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Suarez-Zdunek MA, Arentoft NS, Krohn PS, Lauridsen EHE, Afzal S, Høgh J, Thomsen MT, Knudsen AD, Nordestgaard BG, Hillingsø JG, Villadsen GE, Holland-Fischer P, Rasmussen A, Fialla AD, Feldt-Rasmussen U, Nielsen SD. Prevalence of hyperthyroidism and hypothyroidism in liver transplant recipients and associated risk factors. Sci Rep 2024; 14:7828. [PMID: 38570629 PMCID: PMC10991542 DOI: 10.1038/s41598-024-58544-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/01/2024] [Indexed: 04/05/2024] Open
Abstract
The prevalence of hyperthyroidism and hypothyroidism and associated risk factors are unknown in liver transplant recipients. We aimed to determine the prevalence of hyperthyroidism and hypothyroidism and associated risk factors in liver transplant recipients and to compare it with controls from the general population. As part of the Danish Comorbidity in Liver Transplant Recipients (DACOLT) Study, all Danish liver transplant recipients over the age of 20 were invited for measurements of concentrations of thyrotropin and thyroid hormones. The prevalence of hyperthyroidism and hypothyroidism was compared to age- and sex-matched controls from the Copenhagen General Population Study. Using logistic regression adjusted for age, sex, smoking, and body-mass index, we investigated potential risk factors. We recruited 489 liver transplant recipients and 1808 controls. Among liver transplant recipients, 14 (2.9%) had hyperthyroidism compared with 21 (1.2%) of controls (adjusted odds ratio [aOR] 2.24, 95% confidence interval [CI] 1.05-4.75, P = 0.04), while 42 (5.7%) had hypothyroidism compared with 139 (7.7%) of controls (aOR 0.68, 95% CI 0.43-1.08, P = 0.10). Female sex, and autoimmune hepatitis and primary sclerosing cholangitis as causes of transplantation were associated with hyperthyroidism after adjustments. Age, female sex, and autoimmune liver diseases as cause of transplantation were associated with hypothyroidism after adjustments. DACOLT is registered in ClinicalTrials.gov (NCT04777032).
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Affiliation(s)
- Moises Alberto Suarez-Zdunek
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Esther Møllers Vej 6, 2100, Copenhagen, Denmark
| | - Nicoline Stender Arentoft
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Esther Møllers Vej 6, 2100, Copenhagen, Denmark
| | - Paul Suno Krohn
- Department of Surgical Gastroenterology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Shoaib Afzal
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Høgh
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Esther Møllers Vej 6, 2100, Copenhagen, Denmark
| | - Magda Teresa Thomsen
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Esther Møllers Vej 6, 2100, Copenhagen, Denmark
| | - Andreas Dehlbæk Knudsen
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Esther Møllers Vej 6, 2100, Copenhagen, Denmark
| | - Børge Grønne Nordestgaard
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Georg Hillingsø
- Department of Surgical Gastroenterology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Allan Rasmussen
- Department of Surgical Gastroenterology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Anette Dam Fialla
- Department of Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department Endocrinology and Metabolism, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Susanne D Nielsen
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Esther Møllers Vej 6, 2100, Copenhagen, Denmark.
- Department of Surgical Gastroenterology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Henjum S, Groufh-Jacobsen S, Aakre I, Gjengedal ELF, Langfjord MM, Heen E, Sele V, Andersson M. Thyroid function and urinary concentrations of iodine, selenium, and arsenic in vegans, lacto-ovo vegetarians and pescatarians. Eur J Nutr 2023; 62:3329-3338. [PMID: 37592132 PMCID: PMC10611878 DOI: 10.1007/s00394-023-03218-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/18/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE Populations following a plant-based diet may be at particular risk of thyroid dysfunction due to low iodine and selenium intakes. The main purpose was to assess thyroid function and urinary concentration of iodine, selenium, and arsenic, in subjects following a vegan, lacto-ovo vegetarian, or pescatarian diet. METHODS In Norway, a country without mandatory dietary iodine fortification, 205 adults, following vegan (n = 115), lacto-ovo vegetarian (n = 55) and pescatarian diet (n = 35) were included. Thyroglobulin (Tg), thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), and serum anti-TPO (S-anti-TPO) were measured in a venous blood sample and concentrations of iodine (UIC), creatinine (UCC), selenium, and arsenic were measured from single spot urine samples. RESULTS Subclinical hypothyroidism (TSH > 4.0 mU/L) was observed in 3% of subjects. The overall median (p25, p75) Tg was 17 (9, 30) µg/L and vegans had higher Tg compared to pescatarians. Vegans not consuming iodine-containing supplements (n = 43) had higher Tg, than supplement users (n = 72), 27 (11, 44) vs. 16 (8, 25) µg/L and higher fT4, 16 (15, 17) vs. 15 (14, 17) pmol/L, respectively. The overall median UIC was 57 (28, 130) µg/L, all dietary groups had median UIC below WHO thresholds. Median urinary selenium and arsenic concentration was 13 (6, 22) and 3 (2, 8) µg/L, respectively. CONCLUSION The prevalence of subclinical hypothyroidism was low and fT4 and fT3 were within the normal range for all dietary groups. Vegans had significantly increased Tg compared to pescatarians.
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Affiliation(s)
- Sigrun Henjum
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Kunnskapsveien 55, 2007 Kjeller, 0130, Oslo, Norway.
