Wole – Epidemiologia

Wole
Epidemiologia

Wole, definiowane jako powiększenie gruczołu tarczowego, jest globalnym problemem zdrowotnym, dotykającym około 10 milionów osób, z niedoborem jodu jako główną przyczyną dotyczącą około 2,2 miliarda ludzi. Częstość występowania wola koreluje ze stopniem niedoboru jodu: przy łagodnym niedoborze wynosi 5-20%, umiarkowanym 20-30%, a ciężkim przekracza 30%, sięgając nawet 80% w niektórych regionach. W populacjach z prawidłową podażą jodu częstość klinicznie wyczuwalnego wola jest poniżej 4%. Epidemiologia wykazuje wyraźne różnice płciowe (stosunek kobiet do mężczyzn 4:1) oraz wiekowe, z wyższą częstością u kobiet i zmniejszaniem się częstości wola z wiekiem, w przeciwieństwie do guzków tarczycy, których częstość rośnie z wiekiem. Wole toksyczne guzkowe najczęściej występuje u osób powyżej 50 roku życia, stanowiąc 15-30% przypadków nadczynności tarczycy w USA, z rozpowszechnieniem 100/100 000 populacji i roczną zapadalnością 4,8/100 000. Diagnostyka opiera się na oznaczeniu TSH, ultrasonografii, biopsji cienkoigłowej oraz ocenie stężenia jodu w moczu jako markera spożycia jodu na poziomie populacji.

Epidemiologia wola

Wole, definiowane jako powiększenie gruczołu tarczowego, stanowi istotny problem zdrowotny na całym świecie. Szacuje się, że dotyka około 10 milionów ludzi na świecie, przy czym niedobór jodu, będący najczęstszą przyczyną wola, dotyczy około 2,2 miliarda osób¹². Częstość występowania i zapadalność na wole zależą w dużej mierze od stopnia niedoboru jodu w danej populacji.

Częstotliwość występowania w zależności od niedoboru jodu

Występowanie wola wykazuje ścisłą korelację ze stopniem niedoboru jodu w danej populacji:¹²

Przy łagodnym niedoborze jodu, częstość występowania wola wynosi od 5% do 20%
Przy umiarkowanym niedoborze jodu, częstość wzrasta do 20% do 30%
Przy ciężkim niedoborze jodu, częstość przekracza 30%

¹²

W regionach z prawidłową podażą jodu częstość występowania wola klinicznie wyczuwalnego wynosi poniżej 4%¹. Jednak w obszarach o ciężkim niedoborze jodu częstość występowania wola może sięgać nawet 80%¹².

Występowanie wola w populacji ogólnej

Na całym świecie częstość występowania wola wynosi około 1400 do 1700 na 100 000 osób u kobiet oraz 900 na 100 000 osób u mężczyzn¹. Natomiast częstość występowania pojedynczych guzków tarczycy wynosi około 3000 na 100 000 osób¹.

Badania autopsyjne sugerują, że częstość występowania guzków tarczycy przekracza 50%, a przy zastosowaniu ultrasonografii o wysokiej rozdzielczości wartość ta zbliża się do 40% u pacjentów bez chorób tarczycy¹. W badaniu Framingham ultrasonografia wykazała, że 3% mężczyzn powyżej 60 roku życia miało guzki tarczycy, podczas gdy u 36% kobiet w wieku 49-58 lat wykryto guzki tarczycy¹.

W Stanach Zjednoczonych rozpowszechnienie wola szacuje się na 37%, chociaż jest ono znacznie wyższe w regionach z niedoborem jodu (15,8% na całym świecie)¹. W badaniu Wickham z Wielkiej Brytanii 16% populacji miało wole¹.

Wole u dzieci w wieku szkolnym

Występowanie wola u dzieci w wieku szkolnym waha się od 1,9% do 6,8%¹. Częstość występowania wola w dzieciństwie osiąga szczyt w okresie dojrzewania, przy czym kobiety są częściej dotknięte niż mężczyźni¹.

Według Światowej Organizacji Zdrowia, częstość występowania wola na poziomie 5% lub więcej u dzieci w wieku szkolnym jest wskaźnikiem niedoboru jodu w populacji¹². W badaniach przeprowadzonych w Etiopii Południowej, ogólna częstość występowania wola wśród dzieci w wieku szkolnym wynosiła 35,2% (CI: 30,4-40,5%)¹².

Różnice związane z płcią i wiekiem

Wole występuje znacznie częściej u kobiet niż u mężczyzn, ze stosunkiem kobiet do mężczyzn wynoszącym około 4:1¹²³. W badaniu Wickham 26% kobiet miało wole, w porównaniu do 7% mężczyzn¹. Guzki tarczycy są rzadsze u mężczyzn niż u kobiet, ale gdy są obecne, istnieje większe prawdopodobieństwo, że są złośliwe¹.

Częstość występowania wola zmniejsza się wraz z wiekiem¹², co różni się od częstości występowania guzków tarczycy, która rośnie wraz z wiekiem¹. W regionach z niedoborem jodu, częstość występowania guzków tarczycy zwiększa się z wiekiem (bez różnic związanych z płcią)¹, podczas gdy w regionach z wystarczającą ilością jodu częstość występowania wola guzkowego zmniejsza się z wiekiem¹.

Wole toksyczne guzkowe występuje najczęściej u osób powyżej 50 roku życia¹. Tyreotoksykoza często występuje u pacjentów z długotrwałym wolem, a toksyczność zwykle osiąga szczyt w szóstej i siódmej dekadzie życia, szczególnie u osób z rodzinnym wywiadem wola wieloguzkowego¹.

Czynniki ryzyka i predyktory wola

Oprócz niedoboru jodu, który jest głównym czynnikiem ryzyka wola endemicznego, zidentyfikowano inne czynniki związane z występowaniem wola:¹²³

Wykształcenie matki (brak formalnego wykształcenia zwiększa ryzyko około 2,5 razy)
Dochód rodziny (niższy dochód zwiększa ryzyko około 2,2 razy)
Rodzaj używanej soli (używanie soli niejodowanej zwiększa ryzyko około 2,7 razy)
Moment dodawania soli do potrawy (dodawanie soli podczas gotowania zwiększa ryzyko około 2,2 razy)
Stosowanie kasuby (manioku) jako pokarmu (zwiększa ryzyko około 2,2 razy)
Czynniki środowiskowe: narażenie na nadchloran, tiocyjanian, ftalany, azotany, izoflawony, związki chloroorganiczne
Narkotyki, palenie tytoniu i spożywanie alkoholu
Doustne środki antykoncepcyjne, ciąża, insulinooporność i niedobór selenu

¹²³⁴

Badania wykazały również specyficzne dla płci determinanty wola: u kobiet są to parzystość i status jodu, a u mężczyzn palenie tytoniu i zwiększający się wiek¹.

