Frontiers in Endocrinology (May 2021)

Hyperthyroidism Prevalence in China After Universal Salt Iodization

  • Chuyuan Wang,
  • Yongze Li,
  • Di Teng,
  • Xiaoguang Shi,
  • Jianming Ba,
  • Bing Chen,
  • Jianling Du,
  • Lanjie He,
  • Xiaoyang Lai,
  • Yanbo Li,
  • Haiyi Chi,
  • Eryuan Liao,
  • Chao Liu,
  • Libin Liu,
  • Guijun Qin,
  • Yingfen Qin,
  • Huibiao Quan,
  • Bingyin Shi,
  • Hui Sun,
  • Xulei Tang,
  • Nanwei Tong,
  • Guixia Wang,
  • Jin-an Zhang,
  • Youmin Wang,
  • Yuanming Xue,
  • Li Yan,
  • Jing Yang,
  • Lihui Yang,
  • Yongli Yao,
  • Zhen Ye,
  • Qiao Zhang,
  • Lihui Zhang,
  • Jun Zhu,
  • Mei Zhu,
  • Zhongyan Shan,
  • Weiping Teng

DOI
https://doi.org/10.3389/fendo.2021.651534
Journal volume & issue
Vol. 12

Abstract

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BackgroundUniversal salt iodization (USI) was implemented in mainland China in 1996. The prevalence of hyperthyroidism and its risk factors now require examination.MethodsData were acquired from a nationwide Thyroid, Iodine, and Diabetes Epidemiological survey (TIDE 2015–2017) of 78,470 subjects from 31 provinces. Iodine status, and thyroid hormones and antibodies were measured. ResultsAfter two decades of USI, the prevalence of overt hyperthyroidism (OH), Graves’ disease (GD), severe subclinical hyperthyroidism (severe SCH), and mild subclinical hyperthyroidism (mild SCH) in mainland China was 0.78%, 0.53%, 0.22%, and 0.22%, respectively. OH and GD prevalence were higher in women than in men (OH: 1.16% vs. 0.64%, P<0.001; GD: 0.65% vs. 0.37%, P<0.001).Prevalence was significantly decreased after 60 years-of-age compared with 30–39 years-of-age (OH:0.61% vs. 0.81%, P<0.001; GD: 0.38% vs. 0.57%, P<0.001).Excessive iodine(EI) and deficient iodine(DI) were both related to increased prevalence of OH (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.68–2.59; OR1.35, 95%CI 1.07–1.72, respectively); however, only deficient iodine was associated with increased prevalence of GD (OR1.67, 95%CI 1.30–2.15). Increased thyroid peroxidase antibody and thyroglobulin antibody levels were significantly associated with prevalence of OH and GD, but not severe SCH and mild SCH. Although hyperthyroidism was more prevalent in women, the association disappeared after adjusting for other factors such as antibody levels.ConclusionOH and GD prevalences in mainland China are stable after two decades of USI. Iodine deficiency, elevated thyroid antibody levels, and middle age are the main risk factors for OH and GD. The severe SCH population, rather than the mild SCH population, shows similar characteristics to the OH population.

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