The Spectrum of Thyroid Disorders in an Iodine-
Deficient Community: The Pescopagano Survey*
FABRIZIO AGHINI-LOMBARDI, LUCIA ANTONANGELI, ENIO MARTINO,
PAOLO VITTI, DORETTA MACCHERINI, FRANCESCO LEOLI, TERESA RAGO,
LUCIA GRASSO, ROCCO VALERIANO, ANGELO BALESTRIERI, AND
Department of Endocrinology (F.A.-L., L.A., E.M., P.V., D.M., F.L., T.R., L.G., R.V., A.P.), University
of Pisa, Pisa; and the Department of Internal Medical Sciences, University of Cagliari (A.B.), Cagliari,
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 ?g/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, progres-
sively increased with age up to 15.4% in the elderly, and was related
to nodular goiter. The prevalences of overt and subclinical hypothy-
roidism in the adults were 0.2% and 3.8%, respectively. Serum au-
toantibodies 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 prev-
alence, thyroid nodularity, and functional autonomy was observed.
Hyperthyroidism was twice as high as that reported in iodine-suffi-
cient 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. (J Clin Endocrinol Metab 84: 561–566, 1999)
iodine-sufficient environment were well documented in the
classic Whickham survey carried out by Tunbridge et al. in
a mixed urban and rural region in Northeastern England (1).
Studies of other iodine-sufficient areas confirmed the find-
ings of this survey (2, 3). The spectrum and the prevalence
of thyroid disorders are known to be influenced by envi-
ronmental factors, especially by iodine intake (4). Indeed,
iodine deficiency is regarded as the most common cause of
thyroid disorders worldwide (4–6). Epidemiological studies
in iodine-deficient areas have mainly focused on the prev-
alence of goiter and cretinism (6–9). To our knowledge there
are no recent cross-sectional studies using modern technol-
ogies on the spectrum of thyroid disorders occurring in com-
munities with mild or moderate iodine deficiency.
In the present study, the prevalence of thyroid disorders
has been investigated in virtually the entire child population
HE SPECTRUM and the natural history of thyroid dis-
orders occurring in the adult population living in an
and in a high and representative proportion of the adult
population living in Pescopagano, a southern Italian village
with mild to moderate iodine deficiency.
Subjects and Methods
The survey was conducted in Pescopagano, a southern Italian village
located in the Lucan Apennines at 954 meters above the sea level. The
nearest town is 70 km away. Pescopagano was selected for its long term
exposure to iodine deficiency with no previous iodine prophylaxis. The
economy of this area is progressively converting from agriculture to
service activities. The usual diet consists mainly of local products. At the
time of the survey, the registered population of Pescopagano was 2348
people. Daily commuters with neighboring towns accounted for 620
people. They were excluded from the survey because of their exposure
to higher iodine dietary intake. A total of 317 people of the 1728 per-
manently residing in the village failed to respond to 2 consecutive calls
to participate in the survey. Thus, 1411 residents were actually exam-
ined: 419 (215 males and 204 females) 1- to 14-yr-old children, repre-
senting 94.1% of this age group, and 992 (573 females and 419 males) of
the 1368 subjects aged 15 yr or more, representing 72.5% of this age
group and referred to as the adult population. General practitioners of
the village actively took part in each step of the survey. Civil and health
authorities strongly supported the project, and informed consent was
obtained from parents of the minors and from adult subjects. A ques-
tionnaire sheet was completed for each subject and included personal
and family histories of thyroid disease with details of treatment and
special attention being paid to l-T4and any other medication affecting
thyroid function. Alimentary habits and coexistent autoimmune disor-
ders were also taken into account. In the schoolchildren, population
height and weight were measured.
A randomized sample of 75 adult subjects, drawn from the group of
317 subjects who failed to respond to the first and second calls, was
personally approached by family physicians and invited to participate
Received February 4, 1998. Revision received September 30, 1998.
Accepted November 12, 1998.
Address all correspondence and requests for reprints to: Fabrizio
Aghini-Lombardi, M.D., Department of Endocrinology, University of
Pisa, via Paradisa 2, I-56124 Pisa, Italy.
dell’Universita ` e della Ricerca Scientifica e Tecnologica (MURST 40%),
the National Research Council (National Research Center, Rome, Italy);
Target Project Biotechnology and Bioinstrumentation (Grant 91.01219,
PF70), Target Project Aging (Grant 91.00418, PF40), Target Project Pre-
vention and Control of Disease Factors (FATMA, Grant 9300689 PF41),
by grantsfrom theMinistero
Journal of Clinical Endocrinology and Metabolism
Copyright © 1999 by The Endocrine Society
Vol. 84, No. 2
Printed in U.S.A.
Cagliari (Cagliari, Italy); Daniela Balzi, M.D., Unita ` Operativa di Epi-
demiologia, Servizio Multizonale di Prevenzione Oncologica, USL 10
(Firenze, Italy); Giuseppe Araneo, M.D., Assessore Sanita `, Comune di
Pescopagano (Potenza, Italy); and Lidia Gallucci, M.D., and Carmela
Silvestri, M.D., general practitioners of Pescopagano, Italy.
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