ผลลัพธ์ข้อมูลประชากร วิถีชีวิต และลักษณะทางการแพทย์ของประชากรศึกษาBased on the criteria of inclusion and exclusion, a total of 3084 (out of 6323) subjects were analyzed by the study (Table 1). Demographic data included age, education and marital status. Within the study population, participants less than 30 years of age were 3%, near 40 were 11%, near 50 were 25%, near 60 were 33%, near 70 were 24%, and older than 70 were 5%. The age showed a normal distribution with the median age being 52. In education, 7% participants received no formal education, 22% graduated from elementary school, 43% graduated from middle school, 21% graduated from high school, 5% graduated from junior college, and 2% completed undergraduate studies or above. Near 100% of the study population was currently married. The life style included drinking, smoking, seafood intake, exercise and salt intake. Of the study population, 96% denied drinking, 1% admitted prior drinking, and 3% was actively drinking. Compatible with this data, 94% participants denied smoking, 1% had prior smoking history, and 5% was smoking at present. In seafood consumption, 15% of the study population reported rarely, 79% occasionally, and 6% frequently had seafood in their diet. Excise was classified into high, modest and low intensities, for which the study population responded with 1%, 8% and 92%, respectively. Last in salt intake, 23% of the study group had low, 47% had medium, and 30% had high salt in their diet. Medical characteristics included parity, menopause, BMI, waist circumference, hypertension, hyperglycemia, dyslipidemia and hyperuricemia. 46% of the women had one child, 50% had two to three, and 4% had four children. 40% were actively menstruating, and 60% had reached their menopause. As stated earlier, obesity was defined as BMI ≥25 in China. In the study group, 32% participants were normal, and 68% were obese. This was consistent with another obesity parameter, waist circumference. Of the tested participants, 21% showed less than (normal) and 79% showed more than 80 cm (obese) in length.Table 1Table 1Characteristics of the Study Population and Thyroid NoduleClinical and demographic features of TN and goiterWe next examined various clinical and demographical features of TN and goiter (Tables 1 and and2).2). For TN, we observed a significant relationship (P<0.05) with following variables: education level, age, parity, menopause, smoking, high salt intake, BMI, waist circumference, hypertension, hyperglycemia and dyslipidemia. The prevalence of TN increased with the number of parity, while declined with the educational level. We found no correlation with marital status, drinking, exercise and hyperuricemia. For goiter, we observed a significant association (P<0.05) with menopause, waist circumference, BMI, hypertension, dyslipidemia and hyperglycemia. Interestingly, age of the population displayed a discordant correlation with goiter. At before or near 60 years of age, it showed a positive relationship, and after 60 a negative relationship. Other factors not relevant to goiter included education level, marital status, parity, drinking, smoking, sea food intake, salt intake, exercise and hyperuricemia. Taken together, the factors associated with both TN and goiter included menopause, waist circumference, BMI, hypertension, dyslipidemia, and hyperglycemia.Table 2Table 2Characteristics of the Study Population and GoiterObesity and dyslipidemia are associated with increased prevalence of TN and goiterFrom the above analyses, we concluded that menopause, obesity, hypertension and dyslipidemia were significantly related to TN and goiter. To further determine the relationship, we directly compared the participants with or without TN or goiter, and their waist-hip ratio (WHR), BMI, TC, TG, and menopausal age (Table 3). Note that other metabolic parameters such as HDL and FPG were excluded from the analysis given that they showed large variations in our study. Shown in Table 3, WHR, BMI and TG had a significant association (P<0.01) with both TN and goiter, and TC only correlated (P<0.001) with TN. With this method, we did not observe statistical significance for median menopausal age (approximately 49 years of age).Table 3Table 3Relationship between WHR, BMI, TC, TG and Menopause with TN or GoiterThe relationship of medical management of comorbidities with TN and goiterNext we examined whether medical management of aforementioned comorbidities and risk factors could affect the prevalence of TN and goiter. We observed in our TN study group statistical significance (P<0.05) of anti-hypertensive therapy. Medical therapies in patients with diabetes and dyslipidemia, and estrogen supplementation in postmenopausal participants however had no statistical significant impact on either TN or goiter (Table 4).Table 4Table 4Relationship of Medical Management of