Classical Thyroid Epidemiology - Trends, Reference Values and Predictive Models
Epidemiology and Medical Biometry/Statistics
Final Report Abstract
The major task of this proposal was to investigate the incidence and prevalence trends of thyroid disorders after initiation of the German iodine fortification program in 1993. Based on longitudinal data from the initial SHIP cohort we demonstrated a modest mean thyroid growth, a negative net balance between occurring and reverting goiter and thyroid nodules along with balanced incidences of hyper- and hypothyroid dysfunction and a low incidence of autoimmune-related thyroid findings. Comparing the prevalence of thyroid disorders in initial SHIP with data from SHIP-Trend-0 conducted 10 years later in the same study region revealed a significant decrease in goiter prevalence and a significant increase in median serum TSH levels between SHIP-0 and SHIP-Trend-0, while the prevalence of positive TPO-Ab was comparable between SHIP-0 and SHIP-Trend-0. Both of these studies indicate that the current iodine status on a lower recommended level is sufficient to prevent iodine deficiency related disorders on the one hand and to not substantially increase the risk of autoimmune thyroid disease on the other hand. However, the prevalence of diagnosed thyroid disorders and the intake of thyroid medication increased, which may be related to inappropriate therapeutical decisions, but could also be related to an increased awareness of thyroid disorders in clinical practice during the last ten years. We furthermore demonstrated regional disparities in the prevalence of thyroid disorders between Northern and Southern Germany. In SHIP-Trend and KORA-F4 we established new reference ranges for thyroid hormones, which substantially differed from those ten years earlier due to the long-term sufficient iodine supply. Finally, we identified novel genetic loci for goiter, thyroid function, and TPO-Abs by data mining approaches. In the future we aim to extend the use of data mining as tool to not only determine novel genetic but also novel environmental risk factors for thyroid disease.
Publications
- 2011 Genome-wide association study identifies four genetic loci associated with thyroid volume and goiter risk. Am J Hum Genet 88:664-673
Teumer A, Rawal R, Homuth G, Ernst F, Heier M, Evert M, Dombrowski F, Volker U, Nauck M, Radke D, Ittermann T, Biffar R, Doring A, Gieger C, Klopp N, Wichmann HE, Wallaschofski H, Meisinger C, Volzke H
- 2012 Five-year change in morphological and functional alterations of the thyroid gland: the study of health in pomerania. Thyroid 22:737-746
Volzke H, Ittermann T, Albers M, Friedrich N, Nauck M, Below H, Kramer A
(See online at https://doi.org/10.1089/thy.2011.0525) - 2012 Geographie variations in the frequency of thyroid disorders and thyroid peroxidase antibodies in persons without former thyroid disease within Germany. European journal of endocrinology / European Federation of Endocrine Societies 167:363-371
Meisinger C, Ittermann T, Wallaschofski H, Heier M, Below H, Kramer A, Döring A, Nauck M, Volzke H
(See online at https://doi.org/10.1530/EJE-12-0111) - 2012 Meta-analysis of two genome-wide association studies identifies four genetic loci associated with thyroid function. Hum Mol Genet 21:3275-3282
Rawal R, Teumer A, Volzke H, Wallaschofski H, Ittermann T, Asvold BO, Bjoro T, Greiser KH, Tiller D, Werdan K, zu Schwabedissen HE, Doering A, lllig T, Gieger C, Meisinger C, Homuth G
(See online at https://doi.org/10.1093/hmg/dds136) - 2013. Association of socioeconomic status with iodine supply and thyroid disorders in northeast Germany. Thyroid 23:346-353
Volzke H, Craesmeyer C, Nauck M, Below H, Kramer A, John U, Baumeister S, Ittermann T
(See online at https://doi.org/10.1089/thy.2012.0416) - 2014 [TSH-reference range of adults: results from the population-based study KORA F4]. Deutsche medizinische Wochenschrift (1946) 139:317-322
Burkhardt K, Ittermann T, Heier M, Kirchberger I, Volzke H, Wallaschofski H, Below H, Nauck M, Meisinger C
(See online at https://doi.org/10.1063/1.4906440) - 2014. Identification of novel genetic Loci associated with thyroid peroxidase antibodies and clinical thyroid disease. PLoS Genet 10:e1004123
Medici M, ... Volzke H, Cappola A, Toniolo D, Sanna S, Naitza S, Peeters RP
(See online at https://doi.org/10.1371/journal.pgen.1004123) - 2014. Shift of the TSH reference range with improved iodine supply in Northeast Germany. European journal of endocrinology / European Federation of Endocrine Societies 172:261-267
Ittermann T, Khattak RM, Nauck M, Cordova CM, Volzke H
(See online at https://doi.org/10.1530/EJE-14-0898) - Monitoring the Prevalence of Thyroid Disorders in the Adult Population of Northeast Germany, Popul Health Metr. 2016 Nov 8;14:39
Khattak RM, Ittermann T, Nauck M, Below H, Volzke H
(See online at https://doi.org/10.1186/s12963-016-0111-3) - 2017. Factors Affecting Sustainable Iodine Deficiency Elimination in Pakistan: A Global Perspective. Journal of Epidemiology, 2017 Jun; 27(6): 249–257
Khattak RM, Khattak NKK, Ittermann T, Völzke H
(See online at https://doi.org/10.1016/j.je.2016.04.003)
