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DOI: 10.1055/s-0029-1241861
© Georg Thieme Verlag KG Stuttgart · New York
Impact of Pregnancy on Prevalence of Goitre and Nodular Thyroid Disease in Women Living in a Region of Borderline Sufficient Iodine Supply
Publikationsverlauf
received 14.04.2009
accepted 17.09.2009
Publikationsdatum:
30. Oktober 2009 (online)

Abstract
An interplay of genetic, epigenetic, and environmental factors contributes to thyroid disease. In a cross-sectional study, we aimed to determine the influence of parity in combination with other risk factors on the prevalence of goitre and nodular thyroid disease (NTD) in women living in a region of previous overt iodine deficiency, which experienced a continuous improvement in alimentary iodine supply in the last two decades. Thyroid ultrasonography (7.5 MHz; Merck Thyromobil) was performed by the same investigator in 736 women living in Thuringia and Saxony. Age and BMI were documented and a comprehensive history on pregnancies, family history of thyroid disease, and past or present smoking was obtained. Goitre prevalence was 19.1%. Solitary thyroid nodules were detected in 21.5%, and multiple nodules in 23.8% of women. In a multivariate analysis, neither age nor parity was positively correlated with goitre prevalence and NTD. A significant correlation was detected between BMI and goitre and multinodular disease. Goitre was found in 25.3% of women with a positive family history for thyroid disease, as opposed to 16.1% goitre in women with a negative family history. Neither goitre nor NTD were associated with a history of smoking in the whole study population. Thyroid nodules and/or goitre are present in up to 45% of women in an area of previous overt iodine deficiency. Whereas BMI and family history are positively correlated with the presence of NTD and goitre, no such correlation could be detected for pregnancy and smoking after processing our data with multivariate analyses.
Key words
thyroid volume - thyroid nodules - parity - risk factors - iodine deficiency
References
- 1
Hegedüs L, Bonnema SJ, Bennedbaek FN.
Management of simple nodular goiter: current status and future perspectives.
Endocr Rev.
2003;
24
102-132
MissingFormLabel
- 2
Knudsen N, Perrild H, Christiansen E, Rasmussen S, Dige-Petersen H, Jorgensen T.
Thyroid structure and size and two-year follow-up of solitary cold thyroid nodules
in an unselected population with borderline iodine deficiency.
Eur J Endocrinol.
2000;
142
224-230
MissingFormLabel
- 3
Andersson M, Takkouche B, Egli I, Allen HE, de Benoist B.
Current global iodine status and progress over the last decade towards the elimination
of iodine deficiency.
Bull World Health Organ.
2005;
83
518-525
MissingFormLabel
- 4
Brauer VF, Brauer WH, Führer D, Paschke R.
Iodine nutrition, nodular thyroid disease, and urinary iodine excretion in a German
university study population.
Thyroid.
2005;
15
364-370
MissingFormLabel
- 5
Hampel R, Külberg T, Klein K, Jerichow JU, Pichmann EG, Clausen V, Schmidt I.
Goiter incidence in Germany is greater than previously suspected].
Med Klin (Munich).
1995;
90
324-329
MissingFormLabel
- 6
Laurberg P, Jorgensen T, Perrild H, Ovesen L, Knudsen N, Pedersen IB, Rasmussen LB, Carle A, Vejbjerg P.
The Danish investigation on iodine intake and thyroid disease, DanThyr: status and
perspectives.
Eur J Endocrinol.
2006;
155
219-228
MissingFormLabel
- 7
Knudsen N, Bülow I, Jorgensen T, Laurberg P, Ovesen L, Perrild H.
Goitre prevalence and thyroid abnormalities at ultrasonography: a comparative epidemiological
study in two regions with slightly different iodine status.
Clin Endocrinol (Oxf).
2000;
53
479-485
MissingFormLabel
- 8
Aghini-Lombardi F, Antonangeli L, Martino E, Vitti P, Maccherini D, Leoli F, Rago T, Grasso L, Valeriano R, Balestrieri A, Pinchera A.
The spectrum of thyroid disorders in an iodine-deficient community: the Pescopagano
survey.
J Clin Endocrinol Metab.
1999;
84
561-566
MissingFormLabel
- 9
Knudsen N, Laurberg P, Perrild H, Bülow I, Ovesen L, Jorgensen T.
Risk factors for goiter and thyroid nodules.
Thyroid.
2002;
12
879-888
MissingFormLabel
- 10
Völzke H, Schwahn C, Kohlmann T, Kramer A, Robinson DM, John U, Meng W.
Risk factors for goiter in a previously iodine-deficient region.
Exp Clin Endocrinol Diabetes.
2005;
113
507-515
MissingFormLabel
- 11
Brander A, Viikinkoski P, Nickels J, Kivisaari L.
Thyroid gland: US screening in a random adult population.
Radiology.
1991;
181
683-687
MissingFormLabel
- 12
Derwahl M, Studer H.
Nodular goiter and goiter nodules: Where iodine deficiency falls short of explaining
the facts.
Exp Clin Endocrinol Diabetes.
