AI Article Synopsis
- A retrospective cohort study in Denmark investigated the impact of iodine fortification (IF) on hyperthyroidism and mortality in older adults.
- Before IF, no significant link was found between hyperthyroidism and mortality; however, after IF, hyperthyroid individuals faced a notably increased risk of death (adjusted hazard ratio: 2.22).
- The study emphasizes the importance of careful iodine supplementation and monitoring in older populations, particularly those with a history of hyperthyroidism.
Article Abstract
Objective: A transient rise in the occurrence of hyperthyroidism ensued the introduction of iodine fortification (IF) of salt in Denmark. Older adults are at risk of complications to hyperthyroidism that could prove fatal to vulnerable individuals. We evaluated the association between thyroid function and mortality in older adults before and after nationwide implementation of IF.
Design: Retrospective cohort study.
Patients: All 68-year-olds from the general population in the city of Randers were invited to participate in a clinical study in 1988 and followed until death, emigration or end of study (31 December 2017) using Danish registries.
Measurements: Baseline measures comprised of a questionnaire, physical examination and blood and urine samples. Kaplan-Meier survival curves and Cox regression were used to determine the association between thyroid function and death before and after IF. Time-stratification of results before and after IF was employed due to violation of proportional hazards assumptions in Cox regression.
Results: Median urinary iodine concentration was 42 µg/L at baseline consistent with moderate iodine deficiency. Hyperthyroidism (thyrotropin < 0.4 mIU/L) occurred in 37 (9.1%) participants. Kaplan-Meier survival curves showed an increase in mortality among participants with hyperthyroidism after IF. There was no significant association between hyperthyroidism and mortality before IF compared to euthyroid participants, but after IF hyperthyroid subjects had an increased mortality (adjusted hazard ratio: 2.22, 95% confidence interval: 1.44-3.44).
Conclusions: IF was associated with raised mortality among older adults with a history of hyperthyroidism and moderate iodine deficiency. Our results highlight the need for cautious iodine supplementation and for monitoring of IF.
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Article Synopsis
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- Outcomes will include monitoring women's consumption of the salts, changes in biomarker levels for folate and iodine, and any adverse events, with results analyzed to determine the effectiveness of the fortification strategy
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