Exp Clin Endocrinol Diabetes 2005; 113(9): 507-515
DOI: 10.1055/s-2005-865741
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Risk Factors for Goiter in a Previously Iodine-Deficient Region

H. Völzke1 , C. Schwahn1 , T. Kohlmann2 , A. Kramer3 , D. M. Robinson4 , U. John1 , W. Meng[] 4
  • 1Institute of Epidemiology and Social Medicine, Ernst Moritz Arndt University Greifswald, Germany
  • 2Institute for Community Medicine, Ernst Moritz Arndt University Greifswald, Germany
  • 3Institute of Hygiene and Environmental Medicine, Ernst Moritz Arndt University Greifswald, Germany
  • 4Clinic of Internal Medicine, Ernst Moritz Arndt University Greifswald, Germany
Further Information

Publication History

Received: May 27, 2004 First decision: March 7, 2005

Accepted: May 14, 2005

Publication Date:
19 October 2005 (online)

Abstract

Objective: Little information exists from formerly iodine-deficient areas regarding gender-specific risk factors for goiter and their synergisms. The aim of the present study was to investigate such gender-specific risk factors and their interactions in a large population-based sample. Methods and Results: The Study of Health in Pomerania (SHIP) comprised 4310 randomly selected participants, aged 20 - 79 years. SHIP was performed in a previously iodine-deficient region. Data from 3915 participants with no known thyroid disorders were analyzed. Goiter was determined by thyroid ultrasound. Sociodemographic characteristics, smoking and alcohol drinking habits, marital status, education level, urine thiocyanate concentrations, and specifically in women, parity and previous or current use of oral contraceptives and hormone replacement therapy, were considered as candidate risk factors for multivariable statistical tests. Only two variables, an advanced age and current smoking, were independently associated with an increased risk for goiter in both genders. Analyses further revealed specific risk factor profiles for goiter which were different among men, pre- and postmenopausal women. Conclusion: We conclude that besides previous iodine deficiency, other risk factors for goiter exist which differ between gender. Among the avoidable risk factors, current smoking was strongly associated with the risk of goiter in men and women. These findings should influence activities which are intended to prevent thyroid disease.

