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Thyroid volume in Swedish school children: a national, stratified, population-based survey

European Journal of Clinical Nutrition volume 64, pages 1289–1295 (2010)Cite this article

Subjects

Abstract

Background/Objectives:

Sweden has had a salt iodination program since 1936. This first national surveillance study on iodine nutrition infers an adequate level of urinary iodine concentration (UIC 125 μg/l) and the aim is now to evaluate thyroid volume (Tvol) in the same national sample.

Subjects/Methods:

A stratified probability proportionate to size cluster sampling was used to obtain a representative national sample of Swedish children aged 6–12 years. Median Tvol obtained ultrasonographically and the prevalence of enlarged thyroid glands were compared with an international reference standard. Regional differences were evaluated through comparisons of Tvol between coastal and inland areas, urban and rural regions, and former goitre and non-goitre regions.

Results:

Tvol was correlated with age, body surface area (BSA), weight, height and body mass index for both sexes (P<0.0001) but not with UIC. The most important predictors for Tvol were age (girls: P<0.0001, boys: P=0.001) and BSA (girls: P<0.0001, boys: P<0.01). Median Tvol was higher in Sweden than in the reference study (P<0.0001). The prevalence of goitre was higher in Sweden (correlated to age 22.3%, BSA 15.7%, weight 17.6%, height 12.9%) than in the international reference (correlated to age 2.5%, BSA 2.5%, weight 2.5%, height 2.5%) (P<0.0001). Thyroids were larger in boys from urban and former non-goitre areas.

Conclusions:

Tvols were higher in Swedish school children than in the international reference study although iodine intake is considered optimal in Sweden. These findings underline the importance of regular monitoring of iodine intake, especially with regard to the decreased intake of table salt that is likely to follow initiation of health campaigns.

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References

  • Andermann P, Schlogl S, Mader U, Luster M, Lassmann M, Reiners C (2007). Intra- and interobserver variability of thyroid volume measurements in healthy adults by 2D versus 3D ultrasound. Nuklearmedizin 46, 1–7.

    Article  CAS  PubMed  Google Scholar 

  • Andersson M, Berg G, Eggertsen R, Filipsson H, Gramatkovski E, Hansson M et al. (2009). Adequate iodine nutrition in Sweden: a cross-sectional national study of urinary iodine concentration in school-age children. Eur J Clin Nutr 63, 828–834.

    Article  CAS  PubMed  Google Scholar 

  • Brunn J, Block U, Ruf G, Bos I, Kunze WP, Scriba PC (1981). Volumetric analysis of thyroid lobes by real-time ultrasound (author's transl.). Dtsch Med Wochenschr 106, 1338–1340.

    Article  CAS  PubMed  Google Scholar 

  • Delange F, Benker G, Caron P, Eber O, Ott W, Peter F et al. (1997). Thyroid volume and urinary iodine in European schoolchildren: standardization of values for assessment of iodine deficiency. Eur J Endocrinol 136, 180–187.

    Article  CAS  PubMed  Google Scholar 

  • Dubois D, Dubois E (1916). Clinical calorimetry. A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med 17, 863–871.

    Article  CAS  Google Scholar 

  • Erdogan MF (2003). Thiocyanate overload and thyroid disease. Biofactors 19, 107–111.

    Article  CAS  PubMed  Google Scholar 

  • Greenwald I (1960). Notes on the history of goitre in Sweden. (Remarks on its significance for the aetiology of the disorder). Med Hist 4, 218–227.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Gutekunst R, Smolarek H, Hasenpusch U, Stubbe P, Friedrich HJ, Wood WG et al. (1986). Goitre epidemiology: thyroid volume, iodine excretion, thyroglobulin and thyrotropin in Germany and Sweden. Acta Endocrinol (Copenh) 112, 494–501.

    Article  CAS  Google Scholar 

  • Hansen PS, Brix TH, Bennedbaek FN, Bonnema SJ, Kyvik KO, Hegedus L (2004). Genetic and environmental causes of individual differences in thyroid size: a study of healthy Danish twins. J Clin Endocrinol Metab 89, 2071–2077.

    Article  CAS  PubMed  Google Scholar 

  • Hegedus L, Rasmussen N, Knudsen N (1987). Seasonal variation in thyroid size in healthy males. Horm Metab Res 19, 391–392.

    Article  CAS  PubMed  Google Scholar 

  • Höjer J (1931). Kropfstudien Die Verbreitung des endemischen Kropfes in Schweden. Svenska Läkarsällskapets Handlingar 57, 1–104.

    Google Scholar 

  • Johnsson S (1965). Endemic struma—average frequency. Lakartidningen 62, 2049–2056.

