing Thyroid Pathology |publisher=Lippincott Williams & Wilkins |year=2020 |isbn=978-1-4963-9653-2 |edition=3rd |location=Philadelphia, PA |pages=59–72}}</ref> Hashimoto's thyroiditis disorder is thought to be the most common cause of primary hypothyroidism in North America.<ref name="Maitra 2014 The Endocrine System" />

=== Age ===
Hashimoto's thyroiditis can occur at any age, including children,<ref name="Monaco" /> but more commonly appears in [[middle age]], particularly for men.<ref>{{cite web |date=16 July 2012 |title=Hashimoto's disease fact sheet |url=http://www.womenshealth.gov/publications/our-publications/fact-sheet/hashimoto-disease.html |url-status=live |archive-url=https://web.archive.org/web/20141202154021/http://www.womenshealth.gov/publications/our-publications/fact-sheet/hashimoto-disease.html |archive-date=2 December 2014 |access-date=23 November 2014 |publisher=Office on Women's Health, U.S. Department of Health and Human Services, womenshealth.gov (or girlshealth.gov)}}</ref> [[Incidence (epidemiology)|Incidence]] peaks in the fifth decade of life, but patients are usually diagnosed between age 30–50.<ref name="Niddk2021" /><ref name=":3a" /> The highest prevalence from one study was found in the elderly members of the community.<ref name="Vanderpump-2011">{{cite journal | vauthors = Vanderpump MP | title = The epidemiology of thyroid disease | journal = British Medical Bulletin | volume = 99 | issue = 1 | pages = 39–51 | date = 2011-09-01 | pmid = 21893493 | doi = 10.1093/bmb/ldr030 }}</ref> It has been shown that the prevalence of positive tests for thyroid antibodies increases with age, "with a frequency as high as 33 percent in women 70 years old or older."<ref name="Dayan96" />

=== Race ===
The prevalence of Hashimoto's varies geographically. The highest rate is in Africa, and the lowest in Asia.<ref name="Hu">{{cite journal | vauthors = Hu X, Chen Y, Shen Y, Tian R, Sheng Y, Que H | title = Global prevalence and epidemiological trends of Hashimoto's thyroiditis in adults: A systematic review and meta-analysis | journal = Frontiers in Public Health | volume = 10 | issue =  | pages = 1020709 | date = 2022 | pmid = 36311599 | pmc = 9608544 | doi = 10.3389/fpubh.2022.1020709 | doi-access = free }}</ref> In the US, the African-American population experiences it less commonly but has greater associated mortality.<ref>{{cite news | vauthors = Boyles S |title=Hypothyroidism Hikes Death Risk in Blacks |url=https://www.medpagetoday.org/endocrinology/thyroid/39357 |work=MedPage Today |date=23 May 2013 }}</ref>

=== Autoimmune diseases ===
Those that already have an autoimmune disease are at greater risk of developing Hashimoto's as the diseases generally coexist with each other.<ref name="Chistiakov-2005" /> See Causes > Comorbidities, above.

=== Secular trends ===
The [[secular trends]] of hypothyroidism reveal how the disease has changed over the course of time given changes in technology and treatment options. Even though ultrasound technology and treatment options have improved, the incidence of hypothyroidism has increased according to data focused on the US and Europe. Between 1993 and 2001, per 1000 women, the disease was found varying between 3.9 and 4.89. Between 1994 and 2001, per 1000 men, the disease increased from 0.65 to 1.01.<ref name="Vanderpump-2011" />