The volumes of the thyroid gland in adults aged 18-65 years in Czech republic - determination of the norms

Česká verzia

Authors: M. Dvořáková ¹; R. Bílek ¹; J. Čeřovská ¹; M. Hill ¹; Z. Novák ¹; V. Vavrejnová ¹; P. Vlček ²; J. Vrbíková ¹; V. Zamrazil ¹
Authors place of work: Endokrinologický ústav, Praha, ředitel doc. MUDr. Vojtěch Hainer, DrSc. ¹; Klinika nukleární medicíny a endokrinologie 2. lékařské fakulty UK a FN Motol, Praha, přednosta doc. MUDr. Petr Vlček, CSc. ²
Published in the journal: Vnitř Lék 2006; 52(1): 57-63
Category: Original Contributions

Summary

Objective:
In the areas with moderate iodine deficit the sonographic examination of thyroid gland is a precious method of precise determination of its volume. The objective of the work was the sonographic examination of males and females aged 18–65 years and to determine the norms of the volumes of thyroid gland.

Methods and results:
In total, by random sampling, there were sonographically examined 3 416 adults in 11 areas of the Czech Republic; there was chosen a set of 971 females and 681 males whose iodinuria level in first morning urine sample was equal or higher than 100 μg/l. This set was divided according to sex and into the age categories in 5-year interval. The measurement of 3 dimensions of the thyroid gland was determined by Medison-Kretz SA 600 sonographic device with the use of 7.5 MHz linear probe for the depth and width measurement and 3.5 MHz probe was used for the lengths measurement. The volume was determined for each lobe individually using Brunn’s formula: V (ml) = 0.479 × length × depth × width. Our results imply the age-related increase of the volume of thyroid gland at both sexes (F-ratio = 1.99, p < 0.0001). At men and women the volume of thyroid gland fluently increases to the 30th year equally, from 30 years to 55 years it increases more rapidly in men while in women there is observed a moderate plateau. Further increase of the volume of thyroid gland is equally fluent from the age of 55 years.

Conclusion:
We managed to determine first own norms of the volumes of thyroid gland for men and women aged 18–65 years in the Czech Republic in five-year age categories. In terms of practical use we recommend 90th percentile as a limit for the evaluation of upper limit of thyroid gland and the 10th percentile for the evaluation of lower limit of the volume of thyroid gland.

Key words:
thyroid gland volume – norms – USG in adult population – iodinuria

Zdroje

1. Gutekunst R et al. Ultraschalldiagnostik der Schilddrüse. Dtsch med Wschr 1988; 113: 1109-1112.

2. Olbricht T, Hoff HG. Faktoren mit Einfluss auf das Schilddrüsenvolumen. Med Klin 1988; 83: 279-284.

3. Berghout A et al. Determinants of thyroid volume as measured by ultrasonography in healthy adults in a non iodine deficient area. Clin Endocr 1987; 26: 273-280.

4. Delange F. Iodine deficiency in Europe. Thyroid Int 2002; 5: 3-18.

5. Gutekunst R, Smolarek H, Hasenpusch U et al. Goitre epidemiology: thyroid volume, iodine excretion, thyroglobulin and thyrotropin in Germany and Swede. Acta Endocrinol (Cophen) 1986; 112: 494-501.

6. Nygaard B, Gideon P, Dige-Petersen H et al. Thyroid volume and morphology and urinary iodine excretion in a Danish municipality. Acta Endocrinol (Cophen) 1993; 119: 505-510.

7. Gutekunst R, Martin-Teichert H. Requirements for goiter surveys and the determination of thyroid size. In: Delange F, Dunn JT, Glinoer D (eds). Iodine Deficiency in Europe. A continuing concern. New York: Plenum Press 1993: 109-118.

8. Wesche MFT, Wiersinga VM, Smits NJ. Lean body mass as a determinant of thyroid size. Clin Endocrinol (Oxf) 1998; 48: 701-706.

9. Delange F et al. Thyroid volume and urinary iodine in European schoolchildren: standardization of values for assessment of iodine deficiency. European Journal of Endocrinology 1997; 136: 180-187.

10. Brunn J et al. Volumetrie der Schilddrusenlappen Mittels real-time-Sonographie. Dtsch Med Wochenschr 1981; 106: 1338-1340.

11. Barrere X, Valeix P, Preziosi P et al. Determinants of thyroid volume in healthy french adults participating in the SU.VI.MAX cohort. Clin Endocrinol (Oxf) 2000; 52: 273-278.

