Classical Thyroid Epidemiology - Trends, Reference Values and Predictive Models

在过去的15年里，德国的碘缺乏通过强化碘计划得到了有效的治疗。我们可以预期，德国人口碘供应的改善将导致与碘缺乏相关的甲状腺疾病患病率下降。很有可能，特别是没有任何甲状腺疾病的年轻人将从这种情况中受益。然而，目前也可以推测出一些风险。这些风险包括有结节性甲状腺肿的老年人甲状腺机能亢进症的发生率增加，以及整个人群中自身免疫性甲状腺疾病和甲状腺功能减退症的发生率增加。最后，在缺乏监测方案的情况下，自满可能导致不受控制的、不稳定的碘供应。因此，迫切需要研究观察普通人群中碘供应和甲状腺疾病的趋势。本项目的第一个资助期支持一个甲状腺模块的数据收集，该模块是在德国东北部一项为期十年的基于人口的趋势研究(SHIP-TRANCE)中实施的。第二个资助期现在的目的是利用这些数据回答有关甲亢、自身免疫性甲状腺疾病、甲减和碘供应的流行趋势的主要科学问题。此外，现有的数据将被用来回答有关甲状腺功能测试的参考值、安全的促甲状腺激素范围、甲状腺疾病的社会经济决定因素以及探索新的、尚不清楚的甲状腺疾病预测因素的次要问题。一方面，该项目的科学成果对流行病学家以及临床内分泌学家、全科医生和内科医生具有潜在的兴趣。另一方面，这项研究提供了有关碘监测的重要数据，这些数据对评估和调整德国碘强化计划的有效性具有很高的相关性。

For the past 15 years, iodine deficiency in Germany has been effectively treated by the iodine fortification programme. We can expect that the improved iodine supply of the German population lead to a decreased prevalence of iodine deficiency-related thyroid disorders. It is very likely that particularly young individuals without any pre-existent thyroid disorder will benefit from this situation. Some risks, however, can also be postulated currently. These risks include an increased incidence of hyperthyroidism in elder people with previous nodular goitre as well as an increased incidence of autoimmune thyroid disorders and hypothyroidism in the whole population. Finally, complacency may lead to an uncontrolled, unstable iodine supply in the absence of monitoring programmes. Therefore, there is a strong need for studies observing the trend of iodine supply and thyroid disorders in the general population.The first funding period of the present project supported the data collection for a thyroid module, which was implemented in a ten-year population-based trend study (SHIP-Trend) in Northeast Germany. The second funding period is now aimed at using these data to answer the primary scientific questions regarding the prevalence trend of hyperthyroidism, autoimmune thyroid disorders, hypothyroidism and iodine supply. In addition, available data will be used to answer secondary questions on reference values of thyroid function tests, the safe TSH range, socioeconomic determinants of thyroid disorders and the exploration of new, yet unknown predictors of thyroid diseases. On the one hand, the scientific results of this project are of potential interest for epidemiologists as well as clinical endocrinologists, general practitioners and internists. On the other hand, this study provides important data on the iodine monitoring, which are of high relevance to asses and adjust the effectiveness of the German iodine fortification programme.