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Smoking as a risk factor for thyroid volume progression and incident goiter in a region with improved iodine supply

T Ittermann, University of Greifswald, Institute for Community Medicine of the Ernst-Moritz-Arndt University, Greifswald, 17487, Germany
C Schmidt, University of Greifswald, Institue for Community Medicine, Greifswald, Germany
A Kramer, University of Greifswald, Institute of Hygiene and Environmental Medicine, Greifswald, Germany
H Below, University of Greifswald, Institute of Hygiene and Environmental Medicine, Greifswald, Germany
U John, University of Greifswald, Institute of Epidemiology and Social Medicine, Greifswald, Germany
M Thamm, Robert-Koch-Institute, Berlin, Germany
H Wallaschofski, University of Greifswald, Department of Gastroenterology, Endocrinology and Nutrition, Greifswald, Germany
H Volzke, Greifswald, Germany

Correspondence: Till Ittermann, Email: till.ittermann{at}uni-greifswald.de

Abstract

Objective: The role of smoking in the pathogenesis of thyroid enlargement is currently under debate. It has been hypothesized that the effect of smoking on increased thyroid volume is larger in regions with than in regions without iodine deficiency. The aim of this paper was to investigate the association of smoking with thyroid volume progression and incident goiter for different age-strata in a region with improved iodine supply.

Design and Methods: The population-based Study of Health in Pomerania (SHIP) compromised 3300 subjects with complete 5-year follow-up. Data from 2484 participants without known history of thyroid disorder or thyroid medication were analyzed. Thyroid size was evaluated by ultrasound. Determinants of thyroid volume progression and incident goiter were analyzed by linear and logistic regression, respectively.

Results: Participants aged 20 to 39 years who were current smokers at baseline and at follow-up had a lower risk of incident goiter (odds ratio: 0.33; 95%; confidence interval: 0.15; 0.71; p=0.005). In this subpopulation age was inversely related to thyroid volume progression. In subjects aged 60 to 79 years smoking at baseline and follow-up was a risk factor for thyroid volume progression (β: 3.37; 95% confidence interval: 0.84; 5.89; p=0.009). After exclusion of individuals who had goiter at baseline this association disappeared.

Conclusion: We conclude that the inverse association between smoking and goiter in young adults and the lacking association of smoking with goiter and thyroid volume progression in adult non-goitrous subjects indicate that smoking has a declining impact on thyroid growth in the study region.