What Is The Normal Size Of A Woman's Thyroid Gland
Eur Thyroid J. 2015 Mar; 4(1): 55–61.
Thyroid Volume and Its Relation to Anthropometric Measures in a Healthy Cuban Population
Silvia Turcios
aNational Institute of Endocrinology, Havana, Cuba
Juan J. Lence-Anta
bPlant of Oncology and Radiobiology, Havana, Republic of cuba
Jose-Luis Santana
bPlant of Oncology and Radiobiology, Havana, Cuba
Celia M. Pereda
bInstitute of Oncology and Radiobiology, Havana, Cuba
Milagros Velasco
bPlant of Oncology and Radiobiology, Havana, Cuba
Mae Chappe
bInstitute of Oncology and Radiobiology, Havana, Cuba
Idalmis Infante
cCuban Health Public Ministry, Havana, Cuba
Marlene Bustillo
bEstablish of Oncology and Radiobiology, Havana, Cuba
Anabel García
bInstitute of Oncology and Radiobiology, Havana, Republic of cuba
Enora Clero
dRadiation Epidemiology Grouping, Unit 1018-Inserm, Villejuif, French republic
eThe Gustave Roussy Cancer Center, Villejuif, French republic
fParis-Sud University, Villejuif, France
Stephane Maillard
dRadiation Epidemiology Group, Unit of measurement 1018-Inserm, Villejuif, France
eastwardThe Gustave Roussy Cancer Center, Villejuif, France
fParis-Sud University, Villejuif, French republic
Regla Rodriguez
cCuban Wellness Public Ministry, Havana, Cuba
Constance Xhaard
dRadiation Epidemiology Group, Unit 1018-Inserm, Villejuif, French republic
eThe Gustave Roussy Cancer Center, Villejuif, France
fParis-Sud University, Villejuif, France
Yan Ren
dRadiations Epidemiology Group, Unit 1018-Inserm, Villejuif, French republic
eThe Gustave Roussy Cancer Eye, Villejuif, France
fParis-Sud Academy, Villejuif, France
Carole Rubino
dRadiation Epidemiology Group, Unit 1018-Inserm, Villejuif, France
eThe Gustave Roussy Cancer Eye, Villejuif, France
fParis-Sud University, Villejuif, France
Rosa M. Ortiz
bInstitute of Oncology and Radiobiology, Havana, Cuba
Florent de Vathaire
dRadiation Epidemiology Group, Unit 1018-Inserm, Villejuif, France
due eastThe Gustave Roussy Cancer Center, Villejuif, France
fParis-Sud University, Villejuif, France
Received 2014 Apr 24; Revised 2014 Dec 2
Abstract
Objectives
The aim of this report was to describe the thyroid book in healthy adults by ultrasound and to correlate this volume with some anthropometric measures and other differentiated thyroid cancer risk factors.
Written report Design
Thyroid volume and anthropometric measures were recorded in a sample of 100 healthy adults, including 21 men and 79 women aged eighteen-50 years, living in a non-iodine-deficient area of Havana city.
Results
The average thyroid volume was 6.6 ± 0.26 ml; information technology was higher in men (7.3 ml) than in women (6.4 ml; p = 0.15). In the univariate analysis, thyroid volume was correlated with all anthropometric measures, merely in the multivariate assay, trunk surface area was found to be the but pregnant anthropometric parameter. Thyroid volume was also college in current or onetime smokers and in persons with blood group AB or B.
Conclusion
Specific reference values of thyroid volume as a office of trunk surface area could be used for evaluating thyroid volume in clinical practice. The relation between torso surface area and thyroid volume is coherent with what is known about the relation of thyroid volume to thyroid cancer risk, but the same is not true about the relation betwixt thyroid volume and smoking habit.
Central Words: Thyroid volume, Ultrasound, Thyroid cancer take a chance factors, Example-control written report
Introduction
The thyroid is an important endocrine gland that plays a significant role in human development. Its size and shape vary widely in normal individuals. Several factors are involved in the growth of the thyroid gland, including dietary iodine intake, historic period, gender, smoking and some anthropometric measures such as weight, superlative, trunk mass alphabetize (BMI), waist-to-hip ratio (WHR), torso fat (BF) and body surface area (BSA) [i,2]. Additionally, the relation betwixt a large body size and nonmedullary differentiated thyroid cancer (DTC) risk could be due to a mutual correlation with thyroid volume [iii]. Anthropometric and clinical determinants of thyroid volume in adults [1,4,5] and children [6,seven,8] accept been investigated, particularly the potential interactions with other take a chance factors for DTC such every bit iodine intake, previous pregnancies in women, cigarette smoking and alcohol consumption [5].
