The spectrum of thyroid disorders in iodine deficient community: The Pescopagano Survey

Università di Pisa, Pisa, Tuscany, Italy
Journal of Clinical Endocrinology & Metabolism (Impact Factor: 6.21). 03/1999; 84(2):561-6. DOI: 10.1210/jcem.84.2.5508
Source: PubMed
We carefully assessed thyroid status and goiter by ultrasound in 1411 subjects virtually representing the entire resident population of Pescopagano, an iodine-deficient village of Southern Italy. Median urinary iodine excretion was 55 microg/L. The prevalence of goiter was 16.0% in children and 59.8% in adults. Thyroid nodularity was 0.5% in children and progressively increased with age to 28.5% in the 56- to 65-yr-old group. The prevalence of present or past hyperthyroidism was 2.9%, including 9 cases with toxic diffuse goiter and 20 with toxic nodular goiter. Functional autonomy was rare in children, progressively increased with age up to 15.4% in the elderly, and was related to nodular goiter. The prevalences of overt and subclinical hypothyroidism in the adults were 0.2% and 3.8%, respectively. Serum autoantibodies to thyroglobulin and thyroperoxidase were detected in 12.6% of the entire population. The prevalence of diffuse autoimmune thyroiditis was 3.5%, being very low in children. Thyroid cancer was found in only 1 case. In conclusion, in the present survey of an iodine-deficient community, a progressive increase with age of goiter prevalence, thyroid nodularity, and functional autonomy was observed. Hyperthyroidism was twice as high as that reported in iodine-sufficient areas, mainly due to an increased frequency of toxic nodular goiter. Although low titer serum thyroid antibodies were relatively frequent, the prevalences of both overt and subclinical autoimmune hypothyroidism were not different from those observed in iodine-sufficient areas.

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    • "The differences may be due to age, gender, inheritance, living environment, eating habits, and iodine nutritional status, among others [12][13][14]. This survey showed that the prevalence of TNs increased significantly with age, which is consistent with previous studies [15][16][17]. The prevalence among Japanese women over 40 years of age was 35.3%, and increased with age [18]. "
    [Show abstract] [Hide abstract] ABSTRACT: Thyroid nodules (TNs) have annual increasing trends worldwide, and large-scale investigations on the prevalence of TNs in Beijing communities have not been conducted since the introduction of salt iodization in 1995. We performed a cross-sectional study to determine the prevalence of TNs, their epidemiological characteristics, and their correlation with lifestyle factors. A total of 6324 permanent residents aged 18 years or older (mean age, 52.15 ± 11.58 years) from seven representative communities in Beijing were included in the analyses. Once informed consent was obtained, the subjects were asked to complete questionnaires, a physical examination, and thyroid ultrasound. A total of 3100 cases had TNs. The overall prevalence rate was 49.0%, and the age-standardized prevalence was 40.1%, which increased significantly as age increased (p < 0.001). The prevalence was significantly higher in females compared to males (p < 0.001), and it was significantly higher among female current smokers and former smokers compared to non-smokers (p = 0.007). There was no correlation between alcohol consumption and TNs, and there were no significant differences in the prevalence among different groups of taste preference. The prevalence decreased with an increased frequency of seafood intake (p = 0.015) and with higher literacy levels (p < 0.001). The Cochran-Armitage trend test showed that the prevalence significantly increased with decreased physical labor and exercise intensity (p < 0.001, p = 0.009). Logistic regression analysis showed that age (Odds ratio (OR) = 1.039 (1.034-1.044), p < 0.001), the female sex (OR = 1.789 (1.527-2.097)), Body mass index (BMI) (OR = 1.019 (1.005-1.034)), and current smoking habits (OR = 1.246 (1.046-1.483)) were independent risk factors for TNs. Our findings indicate that there is a high prevalence of TNs in Beijing, with a higher prevalence in females than in males. Moreover, the prevalence increases as age increases. Smoking and BMI are independent risk factors for TNs. Therefore, intervention against smoking and weight loss might help reduce the risk of TN occurrence.