| | - Synne Groufh-Jacobsen
- Department of Nutrition and Public Health, Faculty of Health and Sport Science, University of Agder, Universitetsveien 25, 4630, Kristiansand, Norway
| | - Inger Aakre
- Department of Marine Toxicology, Institute of Marine Research, 5817, Bergen, Norway
| | - Elin Lovise Folven Gjengedal
- Faculty of Environmental Sciences and Natural Resource Management, Norwegian University of Life Sciences, 1432, Ås, Norway
| | - Mina Marthinsen Langfjord
- Faculty of Environmental Sciences and Natural Resource Management, Norwegian University of Life Sciences, 1432, Ås, Norway
| | - Espen Heen
- Institute of Health and Society, Medical Faculty, University of Oslo, Oslo, Norway
| | - Veronika Sele
- Department of Marine Toxicology, Institute of Marine Research, 5817, Bergen, Norway
| | - Maria Andersson
- Nutrition Research Unit, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
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Kravchenko V, Zakharchenko T. Thyroid hormones and minerals in immunocorrection of disorders in autoimmune thyroid diseases. Front Endocrinol (Lausanne) 2023; 14:1225494. [PMID: 37711890 PMCID: PMC10499380 DOI: 10.3389/fendo.2023.1225494] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/08/2023] [Indexed: 09/16/2023] Open
Abstract
Thyroid hormones and essential elements iodine (I), selenium (Se), iron (Fe), copper (Cu), zinc (Zn), calcium (Ca), magnesium (Mg), etc. play an important role in the work of many organs and systems of the body, including the immune system and the thyroid gland, and a violation of their supply can be the cause of pathological changes in them. In pathology, the interaction between thyroid hormones (TG), minerals and the immune system is disturbed. The review of the literature examines the immunomodulatory role of TG, minerals, their properties, and their participation in the pathogenesis of autoimmune thyroid diseases (AITD). The study of the relationship between the excess or deficiency of minerals and AITD is described. The basis of the development of AITD - Hashimoto's thyroiditis (HT), Graves' disease (GD), Graves' ophthalmopathy (GO) is the loss of immune tolerance to thyroid antigens - thyroid peroxidase (TPO), thyroglobulin (Tg) and thyroid-stimulating hormone receptor (TSH-R). Immune-mediated mechanisms - production of autoantibodies to thyroid antigens and lymphocytic thyroid infiltration - are involved in the pathogenesis of AITD. Insufficiency of regulatory T cells (Treg) and regulatory B cells (Breg), imbalance between Th17-lymphocytes and Treg-lymphocytes, abnormal production of pro-inflammatory cytokines has a significant influence on the progression of AITD. With AITD, the balance between oxidants and antioxidants is disturbed and oxidative stress (OS) occurs. The lack of modern effective pharmacological therapy of AITD prompted us to consider the mechanisms of influence, possibilities of immunocorrection of pathogenetic factors using TG, micro/macronutrients. In order to develop a more effective treatment strategy, as well as approaches to prevention, a critical analysis of the ways of immunotherapeutic use of dietary supplements of I, Se, Zn, Mg and other minerals in AITD was carried out.
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Affiliation(s)
- Viktor Kravchenko
- Epidemiology of Endocrine Diseases, Vasily Pavlovich Komisarenko Institute of Endocrinology and Metabolism, Kyiv, Ukraine
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Zhang M, Ni W, Zhang L, Fan K, Sun Y, Liu C, Xu S. Age-specific association between thyroid autoimmunity and hypothyroidism in Chinese adults aged over 65 years: a cross-sectional study. Front Endocrinol (Lausanne) 2023; 14:1216308. [PMID: 37564984 PMCID: PMC10410462 DOI: 10.3389/fendo.2023.1216308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/05/2023] [Indexed: 08/12/2023] Open
Abstract
Background The correlation between thyroid autoimmune (TAI) disease and hypothyroidism in the elderly of different ages remains unclear. This study aimed to investigate the epidemiological characteristics of hypothyroidism, including subclinical hypothyroidism (Shypo) and overt hypothyroidism (Ohypo) in those aged ≥65 years from iodine-adequate areas and reveal the correlation between TAI and hypothyroidism in the elderly of different ages. Methods It was a cross-sectional study involving 2,443 subjects aged ≥65 years from two iodine-adequate areas in China by cluster sampling. They were assigned to the 65-69-, 70-79-, and ≥80-year-old age group. All subjects were surveyed by questionnaires and received physical examinations, laboratory testing, and thyroid ultrasound. Epidemiological characteristics of thyroid diseases in the elderly were compared among the three groups. Risk factors for hypothyroidism were predicted by binary logistic regression analysis. Results The median urinary iodine level was 238.70 (197.00, 273.70) μg/L. Thyroid peroxidase antibody or thyroglobulin antibody positivity (11.87%) and Shypo (9.13%) were common in the elderly. The prevalence of hypothyroidism in the elderly increases with age. TAI was a risk factor for Shypo (OR, 1.94; 95% CI, 1.35, 2.80; p < 0.01) and Ohypo (OR, 7.64; 95% CI, 3.40, 17.19; p < 0.01) in elderly Chinese. There was an age-specific correlation between TAI and hypothyroidism in the elderly. However, a significant correlation was not identified between TAI and hypothyroidism in ≥80-year-old age group (p > 0.05). Conclusion Hypothyroidism, particularly Shypo, is common in the elderly from iodine-adequate areas in China. TAI serves as a risk factor for hypothyroidism in the elderly, with an age-specific correlation with hypothyroidism.
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Affiliation(s)
- Mengjie Zhang
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Endocrine and Diabetes Center, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Wenjing Ni
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Endocrine and Diabetes Center, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Lina Zhang
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Endocrine and Diabetes Center, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Kuanlu Fan
- Department of Endocrinology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yu Sun
- Department of Endocrinology and Metabolism, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - Chao Liu
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Endocrine and Diabetes Center, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- Key Laboratory of Traditional Chinese Medicine Syndrome and Treatment of Yingbing (Thyroid Disease) of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Shuhang Xu
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Endocrine and Diabetes Center, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
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Shan Z, Li Y, Li Y, Wang H, Teng D, Teng X, Chong W, Shi X, Li J, Guo J, Lou Z, Fan C, Ding S, He L, Liu H, Pearce EN, Teng W. Changing iodine status and the incidence of thyroid disease in mainland China: A prospective 20-year follow-up study. Thyroid 2023. [PMID: 37082958 DOI: 10.1089/thy.2022.0505] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND We aimed to assess the long-term effects of the transition in iodine status on the incidence of thyroid disorders over 20 years of follow up. METHODS The original prospective cohort study, started in 1999 (n=3,761), classified three regions in north China based on iodine status (insufficient iodine, more than adequate iodine, and excessive iodine, respectively) for 5 years. Subsequently, participants were followed for up to another 15 years to assess the long-term effects of shifts to adequate iodine on the incidence of thyroid disorders. Panshan transitioned from insufficient to adequate iodine and Huanghua transitioned from excessive to more than adequate iodine. Both regions were compared to Zhangwu, which iodine status changed from more than adequate to adequate iodine (from 214μg/L to 167.2μg/L). A cluster sampling method was used to select participants in the three regions. Participants completed questionnaires and underwent thyroid ultrasonography. Urinary iodine concentrations (UIC), serum thyroid hormone concentration, and thyroid antibodies were measured. RESULTS When the iodine status changed from insufficient to adequate (with the median UIC increasing from 88μg/L to 141.9μg/L), the incidence density of subclinical hyperthyroidism, positive thyroperoxidase antibody (TPOAb), positive thyroglobulin antibody (TgAb), and goiter decreased significantly (p<0.05 for all). Additionally, the cumulative incidence of subclinical hypothyroidism was significantly lower compared to the region where the iodine status changed from being more than adequate to adequate (1.9% vs. 6.0%, p<0.001). When the iodine status changed from excessive to more than adequate (median UIC from 634μg/L to 266.7μg/L), a significant decrease in the incidence density of subclinical hyperthyroidism, positive thyroid antibodies, positive TgAb, and goiter (p<0.05 for all), were also found. However, an increase in thyroid nodule incidence density (17.26 vs. 28.25 per 1000 person-years, p<0.001) was seen. CONCLUSIONS The incidence of thyroid disorders (except for thyroid nodules) stabilized or decreased among adults in the three communities from year 5 to year 15 of follow-up. Appropriate iodine fortification is safe and effective over the long term. Restoring urinary iodine to appropriate levels reduces population risk for thyroid disorders.
