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Non-immune-related hypothyroidism and its relationship with excess iodine

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Abstract

Purpose

In iodine-sufficient areas, autoimmune hypothyroidism has been regarded as the major subtype of hypothyroidism. Non-immune-related hypothyroidism has received little attention because it is considered to be rare. The aim of this study was to evaluate the prevalence of non-immune-related hypothyroidism in Korea and to identify its associating factors.

Methods

A total of 6434 participants in the Korea National Health and Nutrition Examination Survey VI (2013–2015) without known thyroid disease who were examined for thyroid stimulating hormone, free thyroxine, TPO Ab, and urine iodine concentration (UIC) were enrolled. The weighted proportions, demographic variables, and severity of immune-related and non-immune-related hypothyroidism were compared. To assess the effect of iodine on hypothyroidism in TPO Ab positive or negative populations, the weighted prevalence of hypothyroidism was assessed in each population according to UIC or estimated iodine intake subgroups.

Results

The prevalence of undetected hypothyroidism in Korea was 3.8% (n = 233). Of these 233 cases, 171 (71.8%) were non-immune-related. In the TPO Ab negative population, the prevalence of hypothyroidism was increased significantly in the subgroup with UIC between 250 and 749 µg/L (HR 2.12 [1.17, 3.83]) and ≥ 750 µg/L (HR 3.42 [1.93, 6.04]) or the subgroups with estimated iodine intake ≥ 750 µg/day (HR 2.81 [1.64, 4.80]).

Conclusions

This nationwide study demonstrated that most cases of hypothyroidism in iodine-sufficient areas are non-immune-related and are associated with excess iodine above a certain level. More attention to this unrecognized but widespread potential health risk is needed.

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Acknowledgements

The authors thank the Korea National Health and Nutrition Examination Survey for providing public access to its data.

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Author notes

  1. Hye In Kim and Hyun-Kyung Oh contributed equally to this study.

Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea

    Hye In Kim, Ji Min Han & Ji Cheol Bae

  2. Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea

    Hyun-Kyung Oh & Myung-Hee Shin

  3. Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    So Young Park, Sun Wook Kim, Tae Hyuk Kim & Jae Hoon Chung

  4. Department of Medical Education, Sungkyunkwan University School of Medicine, Seoul, Korea

    Hye Won Jang

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  1. Hye In Kim
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Correspondence to Tae Hyuk Kim or Jae Hoon Chung.

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Kim, H.I., Oh, HK., Park, S.Y. et al. Non-immune-related hypothyroidism and its relationship with excess iodine. Eur J Nutr 58, 2851–2858 (2019). https://doi.org/10.1007/s00394-018-1837-4

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  • DOI: https://doi.org/10.1007/s00394-018-1837-4

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