    Preview · Article · Apr 2016 · International Journal of Environmental Research and Public Health
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    • "Thyroid nodules are commonly diagnosed in adults; however, they are rare cases in pediatrics. Depending on the iodine intake, they have been ranged from 19 to 35% in adults by ultrasonography (US) [1] and from 0.2 to 5.1% in children [2, 3]. Cancer risk of a thyroid nodule is significantly greater in children than in adults, as it ranges from 3 to 70% and 5 to 14% [2,[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]in regard to children and adults, respectively. "
    [Show abstract] [Hide abstract] ABSTRACT: The clinical and pathological presentation of thyroid nodules among younger and adult patients was compared in an iodine-deficient (ID) region. Data of 3,010 consecutive patients younger than 20 years and 3,010 patients older than 20 years were compared. The proportion of nodular goiters (22.8% versus 39.3%), the ratio of surgically treated nodules (33.2% versus 15.2%), and the proportion of malignant nodules (4.3% versus 2.1%) among diseased patients differed significantly between the two groups (younger versus adult). Nine papillary and 1 medullary carcinoma were found among children, while 15 papillary, 2 follicular, 1 insular, 1 anaplastic, and 1 medullary carcinomas occurred among adults. The ratio of follicular adenoma to hyperplastic nodules (3 : 1 to 1 : 1.67), the proportion of follicular variant (77.8% versus 26.7%), T4 tumors (77.8% versus 33.3%), and tumors with lymph node metastasis (88.9% versus 66.7%) were significantly higher among younger papillary carcinoma patients. No malignancies occurred among spongiform and central type cysts. Similarly to iodine-sufficient regions, more nodules are malignant and carcinomas have a clinically more aggressive presentation in children in comparison with adult patients in ID. Taking the significantly greater proportion of adenomas and the lack of follicular carcinoma into account, a conservative approach has to be considered in follicular tumors among children.
    Full-text · Article · Mar 2016 · International Journal of Endocrinology
    • "In this paper, we show an elevated incidence of new cases of hypothyroidism , TD, AbTPO positivity, appearance of a hypoechoic thyroid pattern, and thyroid autoimmunity in MC + HCV patients with respect to controls. It is noteworthy that the incidence of new cases of hypothyroidism and AbTPO in control subjects was similar to the one reported by other epidemiological studies [16][17][18], indicating that the control group is not biased, vs. a low AT [19]. Mean TSH value, thyroid hypoechoic pattern and small thyroid volume , and the percentage of anti-thyroid antibodies were significantly higher in MC + HCV patients than in the control group, according with other studies, and our previous transversal study [20]. "
    [Show abstract] [Hide abstract] ABSTRACT: No study has evaluated the incidence of new cases of thyroid autoimmunity (AT) and dysfunction (TD) in hepatitis C-associated mixed cryoglobulinemia (MC) patients. We aimed to evaluate the incidence of new cases of AT and TD in a wide group of MC patients, vs. age- and gender-matched controls from the same geographic area. After exclusion of MC patients with TD at the initial evaluation, the appearance of new cases of TD was evaluated in 112 MC patients and 112 matched controls, with similar iodine intake (median follow-up 67months in MC vs. 78 in controls). A high incidence (P<0.05) of new cases of hypothyroidism, TD, anti-thyroperoxidase antibody (AbTPO) positivity, appearance of a hypoechoic thyroid pattern, and thyroid autoimmunity in MC patients vs. controls was shown. A logistic regression analysis showed that in MC the appearance of hypothyroidism was related to female gender, a border line high initial thyroid-stimulating hormone (TSH), AbTPO positivity, a hypoechoic and small thyroid. In conclusion, we show a high incidence of new cases of AT and TD in MC patients. MC patients at high risk (female gender, a border line high initial TSH, AbTPO positivity, a hypoechoic and small thyroid) should have periodically thyroid function follow-up.
    No preview · Article · Mar 2016 · Autoimmunity reviews
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