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Affiliation(s)
- Zhongyan Shan
- The Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, 1Department of Endocrinology and Metabolism, No.155 Nanjing Bei Street, Hepig District, Shengyang 110001, China., Shengyang, China, 110001;
| | - Yushu Li
- The First Affiliated Hospital of China Medical University, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China, 110000
- United States;
| | - Yongze Li
- The First Hospital of China Medical University, Department of Endocrinology and Metabolism, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Shenyang, Liaoning, China, 110001
- United States;
| | - Haoyu Wang
- The First Hospital of China Medical University, 159407, Shenyang, Liaoning, China;
| | - Di Teng
- Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases,, Endocrinology and Metabolism, 1, Shenyang, Liaoning, China, 110000;
| | - Xiaochun Teng
- The Endocrine Institute , Department of Endocrinology and Metabolism, No 155, Nanjing Bei Street, Heping District, Shenyang City, Shenyang, China, 110001;
| | - Wei Chong
- The First Hospital of China Medical University, 159407, Shenyang, Liaoning, China;
| | - Xiaoguang Shi
- China Medical University, 26488, Nanjingnan Street, Shenyang, Liaoning, China, 110001;
| | - Jing Li
- Institute of endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, Department of Endocrinology and Metabolism, The First Affiliated Hospital of China Medical University, No. 155 in Nanjing North Street, Heping Distinct, Shenyang, China, 110001;
| | - Jiahui Guo
- The First Hospital of China Medical University, Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China, 110001;
| | - Zhe Lou
- China Medical University First Hospital, 159407, Endocrinology and Metabolism, Shenyang, China;
| | - Chenling Fan
- Key Laboratory of Endocrine Diseases, Liaoning Province, Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, Liaoning, China, Shenyang, China, 110001;
| | - Shuangning Ding
- Institute of endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases , The First Affiliated Hospital of China Medical University, Department of Endocrinology and Metabolism, Shenyang, China;
| | - Li He
- Zhangwu County Center for Disease Control and Prevention, Fuxin, China;
| | - Hua Liu
- Cangzhou Center for Disease Control and Prevention, Cangzhou, China;
| | - Elizabeth N Pearce
- Boston University Medical Center, Sectionof Endocrinology, Diabetes, and Nutrition, 88 East newton Street, eVANS 201, Boston, Massachusetts, United States, 02118;
| | - Weiping Teng
- the 1st hospital of China Medical University, Institute of Endocrinology, Department of Endocrinology and Metabolism, 155,Nanjing Bei Street, Heping District, Shenyang, Liaoning, China, 110001
- the first hospital of CMU, Department of endocrinology, 155,Nanjing Bei street, shenyang, Liaoning, China, 110001;
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Zheng G, Cai Y, Guo Y, Song F, Hu Y, Li L, Zhu L. The association between dietary selenium intake and Hashimoto's thyroiditis among US adults: National Health and Nutrition Examination Survey (NHANES), 2007-2012. J Endocrinol Invest 2022:10.1007/s40618-022-01987-0. [PMID: 36515869 DOI: 10.1007/s40618-022-01987-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Selenium has been shown to influence the pathological processes and physiological functions of thyroid. Although growing evidence has shown that selenium can improve the treatment of Hashimoto's thyroiditis (HT), there is a need to evaluate the association between dietary selenium intake and HT in a large cross-sectional study. This study explored the association between dietary selenium intake and HT based on the National Health reand Nutrition Examination Survey (NHANES) database (2007-2012). METHODS A total of 8756 of 30,442 participants were included in the study. Dietary selenium intake was the independent variable, while HT was the dependent variable. In addition, the relative importance of the selected variables was determined using the XGBoost model. A smooth curve was constructed based on the fully adjusted model to investigate the potential linear relationship between dietary selenium intake and HT. Smooth curves were also constructed to explore the linear/non-linear relationship between dietary selenium intake and thyroid peroxidase antibody (TPOAb)/ thyroglobulin antibody (TgAb). RESULTS The mean age of the enrolled participants was 44.35 years (± 20.92). The risk of HT was significantly reduced by a 35% per-unit increase in dietary selenium intake after fully adjusting for covariates according to the model (log2-transformed data; OR 0.65; 95% CI 0.51, 0.83). The XGBoost model revealed that dietary selenium intake was the most important variable associated with Hashimoto's thyroiditis. Dietary selenium intake (Log2-transformed) was negatively correlated with TPOAb levels [- 16.42 (- 22.18, - 10.65), P < 0.0001], while a non-linear relationship was observed between dietary selenium intake and TgAb with an inflection point of 6.58 (95.67 μg, Log2-transformed). CONCLUSION Dietary selenium intake is independently and inversely associated with HT risk. Moreover, dietary selenium intake is negatively correlated with TPOAb levels and non-linearly correlated with TGAb levels. Therefore, dietary selenium intake may be a safe and low-cost alternative for the prevention and treatment of HT.
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Affiliation(s)
- G Zheng
- Otolaryngology Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou City, Zhejiang Province, China
- Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou City, Zhejiang Province, China
| | - Y Cai
- Department of Thyroid Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
- Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou City, Zhejiang Province, China
| | - Y Guo
- Otolaryngology Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou City, Zhejiang Province, China
- Department of Public Health, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
- Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou City, Zhejiang Province, China
| | - F Song
- Otolaryngology Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou City, Zhejiang Province, China
- Department of Public Health, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
- Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou City, Zhejiang Province, China
| | - Y Hu
- Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China
| | - L Li
- School of Information Science and Engineering, Zhejiang Sci-Tech University, Hangzhou, 310018, China
| | - L Zhu
- Department of Thyroid Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui City, Zhejiang Province, China.
- Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou City, Zhejiang Province, China.
