The Relationship between High Iodine Consumption and Levels of Autoimmune Thyroiditis-Related Biomarkers in a Chinese Population: a Meta-Analysis

Abstract

To comprehensively evaluate the relationship between high iodine concentration and biomarker abnormalities related to autoimmune thyroiditis in a Chinese population. Medline, PubMed, and Embase electronic databases were searched for articles published domestically and internationally on the relationship between high iodine concentrations and thyroid hormone antibodies and thyroid-stimulating hormone in China before March 2019. Articles published in Chinese were searched in the China Biology Medicine (CBM) disc, Wanfang Database, and China National Knowledge Infrastructure (CNKI). A total of 16 cross-sectional articles were included in this study, including 9061 participants. A meta-analysis was conducted in Stata 14.0. The binary categorical and continuous variables used odds ratios (ORs) and standardized mean differences (SMDs) with the corresponding 95% confidence intervals (CIs) as the effect statistics, respectively. The results showed that high iodine concentrations had a minimal association with the abnormal rates of thyroid peroxidase antibody (TPOAb) (OR = 1.274, 95% CI (0.957, 1.695), P > 0.05) and thyroglobulin antibody (TGAb) (OR = 1.217, 95% CI (0.911, 1.626), P > 0.05) in the entire population. The thyroid-stimulating hormone (TSH) level in the high iodine group was greater than that in the adaptive iodine group (SMD = 0.202, 95% CI (0.096, 0.309), P < 0.05). The results of the subgroup analysis showed that the abnormal TPOAb rate in pregnant women (OR = 1.519, 95% CI (1.007, 2.291), P < 0.05) and children (OR = 3.365, 95% CI (1.966, 5.672), P < 0.05) in the high iodine group was greater than that in the adaptive iodine group, and the abnormal TGAb rate of children in the high iodine group was greater than that in the adaptive iodine group. The TSH levels of lactating women (SMD = 0.24, 95% CI (0.053, 0.427), P < 0.05), pregnant women (SMD = 0.301, 95% CI (0.176, 0.426), P < 0.05), and children (SMD = 0.25, 95% CI(0.096, 0.309), P < 0.05) in the high iodine group were higher than those in the adaptive iodine group. Egger’s and Begg’s tests showed no significant (P > 0.1) publication bias. High iodine can increase the risk of abnormal levels of TPOAb, TGAb, and TSH related to autoimmune thyroiditis in pregnant women, lactating women, and children in China.

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References

  1. 1.

    Yadav K, Pandav CS (2018) National iodine deficiency disorders control programme: current status & future strategy. Indian J Med Res 148:503–510

    PubMed  PubMed Central  Article  Google Scholar 

  2. 2.

    Leung AM, Braverman LE (2014) Consequences of excess iodine. Nat Rev Endocrinol 10:136–142

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Chen Z (2002) The significance of universal salt iodization and the basic evaluation of iodine nutritional status of the current population. Chin J Ctrl Endem Dis 17:251–254

    Google Scholar 

  4. 4.

    Yan Y (2003) A survey on iodine nutrition in 5 groups of target population in China. Chin J Epidemiol 22:141–143

    Google Scholar 

  5. 5.

    Teng W, Shan Z, Teng X, Guan H, Li Y, Teng D, Jin Y, Yu X, Fan C, Chong W, Yang F, Dai H, Yu Y, Li J, Chen Y, Zhao D, Shi X, Hu F, Mao J, Gu X, Yang R, Tong Y, Wang W, Gao T, Li C (2006) Effect of iodine intake on thyroid diseases in China. N Engl J Med 354:2783–2793

    CAS  PubMed  Article  Google Scholar 

  6. 6.

    Armando F, Lidia M, Norman S et al (2015) Prevalence of autoimmune thyroiditis and thyroid dysfunction in healthy adult Mexicans with a slightly excessive iodine intake. Nutr Hosp 32:918–924

    Google Scholar 

  7. 7.

    Vagenakis A, Downs P, Braversman L et al (1973) Control of thyroid hormone secretion in normal subjects receiving iodines. J Clin Invest 52:528–532

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  8. 8.

    Norimiochi K, Hideo T, Kinnichi M et al (1993) Serum thyrotropin concentration in apparently healthy adults, in relation to urinary iodide concentration. J Clin Chem 39:174–175

    Article  Google Scholar 

  9. 9.