Występowanie geograficzne wola

Częstość występowania wola wykazuje znaczne zróżnicowanie geograficzne, co jest ściśle związane z zawartością jodu w glebie i środowisku¹.

Obszary endemiczne

Wole występuje endemicznie w obszarach odległych od morza, takich jak regiony górskie¹. Jod gromadzi się głównie w morzu i w warstwie ornej. Przed wprowadzeniem programów wzbogacania jodu, wole było powszechne w obszarach z powtarzającymi się powodziami lub działalnością lodowców, które erodują warstwę orną¹.

Przykłady takich regionów obejmują:¹

Regiony alpejskie Europy Południowej (np. Szwajcaria)
Himalaje
Basen Wielkich Jezior

W Etiopii przeprowadzono warstwowe badanie wola na 35635 dzieciach w wieku szkolnym i 19158 członkach gospodarstw domowych we wszystkich regionach z wyjątkiem Erytrei i Tigrai. Ogólna częstość występowania wola (średnia wartości dla mężczyzn i kobiet) wśród dzieci w wieku szkolnym i członków gospodarstw domowych wynosiła odpowiednio 30,6% i 18,7%¹.

Różnice między krajami

W Stanach Zjednoczonych większość przypadków wola wynika z autoimmunologicznego zapalenia tarczycy (tj. choroby Hashimoto)¹. Wole toksyczne wieloguzkowe jest mniej powszechne w Stanach Zjednoczonych, co można przypisać jodowaniu soli kuchennej. Ponadto w Stanach Zjednoczonych spożycie jodowanej soli (200 do 600 μg/dzień) jest prawie dwukrotnie większe ilościowo w porównaniu z krajami europejskimi (25 do 100 μg/dzień)¹.

W rozwiniętych krajach, kraje europejskie mają tendencję do wyższej częstości występowania toksycznego wola wieloguzkowego w porównaniu do Stanów Zjednoczonych¹.

W Australii niedobór jodu pojawił się ponownie w ostatnich dziesięcioleciach. Stężenie jodu w moczu (UIC) jest doskonałym markerem zastępczym dla bieżącego spożycia jodu i jest przydatnym narzędziem przesiewowym do wykrywania niedoboru jodu na poziomie populacji¹. Od października 2009 roku, cały chleb produkowany w Australii i Nowej Zelandii (z wyjątkiem chleba organicznego) musi zawierać dodatkowy jod z soli jodowanej¹.

Nadzór i monitorowanie wola

Skuteczny nadzór nad występowaniem wola jest kluczowy dla monitorowania skuteczności programów suplementacji jodu i identyfikacji obszarów ryzyka¹.

Metody badania i nadzoru

W diagnostyce i monitorowaniu wola stosuje się następujące metody:¹

Badanie stężenia TSH w surowicy do określenia aktualnego stanu funkcjonalnego tarczycy
Ultrasonografia tarczycy jako niezbędna część oceny pacjentów z wolem
Biopsja aspiracyjna cienkoigłowa (BAC) u pacjentów z guzkami tarczycy
Oznaczanie stężenia jodu w moczu jako marker spożycia jodu na poziomie populacji

¹²³

Definicja wola zależy od wieku i płci. Górna granica prawidłowej objętości gruczołu tarczowego wynosi:¹²

Dorośli mężczyźni: 12-18 ml
Dorosłe kobiety: 10-15 ml
Wiek 13-14 lat: 8-10 ml
Wiek 3-4 lata: 3 ml
Noworodki: 0,8-1,5 ml

¹²

Programy prewencyjne i ich skuteczność

Istnieją dowody na to, że podawanie jodu jako suplementu zmniejsza częstość występowania wola u osób zamieszkujących obszary z niedoborem jodu¹. Przełomowe badania potwierdziły, że suplementacja jodu w soli stołowej zmniejsza ryzyko występowania wola endemicznego z 20% do 5% u nastoletnich dziewcząt w Ohio¹.

Australijska Narodowa Rada ds. Zdrowia i Badań Medycznych zaleca, aby wszystkie kobiety, które są w ciąży, karmią piersią lub rozważają ciążę, przyjmowały suplement jodu w ilości 150 mikrogramów każdego dnia¹.

Zapobieganie wolu za pomocą kapsułek z olejkiem jodowym jest znacznie skuteczniejsze niż zapobieganie za pomocą soli jodowanej w miejskich umiarkowanie endemicznych obszarach wola pod względem poprawy klinicznych i fizycznych cech dzieci oraz zdolności intelektualnych¹.

Trendy i zmiany w epidemiologii wola

W ostatnich latach zaobserwowano kilka istotnych trendów w epidemiologii wola.

Wzrost wykrywalności guzów tarczycy

Nawet przy stosowaniu jodu zaobserwowano wzrost częstości występowania guzków tarczycy¹. Nie jest jasne, czy wzrost częstości występowania stanowi prawdziwy wzrost, czy zwiększoną wykrywalność. Jedną z przyczyn tego może być zwiększone wykorzystanie obrazowania radiologicznego i częstsze badania przesiewowe za pomocą ultradźwięków¹.

Obecnie ultrasonografia może wykryć nawet najmniejsze guzki, powodując, że częstość występowania guzków wynosi 60% do 70% u dorosłych¹. Jednak obrazowanie i badania przesiewowe nie są jedyną przyczyną wzrostu częstości występowania. Uważa się, że otyłość, insulinooporność i zespół metaboliczny mogą być czynnikami, które spowodowały zwiększoną częstość występowania wola¹.

Częstość występowania raka tarczycy rośnie na całym świecie. Przyczyny nie są jasne, ale tendencja ta może być związana z lepszymi metodami wykrywania i diagnostyki¹.

Wpływ programów suplementacji jodu

Programy suplementacji jodu miały znaczący wpływ na zmniejszenie częstości występowania wola w wielu regionach. Jednak w niektórych obszarach niedobór jodu nadal stanowi problem, mimo wdrożenia programów suplementacji.

