Background: In Germany, alimentary iodine supply is insufficient and goiter is still endemic. Iodine deficiency, although moderate to mild, has nevertheless been estimated to cost Germany more than one billion Euros per year solely from its effects on the thyroid, including diagnosis and treatment of hypothyroidism and lost work time.
Methods: To gain data regarding morphological changes of the thyroid gland and goiter prevalence in the state of Rhenania-Palatinate (Rh./ P.), a highly representative population of 4457 volunteers or 1 of 100 inhabitants of Rh./ P, (75% female, median age 45 years, range 18–64 yr.) were investigated in 11 different institutions through the state (Andernach, Bendorf, Dernbach, Koblenz, Mainz: Gutenberg – University Hospital, n=1159, Neuwied, Saarburg, Trier, and Wittlich).
Results: Morphological changes of the thyroid were prevalent in the state of Rh. / P. As much as 1729 volunteers or 38.8% of the investigated collective showed pathological changes of the gland. Age was the most important factor, since a clear and significant correlation between age and both prevalence as well as number of thyroid nodules was noted (p<0.0001). Goiter was present in 801 subjects (18%): 617 females (thyroid volume >18ml, 18%) and 184 males (>25ml, 18,6%). Thyroid volume was 14.5ml (median), range 1.2–68ml, with 12ml, 1.2–68ml, and 17ml, 5.5–56ml, for the female and male groups, respectively. Using thyroid ultrasound (linear transducer 7.5MHz), unifocal or multifocal echo alterations (cysts, calcifications, echosolid nodules) were noted in 1386 volunteers (31%), whereas thyroid nodules were observed more frequently in females (32.3%) than in males (26.7%). Finally, a nodular goiter was registered in 458 subjects or in 10.3% of the investigated population. In conclusion, more than one third of the population of Rh. / P. and nearly every second volunteer over the age of 45 years shows pathological morphological changes of the thyroid gland which are mostly caused by a still present mild to moderate iodine deficiency.