    Ren Y, Jia Q, Zhang X et al (2018) Prevalence of thyroid function in pregnant and lactating women in areas with different iodine levels of Shanxi province. Chin J Epidemiol 39:609–613

    CAS  Google Scholar 

  10. 10.

    Zhang M, Zhang L, Fan Y et al (2011) Relationship between iodine intake and the prevalence of thyroid disease in Urumqi, Xinjiang. Chin J Endocrinol Metab 27:972–974

    CAS  Google Scholar 

  11. 11.

    Zhao D, Lu T, Yang Y et al (1999) Study on thyroid serology comparison between residents in high iodine area and residents in non-high iodine areas. Chin J Ctrl Endem Dis 14:244–245

    Google Scholar 

  12. 12.

    WHO/UNICEF/ICCIDD. (2007) Assessment of iodine deficiency disorders and monitoring their elimination: a guide for program managers, 3rd ed. Geneva: WHO, 33

  13. 13.

    Rostom A, Dubé C, Cranney A, et al. (2004) Celiac disease: Evid Rep Technol Assess (Summ) 104(104): 1-6

  14. 14.

    Tan L, Sang Z, Shen J, Liu H, Chen W, Zhao N, Wei W, Zhang G, Zhang W (2015) Prevalence of thyroid dysfunction with adequate and excessive iodine intake in Hebei Province, People’s Republic of China. Public Health Nutr 18:1692–1697

    PubMed  Article  Google Scholar 

  15. 15.

    Jin X, Guan Y, Shen H et al (2018) Copy number variation of immune-related genes and their association with iodine in adults with autoimmune thyroid diseases. Int J Endocrinol 2018:1705478

    PubMed  PubMed Central  Article  Google Scholar 

  16. 16.

    Ren Y, Jia Q, Zhang X et al (2014) Epidemiological investigation on thyroid disease among fertile women in different iodine intake areas of Shanxi province. Chin J Epidemiol 35:45–48

    Google Scholar 

  17. 17.

    Zhang M, Zhang L, Fan Y et al (2011) Study of the relationship between iodine intake level and the occurrence of thyroid disease of Uygur nationality in Urumqi. Journal of Xinjiang Medical University 34:1019–1021

    CAS  Google Scholar 

  18. 18.

    Li Y, Jin Y, Teng W et al (2002) The comparative screening for thyroid autoantibodies in areas with different iodine intakes. Shanghai Journal of Immunology 22:91–95

    Google Scholar 

  19. 19.

    Sang Z, Chen W, Shen J, Tan L, Zhao N, Liu H, Wen S, Wei W, Zhang G, Zhang W (2013) Long-term exposure to excessive iodine from water is associated with thyroid dysfunction in children. J Nutr 143:2038–2043

    CAS  PubMed  Article  Google Scholar 

  20. 20.

    Wang Y, Hou C, Cui B et al (2015) An investigation of iodine nutritional status and thyroid function among school-age children in high water iodine areas of Tianjin in 2014. Chin J Epidemiol 34:518–521

    Google Scholar 

  21. 21.

    Li H, Xu S, Wang X et al (2012) Influence of different iodine concentration in drinking water on the function of children’s thyroid. Henan J Prev Med 4:262–263

    Google Scholar 

  22. 22.

    Liu L, Wang D, Liu P et al (2015) The relationship between iodine nutrition and thyroid disease in lactating women with different iodine intakes. Br J Nutr 114:1487–1495

    CAS  PubMed  Article  Google Scholar 

  23. 23.

    Wang D, Du Y, Liu L et al (2016) Study on iodine nutrition and its influencing factors in pregnant women with different iodine intake areas. Chin J Epidemiol 31(1):1–6

    Google Scholar 

  24. 24.

    Su H, Zhong Y, Liang H et al (2010) Variations of thyroid hormone levels in pregnant women with different iodine nutrition and in different stages of gestation. Acta Acad Med Xuzhou 30(4):243–246

    CAS  Google Scholar 

  25. 25.

    Sang Z, Zhao N, Zhang S, et al. (2010) Effects of iodine intake on thyroid function and thyroid autoimmunity in pregnant women. The 7th National Academic Conference of maternal and child nutrition of China nutrition society 354-359

  26. 26.