Na przykład, badanie zawartości jodu w moczu u 3046 dzieci w wieku szkolnym przeprowadzone w 2015 roku wykazało, że niedobór jodu był nadal powszechny i endemiczny (ponad 23% badanych) w regionie Asir w Arabii Saudyjskiej¹.

W regionie północno-zachodniej Tunezji, mimo stosowania suplementacji jodu, 49,5% badanych nastolatków miało wole¹. Badania wykazały łagodny niedobór jodu na podstawie stężenia jodu w moczu. Zidentyfikowano dwa czynniki ryzyka: wiek nastolatków i obecność znanego wola w rodzinie¹.

Wole toksyczne – epidemiologia

Wole toksyczne guzkowe stanowi około 15-30% przypadków nadczynności tarczycy w Stanach Zjednoczonych, ustępując jedynie chorobie Gravesa-Basedowa¹.

Częstotliwość występowania wola toksycznego

Częstość występowania toksycznego wola wieloguzkowego szacuje się na 4,8 przypadków na 100 000 populacji rocznie¹. Rozpowszechnienie toksycznego wola wieloguzkowego wynosi 100 przypadków na 100 000 populacji i stanowi 5% wszystkich pacjentów z nadczynnością tarczycy¹.

W obszarach endemicznego niedoboru jodu, toksyczne wole guzkowe (TNG) stanowi około 58% przypadków nadczynności tarczycy, z czego 10% pochodzi z pojedynczych toksycznych guzków. Choroba Gravesa-Basedowa stanowi 40% przypadków nadczynności tarczycy¹.

Rozpowszechnienie toksycznych gruczolaków w Stanach Zjednoczonych oszacowano na 1,6% spośród 2 846 pacjentów z tyreotoksykozą w badaniu przeprowadzonym w Cleveland. Innymi słowy, rozpowszechnienie toksycznych gruczolaków w Stanach Zjednoczonych wynosi 1 580 przypadków na 100 000 populacji¹.

Czynniki demograficzne w wolu toksycznym

Toksyczne wole guzkowe występuje częściej u kobiet niż u mężczyzn¹. U kobiet i mężczyzn powyżej 40 roku życia wskaźnik rozpowszechnienia wyczuwalnych guzków wynosi odpowiednio 5-7% i 1-2%¹.

Większość pacjentów z toksycznym wolem guzkowym (TNG) jest w wieku powyżej 50 lat¹. Stosunek kobiet do mężczyzn wynosi 4:1 dla toksycznego wola wieloguzkowego¹.

Nadczynność tarczycy związana z autonomicznym guzkiem wystąpiła u 57% pacjentów w wieku powyżej 60 lat, podczas gdy 13% osób poniżej 60 roku życia miało nadczynność tarczycy¹.

Znaczenie dla zdrowia publicznego

Wole stanowi istotny problem zdrowia publicznego, szczególnie w regionach z niedoborem jodu. Częstość występowania wola na poziomie 5% lub więcej wśród dzieci w wieku szkolnym jest wskaźnikiem niedoboru jodu w populacji¹².

Implikacje dla systemów opieki zdrowotnej

W kontekście indyjskim nie istnieje rutynowy system nadzoru służący identyfikacji częstości występowania wola, dlatego nadzór na poziomie lokalnym jest konieczny¹. Wysokie rozpowszechnienie niskiej zawartości jodu w soli w badaniu jest poparte obecnością wysokiego rozpowszechnienia niskiego wydalania jodu z moczem u uczestników badania¹.

Jako środek krótkoterminowy, zaleca się zapewnienie dostępności jodowanej soli w regionach o wysokim rozpowszechnieniu wola. Jednocześnie, okresowy nadzór musi być kontynuowany w celu pomiaru wpływu programu¹.

Strategie zdrowia publicznego

Badania podkreślają potrzebę ukierunkowanych strategii zdrowia publicznego, w tym suplementacji jodu i edukacji, szczególnie w obszarach zagrożonych¹. Edukacja kobiet, dodawanie soli po gotowaniu potraw, zapewnienie spożycia jodowanej soli i zwiększanie świadomości publicznej na temat konsekwencji wola powinny być szczególnie podkreślane¹.

Konieczne jest również systematyczne badanie profilu epidemiologicznego pacjentów z wolem rozlanym¹. Wole stanowi wskaźnik statusu jodu w regionie i może być wykorzystane jako długoterminowy wskaźnik powodzenia programu suplementacji jodu¹.

