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      Prevalence of Thyroid Nodules in China: A Health Examination Cohort-Based Study

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          Abstract

          Background

          Thyroid nodules are a common clinical problem and some are potentially cancerous; however, little is known about the prevalence of thyroid nodules in China. The objective of this study was to investigate the prevalence of thyroid nodules in a healthy Chinese population.

          Methods

          We reviewed electronic medical records of 13,178,313 participants from 30 provinces and regions who received health examinations and underwent thyroid ultrasound at Meinian Onehealth Healthcare in 2017. Among them, 6,192,357 were excluded based on predefined criteria. All thyroid nodules were diagnosed by ultrasonography, and standardized protocols were adopted for data collection, quality control, and data management.

          Results

          A total of 6,985,956 participants (mean age: 42.1 ± 13.1 years) were included in this study. The overall prevalence of thyroid nodules was 36.9% (95% CI, 35.7%–38.1%; age- and sex-standardized prevalence 38.0% [95% CI, 37.0%–39.1%]). The prevalence of thyroid nodules in females (44.7% [95% CI, 43.4%–45.9%], age-standardized prevalence: 45.2% [95% CI, 44.1%–46.4%]) was significantly higher than that in males (29.9% [95% CI, 28.8%–31.0%], age-standardized prevalence 31.2% [95% CI, 30.1%–32.2%]; P < 0.001). The prevalence of thyroid nodules decreased from <18 to 25 years, while increased with age over 25 years old. The top three provinces with the highest prevalence of thyroid nodules were Jilin (47.6%), Liaoning (44.8%), and Shandong (43.9%), whereas Guizhou (23.9%), Chongqing (26.2%), and Shaanxi (26.4%) had the lowest prevalence. Females had more than 10% higher rates of thyroid nodules than males in all included provinces and regions, except for Tianjin (8.0%). Based on the geographical regions of China, the northeast had the highest prevalence (46.8% [95% CI, 44.1%–49.2%]), whereas northwest had the lowest prevalence (28.9% [95% CI, 26.9%–31.6%]. Based on multivariable logistic regression analysis, factors including age, gender, body mass index, systolic blood pressure, diastolic blood pressure, uric acid, fasting blood glucose, triglycerides, high-density lipoproteins, and low-density lipoproteins were significantly associated with the presence of thyroid nodules.

          Conclusion

          This study provides the first nationwide analysis of the prevalence of thyroid nodules in China. Our results showed that the prevalence of thyroid nodules was high in health screening Chinese people with regional-specific patterns.

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          Most cited references32

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          2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer.

          Bryan Haugen, Erik Alexander, Keith Bible … (2016)
          Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer.
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            2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum.

            Erik Alexander, Elizabeth N Pearce, Gregory A Brent … (2017)
            Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2011, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception, and the postpartum period.
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              The Diagnosis and Management of Thyroid Nodules

              Livia Lamartina, Cosimo Durante, Giorgio Grani … (2018)
              Thyroid nodules are common, being detected in up to 65% of the general population. This is likely due to the increased use of diagnostic imaging for purposes unrelated to the thyroid. Most thyroid nodules are benign, clinically insignificant, and safely managed with a surveillance program. The main goal of initial and long-term follow-up is identification of the small subgroup of nodules that harbor a clinically significant cancer (≈10%), cause compressive symptoms (≈5%), or progress to functional disease (≈5%).
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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Endocrinol (Lausanne)
                Journal ID (iso-abbrev): Front Endocrinol (Lausanne)
                Journal ID (publisher-id): Front. Endocrinol.
                Title: Frontiers in Endocrinology
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 1664-2392
                Publication date (Electronic): 26 May 2021
                Publication date Collection: 2021
                Volume: 12
                Electronic Location Identifier: 676144
                Affiliations
                [1] 1 Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University , Chongqing, China
                [2] 2 Meinian Institute of Health , Beijing, China
                [3] 3 Peking University Health Science Center, Meinian Public Health Research Institute , Beijing, China
                [4] 4 Chongqing Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University , Chongqing, China
                Author notes

                Edited by: Paolo Miccoli, University of Pisa, Italy

                Reviewed by: Daniele Barbaro, UO Endocrinologia ASL Nord Ovest Toscana, Italy; Stefano Spiezia, Local Health Authority Naples 1 Center, Italy

                *Correspondence: Yi Ning, ningyi@ 123456vip.163.com ; Guosheng Ren, rengs726@ 123456126.com

                †These authors have contributed equally to this work

                This article was submitted to Thyroid Endocrinology, a section of the journal Frontiers in Endocrinology

                Article
                DOI: 10.3389/fendo.2021.676144
                PMC ID: 8188053
                PubMed ID: 34122350
                SO-VID: 86cc4a7f-1138-4655-8cfe-c67967da4cf3
                Copyright © Copyright © 2021 Li, Jin, Li, Tong, Wang, Huang, Ning and Ren
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 04 March 2021
                Date accepted : 10 May 2021
                Page count
                Figures: 4, Tables: 2, Equations: 0, References: 32, Pages: 9, Words: 4975
                Categories
                Subject: Endocrinology
                Subject: Original Research

                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: thyroid nodes,prevalence,risk factor,ultrasonography,china
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: thyroid nodes, prevalence, risk factor, ultrasonography, china

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