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Abstract
BACKGROUND Increasingly, patients are asking their physicians about the benefits of dietary and alternative approaches to manage their diseases, including thyroid disease. We seek to review the evidence behind several of the vitamins, minerals, complementary medicines, and elimination diets that patients are most commonly using for the treatment of thyroid disorders. SUMMARY Several trace elements are essential to normal thyroid function, and their supplementation has been studied in various capacities. Iodine supplementation has been implemented on national scales through universal salt iodization with great success in preventing severe thyroid disease, but can conversely cause thyroid disorders when given in excess. Selenium and zinc supplementation has been found to be beneficial in specific populations with otherwise limited generalizability. Other minerals, such as vitamin B12, low-dose naltrexone, and ashwagandha root extract, have little to no evidence of any impact on thyroid disorders. Avoidance of gluten and dairy has positive impacts only in patients with concomitant sensitivities to those substances, likely by improving absorption of levothyroxine. Avoidance of cruciferous vegetables and soy has little proven benefit in patients with thyroid disorders. CONCLUSION While many patients are seeking to avoid conventional therapy and instead turn to alternative and dietary approaches to thyroid disease management, many of the most popular approaches have no proven benefit or have not been well studied. It is our responsibility to educate our patients about the evidence for or against benefit, potential harms, or dearth of knowledge behind these strategies.
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Affiliation(s)
- Dana Larsen
- Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA
| | - Sargun Singh
- Government Medical College Amritsar, Amritsar, Punjab, India
| | - Maria Brito
- Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA
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Møllehave LT, Eliasen MH, Strēle I, Linneberg A, Moreno-Reyes R, Ivanova LB, Kusić Z, Erlund I, Ittermann T, Nagy EV, Gunnarsdottir I, Arbelle JE, Troen AM, Pīrāgs V, Dahl L, Hubalewska-Dydejczyk A, Trofimiuk-Müldner M, de Castro JJ, Marcelino M, Gaberšček S, Zaltel K, Puig-Domingo M, Vila L, Manousou S, Nyström HF, Zimmermann MB, Mullan KR, Woodside JV, Völzke H, Thuesen BH. Register-based information on thyroid diseases in Europe: lessons and results from the EUthyroid collaboration. Endocr Connect 2022; 11:e210525. [PMID: 35044931 PMCID: PMC8942317 DOI: 10.1530/ec-21-0525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/19/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Registers of diagnoses and treatments exist in different forms in the European countries and are potential sources to answer important research questions. Prevalence and incidence of thyroid diseases are highly dependent on iodine intake and, thus, iodine deficiency disease prevention programs. We aimed to collect European register data on thyroid outcomes to compare the rates between countries/regions with different iodine status and prevention programs. DESIGN Register-based cross-sectional study. METHODS National register data on thyroid diagnoses and treatments were requested from 23 European countries/regions. The provided data were critically assessed for suitability for comparison between countries/regions. Sex- and age-standardized rates were calculated. RESULTS Register data on ≥1 thyroid diagnoses or treatments were available from 22 countries/regions. After critical assessment, data on medication, surgery, and cancer were found suitable for comparison between 9, 10, and 13 countries/regions, respectively. Higher rates of antithyroid medication and thyroid surgery for benign disease and lower rates of thyroid hormone therapy were found for countries with iodine insufficiency before approx. 2001, and no relationship was observed with recent iodine intake or prevention programs. CONCLUSIONS The collation of register data on thyroid outcomes from European countries is impeded by a high degree of heterogeneity in the availability and quality of data between countries. Nevertheless, a relationship between historic iodine intake and rates of treatments for hyper- and hypothyroid disorders is indicated. This study illustrates both the challenges and the potential for the application of register data of thyroid outcomes across Europe.
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Affiliation(s)
- Line Tang Møllehave
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Correspondence should be addressed to L T Møllehave:
| | - Marie Holm Eliasen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Ieva Strēle
- The Institute of Occupational Safety and Environmental Health, Riga Stradiņš University, Riga, Latvia
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rodrigo Moreno-Reyes
- Nuclear Medicine Department, Erasme Hospital, Brussels, Belgium
- Université Libre de Bruxelles, Bruxelles, Belgium
| | - Ludmila B Ivanova
- Faculty of Medicine, Sofia University St. Kl. Ohridski, Sofia, Bulgaria
| | - Zvonko Kusić
- Croatian Academy of Sciences and Arts, Zagreb, Croatia
- School of Medicine, Zagreb, Croatia
| | - Iris Erlund
- Department of Government Services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Endre V Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ingibjorg Gunnarsdottir
- Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
- Department of Clinical Nutrition, Landspitali-National University Hospital, Reykjavik, Iceland
| | - Jonathan Eli Arbelle
- Division of Medicine, Maccabi Healthcare Services, Tel Aviv, Israel
- Goldman School of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Aaron Milton Troen
- The Institute of Biochemistry Food Science and Nutrition, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Valdis Pīrāgs
- Internal Medicine, University of Latvia, Riga, Latvia
| | - Lisbeth Dahl
- Seafood, Nutrition and Environmental State, Institute of Marine Research (IMR), Bergen, Norway
| | | | | | | | | | - Simona Gaberšček
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Katja Zaltel
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Manuel Puig-Domingo
- Department of Endocrinology and Nutrition, Germans Trias Research Institute and Hospital, Badalona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lluis Vila
- Endocrinology and Nutrition Service, Hospital Moisés Broggi, Sant Juan Despi, Barcelona, Spain
| | - Sofia Manousou
- Sahlgrenska Academy, Institute of Medicine, Gothenburg, Sweden
- Frölunda Specialist Hospital, Västra Frölunda, Sweden
| | - Helena Filipsson Nyström
- Department of Endocrinology, Specialist Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre of Molecular and Translational Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Karen R Mullan
- Regional Centre for Endocrinology and Diabetes, Belfast Health and Social Care Trust, Belfast, UK
| | | | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Betina Heinsbæk Thuesen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
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9
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Liu T, Li Y, Teng D, Shi X, Yan L, Yang J, Yao Y, Ye Z, Ba J, Chen B, Du J, He L, Lai X, Teng X, Li Y, Chi H, Liao E, Liu C, Liu L, Qin G, Qin Y, Quan H, Shi B, Sun H, Tang X, Tong N, Wang G, Zhang JA, Wang Y, Xue Y, Yang L, Zhang Q, Zhang L, Zhu J, Zhu M, Shan Z, Teng W. The Characteristics of Iodine Nutrition Status in China After 20 Years of Universal Salt Iodization: An Epidemiology Study Covering 31 Provinces. Thyroid 2021; 31:1858-1867. [PMID: 34806437 DOI: 10.1089/thy.2021.0301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: Despite the implementation of the universal salt iodization (USI) program for correction of iodine deficiency in China for ∼20 years, the actual iodine nutrition status of Chinese residents and the prevalence of iodine deficiency and iodine excess are issues that need to be addressed. This nationally representative cross-sectional study was conducted across all 31 provinces of mainland China to gather extensive data on iodine nutrition status and the influential factors. Methods: This study included 78,470 participants, aged 18 years or older, who were interviewed and asked to answer a questionnaire. Urine iodine concentration (UIC) was measured by the inductively coupled plasma mass spectrometry method, and goiter was examined by thyroid ultrasonography. In addition, sixty 9-11 years old school children in each province were randomly selected to evaluate the UIC and thyroid ultrasonography. The iodine nutrition status was determined according to the World Health Organization guidelines. Results: The iodized salt coverage was 95.37%. The median urine iodine (MUI) was 177.89 μg/L (interquartile range [IQR], 117.89-263.90 μg/L) and goiter prevalence was 1.17% (confidence interval [95% CI 0.95-1.43]) in the adult population. The MUI was 199.75 μg/L (IQR, 128.41-303.37 μg/L) in school-age children, and goiter prevalence was 3.50% [95% CI, 2.93-4.13]. The percentage of individuals with UIC <50 μg/L was 3.43%, <20%. Analysis indicated that sex, age, geographic factors, body mass index, and smoking habits influence the iodine nutrition level. Conclusion: The mandatory USI program has successfully eliminated iodine deficiency disorders, and the findings indicate that the iodine nutrition level in the general population is within the safe range.
