Yu X, Fan C, Shan Z, Teng X, Guan H, Li Y, Teng D, Jin Y, Chong W, Yang F, Dai H, Yu Y, Li J, Chen Y, Zhao D, Shi X, Hu F, Mao J, Gu X, Yang R, Tong Y, Wang W, Gao T, Li C, Teng W
Institute of Endocrinology, First Hospital Affiliated to China Medical University, Shenyang, Liaoning Province, PR China.
J Endocrinol Invest. 2008 Mar;31(3):243-50. doi: 10.1007/BF03345597.
The association between iodine status and the prevalence of goiter and thyroid nodules has been well established but the extent to which different iodine intake levels influence the incidence of goiter and thyroid nodules is unclear. The aim of the study was to determine the incidence of goiter and thyroid nodules in 3 regions with different iodine intake levels: mildly deficient, more than adequate, and excessive.
DESIGN, PATIENTS AND MEASUREMENTS: Of the 3385 unselected subjects enrolled in 1999 in Panshan, Zhangwu, and Huanghua where median urinary iodine excretion (UIE) was 83.5 microg/l, 242.9 microg/l, and 650.9 microg/l, respectively, 2708 (80.0%) participated in the follow-up study in 2004. The examinations of thyroid ultrasonography, thyroid function, thyroid autoantibodies and UIE were performed at baseline and follow-up.
The cumulative incidence of diffuse goiter was 7.1%, 4.4%, and 6.9%, respectively, higher in Panshan and Huanghua than in Zhangwu (p=0.013 and p=0.015) and that of nodular goiter was 5.0%, 2.4%, and 0.8%, respectively, declining with increasing iodine intake levels (p<0.001). Mild iodine deficiency, chronic iodine excess as well as positive thyroid autoantibodies were associated with the occurrence of goiter [Logistic regression: odds ratio (OR)=1.83 (95% confidence interval (CI) 1.26-2.65), OR=1.46 (95% CI 1.01-2.11) and OR=1.68 (95% CI 1.14-2.48), respectively]. The cumulative incidence of single nodule was 4.0%, 5.7%, and 5.6%, respectively and that of multiple nodules was 0.4%, 1.2%, and 1.0%, respectively.
The relationship between iodine and the risk for the occurrence of diffuse goiter shows a U-shaped curve. Nodular goiters are more prevalent in iodine-deficient areas.
碘状态与甲状腺肿及甲状腺结节患病率之间的关联已得到充分证实，但不同碘摄入量水平对甲状腺肿和甲状腺结节发病率的影响程度尚不清楚。本研究的目的是确定在碘摄入量轻度不足、充足及过量的3个地区甲状腺肿和甲状腺结节的发病率。
设计、研究对象与测量方法：1999年在盘山、彰武和黄骅招募了3385名未经挑选的受试者，其尿碘中位数排泄量（UIE）分别为83.5微克/升、242.9微克/升和650.9微克/升，2004年有2708名（80.0%）受试者参与了随访研究。在基线和随访时进行甲状腺超声检查、甲状腺功能、甲状腺自身抗体及尿碘中位数排泄量的检测。
弥漫性甲状腺肿的累积发病率分别为7.1%、4.4%和6.9%，盘山和黄骅地区高于彰武地区（p=0.013和p=0.015）；结节性甲状腺肿的累积发病率分别为5.0%、2.4%和0.8%，随着碘摄入量增加而下降（p<0.001）。轻度碘缺乏、慢性碘过量以及甲状腺自身抗体阳性均与甲状腺肿的发生有关[逻辑回归：比值比（OR）分别为1.83（95%置信区间（CI）1.26 - 2.65）、1.46（95%CI 1.01 - 2.11）和1.68（95%CI 1.14 - 2.48）]。单发结节的累积发病率分别为4.0%、5.7%和5.6%，多发结节的累积发病率分别为0.4%、1.2%和1.0%。
碘与弥漫性甲状腺肿发生风险之间的关系呈U形曲线。结节性甲状腺肿在碘缺乏地区更为普遍。
