Are ethnic differences, urinary iodine status, lead and cadmium exposure associated with thyroid autoimmunity and hypothyroid status? A cross-sectional study

Abstract

Objective: We aimed to evaluate the effects of different ethnicities and potential environmental exposure on the prevalence of thyroid autoimmune status and hypothyroid status.

Design: The data were obtained from two cross-sectional studies.

Participants: 2105 participants in Shanghai (Han) and 772 participants in Yunnan Honghe Prefecture (Han, Yi, Miao and Hani), aged 18-75 were enrolled.

Methods: Participants underwent several checkups, including urinary iodine concentration, blood lead (BPb) and blood cadmium (BCd), thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), thyroid stimulating hormone (TSH) as well as thyroid ultrasonography (US). Thyroid autoimmune status was defined as: antithyroid antibody positive (ATA+): TPOAb + or TgAb+; and ATA + and US+: TPOAb + or TgAb + together with characteristic US features.

Results: The standardised prevalence of thyroid autoimmune positivity in Yunnan were higher than those in Shanghai (TPOAb+: 13.56% vs 8.27%, p<0.001; TgAb+: 9.28% vs 7.09%, p=0.045; ATA+: 16.96% vs 11.10%, p<0.001; ATA + and US+: 8.96% vs 6.64%, p=0.036). For urinary iodine-to-creatinine ratio (UI/Cr), compared with the level of 100.00-199.99 µg/g, the level of ≥300.00 µg/g had a 1.5-fold risk for ATA + and US+ (OR 1.455, p=0.041). The levels of 200.00-299.99 µg/g and ≥300.00 µg/g were positively associated with hypothyroid status (OR 1.509, p=0.002 and OR 1.338, p=0.043). Compared with the first quartiles, the fourth quartiles of BPb were positively associated with TPOAb+: (OR 1.637, p=0.006), ATA+ (OR 1.435, p=0.025), ATA + and US+ (OR 1.641, p=0.013), hypothyroid status (OR 1.467, p=0.013) and TSH levels (B 0.092, p=0.021). The fourth quartile of BCd was positively associated with the prevalence of ATA+ (OR 1.427, p=0.036).

Conclusions: Higher levels of UI/Cr, BPb and BCd may be associated with thyroid autoimmunity and hypothyroid status.

Keywords: cadmium; epidemiology; ethnic; hypothyroidism; iodine; lead; public health; thyroid disease.

Figure 1

Flowchart of participants’ inclusion and exclusion.

Figure 2

Standardised prevalence of thyroid disorders in the current study. (A) The standardised prevalence of thyroid disorders was significantly higher in Yunnan than in Shanghai. (B) The standardised prevalence of thyroid disorders in four ethnic groups in Yunnan, the Han population ranked first in TPOAb+, TgAb+, ATA+, ATA + and US+ and hypothyroid status. The standardised prevalence of thyroid disorders was based on the age and sex distribution in The Sixth National Population Census of China (2010). ATA+: serum TPOAb +or TgAb+; ATA+ and US+: serum TPOAb+ or TgAb+ together with characteristic ultrasonographic features; hypothyroid status: with higher thyroid stimulating hormone levels (>4.20 mIU/L), or with a history of thyroxine replacement therapy. ATA, antithyroid antibody; TgAb, thyroglobulin antibody; TPOAb, thyroid peroxidase antibody; US, ultrasound.