Bajuk Vid, Zaletel Katja, Pirnat Edvard, Hojker Sergej, Gaberšček Simona
1 Faculty of Medicine, University of Ljubljana , Ljubljana, Slovenia .
2 Department of Nuclear Medicine, University Medical Centre Ljubljana , Ljubljana, Slovenia .
Thyroid. 2017 Apr;27(4):558-566. doi: 10.1089/thy.2016.0186. Epub 2017 Feb 1.
This study aimed to establish the changes in the incidence and characteristics of iodine-induced hyperthyroidism (II-Hyper) and iodine-induced hypothyroidism (II-Hypo) in the two-year period before and the 10-year period after the increase in mandatory salt iodization from the previous 10 mg/kg of potassium iodide to 25 mg/kg in 1999. Furthermore, the aim was to determine the duration of treatment in II-Hyper patients, since no data regarding severity and treatment of II-Hyper with respect to iodine supply are available.
This retrospective study reviewed medical records of 885 Slovenian patients first diagnosed with II-Hyper or II-Hypo between 1998 and 2009 at the Thyroid Department of the University Medical Centre Ljubljana. II-Hyper and II-Hypo were diagnosed by one out of 10 senior internal medicine specialists. The diagnosis was based on an adequate patient history, and laboratory measurements of thyrotropin, thyroid hormones, and thyroid antibodies. In most cases, thyroid ultrasound and thyroid scintigraphy were performed. Demographic characteristics and the type and the duration of treatment were also reviewed.
The incidence of II-Hypo was significantly higher after the increase in iodine supply than it was before (p < 0.001). After the increase in iodine supply, the incidence of II-Hyper was significantly lower than before the increase (p < 0.001). Furthermore, the portion of patients with overt hyperthyroidism decreased, predominantly due to the increased proportion of patients with subclinical hyperthyroidism (p = 0.007 and p = 0.015, respectively). The duration of treatment with antithyroid drugs and perchlorate was significantly shorter after the increase in iodine supply than it was before (p = 0.001 and p = 0.002, respectively). A significantly positive correlation between the year of the occurrence of excessive iodine intake (EII)-induced thyroid disease and the duration of treatment with amiodarone was found (R = 0.132; p = 0.048), suggesting that the longer the patients had an adequate iodine supply, the longer they could take amiodarone before EII-induced thyroid disorder developed.
After the increase in iodine supply, a higher incidence of II-Hypo and a lower incidence of II-Hyper were observed than before the increase. Less severe II-Hyper, shorter duration of treatment of II-Hyper, as well as a longer thyroid disease-free period in patients on amiodarone are additional beneficial clinical consequences after the establishment of an adequate iodine supply.
本研究旨在确定1999年强制食盐碘化钾添加量从之前的10毫克/千克增加到25毫克/千克之前两年以及之后十年期间碘致甲状腺功能亢进症（II - 甲亢）和碘致甲状腺功能减退症（II - 甲减）的发病率变化及特征。此外，由于缺乏关于碘供应与II - 甲亢严重程度及治疗方面的数据，本研究旨在确定II - 甲亢患者的治疗时长。
这项回顾性研究回顾了1998年至2009年在卢布尔雅那大学医学中心甲状腺科首次被诊断为II - 甲亢或II - 甲减的885名斯洛文尼亚患者的病历。II - 甲亢和II - 甲减由10名资深内科专家中的一位进行诊断。诊断基于充分的患者病史以及促甲状腺激素、甲状腺激素和甲状腺抗体的实验室检测。大多数情况下，还进行了甲状腺超声和甲状腺闪烁扫描。同时也回顾了人口统计学特征以及治疗类型和时长。
碘供应增加后，II - 甲减的发病率显著高于增加前（p < 0.001）。碘供应增加后，II - 甲亢的发病率显著低于增加前（p < 0.001）。此外，显性甲亢患者的比例下降，主要是由于亚临床甲亢患者比例增加（分别为p = 0.007和p = 0.015）。碘供应增加后，抗甲状腺药物和高氯酸盐的治疗时长显著短于增加前（分别为p = 0.001和p = 0.002）。发现碘摄入过量（EII）所致甲状腺疾病发生年份与胺碘酮治疗时长之间存在显著正相关（R = 0.132；p = 0.048），这表明患者碘供应充足的时间越长，在EII所致甲状腺疾病发生前服用胺碘酮的时间就越长。
碘供应增加后，观察到II - 甲减的发病率高于增加前，II - 甲亢的发病率低于增加前。II - 甲亢病情较轻、II - 甲亢治疗时长较短，以及服用胺碘酮患者的甲状腺无病期较长，是碘供应充足后额外的有益临床结果。
