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The Status of Iodine Nutrition and Thyroid Disorders in China: Two Decades After the Universal Salt Iodization

49 Pages Posted: 15 Oct 2018

See all articles by Zhongyan Shan

Zhongyan Shan

China Medical University - Department of Endocrinology and Metabolism; China Medical University - Institute of Endocrinology

Weiping Teng

China Medical University - Department of Endocrinology and Metabolism; China Medical University - Institute of Endocrinology

Yongze Li

China Medical University - Department of Endocrinology and Metabolism; China Medical University - Institute of Endocrinology

Guang Ning

Shanghai Jiao Tong University (SJTU) - Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases; Shanghai Jiao Tong University (SJTU) - Shanghai Institute of Endocrine and Metabolic Diseases; Shanghai Jiao Tong University (SJTU) - Shanghai Clinical Center for Endocrine and Metabolic Diseases

Yiming Mu

Government of the People's Republic of China - Department of Endocrinology

Jiajun Zhao

Shandong University - Department of Endocrinology and Metabolism; Shandong Academy of Clinical Medicine - Institute of Endocrinology; Shandong Clinical Medical Center of Endocrinology and Metabolism

Xiaochun Teng

China Medical University - Department of Endocrinology and Metabolism; China Medical University - Institute of Endocrinology

Di Teng

China Medical University - Department of Endocrinology and Metabolism; China Medical University - Institute of Endocrinology

Xiaoguang Shi

China Medical University - Department of Endocrinology and Metabolism; China Medical University - Institute of Endocrinology

Jianming Ba

Government of the People's Republic of China - Department of Endocrinology

Bing Chen

Third Military Medical University - Department of Endocrinology

Jianling Du

Dalian University - Department of Endocrinology

Lanjie He

Ningxia Medical University - Department of Endocrinology

Xiaoyang Lai

Nanchang University - Department of Endocrinology and Metabolism

Yanbo Li

Harbin Medical University - Department of Endocrinology

Haiyi Chi

Hohhot First Hospital - Department of Endocrinology

Eryuan Liao

Central South University - Department of Endocrinology and Metabolism

Chao Liu

Nanjing University of Chinese Medicine (NJUCM) - Research Center of Endocrine and Metabolic Diseases

Libin Liu

Fujian Medical University - Fujian Institute of Endocrinology

Guijun Qin

Zhengzhou University - Division of Endocrinology

Yingfen Qin

Guangxi Medical University - Department of Endocrine

Huibiao Quan

Hainan General Hospital - Department of Endocrinology

Bingyin Shi

Xi'an Jiaotong University (XJTU) - Department of Endocrinology

Hui Sun

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Endocrinology

Xulei Tang

Lanzhou University - Department of Endocrinology

Nanwei Tong

Sichuan University - Department of Endocrinology and Metabolism

Guixia Wang

Jilin University (JLU) - Department of Endocrinology and Metabolism

Jin-an Zhang

Shanghai University of Medicine and Health Sciences - Department of Endocrinology & Rheumatology

Youmin Wang

Anhui Medical University - Department of Endocrinology

Yuanming Xue

Kunming University of Science and Technology - Department of Endocrinology

Li Yan

Sun Yat-Sen University (SYSU) - Department of Endocrinology and Metabolism

Jing Yang

Shanxi Medical University - Department of Endocrinology

Lihui Yang

People's Hospital of Tibet Autonomous Region - Department of Endocrinology and Metabolism

Yongli Yao

Qinghai Provincial People's Hospital - Department of Endocrinology

Zhen Ye

Zhejiang Provincial Center for Disease Control and Prevention

Qiao Zhang

Guizhou Medical University (Guiyang Medical University) - Department of Endocrinology and Metabolism

Lihui Zhang

Hebei Medical University - Department of Endocrinology

Jun Zhu

Xinjiang Medical University - Department of Endocrinology

Mei Zhu

Tianjin Medical University - Department of Endocrinology and Metabolism

More...

Abstract

BACKGROUND: The mandatory universal salt iodization (USI) program has been implemented in China for twenty years. Although iodine deficiency disorders are effectively controlled, the dangers of excess iodine have been debated.

METHODS: A nationally representative cross-sectional study of 78,470 participants, aged 18 or older, were enrolled from all 31 provincial regions of mainland China. The participants were given a questionnaire and B-mode ultrasonography on the thyroid. Serum concentrations of thyroid hormones, thyroid antibodies and urine iodine concentration (UIC) were measured.

