Prevalence of Palpable Thyroid Nodule in Isfahan, Iran, 2006: A Population Based Study

Abstract

Subjects: This cross-sectional study enrolled 2 523 of adult general population (age > 20 years) of Isfahan city. History taking and thyroid exam was performed by seven trained general practitioners. The concentration of TSH was measured in all, TgAb and TPOAb in approximately one in six and urinary iodine concentration in one fourth of them, randomly. We recalled people with any suspicious abnormality in thyroid exam or whose TSH levels were not normal at present or past. They were re-visited by an endocrinologist to confirm or rule out the diagnosis and second serum sample was obtained to measure T4, T3, T3RU and TSH.

Results: Thyroid nodule was identified in 62 (17 men and 45 women) out of 2 523 participants (2.5%; 95% CI: 2–3). Single and multiple nodules were found in 56 (2.2%; 95% CI: 1–2.5) and 6 (0.24%; 95% CI: 0.07–0.5) out of 2 523 persons, respectively. The prevalence of nodule was higher in females (3.5%) than in males (1.3%) (OR=2.72, 95% CI, 1.53–5.06, P=0.001). It was significantly higher in patients older than 35 years in comparison with younger people (3.3% vs. 1.3%; OR=2.5; 95% CI, 1.3–4.7; P=0.002).

Conclusion: The prevalence of thyroid nodule in our study is less than what has been reported in other countries. It is due to lower prevalence in female population. Its prevalence in males is similar to other studies. It seems that geographical and racial differences or higher prevalence of deeper location of some nodules in female Isfahani population could explain this finding.

Key words

thyroid nodule - anti thyroglobulin antibody - thyroid function tests

References

• 1 Brander A, Viikinkoski P, Tuuhea J. et al . Clinical versus ultrasound examination of the thyroid gland in common clinical practice.  J Clin Ultrasound. 1992;  20 37-42
• 2 Christensen SB, Tibblin S. The reliability of the clinical examination of the thyroid gland: A prospective study of 100 consecutive patients surgically treated for hyperparathyroidism.  Ann Chir Gynaecol. 1985;  74 151-154
• 3 Cooper DS. Approach to the patient with subclinical hyperthyroidism.  J Clin Endocrinol Metab. 2007;  92 3-9
• 4 Cooper DS. Subclinical hypothyroidism.  N Engl J Med. 2001;  345 260-265
• 5 Ezzat S, Sarti DA, Cain DR. et al . Thyroid incidentalomas: Prevalence by palpation and ultrasonography.  Arch Intern Med. 1994;  154 1838-1840
• 6 Gutekunst R, Smolarek H, Hasenpeusch U. et al . Goiter epidemiology: thyroid volume, iodine excretion, thyroglobulin and thyrotropin in Germany and Sweden.  Acta Endocrine. 1986;  112 494-501
• 7 Hollowell JG, Staehling NW, Flanders WD. et al . T₄, and Thyroid Antibodies in the United States Population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III).  J Clin Endocrinol Met. 2002;  87 489-499
• 8 Karaszewski B, Wilkowski M, Tomasiuk T. et al . The prevalence of incidentaloma–asymptomatic thyroid nodules in the Tricity (Gdansk, Sopot, Gdynia) population.  Endokrynol Pol. 2006;  57 196-200
• 9 Mazzaferri EL. Management of a solitary thyroid nodule.  N Engl J Med. 1993;  328 553-559
• 10 Mortenson JD, Woolner LB, Bennet WA. Gross and microscopic finding in clinically normal thyroid gland.  J Clin Endocrinol met. 1995;  15 1270-1280
• 11 Pino S, Fang SL, Braverman LE. Ammonium persulfate: a safe alternative oxidizing reagent for measuring urinary iodine.  Clin Chem. 1996;  42 239-243
• 12 Premawardhana LD, Parkes AB, Smyth PP. et al . Increased prevalence of thyroglobulin antibodies in Sri Lankan schoolgirl's ± is iodine the cause?.  Eur J Endocrinol. 2000;  143 185-188
• 13 Rago T, Chiovato L, Aghini-Lombardi F. et al . Non-palpable thyroid nodules in a borderline iodine-sufficient area: detection by ultrasonography and follow-up.  J Endocrinol Invest. 2001;  10 770-776
• 14 Rojeski MT, Gharib H. Nodular thyroid disease: Evaluation and management.  N Engl J Med. 1985;  313 428-436
• 15 Tan GH, Gharib H, Reading CC. Solitary thyroid nodule: Comparison between palpation and ultrasonography.  Arch Intern Med. 1995;  155 2418-2423
• 16 Tan GH, Gharib H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging.  Ann Intern Med. 1997;  126 226-231
• 17 Tomer Y. Anti thyroglobulin autoantibodies in autoimmune thyroid disease: cross reactive or pathogenic?.  Clin Immunol Immunopathol. 1997;  82 3-11
• 18 Turnbridge WM, Evered DC, Hall R. The spectrum of thyroid disease in an English community: The Wickham survey.  Clin Endocrinol. 1977;  7 481-493
• 19 Vander JB, Gaston EA, Dawber TR. The significance of nontoxic thyroid nodules: Final report of a 15-year study of the incidence of thyroid malignancy.  Ann Int Med;. 1968;  537-540
• 20 Walsh RM, Watkinson JC, Franklyn J. The management of the solitary thyroid nodule: a review.  Clin Otolaryngol. 1999;  24 388-397
• 21 Welker MJ, Orlov D. Thyroid nodules.  Am Fam Physician. 2003;  67 559-566
• 22 Wong CKM, Wheeler MH. Thyroid nodules: rational management.  World J Surg. 2000;  24 934-941
• 23 World Health Organization (WHO), United Nations Children's Fund (UNICEF) & International Council for the Control of Iodine Deficiency Disorders (ICCIDD) . Assessment of the Iodine Deficiency Disorders and monitoring their elimination. Geneva WHO publ 2001 WHO/NHD/01.1: 1–107

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