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Materiały źródłowe

#1 Goiter – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562161/
The most common cause of goiters worldwide is iodine deficiency that affects an estimated 2.2 billion people. The prevalence and incidence of goiter are based on the degree of iodine deficiency. With mild iodine deficiency, the incidence of goiter is 5% to 20%. With a moderate deficiency, the prevalence increases to 20% to 30%, and with severe iodine deficiency, the incidence increases to greater than 30%. […] Even with the use of iodine, there has been an increase in the incidence of thyroid nodules. It is not clear the increase in prevalence represents a true increase or an increased detection. One of the causes of this could be the increased utilization of radiological imaging and more frequent screening with ultrasound. […] At this time, ultrasonography can detect even the smallest of nodules, causing the incidence of nodules to be 60% to 70% in adults. However, imaging and screening are not the sole causes of the increase in incidence. It has been thought that obesity, insulin resistance, and metabolic syndrome may be factors that have caused an increased incidence of goiter. […] Females are approximately four times more likely to develop goiter as compared to males. There is no racial difference in goiter prevalence.
#1 Goitre Causes, investigation and management
https://www.racgp.org.au/afp/2012/august/goitre
Goitre refers to an enlarged thyroid. […] The prevalence of goitre, diffuse and nodular, is dependent on the status of iodine intake of the population. In general, in iodine sufficient countries the prevalence of clinically palpable goitre is less than 4%. […] Iodine deficiency has re-emerged in Australia over recent decades. Urinary iodine concentration (UIC) is an excellent proxy marker for current iodine intake and is a useful screening tool for iodine deficiency at a population level. […] Since October 2009, all bread produced in Australia and New Zealand (with the exception of organic bread) must contain added iodine from iodised salt. […] The National Health and Medical Research Council recommends that all women who are pregnant, breastfeeding or considering pregnancy, take an iodine supplement of 150 micrograms each day.
#1 Goiter | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/goiter-3?lang=us
The prevalence of goiter varies widely depending on the level of iodine deficiency. In severely iodine-deficient areas the prevalence may be as high as 80%. Goiter is more common in women, and incidence declines with age. […] The definition of goiter depends on age and sex. The upper limit of normal thyroid gland volume: adult males: 12-18 mL, adult females: 10-15 mL, 13-14 years: 8-10 mL, 3-4 years: 3 mL, neonate: 0.8-1.5 mL.
#1 Goiter epidemiology and demographics – wikidoc
https://www.wikidoc.org/index.php/Goiter_epidemiology_and_demographics
Worldwide, the incidence of goiter is approximately 1400 to 1700 per 100,000 individuals in females and 900 per 100,000 individuals in males. […] Worldwide, the prevalence of goiter is approximately 3000 for single thyroid nodules per 100,000 individuals. […] Goiter occurs more commonly in women over 45 years of age. […] The rate of occurrence of goiter in females is higher than that in males by a ratio of 4:1. […] There is no racial predilection of goiter.
#1 Goiter: Practice Essentials, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/120034-overview
Epidemiology […] Frequency […] United States […] Autopsy studies suggest a frequency of greater than 50% for thyroid nodules; with high-resolution ultrasonography, the value approaches 40% of patients with nonthyroidal illness. In the Framingham study, ultrasonography revealed that 3% of men older than 60 years had thyroid nodules, while 36% of women aged 49-58 years had thyroid nodules. In the United States, most goiters are due to autoimmune thyroiditis (ie, Hashimoto disease). […] International […] Worldwide, the most common cause of goiter is iodine deficiency. It is estimated that goiters affect as many as 200 million of the 800 million people who have a diet deficient in iodine. In the Wickham study from the United Kingdom, 16% of the population had a goiter. In a German study, 635 people underwent ultrasonographic thyroid screening, as well as basal TSH measurement, during a preventive-health checkup. Thyroid nodules were detected in 432 (68%) of the persons screened; in a previous German study, ultrasonographic screening of more than 90,000 people detected thyroid nodules in 33% of the normal population. The authors of the latter report attributed this difference to the fact that patients in their study were screened using 13 MHz ultrasonographic scanners, which were more sensitive than the 7.5 MHz scanners used in the previous study. According to the investigators, their results indicated that the question of routine iodine supplementation requires renewed attention.
#1 Goiter | 5-Minute Pediatric Consult
https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617628/1.3.1/Goiter
The incidence of goiter in school-age children ranges from 1.9% to 6.8%. […] The prevalence of goiter in the United States is 37%, although it is much higher in regions of iodine deficiency (15.8% globally). […] Prevalence in childhood peaks during adolescence with females more affected than males. […] Thyroid cancer is a rare cause of pediatric goiter and makes up 0.5-1.5% of all malignancies in children and adolescents.
#1 Epidemiology of goiter and its predictor | Biomedical Research
https://www.currentpediatrics.com/articles/epidemiology-of-goiter-and-its-predictors-among-school-age-children-in-lekutown-southern-ethiopia-9066.html
Epidemiology of goiter and its predictors among school age children in Leku town, Southern Ethiopia. […] A goiter prevalence of 5% or more in school age children is an indication of iodine deficiency in a population. […] The overall magnitude of goiter among school age children was 35.2% (CI: 30.4- 40.5%). […] Maternal education (AOR=2.50, CI: 1.37, 4.57), family monthly income (AOR=2.19, CI=1.09, 4.36), type of salt used (AOR=2.66, CI: 1.15, 6.17), timing of adding salt into food (AOR=2.20, CI: 1.27, 3.82) and using cassava as a food (AOR=2.19, CI: 1.30, 3.68) were identified predictors of goiter. […] The observed magnitude of goiter is considered as a public health problem in the study area. […] In the multiple binary logistic regressions: maternal education, family income, type of salt used, timing of adding salt into the food and using boyina (cassava) as food were identified as independent predictors of goiter among school age children.
#1 Goiter: Practice Essentials, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/120034-overview
The incidence of thyroid cancer has been rising worldwide. The reasons are unclear, but this trend may be related to better detection and diagnostic methods. […] Mortality/Morbidity […] Most goiters are benign, causing only cosmetic disfigurement. Morbidity or mortality may result from compression of surrounding structures, thyroid cancer, hyperthyroidism, or hypothyroidism. […] Race […] No racial predilection exists. […] Sex […] The female-to-male ratio is 4:1. In the Wickham study, 26% of women had a goiter, compared to 7% of men. Thyroid nodules are less frequent in men than in women, but when found, they are more likely to be malignant. […] Age […] The frequency of goiters decreases with advancing age. The decrease in frequency differs from the incidence of thyroid nodules, which increases with advancing age.