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Affiliation(s)
- Tingting Liu
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Yongze Li
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Di Teng
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Xiaoguang Shi
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Li Yan
- Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Jing Yang
- Department of Endocrinology, The First Hospital of Shanxi Medical University, Taiyuan, P.R. China
| | - Yongli Yao
- Department of Endocrinology, Qinghai Provincial People's Hospital, Xining, P.R. China
| | - Zhen Ye
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, P.R. China
| | - Jianming Ba
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Bing Chen
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Jianling Du
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P.R. China
| | - Lanjie He
- Department of Endocrinology, Cardiovascular and Cerebrovascular Disease Hospital of Ningxia Medical University, Yinchuan, P.R. China
| | - Xiaoyang Lai
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, P.R. China
| | - Xiaochun Teng
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Yanbo Li
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, P.R. China
| | - Haiyi Chi
- Department of Endocrinology, Hohhot First Hospital, Hohhot, P.R. China
| | - Eryuan Liao
- Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Chao Liu
- Research Center of Endocrine and Metabolic Diseases, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, P.R. China
| | - Libin Liu
- Department of Endocrinology and Metabolism, Fujian Institute of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, P.R. China
| | - Guijun Qin
- Division of Endocrinology, Department of Internal Medicine, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, P.R. China
| | - Yingfen Qin
- Department of Endocrine, First Affiliated Hospital of Guangxi Medical University, Nanning, P.R. China
| | - Huibiao Quan
- Department of Endocrinology, Hainan General Hospital, Haikou, P.R. China
| | - Bingyin Shi
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shannxi P.R. China
| | - Hui Sun
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Xulei Tang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, P.R. China
| | - Nanwei Tong
- Department of Endocrinology and Metabolism, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, P.R. China
| | - Jin-An Zhang
- Department of Endocrinology, Shanghai University of Medicine & Health Science Affiliated Zhoupu Hospital, Shanghai, P.R. China
| | - Youmin Wang
- Department of Endocrinology, The First Hospital of An Hui Medical University, Hefei, P.R. China
| | - Yuanming Xue
- Department of Endocrinology, The First People's Hospital of Yunnan Province, Kunming, P.R. China
| | - Lihui Yang
- Department of Endocrinology and Metabolism, People's Hospital of Tibet Autonomous Region, Lhasa, P.R. China
| | - Qiao Zhang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Guiyang Medical University, Guiyang, P.R. China
| | - Lihui Zhang
- Department of Endocrinology, Second Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Jun Zhu
- Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, P.R. China
| | - Mei Zhu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, P.R. China
| | - Weiping Teng
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, P.R. China
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10
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Møllehave LT, Jacobsen RK, Linneberg A, Skaaby T, Knudsen N, Jørgensen T, Kårhus LL, Kriegbaum M, Grand MK, Siersma V, Lind B, Andersen CL, Nygaard B, Medici BB, Pedersen IB, Ravn-Haren G, Thuesen BH. Influence of educational level on test and treatment for incident hypothyroidism. Clin Endocrinol (Oxf) 2021; 94:1025-1034. [PMID: 33512012 DOI: 10.1111/cen.14429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/28/2020] [Accepted: 01/12/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The incidence of hypothyroidism is not expected to differ by socioeconomic factors. However, the decision to test and initiate treatment may differ. We aimed to examine whether educational level influences the probability of thyroid stimulation hormone (TSH)-measurement and initiation of levothyroxine treatment. DESIGN Citizens in the greater Copenhagen Area during 2001-2015 were included. Individual-level data on educational level, diagnoses, GP-contact, TSH-measurement and medication were derived from administrative and healthcare registers. The relative risks (RR) between educational levels of annual TSH-measurement and treatment initiation following a TSH-measurement were analysed in Poisson regression models with generalized estimation equations. RESULTS A TSH-measurement was performed in 19% of 9,390,052 person years. The probability of TSH-measurement was higher with short (RR 1.16 [95% CI 1.15-1.16]) and medium (RR 1.11 [95% CI 1.06-1.12]) compared with long education. Treatment was initiated after 0.8% of 2,049,888 TSH-measurements. For TSH < 5 mIU/L, RR for treatment initiation ranged between 0.47 (95%CI 0.39-0.57) and 0.78 (95%CI 0.67-0.91) for short and medium compared with long education. For TSH 5-10 mIU/L, there was no statistically significant difference. For TSH > 10 mIU/L, RR was 1.07 (95% CI 1.02-1.12) for short and 1.08 (95% CI 1.03-1.13) for medium compared with long education. CONCLUSION The probability of TSH-measurement was higher with shorter education, and the probability of treatment initiation with TSH > 10 mIU/L was marginally higher with short-medium education compared with long education. However, the probability of treatment initiation with TSH < 5 mIU/L, that is treatment incongruous with guidelines, was substantially higher in persons with long education.
