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Large Differences in Incidences of Overt Hyper- and Hypothyroidism Associated with a Small Difference in Iodine Intake: A Prospective Comparative Register-Based Population Survey

Bülow Pedersen, Inge, Knudsen, Nils, Jørgensen, Torben, Perrild, Hans, Ovesen, Lars, Laurberg, Peter·2002·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2002-020750
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Abstract

Around 3-4 billion people in the world are covered by iodine supplementation programs to prevent developmental brain damage and other iodine deficiency (ID) disorders. Mild ID is associated with more hyperthyroidism and less hypothyroidism in the population than a high iodine intake. Knowledge of the iodine intake levels where the shifts in incidences occur is important for planning of iodine supplementation programs. A computer-based register linked to thyroid diagnostic laboratories was used to continuously identify all new cases of overt hyper- and hypothyroidism in two population cohorts with moderate and mild ID, respectively (Aalborg, n = 310,124; urinary iodine, 45 micro g/liter; and Copenhagen, n = 225,707; urinary iodine, 61 micro g/liter). The investigation was initiated before iodization of salt in Denmark and was part of the monitoring program. In 1997-1998, the incidence rate of overt hyperthyroidism was high in the area with the lowest iodine intake (92.9/100,000 per year) compared with the area with only mild ID (65.4/100,000 per year). Standardized rate ratio was 1.49, and 95% confidence interval was 1.22-1.81. The opposite relationship was present for overt hypothyroidism (moderate ID, 26.5/100,000 per year; mild ID, 40.1/100,000 per year; standardized rate ratio, 0.73; 95% confidence interval, 0.55-0.97). The different incidence rates were confirmed during each of the two following years. The results of this prospective investigation of the incidence of overt hyper- and hypothyroidism suggest that iodine supplementation of a population may increase the incidence of overt hypothyroidism, even if the population is moderately iodine-deficient. In such a population, the increase in risk of hypothyroidism should be weighed against the risk of ID disorders such as hyperthyroidism due to multinodular toxic goiter. The optimal level of iodine intake to prevent thyroid disease may be a relatively narrow range around the recommended daily iodine intake of 150 micro g.

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  • Graves' disease is the most common cause of subclinical hyperthyroidism in younger patients (<65 years) in iodine-replete areas, while toxic adenoma and toxic multinodular goitre are relatively more frequent in iodine-deficient areas and in older persons (≥65 years).

    “While GD is the most common cause of SHyper in younger patients (<65 years) in iodine-replete areas, TA and toxic MNG are relatively more frequent in iodine-deficient areas and in older persons ( ≥ 65 years) [7] .”

    From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [7]

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Authors
Bülow Pedersen, I., Knudsen, N., Jørgensen, T., Perrild, H., Ovesen, L., & Laurberg, P.
Affiliations
  • Bispebjerg Hospital (DK)
  • Glostrup Hospital (DK)
  • Aalborg University Hospital (DK)
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2002-10
Volume
87
Issue
10
Pages
4462-4469
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2002-020750
OpenAlex
W2089901745
Cited by
156
References
31
Citations by year
2026: 1 · 2025: 3 · 2024: 1 · 2023: 4 · 2022: 4 · 2021: 6 · 2020: 4 · 2019: 5 · 2018: 7 · 2017: 7 · 2016: 8 · 2015: 7 · 2014: 9 · 2013: 11 · 2012: 8
FWCI
2.88
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
  • Technical University of Denmark, DTU Orbit (Technical University of Denmark, DTU) (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
Keywords
iodine deficiency, iodine supplementation, overt hyperthyroidism, overt hypothyroidism, thyroid disease incidence, urinary iodine, salt iodization, toxic multinodular goiter, Denmark
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Denmark, Diet, Female, Health Surveys, Humans, Hyperthyroidism, Hypothyroidism, Infant, Infant, Newborn, Iodine, Male, Middle Aged, Prospective Studies, Registries, Thyrotropin, Thyroxine, Triiodothyronine, Cohort Studies

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