Thyroid volume, selenium levels and nutritional habits in a rural region in Albania

OBJECTIVE Environmental factors are involved in goiter development. An increased number of goitrous patients were identified among outpatients in Gyrocaster, a mountainous region in Southwestern Albania. We examined possible associations of thyroid enlargement with nutritional factors. DESIGN 112 consecutive patients, 104 females, aged 52.8 +/- 12.1 (mean +/- SD), who either were taking thyroxine (n=27) or were suspected to have thyroid disease were examined. Thyroid parameters and nutritional habits were recorded and serum selenium and urine iodine levels were determined; thyroid ultrasound was performed. RESULTS The median thyroid volume (TV) was 20.4ml (range 4.4-97.6). All consumed food was home-produced. TV correlated negatively with the frequency of lamb-goat meat and vegetables consumption (p=0.05 and p=0.03, respectively). Mean TV was significantly lower in those eating lamb-goat >1 times/week (21.4 +/- 13.3 vs 31.9 +/- 23 ml, p<0.01). The association of TV with lamb meat consumption was independent of sex, education or occupation (p<0.009). Selenium levels ranged from 30.6-138 mu g/L (reference range 43-190). There was no association between selenium levels and TV. 43% of the subjects had TSH<0.3 mU/L (those on thyroxine were excluded). Log TSH correlated negatively with TV and fT4 levels (p<0.007), indicating the presence of autonomy (TSHRab positive in two subjects). Mean urinary iodine excretion was 99.8 +/- 35.3 mu g/gr creatinine (normal > 100). CONCLUSIONS Nutritional factors may be involved in the development of goiter in Southwestern Albania. No role of selenium was found. The higher consumption of lamb-goat meat and vegetables, all non-industrialized, appeared to be protective. This finding may reflect better socioeconomic status, although this was not identified. Unrecognized subclinical hyperthyroidism, probably due to thyroid autonomy, was quite common.