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Affiliation(s)
- Line Tang Møllehave
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark
| | - Rikke Kart Jacobsen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tea Skaaby
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark
| | - Nils Knudsen
- Department of Endocrinology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Line Lund Kårhus
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark
| | - Margit Kriegbaum
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mia Klinten Grand
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bent Lind
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Christen Lykkegaard Andersen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - Birte Nygaard
- Department of Endocrinology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bjarke Borregaard Medici
- Department of Endocrinology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Inge Bülow Pedersen
- Department of Endocrinology and Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Gitte Ravn-Haren
- Division of Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Betina Heinsbaek Thuesen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark
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11
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Planck T, Lantz M, Perros P, Papini E, Attanasio R, Nagy EV, Hegedüs L. Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients: A 2020 THESIS Questionnaire Survey of Members of the Swedish Endocrine Society. Front Endocrinol (Lausanne) 2021; 12:795111. [PMID: 34938274 PMCID: PMC8687360 DOI: 10.3389/fendo.2021.795111] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/15/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The standard treatment of hypothyroidism is levothyroxine (LT-4). However, there are several controversies regarding treatment of hypothyroid patients. AIM To investigate the Swedish endocrinologists' use of thyroid hormones in hypothyroid and euthyroid individuals. METHODS Physician members of the Swedish Endocrine Society (SEF) were invited by e-mail to participate in an online survey investigating this topic. RESULTS Out of the eligible 411 members, 116 (28.2%) responded. The majority (98.9%) stated that L-T4 is the treatment of choice. However, around 50% also prescribed liothyronine (L-T3) or a combination of L-T4+L-T3 in their practice. Combination therapy was mostly (78.5%) used in patients with persistent hypothyroid symptoms despite biochemical euthyroidism on L-T4 treatment. Most respondents prescribed L-T4 tablets and did not expect any major changes with alternative formulations such as soft-gel capsules or liquid formulations in situations influencing the bioavailability of L-T4. In euthyroid patients, 49.5% replied that treatment with thyroid hormones was never indicated, while 47.3% would consider L-T4 for euthyroid infertile women with high thyroid peroxidase (TPO) antibody levels. CONCLUSION The treatment of choice for hypothyroidism in Sweden is L-T4 tablets. Combination therapy with L-T4+L-T3 tablets was considered for patients with persistent symptoms despite biochemical euthyroidism. Soft-gel capsules and liquid solutions of L-T4 were infrequently prescribed. Swedish endocrinologists' deviation from endocrine society guidelines merits further study.
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Affiliation(s)
- Tereza Planck
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- *Correspondence: Tereza Planck,
| | - Mikael Lantz
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy
| | - Roberto Attanasio
- Endocrine Unit, Institutes for Care and Scientific Research (IRCCS) Orthopedic Institute Galeazzi, Milan, Italy
| | - Endre V. Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
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12
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Wang X, Li Y, Zhai X, Wang H, Zhang F, Gao X, Liu S, Teng W, Shan Z. Reference Intervals for Serum Thyroid-Stimulating Hormone Based on a Recent Nationwide Cross-Sectional Study and Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:660277. [PMID: 34140930 PMCID: PMC8204855 DOI: 10.3389/fendo.2021.660277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/29/2021] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The aim of our study was to compare the reference intervals (RIs) [median (2.5th-97.5th percentiles)] for thyroid-stimulating hormone (TSH) between subgroups stratified by ethnicity and iodine status in a global context. DESIGN AND METHODS Primary data were derived from a recently published cross-sectional study in mainland China. Secondary data were obtained from online databases. The RIs for TSH were calculated in the reference population according to the National Academy of Clinical Biochemistry (NACB) standard and in the disease-free population. A meta-analysis of ethnicity- and iodine status-specific TSH RIs was performed. RESULTS The primary data showed that the TSH RI (mU/L) in the disease-free population was 2.33 (0.67, 7.87), which is wider than the published RI [2.28 (0.74, 7.04)] in the reference population. The meta-analysis showed that whether in the reference or disease-free population, the RIs in Yellows were much higher than those in Caucasians. In the reference population, the median and 2.5th percentile in the iodine-sufficient subgroup were both lower than the iodine-deficient or more-than-adequate subgroup, while the 97.5th percentile showed a positive trend with increasing sufficiency of iodine. However, in the disease-free population, the iodine-sufficient subgroup had a lower median and 97.5th percentile but higher 2.5th percentile than the iodine-deficient subgroup. CONCLUSION Yellows have a higher TSH RI than Caucasians. In the reference population, both the median and 2.5th percentile TSH in the iodine-sufficient population were the lowest among the different iodine status subgroups, while the 97.5th percentile of TSH showed an upward trend with increasing iodine sufficiency.
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Affiliation(s)
- Xichang Wang
- Department of Endocrinology and Metabolism and the institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Yongze Li
- Department of Endocrinology and Metabolism and the institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Xiaodan Zhai
- Department of Endocrinology and Metabolism, Shengjing Affiliated Hospital of China Medical University, Shenyang, China
| | - Haoyu Wang
- Department of Endocrinology and Metabolism and the institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Fan Zhang
- Department of Endocrinology and Metabolism and the institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Xiaotong Gao
- Department of Endocrinology and Metabolism and the institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Shengyu Liu
- Department of Endocrinology and Metabolism and the institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Weiping Teng
- Department of Endocrinology and Metabolism and the institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism and the institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, China
- *Correspondence: Zhongyan Shan,
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13
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Schaffner M, Rochau U, Mühlberger N, Conrads-Frank A, Qerimi Rushaj V, Sroczynski G, Koukkou E, Thuesen BH, Völzke H, Oberaigner W, Siebert U. The economic impact of prevention, monitoring and treatment strategies for iodine deficiency disorders in Germany. Endocr Connect 2021; 10:1-12. [PMID: 33263563 PMCID: PMC7849460 DOI: 10.1530/ec-20-0384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/27/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE More than 30% of the German population suffers from mild to moderate iodine deficiency causing goiter and other iodine deficiency disorders (IDDs). The economic burden of iodine deficiency is still unclear. We aimed to assess costs for prevention, monitoring and treatment of IDDs in Germany. DESIGN We performed a comprehensive cost analysis. METHODS We assessed direct medical costs and direct non-medical costs for inpatient and outpatient care of IDDs and costs for productivity loss due to the absence of work in 2018. Additionally, we calculated total costs for an IDD prevention program comprising universal salt iodization (USI). We performed threshold analyses projecting how many cases of IDDs or related treatments would need to be avoided for USI to be cost-saving. RESULTS Annual average costs per case in the year of diagnosis were € 211 for goiter/thyroid nodules; € 308 for hyperthyroidism; and € 274 for hypothyroidism. Average one-time costs for thyroidectomy were € 4184 and € 3118 for radioiodine therapy. Average costs for one case of spontaneous abortion were € 916. Annual costs of intellectual disability were € 14,202. In the German population, total annual costs for USI would amount to 8 million Euro. To be cost-saving, USI would need to prevent, for example, 37,900 cases of goiter/thyroid nodules. CONCLUSION USI potentially saves costs, if a minimum amount of IDDs per year could be avoided. In order to recommend the implementation of USI, a full health-economic evaluation including a comprehensive benefit-harm assessment is needed.
