AUTHOR=Wang Chuyuan , Li Yongze , Teng Di , Shi Xiaoguang , Ba Jianming , Chen Bing , Du Jianling , He Lanjie , Lai Xiaoyang , Li Yanbo , Chi Haiyi , Liao Eryuan , Liu Chao , Liu Libin , Qin Guijun , Qin Yingfen , Quan Huibiao , Shi Bingyin , Sun Hui , Tang Xulei , Tong Nanwei , Wang Guixia , Zhang Jin-an , Wang Youmin , Xue Yuanming , Yan Li , Yang Jing , Yang Lihui , Yao Yongli , Ye Zhen , Zhang Qiao , Zhang Lihui , Zhu Jun , Zhu Mei , Shan Zhongyan , Teng Weiping TITLE=Hyperthyroidism Prevalence in China After Universal Salt Iodization JOURNAL=Frontiers in Endocrinology VOLUME=12 YEAR=2021 URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2021.651534 DOI=10.3389/fendo.2021.651534 ISSN=1664-2392 ABSTRACT=Background

Universal salt iodization (USI) was implemented in mainland China in 1996. The prevalence of hyperthyroidism and its risk factors now require examination.

Methods

Data were acquired from a nationwide Thyroid, Iodine, and Diabetes Epidemiological survey (TIDE 2015–2017) of 78,470 subjects from 31 provinces. Iodine status, and thyroid hormones and antibodies were measured.

Results

After two decades of USI, the prevalence of overt hyperthyroidism (OH), Graves’ disease (GD), severe subclinical hyperthyroidism (severe SCH), and mild subclinical hyperthyroidism (mild SCH) in mainland China was 0.78%, 0.53%, 0.22%, and 0.22%, respectively. OH and GD prevalence were higher in women than in men (OH: 1.16% vs. 0.64%, P<0.001; GD: 0.65% vs. 0.37%, P<0.001).Prevalence was significantly decreased after 60 years-of-age compared with 30–39 years-of-age (OH:0.61% vs. 0.81%, P<0.001; GD: 0.38% vs. 0.57%, P<0.001).Excessive iodine(EI) and deficient iodine(DI) were both related to increased prevalence of OH (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.68–2.59; OR1.35, 95%CI 1.07–1.72, respectively); however, only deficient iodine was associated with increased prevalence of GD (OR1.67, 95%CI 1.30–2.15). Increased thyroid peroxidase antibody and thyroglobulin antibody levels were significantly associated with prevalence of OH and GD, but not severe SCH and mild SCH. Although hyperthyroidism was more prevalent in women, the association disappeared after adjusting for other factors such as antibody levels.

Conclusion

OH and GD prevalences in mainland China are stable after two decades of USI. Iodine deficiency, elevated thyroid antibody levels, and middle age are the main risk factors for OH and GD. The severe SCH population, rather than the mild SCH population, shows similar characteristics to the OH population.