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Autoimmune Thyroid Diseases after 25 years of Universal Salt Iodization: An Epidemiologic Study of Chinese Adults in Areas with Different Water Iodine Levels.

The present study aimed to evaluate the status of iodine nutrition and thyroid function in adults, to understand the distribution of thyroid disease in people with autoimmune thyroid disease (AITD) in different water iodine areas, and to explore the relationship between serum iodine, urine iodine and thyroid function in people with AITD. A cross-sectional survey was conducted in areas of Shandong Province with different water iodine levels and subsequently 1225 adults were enrolled from I-deficient (ID), I-adequate (IA), and I-excess (IE) areas. Urinary iodine, water iodine, salt iodine, serum iodine, thyroid function were measured. According to the urine iodine concentration, the ID and IA areas were defined as iodine sufficient and the IE area were iodine excess. Urine iodine, serum iodine, FT4, and TSH levels were comparatively higher in the IE area. The positive rate of TGAb (19.1%) and the prevalence of AITD (21.8%) was higher in the ID areas; the prevalence of subclinical hypothyroidism was lowest in the ID areas (7.3%) and highest in the IE area (16.3%). Among the AITD population, UIC, FT3, FT4, and TSH had a non-linear correlation with serum iodine; abnormal TSH level, SIC >110 µg/l and goiter were risk factors for AITD in adults, especially women. Our data collectively suggest that universal salt iodization has improved the iodine nutritional status of the population in ID areas in China. Non-step-by-step iodine fortification may induce the transformation of thyroid autoimmune diseases from recessive-to-dominant in susceptible people. Moreover, enhanced monitoring of thyroid function in people with AITD is important.