Loviselli A, Velluzzi F, Mossa P, Cambosu M A, Secci G, Atzeni F, Taberlet A, Balestrieri A, Martino E, Grasso L, Songini M, Bottazzo G F, Mariotti S
Department of Medical Sciences M. Aresu, University of Cagliari, Italy.
Thyroid. 2001 Sep;11(9):849-57. doi: 10.1089/105072501316973109.
The relationship among iodine intake, goiter prevalence, and thyroid autoimmunity remains controversial. In the present article, we report the prevalence of antithyroid antibodies (ATA) in relation to iodine intake, frequency of goiter, and thyroid function in a large group of Sardinian schoolchildren living in areas with borderline iodine sufficiency, or mild to moderate iodine deficiency. A total of 8,040 schoolchildren (4,194 males, 3,846 females, ages 6-15 years) from 29 communities were examined between 1986-1994. Thyroid size was assessed by palpation, according to the Pan American Health Organization (PAHO) criteria. In all cases antimicrosomal (MAb) or antithyroid peroxidase antibodies (TPOAb) and thyrotropin (TSH) were assayed. Urinary iodine was determined in a subgroup of 820 children. ATA was detected in 235 (2.92%) sera (88 males, 2.12%; 147 females, 3.82%; chi2 = 20.41, p < 0.0001). ATA prevalence ranged between 0.0%-7.3% in the 29 communities without any geographical correlation with goiter prevalence and urinary iodine excretion. However, ATA was more frequently detected in goitrous children, especially in females. The presence of ATA was not age-dependent in males, whereas a significant increase of ATA was observed in females older than 11 years of age. Seventy-seven (0.96%) children showed borderline to slightly increased serum TSH (>5.2-32 mU/L). Increased serum TSH concentration was more frequently found in children with ATA, especially at higher titers. In summary, our study in Sardinian schoolchildren indicates: (1) ATA display geographical heterogeneity, which seems to be unrelated to goiter prevalence and/or to iodine supply; (2) ATA are more frequently detected in females older than 11 years of age, suggesting that puberty has a role in determining the predominance in females of thyroid autoimmunity; (3) although most goitrous children are ATA-negative, the prevalence of ATA is increased in children with enlarged glands; (4) ATA is associated with an increased prevalence of subclinical hypothyroidism.
碘摄入量、甲状腺肿患病率和甲状腺自身免疫之间的关系仍存在争议。在本文中，我们报告了一大群生活在碘充足临界地区或轻度至中度碘缺乏地区的撒丁岛学龄儿童中抗甲状腺抗体（ATA）的患病率与碘摄入量、甲状腺肿发生频率及甲状腺功能的关系。1986年至1994年间，对来自29个社区的8040名学龄儿童（4194名男性，3846名女性，年龄6至15岁）进行了检查。根据泛美卫生组织（PAHO）标准，通过触诊评估甲状腺大小。所有病例均检测了抗微粒体（MAb）或抗甲状腺过氧化物酶抗体（TPOAb）以及促甲状腺激素（TSH）。对820名儿童的亚组测定了尿碘。在235份血清（88名男性，2.12%；147名女性，3.82%；χ2 = 20.41，p < 0.0001）中检测到ATA。在29个社区中，ATA患病率在0.0%至7.3%之间，与甲状腺肿患病率和尿碘排泄无任何地理相关性。然而，ATA在甲状腺肿儿童中更常被检测到，尤其是在女性中。ATA的存在在男性中与年龄无关，而在11岁以上的女性中观察到ATA显著增加。77名（0.96%）儿童的血清TSH处于临界值至轻度升高（>5.2 - 32 mU/L）。血清TSH浓度升高在ATA儿童中更常见，尤其是在较高滴度时。总之，我们对撒丁岛学龄儿童的研究表明：（1）ATA存在地理异质性，这似乎与甲状腺肿患病率和/或碘供应无关；（2）ATA在11岁以上女性中更常被检测到，表明青春期在决定女性甲状腺自身免疫优势方面起作用；（3）尽管大多数甲状腺肿儿童ATA呈阴性，但腺体肿大儿童中ATA患病率增加；（4）ATA与亚临床甲状腺功能减退患病率增加相关。
