Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, China.
Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, China.
BMJ Open. 2023 Feb 28;13(2):e064613. doi: 10.1136/bmjopen-2022-064613.
To investigate the prevalence and risk factors of hypothyroidism after universal salt iodisation for 20 years in mainland China.
Nationwide, cross-sectional survey.
The Thyroid Disorders, Iodine Status and Diabetes epidemiological study included adults from 31 provinces of China. Data included demographic, physical characteristics, urine, serum thyroid-stimulating hormone (TSH), thyroid-peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb) and thyroid ultrasonography. Subclinical hypothyroidism (SCH) was classified into severe SCH (TSH >10 mU/L) and mild SCH (TSH 4.2-9.9 mU/L). A total of 78 470 (38 182 men and 40 288 women) participants were included in the final analysis.
The prevalence of hypothyroidism was 13.95%. The prevalence rates of overt hypothyroidism (OH) and SCH were 1.02% and 13.93%, which mild SCH was significantly higher than severe SCH (12.18% vs 0.75%). Prevalence was higher in women than in men, and this gender difference was noted among all age groups. The prevalence of mild SCH, severe SCH and OH increases by 1.16%, 1.40% and 1.29% for every 10 years older. TPOAb or/and TgAb positive were significantly associated with OH and severe SCH (OR 15.9, p<0.001). However, SCH was positively correlated with increased urine iodine concentration, but this correlation was only in antibody-negative female patients. In non-autoimmune and male populations, there was a U-shaped relationship between severe SCH and OH and urine iodine concentration.
Mild SCH is the most common form of hypothyroidism, which is related to iodine intake. Severe SCH is more similar to OH which autoimmune is the main cause. The various effects of iodine on hypothyroidism depend on thyroid autoimmune and gender.
调查中国全民食盐碘化 20 年后甲状腺功能减退症的患病率及危险因素。
全国性、横断面调查。
甲状腺疾病、碘状况和糖尿病的流行病学研究纳入了来自中国 31 个省的成年人。数据包括人口统计学、身体特征、尿液、血清促甲状腺激素（TSH）、甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TgAb）和甲状腺超声。亚临床甲状腺功能减退症（SCH）分为严重 SCH（TSH>10mU/L）和轻度 SCH（TSH 4.2-9.9mU/L）。共纳入 78470 名（38182 名男性和 40288 名女性）参与者进行最终分析。
甲状腺功能减退症的患病率为 13.95%。显性甲状腺功能减退症（OH）和 SCH 的患病率分别为 1.02%和 13.93%，其中轻度 SCH 明显高于严重 SCH（12.18%比 0.75%）。女性的患病率高于男性，且在所有年龄组中均存在这种性别差异。轻度 SCH、严重 SCH 和 OH 的患病率每增加 10 岁，分别增加 1.16%、1.40%和 1.29%。TPOAb 或/和 TgAb 阳性与 OH 和严重 SCH 显著相关（OR 15.9，p<0.001）。然而，SCH 与尿碘浓度升高呈正相关，但这种相关性仅存在于抗体阴性的女性患者中。在非自身免疫和男性人群中，严重 SCH 和 OH 与尿碘浓度之间呈 U 形关系。
轻度 SCH 是最常见的甲状腺功能减退症形式，与碘摄入有关。严重 SCH 更类似于 OH，其主要病因是自身免疫。碘对甲状腺功能减退症的各种影响取决于甲状腺自身免疫和性别。