#1 The Role of Nuclear Medicine in the Clinical Management of Benign Thyroid Disorders, Part 2: Nodular Goiter, Hypothyroidism, and Subacute Thyroiditis | Journal of Nuclear Medicine
https://jnm.snmjournals.org/content/62/7/886
Goiter, an enlargement of the thyroid gland (20 cm3 in men and 15 cm3 in women) with or without nodules, is one of the most common endocrine abnormalities. The incidence of new nodular goiter cases in adults in the United States is 0.1%1.5% of the general population per year (2). Goiter is more common in women than men (3). In areas of iodine deficiency, the incidence of thyroid nodules increases with age (without a sex-related difference) (4), whereas in iodine-sufficient areas the prevalence of nodular goiter decreases with age (5). Constitutional factors, genetic abnormalities, and dietary or environmental factors may contribute to the development of nodular goiter (36). Thyroid nodules may become autonomous, possibly evolving to cause thyrotoxicosis. […] The prevalence of thyroid cancer in patients referred for goiter evaluation is 4%18% (20). FNAB should be performed in suggestive nodules with high-risk ultrasound features, especially if combined with the scintigraphic features described further below.
#1 Toxic Nodular Goiter: Practice Essentials, Pathophysiology, Etiology
https://emedicine.medscape.com/article/120497-overview
Toxic nodular goiter accounts for approximately 15-30% of cases of hyperthyroidism in the United States, second only to Graves disease. […] In areas of endemic iodine deficiency, toxic nodular goiter (TNG) accounts for approximately 58% of cases of hyperthyroidism, 10% of which are from solitary toxic nodules. Graves disease accounts for 40% of cases of hyperthyroidism. […] Toxic nodular goiter occurs more commonly in women than in men. In women and men older than 40 years, the prevalence rate of palpable nodules is 5-7% and 1-2%, respectively. […] Most patients with toxic nodular goiter (TNG) are older than 50 years. […] Thyrotoxicosis often occurs in patients with a history of longstanding goiter. Toxicity occurs in a subset of patients who develop autonomous function. This toxicity usually peaks in the sixth and seventh decades of life, especially in persons with a family history of multinodular goiter or TNG, suggesting a genetic component.
#1
https://link.springer.com/article/10.1385/BTER:113:3:223
Despite the strong implications of differences between females and males in the risk of goiter, gender-specific issues have not been extensively addressed in investigations of goiter prevalence. […] The overall prevalence of goiter among study subjects was 204/853 (23.9%). Goiter was present in 80 out of 370 females (21.6%) vs 124/483 (25.7%) in males. […] In 370 females, parity (p=0.004) and lack of daily intake of iodized salt (p=0.01) were the major determinants for goiter, whereas age (p=0.18), oral contraceptives (p=0.82), family history of goiter (p=0.33), and smoking (p=0.09) did not affect goiter prevalence. […] In 483 males, smoking (p<0.0001) and age (p=0.001) affected goiter prevalence, but not family history of goiter (p=0.39), and the iodine status failed just to reach the significant level (p=0.08) in this analysis. Gender-specific determinants of goiter are parity and iodine status in females and smoking and increasing age in males.
#1
https://jhrlmc.com/index.php/home/article/view/184
Goiter, an enlargement of the thyroid gland, continues to be a significant global health issue, affecting approximately ten million people worldwide. […] The prevalence of goiter is notably influenced by geographical and environmental factors, such as soil iodine content, especially in hilly terrains. […] This study aimed to ascertain the prevalence and demographic distribution of goiter in District Buner, Khyber Pakhtunkhwa, Pakistan, and to compare these findings with data from other regions to better understand the condition’s epidemiological characteristics. […] The study confirmed that goiter is more prevalent among females and tends to increase with age. […] The high incidence in hilly areas supports the association with low soil iodine content. […] This research underscores the need for targeted public health strategies, including iodine supplementation and education, particularly in at-risk areas.
#1
https://fpnotebook.com/Endo/Thyroid/Gtr.htm
Endemic in areas distant from sea (e.g. mountains) […] Related to deficient Iodine intake […] Sporadic form much more common in women (8:1)
#1 Goitre – Wikipedia
https://en.wikipedia.org/wiki/Goitre
Goitre is more common among women, but this includes the many types of goitre caused by autoimmune problems, and not only those caused by simple lack of iodine. […] Iodine mainly accumulates in the sea and in the topsoil. Before iodine enrichment programs, goiters were common in areas with repeated flooding or glacial activities, which erodes the topsoil. It is endemic in populations where the intake of iodine is less than 10 g per day. […] Examples of such regions include the alpine regions of Southern Europe (such as Switzerland), the Himalayans, the Great Lakes basin, etc.
#1 Goitre in Ethiopia | British Journal of Nutrition | Cambridge Core
https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/goitre-in-ethiopia/E94AC8E81C8559693C7CE12C9DE95DD5
A stratified goitre survey was conducted on 35635 schoolchildren and 19158 household members in all Regions of Ethiopia except Eritrea and Tigrai. The gross goitre prevalence (mean of male and female values) among schoolchildren and household members was 30.6 and 18.7% respectively, while that of visible goitre was 1.6 and 3.2% respectively. Prevalence was higher in females (27.3% in household members and 36.1% in schoolchildren) than in males (10.1% in household members and 25.1% in schoolchildren) and increased with age more in females than in males. The prevalence rates at higher altitudes were higher than those at lower altitudes in both schoolchildren and household members. […] Using an epidemiological model the consequences of iodine deficiency, including cretinism and maternal wastage, have been estimated.
#1 Toxic multinodular goiter epidemiology and demographics – wikidoc
https://www.wikidoc.org/index.php/Toxic_multinodular_goiter_epidemiology_and_demographics
The female to male ratio is 4:1 for toxic multinodular goiter. […] Toxic multinodular goiter is a common disease that tends to affect African nations. In developed nations, European countries tend to have a higher prevalence of toxic multinodular goiter as compared to the United States. […] Toxic multinodular goiter is less common in United States. This can be attributed to iodination of table salt. Moreover in United States the intake of iodised salt (200 to 600 g/day) is almost double in quantity as compared to European nations (25 to 100 g/day).
#1
https://journals.lww.com/jfmpc/fulltext/2023/12090/prevalence_of_goitre_and_iodine_deficiency_among.55.aspx
