The spectrum of thyroid disorders in an iodine-deficient community: The Pescopagano survey

We carefully assessed thyroid status and goiter by ultrasound in 1411 subje cts virtually representing the entire resident population of Pescopagano, a n iodine-deficient village of Southern Italy. Median urinary iodine excreti on was 55 mu g/L. The prevalence of goiter was 16.0% in children and 59.8% in adults. Thyroid nodularity was 0.5% in children and progressively increa sed with age to 28.5% in the 56-to 65-yr-old group. The prevalence of prese nt or past hyperthyroidism was 2.9%, including 9 cases with toxic diffuse g oiter and 20 with toxic nodular goiter. Functional autonomy was rare in chi ldren, progressively increased with age up to 15.4% in the elderly, and was related to nodular goiter. The prevalences of overt and subclinical hypoth yroidism in the adults were 0.2% and 3.8%, respectively. Serum autoantibodi es to thyroglobulin and thyroperoxidase were detected in 12.6% of the entir e population. The prevalence of diffuse autoimmune thyroiditis was 3.5%, be ing very low in children. Thyroid cancer was found in only 1 case. In concl usion, in the present survey of an iodine-deficient community, a progressiv e increase with age of goiter prevalence, thyroid nodularity, and functiona l autonomy was observed. Hyperthyroidism was twice as high as that reported in iodine-sufficient areas, mainly due to an increased frequency of toxic nodular goiter. Although low titer serum thyroid antibodies were relatively frequent,, the prevalences of both overt and subclinical autoimmune hypoth yroidism were not different from those observed in iodine-sufficient areas.