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Affiliation(s)
- Monika Schaffner
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
- Correspondence should be addressed to S Monika:
| | - Ursula Rochau
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Nikolai Mühlberger
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Annette Conrads-Frank
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Vjollca Qerimi Rushaj
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
- Faculty of Pharmacy, School of PhD Studies, Ss. Cyril and Methodius University, Skopje, Macedonia
| | - Gaby Sroczynski
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | | | | | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Wilhelm Oberaigner
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
- Center for Health Decision Science, Department of Health Policy and Management, Harvard Chan School of Public Health, Boston, Massachusetts, USA
- Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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14
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Li L, Ying YX, Liang J, Geng HF, Zhang QY, Zhang CR, Chen FX, Li Y, Feng Y, Wang Y, Song HD. Urinary Iodine and Genetic Predisposition to Hashimoto's Thyroiditis in a Chinese Han Population: A Case-Control Study. Thyroid 2020; 30:1820-1830. [PMID: 32746755 DOI: 10.1089/thy.2020.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: We aimed to examine the association of urinary iodine concentration with Hashimoto's thyroiditis (HT) risk, and particularly, to investigate whether the HT-related genetic variations might modify the effects of urinary iodine on HT in the Chinese Han population. Methods: We conducted a case-control study with 1723 Chinese (731 cases, 992 controls). The associations between urinary iodine concentration and HT risk were analyzed using logistic regression models. The effects of interactions between the genetic risk scores (GRSs) and urinary iodine on HT risk were assessed by including the respective interaction terms in the models. We also applied restricted cubic spline regression to estimate the possible nonlinear relationship. The multinomial logistic regression models were performed to determine the associations of urinary iodine with euthyroid-HT and hypothyroidism-HT. Results: After controlling for potential confounders, the odds of HT increased with increasing quartiles of urinary iodine concentration: adjusted odds ratios (ORs) and 95% confidence intervals [CIs] were 1.45 [1.06-1.99], 1.66 [1.17-2.34], and 2.07 [1.38-3.10] for the quartiles 2, 3, and 4, respectively, compared with the first quartile (p for trend <0.001). Multivariable restricted cubic spline regression analysis further demonstrated that there was a near-linear association between urinary iodine concentration and HT risk (p-overall <0.001; p-nonlinear = 0.074). However, we did not find significant interactions between urinary iodine and GRSs on the risk of HT (all p for interaction >0.05). Interestingly, we found that each increment of urinary iodine was associated with a more than twofold increase in the odds of hypothyroidism-HT (adjusted OR = 2.64 [CI = 1.73-4.05]), but not with euthyroid-HT (p > 0.05). Conclusions: Higher urinary iodine concentration was associated with increased risk of HT, and this association was near linear, indicating that increased urinary iodine has a continuous and graded impact on HT risk. Moreover, the iodine-HT association was not modified by genetic predisposition to HT. Interestingly, urinary iodine concentration was significantly associated with increased risk of hypothyroidism.
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Affiliation(s)
- Lu Li
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostics and Endocrinology, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
| | - Ying-Xia Ying
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostics and Endocrinology, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
| | - Jun Liang
- Department of Endocrinology, the Central Hospital of Xuzhou, Affiliated Hospital of Southeast University, Xuzhou, Jiangsu, China
| | - Hou-Fa Geng
- Department of Endocrinology, the Central Hospital of Xuzhou, Affiliated Hospital of Southeast University, Xuzhou, Jiangsu, China
| | - Qian-Yue Zhang
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostics and Endocrinology, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
| | - Chang-Run Zhang
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostics and Endocrinology, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
| | - Fu-Xiang Chen
- Department of Clinical Immunology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
| | - Yan Li
- School of Public Health, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
| | - Yan Feng
- School of Public Health, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
| | - Yan Wang
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostics and Endocrinology, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
- School of Public Health, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
| | - Huai-Dong Song
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostics and Endocrinology, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
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Long-term iodine nutrition is associated with longevity in older adults: a 20 years’ follow-up of the Randers–Skagen study. Br J Nutr 2020; 125:260-265. [DOI: 10.1017/s0007114520001592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AbstractIodine intake affects the occurrence of thyroid disorders. However, the association of iodine intake with longevity remains to be described. This led us to perform a 20 years’ follow-up on participants from the Randers–Skagen (RaSk) study. Residents in Randers born in 1920 (n 210) and Skagen born in 1918–1923 (n 218) were included in a clinical study in 1997–1998. Mean iodine content in drinking water was 2 µg/l in Randers and 139 µg/l in Skagen. We collected baseline data through questionnaires, performed physical examinations and measured iodine concentrations in spot urine samples. Income data were retrieved from Danish registries. We performed follow-up on mortality until 31 December 2017 using Danish registries. Complete follow-up data were available on 428 out of 430 of participants (99·5 %). At baseline, the median urinary iodine concentration was 55 µg/l in Randers and 160 µg/l in Skagen residents. Participants were long-term residents with 72·8 and 92·7 % residing for more than 25 years in Randers and Skagen, respectively. Cox regression showed that living in Skagen compared with Randers was associated with a lower hazard ratio (HR) of death in both age- and sex-adjusted analyses (HR 0·60, 95 % CI 0·41, 0·87, P = 0·006), but also after adjustment for age, sex, number of drugs, Charlson co-morbidity index, smoking, alcohol and income (HR 0·60, 95 % CI 0·41, 0·87, P = 0·008). Residing in iodine-replete Skagen was associated with increased longevity. This indicates that long-term residency in an iodine-replete environment may be associated with increased longevity compared with residency in an iodine-deficient environment.