    Jia Q, Zhang X, Ren Y et al (2014) Effects of different iodine concentration in drinking water on iodine nutrition, thyroid function and volume. Chin J Epidemiol 33(5):540–544

    Google Scholar 

  27. 27.

    Aakre I, Strand TA, Moubarek K et al (2017) Associations between thyroid dysfunction and developmental status in children with excessive iodine status. PLoS One 12(11):e0187241

    PubMed  PubMed Central  Article  Google Scholar 

  28. 28.

    Huber G, Staub JJ, Meier C, Mitrache C, Guglielmetti M, Huber P, Braverman LE (2002) Prospective study of the spontaneous course of subclinical hypothyroidism: prognostic value of thyrotropin, thyroid reserve, and thyroid antibodies. J Clin Endocrinol Metab 87:3221–3226

    CAS  PubMed  Article  Google Scholar 

  29. 29.

    Roos A, Links TP, de Jong-van den Berg LT, Gans RO, Wolffenbuttel BH, Bakker SJ (2010) Thyroid peroxidase antibodies, levels of thyroid stimulating hormone and development of hypothyroidism in euthyroid subjects. Eur J Intern Med 21:555–559

    CAS  PubMed  Article  Google Scholar 

  30. 30.

    Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE (2002) Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 87:489–499

    CAS  PubMed  Article  Google Scholar 

  31. 31.

    Li D, Li C, Teng W (2003) Prevalence of postpartum thyroiditis in three different iodine intake areas. Chin J Obstet Gynecol 38(4):216–218

    Google Scholar 

  32. 32.

    Premawardhana L, Parkes A, John R, Harris B, Lazarus JH (2004) Thyroid peroxidase antibodies in early pregnancy: utility for prediction of postpartum thyroid dysfunction and implications for screening. Thyroid 14(8):610–615

    CAS  PubMed  Article  Google Scholar 

  33. 33.

    Aakre I, Bjøro T, Norheim I et al (2015) Excessive iodine intake and thyroid dysfunction among lactating Saharawi women. J Trace Elem Med Biol 31:279–284

    CAS  PubMed  Article  Google Scholar 

  34. 34.

    Wang W, Jin Y, Teng W et al (2002) Epidemiological comparison of serum TSH levels in normal population in different iodine intake areas. Chin J Endocrinol Metab 18(5):355–356

    Google Scholar 

  35. 35.

    Farebrother J, Zimmermann MB, Abdallah F, Assey V, Fingerhut R, Gichohi-Wainaina WN, Hussein I, Makokha A, Sagno K, Untoro J, Watts M, Andersson M (2018) Effect of excess iodine intake from iodized salt and/or groundwater iodine on thyroid function in nonpregnant and pregnant women, infants, and children: a multicenter study in East Africa. Thyroid 28:1198–1210

    CAS  PubMed  Article  Google Scholar 

  36. 36.

    Eng P, Cardona G, Fang S et al (1999) Escape from the acute Wolff-Chaikoff effect is associated with a decrease in thyroid sodium iodide symporter messenger ribonucleic acid and protein. Endocrinology 140:3404–3410

    CAS  PubMed  Article  Google Scholar 

  37. 37.

    Roti E, Uberti E (2001) Iodine excess and hyperthyroidism. Thyroid 1l: 493-500

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Funding

This study was supported by grants from the National Natural Science Foundation of China (81872561).

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Siyuan Wan and Baiming Jin were the principal investigators of this paper. Siyuan Wan, Baiming Jin, and Hongmei Shen developed the hypothesis and study design and supervised this study. All authors contributed to the study concept and design, analysis, and interpretation of data and drafted or critically revised the manuscript for important intellectual content. All authors approved the final manuscript for submission.

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Correspondence to Hongmei Shen.

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Wan, S., Jin, B., Ren, B. et al. The Relationship between High Iodine Consumption and Levels of Autoimmune Thyroiditis-Related Biomarkers in a Chinese Population: a Meta-Analysis. Biol Trace Elem Res 196, 410–418 (2020). https://doi.org/10.1007/s12011-019-01951-9

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Keywords

  • Iodine excess
  • High iodine
  • Thyroid peroxidase antibody
  • Thyroglobulin antibody
  • Thyroid-stimulating hormone
  • Meta-analysis