Overall prevalence of goitre was 17.1% (95% CI: 16.5, 17.7). […] The prevalence of goitre was higher among females (17.9%, vs. male 16.4%, P 0.05). […] North Karnataka has a high goitre prevalence. Low use of iodized salt can be a major reason for the high prevalence of the condition. Ensuring the availability of iodized salt in this region and periodic surveillance to measure the impact of the programme should be the priority in this region. […] In the Indian setting, a routine surveillance system does not exist to identify goitre prevalence, and therefore, surveillance at the local level is a must. […] The prevalence was alarmingly high for almost all the talukas from Bagalkot and Bidar district. […] The high prevalence of low iodine content in salt in our study is supported by the presence of a high prevalence of low urinary iodine excretion in our study participants. […] As a short-term measure, we strongly recommend ensuring the availability of iodized salt in this region. Simultaneously, periodic surveillance must go on to measure the impact of the programme.
#1 Goitre Causes, investigation and management
https://www.racgp.org.au/afp/2012/august/goitre
Patients with goitre or thyroid nodules should have a serum thyroid stimulating hormone (TSH) to determine the current functional status of the thyroid. […] Thyroid ultrasound is an essential part of the evaluation of patients with goitre and will help determine the need for a FNA biopsy in patients with thyroid nodules. […] Patients with euthyroid goitre or benign nodules can generally be observed clinically with repeat ultrasound in 6-18 months. […] Potential treatment options for goitre will depend on the cause and the clinical picture. Options include observation, iodine supplementation, thyroxine suppression, thionamides (carbimazole or propylthiouracil), radioactive iodine (I131) ablation and surgery.
#1 Nontoxic Goiter – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK482274/
The thyroid hormone is synthesized from iodine. Iodine is present in soil and is ingested in food that absorbs iodine from the soil. In mountainous areas and rainy environments, iodine is washed from the land, and the soil may become deficient in iodine. This explains why inhabitants of these areas are at greater risk for developing goiter due to low dietary iodine they consume. There is evidence that giving iodine as a supplement decreases the incidence of goiter in these people. Seminal studies confirmed that supplementation of iodine in table salts decreases the risk of endemic goiter from 20% to 5% in the adolescent girls of Ohio. In the United States, sporadic goiter is the most common cause of nontoxic goiter where it’s incidence is about 5%. […] The prevalence of palpable nodules is about 5% to 6% in those who are 60 years old. However, the incidence of nonpalpable nodules found at autopsy is about 50% of those who are 60 years old. Internationally, 2.2 billion people have some form of iodine deficiency, most of them being people of iodine-deficient areas. The prevalence of goiter is corollated with the severity of iodine deficiency. The absence of iodine deficiency is associated according to studies with 5% prevalence of goiter. When there is a mild deficiency of iodine, the incidence of goiters is 5% to 20%. In the case of moderate deficiency, the prevalence is 20% to 30%. In areas with severe deficiency, the incidence rises to more than 30%. Goiter is 1.2 to 4.3 times more common in female than in male individuals. A low socioeconomic status is a risk factor for goiter. This may be related to decreasing iodine intake. Sporadic goiter due to dysmorphogenesis and endemic goiter mostly occur during childhood, and the thyroid gland increases more in size with age. There is no racial relation to the prevalence of goiter.
#1
https://journals.lww.com/epidem/fulltext/2004/07000/environmental_iodine_deficiency_in_urban_areas_and.305.aspx
Goiter- the endemic disease of the high mountain regions has recently become a common disease for the whole country, including the urban areas. The high prevalence of goiter among children at the age of 6-12 stressed the need to evaluate the effectiveness of goiter preventive measures in relation with the level of endemicity of the areas and preventive means, applied. […] Goiter prevention with iodine oil capsules is significantly effective than prevention with iodine salt in urban moderate endemic areas of goiter in terms of improving children’s clinical-physical characteristics and intellectual ability.
#1 Retrospective Study on the Incidence of Thyroid Disorders in Bisha and Evolving Surgical Management Considerations
https://clinmedjournals.org/articles/ijsrp/international-journal-of-surgery-research-and-practice-ijsrp-8-130.php?jid=ijsrp
There is a high prevalence of goiter in Bisha despite more than 15 years of the national campaign for increased dietary iodine supplementation. […] Goitre is common in the Southwestern region of Saudi Arabia where Bisha is located, in the longest valley of the Arabian Peninsula, standing at an altitude of approximately 610 meters (2,000 ft.) above sea level. In fact, recent studies have shown that Asir region Province (where Bisha is located) has the highest prevalence of goiter in Kingdom of Saudi Arabia (KSA). […] A study of 3046 schoolchildren’s urinary iodine content in 2015 found that iodine deficiency was still prevalent and endemic (more than 23% of the number studied) in the Asir region. […] The overall incidence of toxic goiter in our study was 7.09% (24/339). […] The incidence of malignancy was 8.55% which is lower than what was reported by many studies in Saudi Arabia. […] The overall complication rate in our study was 14.5%.
#1
https://link.springer.com/article/10.1023/A:1007325100138
In order to study the etiology of endemic goiter in the north-western part of Tunisia, we examined 93 adolescents of this region. Among these adolescents, 49.5% of them had a goiter. Urinary iodine concentrations showed mild iodine deficiency. We found two risk factors: the age of adolescents, and the presence of a known goiter in the family. […] These results suggest that the actual prevention may not be adequate, or most likely that goitrogenic factors are to be looked for, especially in drinking water, since the majority of these adolescents drink no controlled water.
#1 Toxic multinodular goiter epidemiology and demographics – wikidoc
https://www.wikidoc.org/index.php/Toxic_multinodular_goiter_epidemiology_and_demographics
The incidence of toxic multinodular goiter is estimated to be 4.8 cases per 100,000 population per year. The prevalence of toxic multinodular goiter is 100 cases per 100,000 population and accounts for 5% of all patients with hyperthyroidism. Toxic multinodular goiter commonly affects individuals older than 60 years of age. The frequency of toxic multinodular goiter increases with age. Females are more commonly affected by toxic multinodular goiter than men. […] The prevalence of toxic adenomas in United States was estimated to be 1.6% of 2,846 thyrotoxic patients in a research done in Cleveland. In other words, the prevalence of toxic adenomas in United States is 1,580 cases per 100,000 population. […] Hyperthyroidism associated with an autonomous nodule occurred in 57% of patients aged more than 60 years, whereas 13% of those younger than 60 years were hyperthyroid.
#1
https://www.alliedacademies.org/abstract/epidemiology-of-goiter-and-its-predictors-among-school-age-children-in-lekurntown-southern-ethiopia-9066.html
