PREVALENCE OF NONTOXIC NODULAR GOITER AFTER A NEARLY TWO-DECADE UNIVERSAL SALT IODIZATION IN A LITTORAL REGION OF SHANDONG PROVINCE, CHINA

Current Iodine Nutrition Status and Morbidity of Thyroid Nodules in Mainland China in the Past 20 Years

The aim of this study was to comprehensively assess the prevalence of goiter and thyroid nodules (TNs) in relation to China's iodine nutrition level over the past 20 years and provide an effective reference for developing health policies. PubMed, EMBASE, Chinese National Knowledge Infrastructure, Chongqing VIP, and Chinese Wan Fang databases were searched for relevant studies from Jan 1996 to Feb 2020. Two reviewers extracted valid data from the eligible citations to determine the morbidity of TNs in different urinary iodine concentrations (UICs) and in patients of different genders, of different ages, who live in different geographic regions, and who live at different altitudes, as well as the P values of interactions between groups. There were 26 articles (34 studies) included in this analysis. The overall morbidity of TNs in mainland China was 23.4%. Morbidity was higher in urban areas (P < 0.001) than in rural and mixed areas. Coastal areas (P < 0.001), female patients (P < 0.001), high-altitude areas (P < 0.001), and residence in south China (P < 0.001) were all associated with higher morbidity of TNs. The lowest morbidity value of TNs, 16%, was in the more-than-adequate iodine subgroup. The highest morbidity, 27.2%, was in the adequate iodine subgroup. The morbidity of TNs increases with age, and women are more likely to have TNs. We also need to perform more epidemiological studies, and in the future, we should cultivate better understanding of the relationship between other thyroid diseases and provide more comprehensive and useful information for other researchers.

Preoperative Use of Intravenous Contrast Media Is Associated With Decreased Excellent Response Rates in Intermediate-Risk DTC Patients Who Subsequently Receive Total Thyroidectomy and Low-Dose RAI Therapy

Purpose: To evaluate the impact of preoperative use of intravenous contrast media (ICM) on the excellent response (ER) rates in a cohort of intermediate-risk differentiated thyroid cancer (DTC) patients who received total thyroidectomy (TT) and low-dose radioactive iodine (RAI) therapy.

Methods: A total of 683 consecutive patients were retrospectively reviewed in a single center between August 2016 and August 2018. Patients were divided into ICM group (n = 532) and non-ICM group (n = 151). Intravenous contrast media patients were 1:1 propensity matched to non-ICM patients based on T stage, N stage, and urinary iodine. Risk-adjusted logistic regression models were constructed to assess the association between the use of ICM and ER rates.

Results: Intravenous contrast media patients had significantly higher T stage (P < 0.001), N stage (P < 0.001), urinary iodine (P < 0.001), and ps-Tg (P = 0.042) than non-ICM patients. Preoperative use of ICM was found to be significantly associated with decreased ER rates in both the primary cohort [odds ratio (OR) = 0.47, 95% confidence interval (CI) = 0.32–0.71; P < 0.001] and the matched cohort (OR = 0.48, 95% CI = 0.25–0.94; P = 0.031). Subgroup analysis on RAI delay time in the primary cohort revealed that ER rates in ICM patients were significantly lower than that of non-ICM patients for 1–2 months (P = 0.0245) and >2–3 months (P = 0.0221) subgroups, but not for >3–4 months, >4–5 months, and >5–6 months subgroups (all P > 0.05). A delay time of >3–4 months exhibited the highest ER rate (63.08%) within the ICM group.

Conclusions: Preoperative use of ICM is associated with decreased ER rates in intermediate-risk DTC patients who subsequently receive TT and low-dose RAI therapy. For such patients, if ICM has already been received, an RAI delay time of >3–4 months would seem to be more appropriate to achieve better ER rates.