2001;
109
250-260
MissingFormLabel
- 13
Manole D, Schildknecht B, Gosnell B, Adams E, Derwahl M.
Estrogen promotes growth of human thyroid tumor cells by different molecular mechanisms.
J Clin Endocrinol Metab.
2001;
86
1072-1077
MissingFormLabel
- 14
Glinoer D.
What happens to the normal thyroid during pregnancy?.
Thyroid.
1999;
9
631-635
MissingFormLabel
- 15
Kung AW, Chau MT, Lao TT, Tam SC, Low LC.
The effect of pregnancy on thyroid nodule formation.
J Clin Endocrinol Metab.
2002;
87
1010-1014
MissingFormLabel
- 16
Knudsen N, Bülow I, Laurberg P, Ovesen L, Perrild H, Jorgensen T.
Parity is associated with increased thyroid volume solely among smokers in an area
with moderate to mild iodine deficiency.
Eur J Endocrinol.
2002;
146
39-43
MissingFormLabel
- 17
Hansen PS, Brix TH, Bennedbaek FN, Bonnema SJ, Kyvik KO, Hegedüs L.
Genetic and Environmental Causes of Individual Differences in Thyroid Size: A study
of healthy Danish twins.
J Clin Endocrinol Metab.
2004;
89
2071-2077
MissingFormLabel
- 18
Rasmussen NG, Hornnes PJ, Hegedüs L.
Ultrasonographically determined thyroid size in pregnancy and post partum: the goitrogenic
effect of pregnancy.
Am J Obstet Gynecol.
1989;
160
1216-1220
MissingFormLabel
- 19
Struve CW, Haupt S, Ohlen S.
Influence of frequency of previous pregnancies on the prevalence of thyroid nodules
in women without clinical evidence of thyroid disease.
Thyroid.
1993;
3
7-9
MissingFormLabel
- 20
Brunn J, Block U, Ruf G, Bos I, Kunze WP, Scriba PC.
Volumetric analysis of thyroid lobes by real-time ultrasound (author's transl).
Dtsch Med Wochenschr.
1981;
106
1338-1340
MissingFormLabel
- 21
Gutekunst R, Becker W, Hehrmann R, Olbricht T, Pfannenstiel P.
Ultrasonic diagnosis of the thyroid gland.
Dtsch Med Wochenschr.
1988;
113
1109-1112
MissingFormLabel
- 22
Iversen GR.
Decomposing Chi-Square: A forgotten technique.
Sociol Meth Res.
1979;
8
143-157
MissingFormLabel
- 23 Agresti A.
Categorical Data Analysis . New York: Wiley 1990MissingFormLabel - 24 Faul F, Erdfelder E. GPOWER .
A priori, post-hoc, and compromise power analyses for MS-DOS Computer program; Version 2.0 Bonn: Universität Bonn, Fachbereich Psychologie 1992MissingFormLabel - 25
Meng W, Bauch K, Knappe G.
Iodine deficiency disease in the GDR.
Endocrinol Exp.
1986;
20
79-84
MissingFormLabel
- 26
Bauch K, Seitz W, Förster S, Keil U.
Interdisciplinary preventive use of iodine in former East Germany following reunification
and the status of packaged iodized table salt for improving alimentary iodine supply.
Retrospect and prospects.
Z Gesamte Inn Med.
1991;
46
615-620
MissingFormLabel
- 27 Jahreis G, Leiterer M, Franke K, Maichrowitz W, Schöne F. Untersuchungen zur Jodversorgung bei Schulkindern und zum Jodgehalt der Milch in Thüringen. In: Bauch K (eds).
Aktuelle Aspekte des Jodmangels und des Jodüberschusses . Berlin, Wien: Blackwell Wissenschaftsverlag 2000: 89-95MissingFormLabel - 28
Thamm M, Ellert U, Thierfelder W, Liesenkötter KP, Völzke H.
Iodine intake in Germany.
Results of iodine monitoring in the German Health Interview and Examination Survey
for Children and Adolescents (KiGGS) Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz.
2007;
50
744-749
MissingFormLabel
- 29 Franke WG, Grüning T, Wunderlich G, Zöphel K.
Neuere Daten zur Jodausscheidung in Sachsen. In: Bauch K, eds. Aktuelle Aspekte des Jodmangels und des Jodüberschusses . Berlin, Wien: Blackwell Wissenschaftsverlag 2000: 96-106MissingFormLabel - 30
Bader N, Möller U, Leiterer M, Franke K, Jahreis G.
Pilot study: tendency of increasing iodine content in human milk and cow's milk.
Exp Clin Endocrinol Diabetes.
2005;
113
8-12
MissingFormLabel
- 31 http://www.dge.de/modules.php?name=news&file=article&sid=415 23.03.2009
MissingFormLabel
- 32
Phitayakorn R, Super DM, McHenry CR.
An investigation of epidemiologic factors associated with large nodular goiter.
J Surg Res.
2006;
133
16-21
MissingFormLabel
- 33
Bundeszentrale für politische Bildung.