References

  • 1 Aghini-Lombardi F, Antonangeli L, Martino E, Vitti P, Maccherini D, Leoli F, Rago T, Grasso L, Valeriano R, Balestrieri A, Pinchera A. The spectrum of thyroid disorders in an iodine-deficient community: the Pescopagano survey.  J Endocrinol Metab. 1999;  84 561-566
  • 2 Alte D, Lüdemann J, Piek M, Adam C, Rose H J, John U. Distribution and dose response of laboratory markers to alcohol consumption in a general population: results of the study of health in Pomerania (SHIP).  J Studies on Alcohol. 2003;  64 75-82
  • 3 Barrere X, Valeix P, Preziosi P, Bensimon M, Pelletier B, Galan P, Hercberg S. Determinants of thyroid volume in healthy French adults participating in the SU. VI. MAX cohort.  Clin Endocrinol. 2001;  52 273-278
  • 4 Below H, Weuffen W. Applicability of the determination of thiocyanate by the chlorcyan-pyridine-barbituric acid method in serum and urine. (Zur Anwendbarkeit der Chlorcyan-Pyridin-Barbitursäure-Methode für die Thiocyanatbestimmung in Serum und Urin.)  Wissenschaftliche Zeitschrift der Ernst Moritz Arndt Universität Greifswald. 1987;  36 120-124
  • 5 Berghout A, Endert E, Ross A, Hogerzeil H V, Smits N J, Wiersinga W M. Thyroid function and thyroid size in normal pregnant women living in an iodine replete area.  Clin Endocrinol. 1994;  41 375-379
  • 6 Berghout A, Wiersinga W M, Smits N J, Touber J L. Determinants of thyroid volume as measured by ultrasonography in healthy adults in a non-iodine deficient area.  Clin Endocrinol. 1987;  26 273-280
  • 7 Biassoni P, Ravera G, Bertocchi J, Schenone F, Bourdoux P. Influence of dietary habits on thyroid status of a nomadic people, the Bororo shepherds, roaming a central African region affected by severe iodine deficiency.  Eur J Endocrinol. 1998;  138 681-685
  • 8 Bland J M, Altman D G. Statistical methods for assessing agreement between two methods of clinical measurement.  Lancet. 1986;  1 (8476) 307-310
  • 9 Brunn J, Block U, Ruf G, Bos I, Kunze W P, Scriba P C. Volumetric analysis of thyroid lobes by real-time ultrasound. (Volumetrie der Schilddrüsenlappen mittels Real-time-Sonographie.)  DMW. 1981;  106 409-414
  • 10 Ericsson U B, Lindgarde F. Effects of cigarette smoking on thyroid function and the prevalence of goiter, thyrotoxicosis and autoimmune thyroiditis.  J Internal Med. 1991;  229 67-71
  • 11 Georgiadis E, Papapostolou C, Korakis T, Evagelopoulou K, Mantzoros C, Batrinos M. The influence of smoking habits on thyroid gland volume: an ultrasonic approach.  Journal of the Royal Society for the Promotion of Health. 1997;  117 355-358
  • 12 Glinoer D, de Nayer P, Bourdoux P, Lemone M, Robyn C, van Steirteghem A, Kinthaert J, Lejeune B. Regulation of maternal thyroid during pregnancy.  J Endocrinol Metab. 1990;  71 276-287
  • 13 Gomez J M, Maravall F J, Gomez N, Guma A, Soler J. Determinants of thyroid volume as measured by ultrasonography in healthy adults randomly selected.  Clin Endocrinol. 2000;  53 629-634
  • 14 Gronbaek M. Factors influencing the relation between alcohol and mortality-with focus on wine.  J Intern Med. 2001;  250 291-308
  • 15 Gutekunst R, Becker W, Hehrmann H, Olbricht W, Pfannenstiel P. Ultrasonic diagnosis of the thyroid gland. (Ultraschalldiagnostik der Schilddrüse.)  DMW. 1988;  113 1109-1112
  • 16 Hampel R, Kulberg T, Klein K, Jerichow J U, Pichmann E G, Clausen V, Schmidt I. Strumaprävalenz in Deutschland größer als bisher angenommnen. (Goiter incidence in Germany is greater than previously suspected).  Medizinische Klinik. 1995;  90 324-329
  • 17 Hansen D, Bennedbaek F N, Hoier-Madsen M, Hegedüs L, Jacobsen B B. A prospective study of thyroid function, morphology and autoimmunity in young patients with type 1 diabetes.  Eur J Endocrinol. 2003;  148 245-251
  • 18 Hegedüs L. Decreased thyroid gland volume in alcoholic cirrhosis of the liver.  J Endocrinol Metab. 1984;  58 930-933
  • 19 Hegedüs L, Karstrup S, Veiergang D, Jacobsen B, Skovsted L, Feldt-Rasmussen U. High frequency of goiter in cigarette smokers.  Clin Endocrinol. 1985;  22 287-292
  • 20 Hegedüs L, Rasmussen N, Ravn V, Kastrup J, Krogsgaard K, Aldershvile J. Independent effects of liver disease and chronic alcoholism on thyroid function and size: the possibility of a toxic effect of alcohol on the thyroid gland.  Metabolism. 1988;  37 229-233
