Ultraschalldiagnostik der Schilddrüse

Objective: To investigate regional variations in the frequency of undiagnosed thyroid disorders among 25-to 88-year-old men and women in two communities in the northeast and the south of Germany. In addition, autoantibodies to thyroperoxidase (TPO-Abs) and urinary iodine excretion were determined. Methods: Two population-based surveys of men and women using a common standardized protocol, the Study of Health in Pomerania (SHIP) in the northeast of Germany (2505 participants) and the Kooperative Gesundheitsforschung in der Region Augsburg (KORA) in the south of Germany (2316 participants), were compared with regard to the frequency of undiagnosed thyroid disorders. Results: Compared with the northeast of Germany, urinary iodine excretion and serum thyroidstimulating hormone (TSH) levels were significantly higher in the south. The median urinary iodine concentration was 110 mg/l (64; 169 mg/l) in SHIP and 151 mg/l (97; 214 mg/l) in KORA, and the median TSH value was 0.81 mIU/l (0.56; 1.15 mIU/l) in SHIP and 1.22 mIU/l (0.84; 1.80 mIU/l) in KORA. The frequency of elevated TSH (TSH R2.12 mIU/l) was 4.3% in SHIP and 14.1% in KORA (P!0.001); the corresponding values for suppressed TSH (!0.25 mIU/l) were 3.5 and 1.7% (P!0.001). The proportion of ultrasonographic findings was 55.5% in SHIP and 68.0% in KORA. The frequency of serum TPO-Abs did not differ significantly between northeast and south Germany. Conclusions: There were considerable regional disparities in the frequency of thyroid disorders within Germany. These differences can be explained not only by different regional histories of natural iodine deficiency but also by current differences in the iodine supply under an identical nationwide iodine fortification program.

Section: Ultrasonography Of the Thyroidmentioning

confidence: 99%

Geographic variations in the frequency of thyroid disorders and thyroid peroxidase antibodies in persons without former thyroid disease within Germany

Meisinger

Ittermann

Wallaschofski

et al. 2012

“…0.479 (ml) for each lobe. Goiter was defined as a thyroid volume exceeding 18 ml in women and 25 ml in men (27). The normal thyroid echo pattern was classified as homogeneous.…”

Section: Thyroid Assessmentsmentioning

confidence: 99%

Shift of the TSH reference range with improved iodine supply in Northeast Germany

Ittermann

Khattak

Nauck

et al. 2015

Objective: Germany was iodine deficient until the mid-1990s when a nationwide iodine fortification program became effective. It is expected that after a longer period of sufficient iodine supply, median TSH values in the general population will shift to the right. Hence, the previous TSH reference range does not reflect the current TSH distribution in the general population of Germany. Thus, we aimed to establish a new reference range for serum TSH levels. Design and methods: We used data from the Study of Health in Pomerania TREND, a population-based study including 4420 individuals. The reference population consisted of 1596 individuals without diagnosed thyroid diseases or thyroid-related findings in ultrasound and serum analysis. Serum TSH levels were measured by an immunochemiluminescent procedure on a Siemens Dimension Vista. Results: The overall reference range for TSH was 0.49 mIU/l (95% CIZ0.44; 0.53)-3.29 mIU/l (95% CIZ3.08; 3.50). The lower reference limit differed significantly by sex, whereas the upper reference limit showed no significant difference between males and females. Age was significantly associated with the 2.5th TSH percentile in males but not in females, whereas age was significantly associated in males and females for the 97.5th TSH percentile. Conclusions: We demonstrate a shift toward the right of the TSH reference range in comparison with data from the same study region 10 years earlier, which is likely due to the improved iodine supply of the study region. Our study indicates that TSH reference limits are dependent on past and current iodine supply of populations.

“…Thyroid enlargement was defined as a thyroid volume O18 ml for women and 25 ml for men, which corresponds to the mean C3 S.D. values in iodine-sufficient populations (14). Records were made on distinct nodules larger than 10 mm in diameter.…”

Section: Thyroid Volume and Thyroid Nodulesmentioning

confidence: 99%

Selenium status, thyroid volume, and multiple nodule formation in an area with mild iodine deficiency

Rasmussen¹,

Schomburg²,

Köhrle³

et al. 2011

115

Objective: The objective was to study the associations between serum selenium concentration and thyroid volume, as well as the association between serum selenium concentration and risk for an enlarged thyroid gland in an area with mild iodine deficiency before and after iodine fortification was introduced. Another objective was to examine the association between serum selenium concentration and prevalence of thyroid nodules. Design: Cross-sectional study. Methods: We studied participants of two similar cross-sectional studies carried out before (1997-1998, nZ405) and after (2004)(2005), nZ400) introduction of iodine fortification. Serum selenium concentration and urinary iodine were measured, and the thyroid gland was examined by ultrasonography in the same subjects. Associations between serum selenium concentration and thyroid parameters were examined in multiple linear regression models or logistic regression models. Results: Serum selenium concentration was found to be significantly, negatively associated with thyroid volume (PZ0.006), and a low selenium status significantly increased the risk for thyroid enlargement (PZ0.007). Furthermore, low serum selenium status had a tendency to increase the risk for development of multiple nodules (PZ0.087). Conclusions: Low serum selenium concentration was associated with a larger thyroid volume and a higher prevalence of thyroid enlargement.