.In: Zahlen und Fakten:
Die soziale Situation in Deutschland, 1 . Kapitel: Bevölkerung 2008: 30-33MissingFormLabel - 34
Hesse V, Bertram-Bewer G, Edelmann H, Furcht R, Kändler H, Maaser M, Pohl H, Rönnefarth G, Scholz C, Sowa H, Strieber B.
Orientierende Untersuchungen zur Strumahäufigkeit und Urinjodausscheidung bei Schülern
der DDR.
Dtsch Ges-Wesen.
1978;
33
2280-2286
MissingFormLabel
- 35 Schindler A, Meng W, Spieker K, Horack S, Lux E, Muche A. Renale Jodausscheidung in Ostdeutschland 1978-1998 unter besonderer Berücksichtigung
von Schülern. In: Bauch K, eds.
Aktuelle Aspekte des Jodmangels und des Jodüberschusses . Berlin, Wien: Blackwell Wissenschaftsverlag 2000: 56-64MissingFormLabel - 36 Hesse V, Böttcher M, Herlinghaus C, Kroschwald P, Oehler K. Monitoring der Urinjodidausscheidung von Neugeborenen als Kriterium der Wirkung einer
Jodprophylaxe-Verlaufsbeobachtung von 1980 bis 1998. In: Bauch K, eds.
Aktuelle Aspekte des Jodmangels und des Jodüberschusses . Berlin, Wien: Blackwell Wissenschaftsverlag 2000: 41-50MissingFormLabel - 37
Bauch K, Meng W, Ulrich FE, Grosse E, Kempe R, Schönmann F, Sterzel G, Seitz W, Möckel G, Weber A, Tiller R, Rockel A, Dempe A, Seige K.
Thyroid status during pregnancy and post partum in regions of iodine deficiency and
endemic goiter.
Endocrinol Exper.
1986;
20
67-77
MissingFormLabel
- 38 Uhlig S, Bauch K, Fritzsche R, Teubner A, Beier L. Untersuchungen zur Jodversorgung während der Schwangerschaft im Strumaendemiegebiet
des Erzgebirges von 1984–1995. In: Bauch K, eds.
Aktuelle Aspekte des Jodmangels und des Jodüberschusses . Berlin, Wien: Blackwell Wissenschaftsverlag 2000: 96-106MissingFormLabel - 39 Hesse V.
Iodprophylaxe bei Kindern . Berlin, Wien: Blackwell Wissenschaftsverlag 1997 20MissingFormLabel - 40
Hampel R, Kühlberg T, Zöllner H, Klinke D, Klein K, Pichmann EG, Kramer A.
Current state of alimentary iodine deficiency in Germany.
Z Ernahrungswiss.
1996;
35
2-5
MissingFormLabel
- 41
Willgerodt H, Keller E, Perschke C, Stach B.
The status of iodine nutrition in newborn infants, schoolchildren, adolescents and
adults in former East Germany.
Exp Clin Endocrinol Diabetes.
1997;
105
38-42
MissingFormLabel
- 42
Bittermann H, Großklaus R.
Jodversorgung von Wehrpflichtigen in Deutschland. Abschlußbericht zur Teilstudie 3
des Forschungsvorhabens “Jod-Monitoring 1996” des BMG.
BgVV-Schriften.
1999;
1-94
MissingFormLabel
- 43 Willgerodt H, Baldauf T, Dannenberg C, Keller E, Stach B. Aktueller Stand der Jodversorgung und Schilddrüsenvolumina von Leipziger Schülern. In: Seibel MJ, Weinheimer B, Ziegler R, eds.
Die Schilddrüse und ihre Beziehung zum Organismus . Berlin, New York: de Gruyter 2000: 304-305MissingFormLabel - 44
Galanti MR, Granath F, Cnattingius S, Ekbom-Schnell A, Ekbom A.
Cigarette smoking and the risk of goitre and thyroid nodules amongst parous women.
J Intern Med.
2005;
258
257-264
MissingFormLabel
- 45
Shahbazian HB, Sarvghadi F, Azizi F.
Prevalence and characteristics of postpartum thyroid dysfunction in Tehran.
Eur J Endocrinol.
2001;
145
397-401
MissingFormLabel
- 46
Serna Arnaiz MC, Serra i Majem L, Gasco Eguiluz E, Munoz Marquez J, Ribas L, Escobar del Rey F.
Current situation of goiter endemic and iodine intake in the population of the Pyrenees
and the Segria region of Lleida.
Aten Primaria.
1998;
22
642-648
MissingFormLabel
- 47
Olbricht T, Hoff HG.
Factors affecting thyroid gland volume.
A contribution to the epidemiology of struma]. Med Klin (Munich).
1988;
83
279-284
MissingFormLabel
- 48
Petersen K, Lindstedt G, Lundberg PA, Bengtsson C, Lapidus L, Nyström E.
Thyroid disease in middle-aged and elderly Swedish women: thyroid-related hormones,
thyroid dysfunction and goitre in relation to age and smoking.
J Intern Med.
1991;
229
407-413
MissingFormLabel
Correspondence
D. FührerMD, PhD
Department of Internal Medicine
University of Leipzig
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eMail: dagmar.fuehrer@medizin.uni-leipzig.de