FINDINGS: The median UIC of school-age children was 199.75µg/L. The weighted prevalence of the thyroid disorders in adults were as follows: 0.78% of overt hyperthyroidism, 0.44 % of subclinical hyperthyroidism, 0.53% of Graves' disease, 1.02% of overt hypothyroidism, 12.93% of subclinical hypothyroidism, 14.19% of autoimmune thyroiditis, 10.19% of positive TPOAb, 9.70% of positive TgAb, 1.17% of goiter and 20.43 % of thyroid nodules. Iodine deficiency was significantly associated with higher odds of most thyroid disorders, while excessive iodine was only significantly associated with higher odds of overt hyperthyroidism and subclinical hypothyroidism. In addition, excessive iodine was negatively associated with thyroid nodules. No elevated prevalence of all thyroid disorders was found in UIC 200-299µg/L group compared with 100-199µg/L group.

INTERPRETATION: The prevalence of overt thyroid dysfunction has maintained at a stable level as a result of twenty years mandatory USI program except for subclinical hypothyroidism and thyroid nodule. The risk of iodine deficiency outweighs that of iodine excess. Definite advantages were implied to combine the two categories of UIC values of 100-199µg/L and 200-299µg/L as one single range of recommended iodine intake for general population.

FUNDING STATEMENT: Research Fund for Public Welfare from National Health and Family Planning Commission of China.

DECLARATION OF INTERESTS: All authors declare no competing interests.

ETHICS APPROVAL STATEMENT: The research protocols were approved by the Medical Ethics Committee of China Medical University. All subjects were provided written informed consent following a thorough explanation of the research procedures.

Keywords: Iodine; Thyroid Disorders; Universal Salt Iodization; China; Prevalence; Risk Factors

Suggested Citation

Shan, Zhongyan and Teng, Weiping and Li, Yongze and Ning, Guang and Mu, Yiming and Zhao, Jiajun and Teng, Xiaochun and Teng, Di and Shi, Xiaoguang and Ba, Jianming and Chen, Bing and Du, Jianling and He, Lanjie and Lai, Xiaoyang and Li, Yanbo and Chi, Haiyi and Liao, Eryuan and Liu, Chao and Liu, Libin and Qin, Guijun and Qin, Yingfen and Quan, Huibiao and Shi, Bingyin and Sun, Hui and Tang, Xulei and Tong, Nanwei and Wang, Guixia and Zhang, Jin-an and Wang, Youmin and Xue, Yuanming and Yan, Li and Yang, Jing and Yang, Lihui and Yao, Yongli and Ye, Zhen and Zhang, Qiao and Zhang, Lihui and Zhu, Jun and Zhu, Mei, The Status of Iodine Nutrition and Thyroid Disorders in China: Two Decades After the Universal Salt Iodization (August 10, 2018). Available at SSRN: https://ssrn.com/abstract=3264976

Zhongyan Shan

China Medical University - Department of Endocrinology and Metabolism

No 155, Nanjing Bei Street
Shenyang, Liaoning 110001
China

China Medical University - Institute of Endocrinology

Shenyang, Liaoning 110001
China

Weiping Teng (Contact Author)

China Medical University - Department of Endocrinology and Metabolism ( email )

No 155, Nanjing Bei Street
Shenyang, Liaoning 110001
China

China Medical University - Institute of Endocrinology ( email )

Shenyang, Liaoning 110001
China

Yongze Li

China Medical University - Department of Endocrinology and Metabolism

No 155, Nanjing Bei Street
Shenyang, Liaoning 110001
China

China Medical University - Institute of Endocrinology

Shenyang, Liaoning 110001
China

Guang Ning

Shanghai Jiao Tong University (SJTU) - Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases ( email )

Shanghai
China

Shanghai Jiao Tong University (SJTU) - Shanghai Institute of Endocrine and Metabolic Diseases ( email )

No.999, Xiwang Road
Malu Town, Shanghai
China

Shanghai Jiao Tong University (SJTU) - Shanghai Clinical Center for Endocrine and Metabolic Diseases ( email )

Shanghai
China

Yiming Mu

Government of the People's Republic of China - Department of Endocrinology

Beijing, 100853
China

Jiajun Zhao

Shandong University - Department of Endocrinology and Metabolism ( email )

China

Shandong Academy of Clinical Medicine - Institute of Endocrinology ( email )

China

Shandong Clinical Medical Center of Endocrinology and Metabolism ( email )

