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Association of Tobacco Smoking With Goiter in a Low-Iodine-Intake Area
Nils Knudsen, MD, PhD;
Inge Bülow, MD;
Peter Laurberg, MD, MDSci;
Lars Ovesen, MD;
Hans Perrild, MD;
Torben Jørgensen, MD, MDSci
Arch Intern Med. 2002;162:439-443.
Background Goiter development depends on genetic and environmental factors. The
major environmental factor is iodine intake, whereas diverging results have
been published concerning the association between smoking and goiter.
Methods A comparable, cross-sectional study was performed of patients from 2
areas in Denmark with mild and moderate iodine deficiency. A random sample
of women and men in selected age groups from the general community was investigated;
4649 subjects participated. Smoking habits were investigated with questionnaires
and interviews. Ultrasonography and clinical examination of the thyroid were
performed, serum thyroglobulin was measured, and iodine concentration in spot
urine samples was analyzed. Data were analyzed in linear models and logistic
regression analyses.
Results Serum thyroglobulin level and thyroid volume at ultrasonography were
positively associated with smoking habits (P<.001);
the association was stronger in the area with the lowest iodine intake (interaction: P<.001 for thyroglobulin, P
= .04 for thyroid volume). A positive association with smoking was also found
for thyroid enlargement (odds ratio, 2.9; 95% confidence interval, 2.2-3.7)
and palpable goiter (odds ratio, 3.1; 95% confidence interval, 1.6-5.8). Ex-smokers
had a goiter prevalence close to that of never smokers. The fraction of goiter
cases attributable to smoking was 49% (95% confidence interval, 29%-65%).
Conclusions Thyroid volume and goiter prevalence were closely associated with smoking
habits, with the strongest association being found in the area with the most
pronounced iodine deficiency. This may have implications for future goiter
prevalences in Third World countries, with their increasing use of tobacco.
Half of goiter cases in this population could be ascribed to smoking.
From the Danish Centre for Prevention of Thyroid Diseases (DanThyr)
(Drs Knudsen, Bülow, Laurberg, Ovesen, Perrild, and Jørgensen)
and Centre for Preventive Medicine (Drs Knudsen and Jørgensen), Glostrup
University Hospital, and Department of Internal Medicine I, Bispebjerg Hospital
(Drs Knudsen and Perrild), University of Copenhagen, Copenhagen; Department
of Endocrinology, Aalborg Hospital, Aalborg (Drs Bülow and Laurberg);
and Institute of Food Research and Nutrition, The Danish Veterinary and Food
Administration, Soeborg (Dr Ovesen), Denmark.
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