Impact of Pregnancy on Prevalence of Goitre and Nodular Thyroid Disease in Women Living in a Region of Borderline Sufficient Iodine Supply
ABSTRACT An interplay of genetic, epigenetic, and environmental factors contributes to thyroid disease. In a cross-sectional study, we aimed to determine the influence of parity in combination with other risk factors on the prevalence of goitre and nodular thyroid disease (NTD) in women living in a region of previous overt iodine deficiency, which experienced a continuous improvement in alimentary iodine supply in the last two decades. Thyroid ultrasonography (7.5 MHz; Merck Thyromobil) was performed by the same investigator in 736 women living in Thuringia and Saxony. Age and BMI were documented and a comprehensive history on pregnancies, family history of thyroid disease, and past or present smoking was obtained. Goitre prevalence was 19.1%. Solitary thyroid nodules were detected in 21.5%, and multiple nodules in 23.8% of women. In a multivariate analysis, neither age nor parity was positively correlated with goitre prevalence and NTD. A significant correlation was detected between BMI and goitre and multinodular disease. Goitre was found in 25.3% of women with a positive family history for thyroid disease, as opposed to 16.1% goitre in women with a negative family history. Neither goitre nor NTD were associated with a history of smoking in the whole study population. Thyroid nodules and/or goitre are present in up to 45% of women in an area of previous overt iodine deficiency. Whereas BMI and family history are positively correlated with the presence of NTD and goitre, no such correlation could be detected for pregnancy and smoking after processing our data with multivariate analyses.
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ABSTRACT: This review aimed at covering cancer risk trends by site and histology in first-generation and second-generation immigrants in Sweden compared with natives. In addition, we reviewed data on cancer survival in immigrants to explore factors explaining cancer survival in the entire population. The Swedish Family-Cancer Database was used to calculate standardized incidence ratios and hazard ratios (HRs) of death from cancer in 77 360 and 993 824 cases among first-generation, and 4356 and 263 485 cases among second-generation immigrants and Swedes, respectively. Ordinal logistic regression analyses were used to calculate odds ratio. To obtain the maximum number of cases, we classified the immigrants according to geographical setting, population, and/or cancer risk. Compared with native Swedes, the highest risk of cancer was observed for nasopharyngeal carcinoma in Southeast Asian men (standardized incidence ratio=35.6) and women (24.6), for hypopharyngeal carcinoma in Indian men (5.4), for squamous-cell carcinoma of the esophagus in Iranian women (3.8), for cardia of the stomach in East Asian women (4.2), for signet-ring cell carcinoma of the stomach in Southeast Asian women (6.7), for the liver in East Asian men (6.8), for the gall bladder in Indian women (3.8), for the pancreas in North African men (2.2), for large cell carcinoma of the lung in former Yugoslavian men (4.2), for pleural mesothelioma in Turkish women (23.8), for the cervix in Danes (1.6), for seminoma in Chileans (2.1), for transitional-cell carcinoma of the bladder in Asian Arab men (2.3), for meningioma in former Yugoslavians (1.3), and for papillary carcinoma of the thyroid in East and Southeast Asian men (3.6). No immigrant groups had an increased risk of breast, uterus, ovary, and prostate cancers or nervous system tumors. The HRs for all breast cancers were between 1.0 in low-risk Europeans and 1.2 in lowest-risk non-Europeans. Low-risk non-Europeans had an HR of 2.9 for lobular carcinoma. Low-risk non-Europeans were diagnosed in a higher T-class (odds ratio=1.9) than Swedes. The HRs for prostate cancer were 0.6 in Turks, Middle Easterners, Asians, and Chileans. In conclusion, environmental and behavioral factors, early-childhood exposures, and infections may play a major role in the risk of esophageal, stomach, liver, nasopharyngeal and hypopharyngeal cancers, malignant pleural mesothelioma, breast, gynecological, testicular, urinary bladder, and thyroid cancers. Pancreatic cancer and nervous system tumors may have a major genetic component in the etiology. The ethnic differences in the risk of breast cancer by histology had no major influence on survival. Middle Easterners, Asians, and Chileans, with the lowest risk of prostate cancer, also had the most favorable survival, suggesting a biological mechanism for this finding.European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP) 01/2015; DOI:10.1097/CEJ.0000000000000106 · 2.76 Impact Factor
Clinical Endocrinology 07/2014; 81(Suppl1):1-122. DOI:10.1111/cen.12515 · 3.35 Impact Factor
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ABSTRACT: Objective The effects of pregnancy on thyroid nodules were investigated in a few number of studies. We aimed to evaluate the prevalence of thyroid nodules, the changes in size, volume and number of nodules during pregnancy and after delivery in pregnant women .Design and methodsThis prospective study was performed in a severe iodine deficient area and included 83 pregnant women (mean age 30.4± 5.5 years). We evaluated thyroid hormone levels, ultrasound examination of thyroid, and urine iodine concentration (UIE) at each trimester and at 3 months postpartum period (PP). All patients with thyroid nodules >1 cm underwent fine needle aspiration biopsy (FNAB) after the last visit at the PP.Results26 women had thyroid nodules on thyroid ultrasonography at the first trimester. The volume of single/dominant nodule showed enlargement during pregnancy and remained at the PP, however it was not significant (first trimester: 0.83±0.8 ml; second trimester: 0.92±1 ml; third trimester: 0.99±1.2 ml; PP: 0.92±1.2 ml). The maximum diameter of single/dominant nodule in the third trimester of pregnancy (12.6±5.4 mm) was greater than the first trimester (11.9± 4.8 mm) (p=0.002). The number of nodules did not change during pregnancy. The mean TV increased during pregnancy and remained 3 months after delivery (p<0.001) and the maximum value of TV was reached in the third trimester (14.2± 7.9 ml). FNAB results revealed a 6.6% prevalence of malignancy among the nodules.Conclusions Thyroid nodules were present in 30.1% of pregnant women. While size of the single/dominant thyroid nodule increased significantly during pregnancy, the number of nodules did not change.This article is protected by copyright. All rights reserved.Clinical Endocrinology 05/2014; 81(5). DOI:10.1111/cen.12490 · 3.35 Impact Factor