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Grob F, Gutiérrez M, Leguizamón L, Fabres J. Hyperthyrotropinemia is common in preterm infants who are born small for gestational age. J Pediatr Endocrinol Metab 2020; 33:375-382. [PMID: 32069242 DOI: 10.1515/jpem-2019-0461] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/07/2020] [Indexed: 01/31/2023]
Abstract
Background To determine the incidence of congenital hypothyroidism (CH) with a delayed increase in thyroid-stimulating hormone (TSH) levels in preterm infants and to describe the associated factors. Methods A prospective newborn screening (NBS) was conducted in 122 very low birth weight (VLBW) premature neonates born between June 2016 and September 2017. A dried blood spot thyroid stimulating hormone (TSH) level ≥15 mIU/L at 7 and 15 days of life, ≥10 in serum at the second screen or ≥5 at the third screen was defined as positive for CH. A concomitant increase in the TSH level and normal free thyroxine (T4) level was classified as hyperthyrotropinemia (HT). Results Before the first month of life, no cases of CH were identified. However, the second and third NBS identified 10 and six subjects with HT, respectively, but no cases of CH. The overall cumulative incidence of HT was 1:8. Small for gestational age (SGA) was a variable that was significantly associated with HT, even after the exclusion of patients with Down syndrome. Conclusions A high incidence of HT, but not CH, was found after the first month of life in preterm infants. Being SGA was strongly associated with having higher TSH. The need for repeating TSH screening after the first month of life in this population remains to be established.
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Affiliation(s)
- Francisca Grob
- Pontificia Universidad Católica de Chile, Faculty of Medicine, School of Medicine, Pediatrics Division, Diagonal Paraguay 362, Piso 8, Santiago 8330074, Chile, Phone: +56-223549088, Fax: +56-226384307
| | - Monserrat Gutiérrez
- Pontificia Universidad Católica de Chile, Faculty of Medicine, School of Medicine, Pediatrics Division, Santiago, Chile
| | - Liliana Leguizamón
- Pontificia Universidad Católica de Chile, Faculty of Medicine, School of Medicine, Department of Neonatology, Santiago, Chile
| | - Jorge Fabres
- Pontificia Universidad Católica de Chile, Faculty of Medicine, School of Medicine, Department of Neonatology, Santiago, Chile
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Petersen M, Bülow Pedersen I, Knudsen N, Andersen S, Jørgensen T, Perrild H, Ovesen L, Banke Rasmussen L, Thuesen BH, Carlé A. Changes in subtypes of overt thyrotoxicosis and hypothyroidism following iodine fortification. Clin Endocrinol (Oxf) 2019; 91:652-659. [PMID: 31400012 DOI: 10.1111/cen.14072] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/26/2019] [Accepted: 08/08/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the impact of mandatory iodine fortification (IF) on the incidence of nosological subtypes of overt thyrotoxicosis and hypothyroidism. DESIGN We identified and scrutinized all possible new cases of overt thyrotoxicosis and hypothyroidism in an open cohort in Northern Jutland (n = 309 434; 1 January 1997) during the years 2014-2016. Individual medical history was evaluated to verify and detail the incidence of overt thyroid dysfunction and for classification into nosological subtypes. A number of cases were excluded during final verification due to spontaneous normalization of thyroid function, as they had no medical history suggesting a known condition, which could transiently affect thyroid function (subacute/silent thyroiditis, PPTD and iatrogenic thyroid dysfunction). An identical survey was conducted in 1997-2000 prior to mandatory IF of salt (13 µg/g) that was in effect from year 2001. RESULTS The standardized incidence rate (SIR) of verified overt thyrotoxicosis decreased markedly from 97.5/100 000/year in 1997-2000 to 48.8 in 2014-2016 (SIRR: 0.50 [95% CI: 0.45-0.56]). This was due to a distinct decrease in the SIR of multinodular toxic goitre (SIRR: 0.18 [0.15-0.23]), solitary toxic adenoma (SIRR: 0.26 [0.16-0.43]) and to a lesser degree Graves' disease (SIRR: 0.67 [0.56-0.79]). SIR for overt hypothyroidism was unaltered by 2014-2016 (SIRR: 1.03 [0.87-1.22]). However, age distribution shifted with more young and fewer elderly cases of verified overt hypothyroidism. CONCLUSION Mandatory IF caused a substantial reduction in SIR of verified overt thyrotoxicosis (especially of nodular origin) while avoiding an increase in SIR of verified overt hypothyroidism.
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Affiliation(s)
- Mads Petersen
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Nils Knudsen
- Department of Endocrinology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Stig Andersen
- Department of Geriatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Torben Jørgensen
- Centre for Clinical Research and Prevention, Bispebjerg/Frederiksberg Hospital, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Hans Perrild
- Department of Endocrinology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lars Ovesen
- Department of Gastroenterology, Slagelse Hospital, Slagelse, Denmark
| | - Lone Banke Rasmussen
- Department of Endocrinology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Betina H Thuesen
- Centre for Clinical Research and Prevention, Bispebjerg/Frederiksberg Hospital, Copenhagen, Denmark
| | - Allan Carlé
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
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Effectiveness of increased salt iodine concentration on iodine status: trend analysis of cross-sectional national studies in Switzerland. Eur J Nutr 2019; 59:581-593. [PMID: 30843107 DOI: 10.1007/s00394-019-01927-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/06/2019] [Indexed: 01/26/2023]
Abstract
PURPOSE Despite longstanding voluntary salt iodisation in Switzerland, data suggest inadequate iodine intake in vulnerable population groups. In response, the salt iodine concentration was increased from 20 to 25 mg/kg and we assessed the impact on iodine status. METHODS We conducted a cross-sectional national study in school-age children (n = 731), women of reproductive age (n = 353) and pregnant women (n = 363). We measured urinary iodine concentration (UIC) and urinary sodium concentration (UNaC) in spot urine samples. The current median UIC was compared with national data from 1999, 2004 and 2009. We measured TSH, total T4 and thyroglobulin (Tg) on dried blood spot samples collected in women. RESULTS The median UIC (bootstrapped 95% CI) was 137 µg/L (131, 143 µg/L) in school children, 88 µg/L (72, 103 µg/L) in women of reproductive age and 140 µg/L (124, 159 µg/L) in pregnant women. Compared to 2009, the median UIC increased modestly in school children (P < 0.001), but did not significantly change in pregnant women (P = 0.417). Estimated sodium intake exceeded the recommendations in all population groups. The prevalence of thyroid disorders in women was low, but Tg was elevated in 13% of the pregnant women. CONCLUSION Iodine intake is overall adequate in Swiss school-age children, but only borderline sufficient in pregnant and non-pregnant women, despite high salt intakes and satisfactory household coverage with iodized salt. Our findings suggest increasing the concentration of iodine in salt may not improve iodine intakes in women if iodised salt is not widely used in processed foods. REGISTRATION This trial was registered at clinicaltrials.gov as NCT02312466.
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