A goiter prevalence of 5% or more in school age children is an indication of iodine deficiency in a population. The study aimed to assess the epidemiology of goiter and associated factors among school aged children in Leku town, Southern Ethiopia. The overall magnitude of goiter among school age children was 35.2% (CI: 30.4- 40.5%). Maternal education (AOR=2.50, CI: 1.37, 4.57), family monthly income (AOR=2.19, CI=1.09, 4.36), type of salt used (AOR=2.66, CI: 1.15, 6.17), timing of adding salt into food (AOR=2.20, CI: 1.27, 3.82) and using cassava as a food (AOR=2.19, CI: 1.30, 3.68) were identified predictors of goiter. The observed magnitude of goiter is considered as a public health problem in the study area. […] Women education, adding salt after cooking food, ensuring iodized salt consumption and increasing public awareness on consequences of goiter need to be given emphasis.
#1
https://biomedres.us/fulltexts/BJSTR.MS.ID.006563.php
Goiter is a condition characterized by enlargement of the thyroid gland by the time one reaches puberty. Several genetic and environmental factors contribute to thyroid disease. Thyroid gland enlargement is frequently observed in clinical practice as a result of iodine deficiency, an increase in TSH levels, natural goitrogen, smoking, and insufficient selenium and iron. These conditions are usually associated with either hypothyroidism or hyperthyroidism, or with elevated TSH levels. The main purpose of the study was to determine the frequency of goiter in the lower Dir population and categorize it on the basis of age, gender, size and visibility. The difference between goiter prevalence in the sexes is well documented, with a higher frequency in women. The study concluded that the prevalence of goiter was overwhelmingly higher in women (n=247/61.0%) than in men (n=158/39.0%) and among people with grade 2 visible goiter was relatively high (n=176/43.5%). A subgroup analysis revealed that many patients (n=272/67.2%) were not aware of goiter, and also that the number of illiterate people (n=267/65.7%) was higher than literate people (n=138/34.1%). The study area has a high prevalence of goiter, so the health sector should increase community awareness of iodized salt and foods rich in iodine through disseminating key messages about these foods. Goiters provide an indication of the iodine status in a region and can be used as a long-term indicator of the success of an iodine programmer. Throughout the world, iodine deficiency is the leading cause of goiter. Iodine deficiency was reported in Pakistan by the World Health Organization in 1990 as affecting an estimated 50 million people; goiter was reported as prevalent as 80-90% in mountainous areas. The study conclusions suggest that goiter prevalence might depend on TSH levels specific to normal or abnormal hormonal dysfunction. The study also concluded that increased goiter risk was independently related to women’s gender and low TSH levels. There is a need for a systematic investigation of the epidemiological profile of patients with diffuse goiter.
#2
https://jhrlmc.com/index.php/home/article/view/184
Goiter, an enlargement of the thyroid gland, continues to be a significant global health issue, affecting approximately ten million people worldwide. […] The prevalence of goiter is notably influenced by geographical and environmental factors, such as soil iodine content, especially in hilly terrains. […] This study aimed to ascertain the prevalence and demographic distribution of goiter in District Buner, Khyber Pakhtunkhwa, Pakistan, and to compare these findings with data from other regions to better understand the condition’s epidemiological characteristics. […] The study confirmed that goiter is more prevalent among females and tends to increase with age. […] The high incidence in hilly areas supports the association with low soil iodine content. […] This research underscores the need for targeted public health strategies, including iodine supplementation and education, particularly in at-risk areas.
#2 Nontoxic Goiter – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK482274/
The thyroid hormone is synthesized from iodine. Iodine is present in soil and is ingested in food that absorbs iodine from the soil. In mountainous areas and rainy environments, iodine is washed from the land, and the soil may become deficient in iodine. This explains why inhabitants of these areas are at greater risk for developing goiter due to low dietary iodine they consume. There is evidence that giving iodine as a supplement decreases the incidence of goiter in these people. Seminal studies confirmed that supplementation of iodine in table salts decreases the risk of endemic goiter from 20% to 5% in the adolescent girls of Ohio. In the United States, sporadic goiter is the most common cause of nontoxic goiter where it’s incidence is about 5%. […] The prevalence of palpable nodules is about 5% to 6% in those who are 60 years old. However, the incidence of nonpalpable nodules found at autopsy is about 50% of those who are 60 years old. Internationally, 2.2 billion people have some form of iodine deficiency, most of them being people of iodine-deficient areas. The prevalence of goiter is corollated with the severity of iodine deficiency. The absence of iodine deficiency is associated according to studies with 5% prevalence of goiter. When there is a mild deficiency of iodine, the incidence of goiters is 5% to 20%. In the case of moderate deficiency, the prevalence is 20% to 30%. In areas with severe deficiency, the incidence rises to more than 30%. Goiter is 1.2 to 4.3 times more common in female than in male individuals. A low socioeconomic status is a risk factor for goiter. This may be related to decreasing iodine intake. Sporadic goiter due to dysmorphogenesis and endemic goiter mostly occur during childhood, and the thyroid gland increases more in size with age. There is no racial relation to the prevalence of goiter.
#2 Goiter | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/goiter-3?embed_domain=external.radpair.com%27%5B0%5Dfavicon.ico%27%5B0%5D&lang=us
The prevalence of goiter varies widely depending on the level of iodine deficiency. In severely iodine-deficient areas the prevalence may be as high as 80%. Goiter is more common in women, and incidence declines with age 5. […] The definition of goiter depends on age and sex. The upper limit of normal thyroid gland volume: adult males: 12-18 mL 9, adult females: 10-15 mL 9, 13-14 years: 8-10 mL 1, 3-4 years: 3 mL 1, neonate: 0.8-1.5 mL 1.
#2
https://www.alliedacademies.org/abstract/epidemiology-of-goiter-and-its-predictors-among-school-age-children-in-lekurntown-southern-ethiopia-9066.html
A goiter prevalence of 5% or more in school age children is an indication of iodine deficiency in a population. The study aimed to assess the epidemiology of goiter and associated factors among school aged children in Leku town, Southern Ethiopia. The overall magnitude of goiter among school age children was 35.2% (CI: 30.4- 40.5%). Maternal education (AOR=2.50, CI: 1.37, 4.57), family monthly income (AOR=2.19, CI=1.09, 4.36), type of salt used (AOR=2.66, CI: 1.15, 6.17), timing of adding salt into food (AOR=2.20, CI: 1.27, 3.82) and using cassava as a food (AOR=2.19, CI: 1.30, 3.68) were identified predictors of goiter. The observed magnitude of goiter is considered as a public health problem in the study area. […] Women education, adding salt after cooking food, ensuring iodized salt consumption and increasing public awareness on consequences of goiter need to be given emphasis.
#2 Current Pediatric Research
https://www.currentpediatrics.com/abstract/epidemiology-of-goiter-and-its-predictors-among-school-age-children-in-lekurntown-southern-ethiopia-9066.html