Comorbidities with TN or GoiterStratification of risk factors and comorbidities in TN and goiterLast, we stratified the risk factors and identified significant comorbidities from our studies. Age directly associated with TN and goiter with statistical significance (P<0.001 and P<0.01, respectively). The risk of TN increased by 3% with age increased by every 1 year, by 18% with age increased by every 5 years, and by 30% with age increased by every 10 years (Table 5). Likewise, age over 40 was a strong predictor of goiter (odds ratio [OR] of age 40-50, 50-60, ≥60 VS <40 was 1.871, 2.531, and 1.706, respectively). Additionally, women with diabetes and hypertension had 1.33 and 1.28 times of risk in developing TN. Obesity, which was quantified by BMI also strongly predicted the likelihood of developing goiter (OR = 2.86).Table 5Table 5Analysis of Risk Factors for TN or GoiterDiscussionTN and goiter are frequent screening findings wherein patients may or may not present with clinical symptoms and abnormal laboratory tests. Given these two conditions are highly prevalent and associated with multiple thyroid pathologic conditions including cancer, it is pertinent to advocate routine thyroid examinations in the general population.In this study, we conducted a large-scale observational study in the Chinese female population, aimed to further identify the risk factors of its pathogenesis. Our data suggest that menopause, waist circumference, BMI, hypertension, dyslipidemia and hyperglycemia are individual risk factors. This agrees with earlier studies performed in other populations [20,22-24]. It is worth noting that most identified risk factors are components of the metabolic syndrome, a disorder of energy utilization and storage manifested as conditions such as hyperglycemia, dyslipidemia, arterial hypertension and obesity. Metabolic syndrome is a major health issue in western countries, with data estimating the prevalence in the United States to be 34% [25]. With the economic development and changes in life habits in recent years, it has become a growing concern in the Chinese population [26]. Recent survey shows that metabolic syndrome occurs in 12.7% in Chinese males and 14.2% in females, and the incidence of cardiovascular disease was high in an epidemiologic survey in 11 provinces in China [27]. It was long speculated that components of the metabolic syndrome may contribute to thyroid conditions including TN and goiter, yet the definitive conclusion could not be drawn due to the insufficiency of data. In one report, abdominal obesity associated with sick euthyroid syndrome in adult Nigerians [28]. In another study, prevalence of dyslipidemia increased accordingly to higher thyroid-stimulating hormone (TSH) concentrations [29]. In contrast to studying single metabolic disorder, our study included most components of the metabolic syndrome thereby providing one-step-further evidence in the strong correlation with the two disorders.TN is more frequent in females than in males [14]. This has promoted us to choose Chinese women as the study population. In our study we observed a correlation between menopause and TN. We excluded estrogen and estrogen use based on the fact that few postmenopausal Chinese women take estrogen containing medications, even though the literature from another country indicated that estrogen contributed to the pathogenesis of TN [22]. Concerning age, our speculation is that advanced age contributes to the high rate of TN in postmenopausal females.Nonetheless, there are other implicated factors that worth further investigation. For instance, smoking was known to precipitate metabolic syndrome [30] and some thyroid pathological conditions [31]. Our female study group was less engaged in smoking compared to the males of same demographic area. Further, Hyperuricemia is a known etiologic factor of gout. It has recently been recognized for its involvement in metabolic syndrome [32,33]. In our survey however we did not identify a strong association with TN and goiter. Future work is needed to determine whether the characteristics of this study population were involved in generating this observational disagreement.Together, our study is one of the first large-scale epidemiological studies of risk factors in the pathogenesis of TN and goiter in Chinese women. We propose that female patients in the Chinese population with advance age, menopause, obesity, and metabolic syndrome should be examined by physicians and imaging tests for TN and goiter. Patients with confirmed TN and goiter should be screened for age and obesity related disorders such as metabolic syndrome.
Acknowledgements
The research related to this work was supported by the Chinese National Science and Technology Major Project (No 2011ZX09307001-08).
Disclosure of conflict of interest
None.
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