The Effect of Voluntary Iodine Prophylaxis in a Small Rural Community: The Pescopagano Survey 15 Years Later

Context: Iodine deficiency disorders are a major public health problem, and programs have been implemented to improve iodine nutrition. Objective: The objective of the study was to verify the effects of voluntary iodine prophylaxis in a small rural community ( Pescopagano, Italy). Design: The design of the study was the evaluation of the prevalence of thyroid disorders 15 years after a previous survey conducted before iodine prophylaxis. Setting: The setting for this study was a general community survey. Participants: One thousand one hundred forty-eight residents were examined in 2010 and 1411 in 1995. Results: In 2010, 757 of 1148 subjects ( 65.9%) routinely used iodized salt, urinary iodine excretion being significantly higher than in 1955 ( median 98.0 mu g/L, vs 55.0 mu g/L, P <.0001). The prevalence of goiter was lower in 2010 than in 1995 ( 25.8% vs 46.1%, P <.0001), mainly due to the reduction of diffuse goiter ( 10.3% vs 34.0%, P <.0001). In 2010 vs 1995, thyroid autonomy in subjects younger than 45 years old ( 3 of 579, 0.5% vs 25 of 1010, 2.5% P = .004) and nonautoimmune hyperthyroidism in subjects older than 45 years old ( 8 of 569, 1.4% vs 18 of 401, 4.5%, P = .03) were less frequent. The prevalence of hypothyroidism was higher in 2010 vs 1995 ( 5.0% vs 2.8%, P = .005), mainly because of an increased frequency of subclinical hypothyroidism in subjects younger than 15 years old ( 7 of 83, 8.4% vs 0 of 419, 0.0%, P < .0001). Accordingly, serum thyroid autoantibodies ( 19.5% vs 12.6%; P < .0001) and Hashimoto's thyroiditis ( 14.5% vs 3.5%; P < .0001) were more frequent in 2010 than in 1995. Conclusions: In the present work, the role of voluntary iodine prophylaxis was assessed in a small rural community relatively segregated, in which genetic and other environmental factors have not substantially changed between the 2 surveys. Iodine intake strongly affected the pattern of thyroid diseases, but the benefits of correcting iodine deficiency ( decreased prevalence of goiter and thyroid autonomy in younger subjects and reduced frequency of nonautoimmune hyperthyroidism in older subjects) far outweighs the risk of development of thyroid autoimmunity and mild hypothyroidism in youngsters. (J Clin Endocrinol Metab 98:1031-1039, 2013)