Thyrotoxicosis incidence in Switzerland and benefit of improved iodine supply
Thyrotoxicosis incidence in Switzerland and benefit of improved iodine supply
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DOI：
10.1016/s0140-6736(05)60076-1
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发表时间：
1998-09-26
期刊：
影响因子：
168.9
通讯作者：
Morselli, B
中科院分区：
文献类型：
--
作者：
Bürgi, H;Kohler, M;Morselli, B
全世界约有16亿人面临碘缺乏相关疾病的风险，消除碘缺乏是世卫组织和其他组织的主要目标之一。1东非甲状腺毒症的爆发引起了人们对立即用碘盐完全纠正碘缺乏症的安全性的关注。2，3继我们之前的报告4之后，我们提供了来自瑞士的16年随访数据，1980年，瑞士的盐碘含量从7.5 mg/kg提高到15 mg/kg。平均尿碘排泄量从90 g/g肌酐（轻度碘缺乏）增加到150 g/g肌酐; 4学龄儿童的超声甲状腺体积变得正常。我们估计了1990年至1996年期间居住在索洛图恩Bürgerspital集水区的109 000人中Graves病和毒性结节性甲状腺肿的发病率。它是该地区唯一拥有甲状腺专家和放射性碘研究和治疗设施的机构。因此，我们认为大多数甲状腺功能亢进症患者在本院至少见过一次。1980年，在碘缺乏得到全面纠正后，毒性结节性甲状腺肿和Graves病的年发病率每10万人总体上升了27%（图）。1980年后，毒性结节性甲状腺肿的发病率大幅下降至每10万人6.9例，而Graves病的发病率下降至每10万人20.6例（最近2年的平均值）。格雷夫斯病的减少可能是由于分类假象，因为多灶性播散性自主性有时被误认为格雷夫斯病。[4]我们的数据表明，完全纠正碘缺乏除了消除甲状腺肿、克汀病和智力的轻微缺陷外，还能大大降低甲状腺毒症的发病率。[1]在非洲出现的甲状腺毒症的高峰在瑞士没有出现，这可能是因为自1922年以来，盐中的碘分三步提高。4，5然而，我们的数据表明，毒性结节性甲状腺肿的低度地方性一定持续了几十年，这就提出了一个问题，即逐步补充是否比立即纠正更可取。5
Worldwide about 1600 million people are exposed to the risk of iodine-deficiency-related disorders, the elimination of which is one of the major goals of WHO and other organisations. 1 Outbreaks of thyrotoxicosis in East Africa have raised concerns about the safety of immediate full correction of iodine deficiency by iodised salt. 2, 3 Further to our previous report4 we present 16-year follow-up data from Switzerland, where the salt iodine content was raised from 7· 5 mg/kg to 15 mg/kg in 1980. Mean urinary iodine excretion increased from 90 g/g creatinine (mild iodine deficiency) to 150 g/g creatinine; 4 and sonographic thyroid gland volumes in schoolchildren became normal. We estimated incidence rates from 1990 to 1996 for Graves’ disease and toxic nodular goitre among the 109 000 people living in the catchment area of the Bürgerspital, Solothurn. It is the only institution in the area that has a thyroid specialist and facilities for radioiodine studies and treatment. We assumed, therefore, that most cases of hyperthyroidism were seen at least once in this hospital. In 1980, after full correction of iodine deficiency, the yearly incidence of toxic nodular goitre and Graves’ disease per 100000 rose overall by 27%(figure). After 1980, the incidence of toxic nodular goitre decreased substantially per 100 000 population to 6· 9 whereas that of Graves’ disease decreased to only 20· 6 (mean of 2 last years). The decrease of Graves’ disease might have been owing to a classification artefact, because of multifocal disseminated autonomy sometimes being mistaken for Graves’ disease. 4 Our data suggest that full correction of iodine deficiency leads to a greatly decreased incidence of thyrotoxicosis, in addition to the disappearance of goitre, cretinism, and minor deficiencies of intellect. 1 The sharp peak of thyrotoxicosis seen in Africa was not seen in Switzerland, probably because iodine in salt was raised in three steps since 1922. 4, 5 Our data suggest, however, that a low-grade endemic of toxic nodular goitre must have continued over decades, which raises the question of whether stepwise supplementation is preferable to immediate corrections. 5