Incidence of thyroid dysfunction in an Iranian adult population: the predictor role of thyroid autoantibodies: results from a prospective population-based cohort study

Abstract

BackgroundThe prevalence of thyroid dysfunction is high in Isfahan, an area of iodine sufficient in Iran. The aim of this study is to investigate the incidence of thyroid dysfunctions in adults of metropolitan Isfahan and to determine the role of thyroid autoantibodies.MethodsIn a population-based cohort study in 2006–2011, we measured TSH, T4, T3, thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb) in 618 out of 2254 people who were euthyroid in 2006. The incidence rates per 1000 person-year (pr) were calculated. The odds ratio (OR), relative risk (RR), and 95% confidence interval (95% CI) were calculated based on logistic regression to quantify the potential predictors of thyroid dysfunction. The receiver-operator characteristic (ROC) analysis along with area under the curve (AUC) was used to determine the optimal cutoff values for baseline TPOAb and TgAb as predictors of thyroid dysfunction.ResultsWithin a 6-year follow-up, the incidence rate of hypothyroidism was 3.3 in women and 2.1 in men while the incidence rate of hyperthyroidism was 3.8 in women and none in men per 1000 (person-year). A cutoff value of TPOAb at 38 IU/mL was obtained to differentiate the patients with hypothyroidism and hyperthyroidism, with specificity of 0.75 and sensitivity of 0.76, and AUC (CI 95%) of 0.882 (0.743–1.02), P = 0.01 and 0.817 (0.600–1.035) P = 0.033, respectively. There is a statistically significant association of hypothyroidism and hyperthyroidism with positive TPOAb [RR (CI 95%): 1.99 (1.27–3.13) and 2.20 (1.23–3.95), respectively].ConclusionsThe incidence rate of thyroid dysfunction is high in Isfahan, and higher TPOAb concentration is its strong predictor.

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“…Intriguingly, previous studies demonstrate the predictor role of thyroid antibodies. [25][26][27] In their 13-year follow-up cohort study, Walsh et al 26 concluded that TPO-Ab and TG-Ab in combination of thyrotropin provide the useful estimate of long-term risk of hypothyroidism. A 5-year follow-up study by Li Y et al 27 from China reported similar results.…”

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“…Normal T4 levels were considered between 4.5 and 12.0 μg/dL for normal participants. T4 value lower than 4.5 was one of the additional criteria' for hypothyroidism patients [31]. The values higher than 40 and 100 IU/mL were considered positive for TPOAb and TGAb, respectively.…”