  • 21 Helmert U. (Personal support and mortality: a cohort analysis of the National Questionnaire Survey 1984 - 86.)  Soz Präventivmed. 2004;  49 318-327
  • 22 John U, Greiner B, Hensel E, Lüdemann J, Piek M, Sauer S, Adam C, Born G, Alte D, Greiser E. et al . Study of Health in Pomerania (SHIP): a health examination survey in an east German region: objectives and design.  Soz Präventivmed. 2001;  46 186-194
  • 23 Kleinbaum D G, Kupper L L, Morgenstern H. Principles and Quantitative Methods. Epidemiologic Research. New York; Van Nostrand Reinhold, International Thomson Publishing Inc 1982: 447-456
  • 24 Knudsen N, Bülow I, Laurberg P, Ovesen L, Perrild H, Jorgensen T. Parity is associated with increased thyroid volume solely among smokers in an area with moderate to mild iodine deficiency.  Eur J Endocrinol. 2002 a;  146 39-43
  • 25 Knudsen N, Bülow I, Laurberg P, Ovesen L, Perrild H, Jorgensen T. Low socio-economic status and familial occurrence of goiter are associated with a high prevalence of goiter.  Eur J Epidemiol. 2003;  18 175-181
  • 26 Knudsen N, Bülow I, Laurberg P, Perrild H, Ovesen L, Jorgensen T. Alcohol consumption is associated with reduced prevalence of goiter and solitary thyroid nodules.  Clin Endocrinol. 2001;  55 41-46
  • 27 Knudsen N, Bülow I, Laurberg P, Perrild H, Ovesen L, Jorgensen T. Low goiter prevalence among users of oral contraceptives in a population sample of 3712 women.  Clin Endocrinol. 2002 b;  57 71-76
  • 28 Knudsen N, Laurberg P, Perrild H, Bülow I, Ovesen L, Jorgensen T. Risk factors for goiter and thyroid nodules.  Thyroid. 2002 c;  12 879-902
  • 29 Knudsen N, Perrild H, Christiansen E, Rasmussen S, Dige-Petersen H, Jorgensen T. Thyroid structure and size and two-year follow-up of solitary cold thyroid nodules in an unselected population with borderline iodine deficiency.  Eur J Endocrinol. 2000;  142 224-230
  • 30 Laurberg P, Andersen S, Knudsen N, Ovesen L, Nohr S B, Bülow Pedersen I. Thiocyanate in food and iodine in milk: from domestic animal feeding to improved understanding of cretinism.  Thyroid. 2002;  12 897-902
  • 31 Meng W, Scriba C. Jodversorgung in Deutschland: Probleme und erforderliche Maßnahmen - Update 2002.  Dt Ärzteblatt. 2002;  99 A2560 B2185 C2048
  • 32 Olbricht T, Hoff H G. Faktoren mit Einfluss auf das Schilddrüsenvolumen. (Factors affecting thyroid gland volume. A contribution to the epidemiology of struma).  Medizinische Klinik. 1988;  83 279-284
  • 33 Petersen K, Lindstedt G, Lundberg P A, Bengtsson C, Lapidus L, Nystrom E. Thyroid disease in middle-aged and elderly Swedish women: thyroid-related hormones, thyroid dysfunction and goiter in relation to age and smoking.  J Internal Med. 1991;  229 407-413
  • 34 Reiners C, Wegscheider K, Schicha H, Theissen P, Vaupel R, Wrbitzky R, Schumm-Draeger P M. Prevalence of thyroid disorders in the working population of Germany. Ultrasonography screening in 98 278 unselected employees.  Thyroid. 2004;  14 926-932
  • 35 Seeman T E, Crimmins E. Social environment effects on health and aging: integrating epidemiologic and demographic approaches and perspectives.  Ann N Y Acad Sci. 2001;  954 88-117
  • 36 Smyth P P, Hetherton A M, Smith D F, Radcliff M, O'Herlihy C. Maternal iodine status and thyroid volume during pregnancy: correlation with neonatal iodine intake.  J Endocrinol Metab. 1997;  82 2840-2843
  • 37 Spitzweg C, Morris J C. Sodium iodide symporter (NIS) and thyroid.  Hormones. 2002;  1 22-34
  • 38 Vermiglio F, Lo Presti V P, Castagna M G, Violi M A, Moleti M, Finocchiaro M D, Mattina F, Artemisia A, Trimarchi F. Increased risk of maternal thyroid failure with pregnancy progression in an iodine deficient area with major iodine deficiency disorders.  Thyroid. 1999;  9 19-24
  • 39 Völzke H, Lüdemann J, Robinson D M, Spieker K W, Schwahn C, Kramer A, John U, Meng W. The prevalence of undiagnosed thyroid disorders in a previously iodine deficient area.  Thyroid. 2003;  13 803-810

1 † died on May 30th, 2004

PD Dr. med., MD Henry Völzke

Department of Epidemiology and Social Medicine
Ernst Moritz Arndt University

Walther Rathenau Straße 48

17487 Greifswald

Germany

Phone: + 493834867707

Fax: + 49 38 34 86 66 84

Email: voelzke@uni-greifswald.de