12. Delange F Iodine deficiency. In: Braverman LE, Utiger RD (eds). Werner & Ingbar´s The Thyroid. A Fundamental and Clinical Text. 8 th ed.. Philadelphia: Lippincot Williams & Wilkins: 2000, 295-316.

13. Hegedüs L, Perrild H, Poulsen RL et al. The determination of thyroid volume by ultrasound and its relationship to body weight, age and sex in normal subjects. J Clin Endocrinol Metabol 1983; 56: 260-263.

14. Vitti P, Delange F, Pinchera A et al. Europe is iodine deficient. Lancet 2001; 361, 1226.

15. Perez C, Scrimshaw NS, Munoz JA Technique of endemic goiter surveys. In: Endemic goiter, Geneva. Geneva World Health Organization 1960; monogr. ser. 44: 369-383.

16. Olbricht T, Schmitka T, Mellinghoff U et al. Sonographic determination of thyroid volume in subjects with healthy thyroids. Dtsch Med Wochenschr 1983; 108: 1355-1358 .

17. Hintze G, Winderler J, Baumert J et al. Thyroid volume and goiter prevalence in elderly as determined by ultrasound and their relationship to laboratory indices. Acta Endocrinol (Cophen) 1991; 124: 12-18 .

18. Milakovic M, Berg G, Nystrom E et al. Urinary iodine and thyroid volume in a Swedish population. Journal of Internal Medicine 2004; 255: 610-614.

19. Maravall FJ, Goméz-Arnáiz N, Gumá A et al. Reference values of thyroid Volume in a healthy, non-iodine-deficient Spanish population. Horm Metab Res. 2004; 36: 645-649.

20. Sandell EB, Koltoff IM. Micro determinations of iodine by a catalytic Metod Mikrochem Acta 1937; 1: 9-25.

21. Bílek R. Jodurie. Národní číselník laboratorních položek, kód U-I-AS25.

22. Bílek R. Spectrophotometric determination of urinary kosine by the Sandell-Kolthoff reaction subsequent to dry alkaline ashing. Results from the Czech Republic in the period 1994-2002. Clin Chem Lab Med 2005; 43: 573-580.

23. Zamrazil V, Bílek R, Čeřovská J et al. The elimination of iodine deficiency in Czech Republic: the steps toward success. Thyroid 2004; 14: 49-56.

24. Lind P, Kumming G. Heinisch ME. Iodine supplementation in Austria: methods and results. Thyroid 2002; 12: 903-907.

25. Heinisch M, Kumming G, Asbock D. Goiter prevalence and urinary iodine excretion in a formely iodine-deficite region after introduction of statutory iodization of common salt. Thyroid 2002; 12: 809-914.

26. Dvořáková M, Zamrazil V, Čeřovská J Sonographic findings in children in the Czech Republic in relation to age, regional differences and to iodine deficiency. Thyroid gland 1997; 3: 59-67.

27. Dvořáková M, Čeřovská J, Zamrazil V. The volume of the thyroid gland in girls and boys of age 6,10,13 in Czech Republic. The Thyroid and Environment MERCK European Thyroid Symposium, Budapest 2000.

28. Zamrazil V, Čeřovská J, Šimečková A et al. Gegenwärtiger Stand des Iodmangels und der Iodversorgung in der Tschechischen Republik. 3. Interdisziplinäres Iodsymposium 2000.

29. Zamrazil V, Čeřovská J, Dvořáková M et al. Iodine deficienty in Czech Republic. In: Néve et al (eds). Therapeutic uses of Trace Elements. New York: Plenum Press 1996, 329-332.

30. Zamrazil V, Čeřovská J, Šimečková A et al. Iodine supply and the thyroid in a district of South Bohemia. Biomarkers Environment 1997; 1: 21-24.

31. Vrbíková J, Zamrazil V, Tomiško F et al. Ultrasonographic examination of thyroid gland in 3 regions of Czech republic in past with different degree of iodine endemic. Eur J Endocrinol 1994; 130(Suppl 2): 132.

32. Dvořáková M, Čeřovská J, Zamrazil V et al. Thyroid gland volume assessment in adults of 18-65 years of age in the Czech Republic with respect to the ioduria. J of Endocrinol Investig (v tisku).

33. Statigraphic Plus, Reference Manual, Version 7 for DOS, Manugistics Inc., 1993. Bistrem Cambridge, MA: Box and Wisher Plot, B11-B15.

34. Meloun M, Hill M, Militky J. Transformation in the PC-aided biochemical data Analysis. Clin Chem Lab Med 2000; 38: 553-559.