    CAS  PubMed  Google Scholar 

  • Knudsen N, Bulow I, Jorgensen T, Laurberg P, Ovesen L, Perrild H (2000). Goitre prevalence and thyroid abnormalities at ultrasonography: a comparative epidemiological study in two regions with slightly different iodine status. Clin Endocrinol (Oxf) 53, 479–485.

    Article  CAS  Google Scholar 

  • Milakovic M, Berg G, Eggertsen R, Lindstedt G, Nystrom E (2001). Screening for thyroid disease of 15–17-year-old schoolchildren in an area with normal iodine intake. J Intern Med 250, 208–212.

    Article  CAS  PubMed  Google Scholar 

  • Milakovic M, Berg G, Nystrom E, Lindstedt G, Gebre-Medhin M, Eggertsen R (2004). Urinary iodine and thyroid volume in a Swedish population. J Intern Med 255, 610–614.

    Article  CAS  PubMed  Google Scholar 

  • Sjöberg K (1972). Strumasjukdomarnas Profylax Och Behandling. Thesis. Uppsala University, Sweden. pp 5–50.

    Google Scholar 

  • Sjoberg KH (1978). Iodine and diet. Lakartidningen 75, 2477–2479.

    CAS  PubMed  Google Scholar 

  • Sjoberg KH, Sundlof G (1971). The occurrence of struma before and after iodine prophylaxis. Lakartidningen 68, 980–984.

    CAS  PubMed  Google Scholar 

  • Statistics NCBo (1969). Historical Statistics of Sweden, 1720–1967. Stockholm.

  • Statistics Sweden (2003). Report MIS2003:1 Orebro, Sweden, Statistics Sweden (SCB).

  • Svensson J, Nilsson PE, Olsson C, Nilsson JA, Lindberg B, Ivarsson SA (2004). Interpretation of normative thyroid volumes in children and adolescents: is there a need for a multivariate model? Thyroid 14, 536–543.

    Article  PubMed  Google Scholar 

  • WHO (1995). World Health Organisation: Physical Status: The Use and Interpretation of Anthropometry. Report of a WHO Expert Committee Technical Report Series No. 854 World Health Organization: Geneva.

  • WHO (1997). Recommended normative values for thyroid volume in children aged 6–15 years. World Health Organization & International Council for Control of Iodine Deficiency Disorders. Bull World Health Organ 75, 95–97.

    Google Scholar 

  • WHO (2005). Proceedings of the WHO Technical Consultation on control on iodine deficiency in pregnant women and in children, February.

  • World Health Organization UNCsFICftCoIDD (2007). Assessment of Iodine Deficiency Disorders and Monitoring Their Elimination. A Guide for Programme Managers 3rd edn. WHO: Geneva.

  • Zimmermann MB (2007). The adverse effects of mild-to-moderate iodine deficiency during pregnancy and childhood: a review. Thyroid 17, 829–835.

    Article  CAS  PubMed  Google Scholar 

  • Zimmermann MB (2009). Iodine deficiency. Endocr Rev 30, 376–408.

    Article  CAS  PubMed  Google Scholar 

  • Zimmermann MB, Hess SY, Molinari L, De Benoist B, Delange F, Braverman LE et al. (2004). New reference values for thyroid volume by ultrasound in iodine-sufficient schoolchildren: a World Health Organization/Nutrition for Health and Development Iodine Deficiency Study Group Report. Am J Clin Nutr 79, 231–237.

    Article  CAS  PubMed  Google Scholar 

  • Zimmermann MB, Jooste PL, Pandav CS (2008). Iodine-deficiency disorders. Lancet 372, 1251–1262.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Michael Zimmermann at the Swiss Federal Institute of Technology in Zurich, Switzerland, and Johan Svensson, the University Hospital of Malmö, Sweden for comments and for supplying data regarding thyroid volumes. We also thank Mattias Molin and Nils-Gunnar Persson for performing the statistical calculations, and the teachers, nurses and children at the participating schools in Sweden. This study was supported by the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.

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Authors and Affiliations

  1. Department of Endocrinology, Sahlgrenska University Hospital, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden

    H Filipsson Nyström & E Nyström

  2. Laboratory for Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland

    M Andersson

  3. Department of Oncology, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden

    G Berg

  4. Department of Primary Health Care, Mölnlycke Primary Health Care and Research Centre, Mölnlycke, Sweden

    R Eggertsen & M Milakovic

  5. Department of Clinical Nutrition, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden

    E Gramatkowski & L Hulthén

  6. Department of Radiation Physics, University of Gothenburg, Gothenburg, Sweden

    M Hansson

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  1. H Filipsson Nyström
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Correspondence to H Filipsson Nyström.

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Filipsson Nyström, H., Andersson, M., Berg, G. et al. Thyroid volume in Swedish school children: a national, stratified, population-based survey. Eur J Clin Nutr 64, 1289–1295 (2010). https://doi.org/10.1038/ejcn.2010.162

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