Department of Endocrinology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Indian J Med Res. 2011 Jan;133(1):103-9.
BACKGROUND & OBJECTIVES: Despite years of salt iodization, goitre continues to be a major public health problem worldwide. We examined the prevalence of goitre in the post-iodization phase and the relationship of goitre with micronutrient status and thyroid autoimmunity in school children of Chandigarh, north India.
Two phase study; in the first phase, 2148 children of 6 to 16 yr were screened for goitre by two independent observers as per the WHO grading system. In the second phase, a case-control study, 191 children with goitre and 165 children without goitre were compared with respect to urinary iodine, iodine content of salt, serum levels of T3, T4, TSH, anti-TPO (thyroid peroxidase) antibody, haemoglobin, ferritin and selenium.
Prevalence of goitre in the studied subjects was 15.1 per cent (13.9% in 6 to 12 yr and 17.7% in 13 to 16 yr age group, P = 0.03). Median urinary iodine excretion in both the groups was sufficient and comparable (137 and 130 μg/l). 3.2 per cent children with goitre and 2.4 per cent without goitre had hypothyroidism (subclinical and clinical) and only one child with goitre had subclinical hyperthyroidism. Nine (4.9%) children in the goitre group and 3 (1.9%) in control group had anti-TPO antibody positivity. The median serum selenium levels were not different in both the groups (181.9 and 193.5 μg/l). Seventy one (37.4%) of the goitrous children had anaemia (haemoglobin <12 g/dl) as compared to 41 (24.8%) of the control group (P < 0.01). More number of goitrous children (39, 20.6%) were depleted of tissue iron stores (serum ferritin <12 μg/l) as compared to controls (11, 6.4%; P < 0.001). Serum ferritin level negatively correlated with the presence of goitre (r = -0.22, P = 0.008) and had an OR of 2.8 (CI 1.20-6.37, P = 0.017).
INTERPRETATION & CONCLUSIONS: There was a high prevalence of goitre in young children despite iodine repletion and low thyroid autoimmunity. The concurrent iron deficiency correlated with the presence of goiter. However, the cause and effect relationship between iron deficiency state and goitre requires further elucidation.
尽管多年来一直在进行食盐碘化，甲状腺肿仍然是全球范围内的一个主要公共卫生问题。我们研究了印度北部昌迪加尔市儿童在碘盐后的甲状腺肿流行情况，以及甲状腺肿与微量营养素状况和甲状腺自身免疫之间的关系。
分两阶段进行研究；第一阶段，2148 名 6 至 16 岁的儿童由两名独立观察者根据世卫组织分级系统筛查甲状腺肿。第二阶段为病例对照研究，对 191 名甲状腺肿患儿和 165 名非甲状腺肿患儿进行比较，比较内容包括尿碘、盐碘含量、血清 T3、T4、TSH、抗甲状腺过氧化物酶（TPO）抗体、血红蛋白、铁蛋白和硒水平。
研究对象中甲状腺肿的患病率为 15.1%（6 至 12 岁组为 13.9%，13 至 16 岁组为 17.7%，P=0.03）。两组的中位数尿碘排泄均充足且相似（137 和 130μg/l）。3.2%的甲状腺肿患儿和 2.4%的非甲状腺肿患儿有甲状腺功能减退症（亚临床和临床），仅有 1 名甲状腺肿患儿有亚临床甲状腺功能亢进症。甲状腺肿组有 9 名（4.9%）儿童和对照组有 3 名（1.9%）儿童抗 TPO 抗体阳性。两组的中位数血清硒水平无差异（181.9 和 193.5μg/l）。与对照组（41 名，24.8%）相比，更多的甲状腺肿患儿（71 名，37.4%）有贫血（血红蛋白<12g/dl）（P<0.01）。与对照组（11 名，6.4%）相比，更多的甲状腺肿患儿（39 名，20.6%）存在组织铁储存耗竭（血清铁蛋白<12μg/l）（P<0.001）。血清铁蛋白水平与甲状腺肿的存在呈负相关（r=-0.22，P=0.008），其比值比为 2.8（95%CI 1.20-6.37，P=0.017）。
尽管碘充足且甲状腺自身免疫率较低，但儿童中仍有很高的甲状腺肿患病率。同时存在的缺铁与甲状腺肿的存在相关。然而，缺铁状态与甲状腺肿之间的因果关系需要进一步阐明。
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