China

Xiaochun Teng

China Medical University - Department of Endocrinology and Metabolism

No 155, Nanjing Bei Street
Shenyang, Liaoning 110001
China

China Medical University - Institute of Endocrinology

Shenyang, Liaoning 110001
China

Di Teng

China Medical University - Department of Endocrinology and Metabolism

No 155, Nanjing Bei Street
Shenyang, Liaoning 110001
China

China Medical University - Institute of Endocrinology

Shenyang, Liaoning 110001
China

Xiaoguang Shi

China Medical University - Department of Endocrinology and Metabolism

No 155, Nanjing Bei Street
Shenyang, Liaoning 110001
China

China Medical University - Institute of Endocrinology

Shenyang, Liaoning 110001
China

Jianming Ba

Government of the People's Republic of China - Department of Endocrinology

Beijing, 100853
China

Bing Chen

Third Military Medical University - Department of Endocrinology

Chongqing, 400038
China

Jianling Du

Dalian University - Department of Endocrinology

Dalian, Liaoning 116011
China

Lanjie He

Ningxia Medical University - Department of Endocrinology

Yinchuan, Ningxia 750004
China

Xiaoyang Lai

Nanchang University - Department of Endocrinology and Metabolism

Nanchang, Jiangxi 330006
China

Yanbo Li

Harbin Medical University - Department of Endocrinology

157 Baojian Rd
Nangang Qu
Haerbin Shi, Heilongjiang Sheng
China

Haiyi Chi

Hohhot First Hospital - Department of Endocrinology

Hohhot, Inner Mongolia 010000
China

Eryuan Liao

Central South University - Department of Endocrinology and Metabolism

Changsha, Hunan 410011
China

Chao Liu

Nanjing University of Chinese Medicine (NJUCM) - Research Center of Endocrine and Metabolic Diseases

Nanjing, Jiangsu 210028
China

Libin Liu

Fujian Medical University - Fujian Institute of Endocrinology

Fuzhou, Fujian 350001
China

Guijun Qin

Zhengzhou University - Division of Endocrinology ( email )

Yingfen Qin

Guangxi Medical University - Department of Endocrine

Nanning, Guangxi 530021
China

Huibiao Quan

Hainan General Hospital - Department of Endocrinology

Haikou, Hainan 570311
China

Bingyin Shi

Xi'an Jiaotong University (XJTU) - Department of Endocrinology

Xi'an, Shannxi 710061
China

Hui Sun

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Endocrinology

Wuhan, Hubei 430022
China

Xulei Tang

Lanzhou University - Department of Endocrinology

Lanzhou, Gansu 730000
China

Nanwei Tong

Sichuan University - Department of Endocrinology and Metabolism

37 GuoXue Lane
Chengdu, Sichuan 610041
China

Guixia Wang

Jilin University (JLU) - Department of Endocrinology and Metabolism ( email )

China

Jin-an Zhang

Shanghai University of Medicine and Health Sciences - Department of Endocrinology & Rheumatology

Shanghai, 201318
China

Youmin Wang

Anhui Medical University - Department of Endocrinology

Hefei, Anhui 230000
China

Yuanming Xue

Kunming University of Science and Technology - Department of Endocrinology

Kunming, Yunnan 650032
China

Li Yan

Sun Yat-Sen University (SYSU) - Department of Endocrinology and Metabolism

Guangzhou, Guangdong 510120
China

Jing Yang

Shanxi Medical University - Department of Endocrinology

Taiyuan, Shanxi 030001
China

Lihui Yang

People's Hospital of Tibet Autonomous Region - Department of Endocrinology and Metabolism

Lhasa, Tibet 850000
China

Yongli Yao

Qinghai Provincial People's Hospital - Department of Endocrinology

Xining, Qinghai 810000
China

Zhen Ye

Zhejiang Provincial Center for Disease Control and Prevention

Binjiang
Hangzhou, Zhejiang 310051
China

Qiao Zhang

Guizhou Medical University (Guiyang Medical University) - Department of Endocrinology and Metabolism

Guiyang, Guizhou 550004
China

Lihui Zhang

Hebei Medical University - Department of Endocrinology

Shijiazhuang, Hebei 050000
China

Jun Zhu

Xinjiang Medical University - Department of Endocrinology

Urumqi, Xinjiang 830054
China

Mei Zhu

Tianjin Medical University - Department of Endocrinology and Metabolism

Tianjin, 300052
China

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