Epidemiology of goiter and its predictors among school age children in Leku town, Southern Ethiopia. […] The study aimed to assess the epidemiology of goiter and associated factors among school aged children in Leku town, Southern Ethiopia. […] The overall magnitude of goiter among school age children was 35.2% (CI: 30.4- 40.5%). […] The observed magnitude of goiter is considered as a public health problem in the study area.
#2 Toxic multinodular goiter epidemiology and demographics – wikidoc
https://www.wikidoc.org/index.php/Toxic_multinodular_goiter_epidemiology_and_demographics
The incidence of toxic multinodular goiter is estimated to be 4.8 cases per 100,000 population per year. The prevalence of toxic multinodular goiter is 100 cases per 100,000 population and accounts for 5% of all patients with hyperthyroidism. Toxic multinodular goiter commonly affects individuals older than 60 years of age. The frequency of toxic multinodular goiter increases with age. Females are more commonly affected by toxic multinodular goiter than men. […] The prevalence of toxic adenomas in United States was estimated to be 1.6% of 2,846 thyrotoxic patients in a research done in Cleveland. In other words, the prevalence of toxic adenomas in United States is 1,580 cases per 100,000 population. […] Hyperthyroidism associated with an autonomous nodule occurred in 57% of patients aged more than 60 years, whereas 13% of those younger than 60 years were hyperthyroid.
#2 Goiter – Knowledge @ AMBOSS
https://www.amboss.com/us/knowledge/goiter/
Epidemiological data refers to the US, unless otherwise specified. […] Sex: (4:1) […] Frequency: decreases with age.
#2 Epidemiology of goiter and its predictor | Biomedical Research
https://www.currentpediatrics.com/articles/epidemiology-of-goiter-and-its-predictors-among-school-age-children-in-lekutown-southern-ethiopia-9066.html
The present study revealed that children whose mothers did not attend formal education were nearly three times more likely to develop goiter (AOR=2.50, CI: 1.37, 4.57). […] The study showed that the odds of goiter was two times higher among children whose family monthly income was below 1000 Ethiopian birr compared with family monthly income of 3000 Ethiopian birr (AOR=2.19, CI=1.09, 4.36). […] The occurrence of goiter was nearly three times higher among children using non-iodized salt (AOR=2.66, CI: 1.15, 6.17). […] It was observed that adding salt into food while cooking contributed to two times increase in goiter prevalence among school age children (AOR=2.20, CI: 1.27, 3.82). […] School age children using boyina (cassava) as a food were two times more likely to develop goiter (AOR=2.19, CI: 1.30, 3.68). […] In general, the magnitude goiter among school age children was high. Maternal education, family income, type of salt used, timing of adding salt into food and using boyina (cassava) as a food were independent predictors of goiter occurrence among school age children in Leku town, Southern Ethiopia.
#2 The Role of Nuclear Medicine in the Clinical Management of Benign Thyroid Disorders, Part 2: Nodular Goiter, Hypothyroidism, and Subacute Thyroiditis | Journal of Nuclear Medicine
https://jnm.snmjournals.org/content/62/7/886
Goiter, an enlargement of the thyroid gland (20 cm3 in men and 15 cm3 in women) with or without nodules, is one of the most common endocrine abnormalities. The incidence of new nodular goiter cases in adults in the United States is 0.1%1.5% of the general population per year (2). Goiter is more common in women than men (3). In areas of iodine deficiency, the incidence of thyroid nodules increases with age (without a sex-related difference) (4), whereas in iodine-sufficient areas the prevalence of nodular goiter decreases with age (5). Constitutional factors, genetic abnormalities, and dietary or environmental factors may contribute to the development of nodular goiter (36). Thyroid nodules may become autonomous, possibly evolving to cause thyrotoxicosis. […] The prevalence of thyroid cancer in patients referred for goiter evaluation is 4%18% (20). FNAB should be performed in suggestive nodules with high-risk ultrasound features, especially if combined with the scintigraphic features described further below.
#3 Goiter – Knowledge @ AMBOSS
https://www.amboss.com/us/knowledge/goiter/
Epidemiological data refers to the US, unless otherwise specified. […] Sex: (4:1) […] Frequency: decreases with age.
#3 Multinodular Goiter – Endocrinology Advisor
https://www.endocrinologyadvisor.com/ddi/multinodular-goiter/
Thyroid nodules are typically benign growths of thyroid cells that form within the thyroid gland. […] The prevalence of goiter varies geographically and may be influenced by the iodine intake of the population. Studies have reported the prevalence of goiter in the adult population to range from 30% to 50% based on sonography data, and the prevalence of goiter may be higher in older adults and those residing in areas with iodine deficiency. […] Because goiter has been diagnosed in people who reside in areas without iodine deficiency, other factors may contribute to its development. Some of these include other environmental causes, gene abnormalities, and demographic causes. Environmental contributors that may interfere with the endocrine system and contribute to the development of goiter include exposure to the following: Perchlorate, Thiocyanate, Phthalates, Nitrates, Isoflavones, Organochlorines. […] Illicit drugs, smoking, and alcohol consumption may contribute to the development of goiter, as may oral contraceptives, pregnancy, insulin resistance, and selenium deficiency.
#3 The Role of Nuclear Medicine in the Clinical Management of Benign Thyroid Disorders, Part 2: Nodular Goiter, Hypothyroidism, and Subacute Thyroiditis | Journal of Nuclear Medicine
https://jnm.snmjournals.org/content/62/7/886
In areas with sufficient dietary iodine intake, thyroid scintigraphy is not necessary in patients with diffuse, nodular, or multinodular goiter when serum TSH is normal, because all such nodules usually appear as cold areas on the scan and should be evaluated with FNAB if exhibiting a high TI-RADS score and exceeding 10 mm in any diameter (26,27). However, in iodine-deficient areas, the serum TSH level alone may not be sufficient to exclude the presence of autonomously functioning thyroid nodules (28), and thyroid scintigraphy should be performed on all patients with nodular goiter. A metaanalysis showed a 50% prevalence (95% CI, 32%68%) of normal TSH values in patients with autonomously functioning thyroid nodules (29).
#4
https://link.springer.com/article/10.1385/BTER:113:3:223
Despite the strong implications of differences between females and males in the risk of goiter, gender-specific issues have not been extensively addressed in investigations of goiter prevalence. […] The overall prevalence of goiter among study subjects was 204/853 (23.9%). Goiter was present in 80 out of 370 females (21.6%) vs 124/483 (25.7%) in males. […] In 370 females, parity (p=0.004) and lack of daily intake of iodized salt (p=0.01) were the major determinants for goiter, whereas age (p=0.18), oral contraceptives (p=0.82), family history of goiter (p=0.33), and smoking (p=0.09) did not affect goiter prevalence. […] In 483 males, smoking (p<0.0001) and age (p=0.001) affected goiter prevalence, but not family history of goiter (p=0.39), and the iodine status failed just to reach the significant level (p=0.08) in this analysis. Gender-specific determinants of goiter are parity and iodine status in females and smoking and increasing age in males.