Knowledge about thyroid volume is needed for the evaluation of a number of physiological and pathological factors such every bit iodine deficiency goiter, thyroiditis, multinodular goiter and thyroid cancer, also as for evaluating the efficacy of levothyroxine therapy [9] and for identifying indications of minimally invasive surgery. Ultrasonography with a linear probe is a useful, applied, safe and comparatively inexpensive method for assessing thyroid volume [10].
Until recently, well-established risk factors for developing thyroid cancer were radiation exposure, a family history of thyroid cancer, residing in an iodine-deficient area, reproductive history and body size [11]. A recent case-command study on thyroid cancer hazard factors, which has been performed in Cuba [12], has shown that thyroid cancer take a chance was lower in populations of African origin and increased with parity and BSA. Being rhesus factor positive, having a personal history of benign thyroid disorder, an agricultural occupation and an artesian well as the principal source of drinking h2o were also factors associated with a significantly increased adventure of developing DTC. In women, irregular cycles and menopause status were associated with a college run a risk of DTC. On the other hand, thyroid cancer risk was lower in current or former smokers than in nonsmokers [12].
The aim of this study was to describe the book of the thyroid gland in a control population and to decide its correlation with anthropometric measures and other selected parameters which have been establish to be significantly associated with thyroid cancer chance in a case-command written report [12].
Thyroid volume was measured by ultrasound in one-half of the controls of the example-control written report in social club to sympathise the relationship between the determinants of thyroid volume and those of the adventure of DTC.
Subjects and Methods
Subjects
The case-control study included 203 patients with DTC aged betwixt 17 and threescore years who were living in Havana and its surrounding municipality of Jaruco (30 km from Havana), and who were treated for DTC betwixt 2000 and 2011 at the National Institute of Oncology and Radiobiology (INOR) and at the Institute of Endocrinology, and 212 controls from the aforementioned area with matching age and gender. No biological thyroid parameter was used as an inclusion or exclusion criterion.
The thyroid measurements were conducted at the INOR in a sample of 100 controls. Several exclusion criteria were applied: subjects with a goiter (divers as a visible and/or palpable thyroid gland) and subjects with a personal or family history of thyroid disease or with signs of thyroid disease. Furthermore, we excluded women during flow, pregnant women and women who had delivered within the last 12 months considering these weather condition may affect thyroid size.
The report was approved by the Upstanding Review Board of the INOR. All subjects agreed and signed an informed consent form for participating in the study.
Method
Subjects were interviewed face-to-face past trained professionals (nursing and medical staff) using a structured questionnaire between January 2009 and December 2011. A standardized questionnaire was used to collect data on demographic characteristics (historic period, gender, identify of residence and occupation), claret group, rhesus factor, anthropometric parameters, reproductive and hormonal history, lifestyle (smoking habits, alcohol consumption), exposure to radiation or chemicals, personal medical history and family medical history in outset-degree relatives. Size, blood group and rhesus cistron obtained past interviewers were compared to the data on the national identity card and in the medical records of individual cases. Ethnicity of subjects was divided into three groups according to the ethnicity of their parents: European (both parents of European origin), African (both parents of African origin) and other (all other combinations of parental origin).
In this written report, urinary iodine and thyroid-stimulating hormone (TSH) blood level were not measured; neither was autoimmune thyroiditis tested. Thyroid volume measurement was estimated by 3D ultrasonography using a linear 7.five-MHz probe. During the ultrasound exam, subjects lay in a supine position with the neck hyperextended and the shoulders were supported past a pillow. All the ultrasound examinations were conducted and interpreted by the same experienced radiologist.
The book of ane lobe of the thyroid was expressed in ml and estimated by the formula: volume of 1 lobe = length × depth × width × π/6. The total thyroid book was obtained by calculation the volumes of both lobes, the isthmus non being taken into business relationship in the volume adding. In determining the volume, nodules smaller than x mm detected by ultrasound were included.
The measures were collected by physical test co-ordinate to standardized procedures [xiii] and were calculated equally follows:
• BMI = weight (kg)/summit (chiliad)2
• BSA = 0.007184 × [height (m)0.725] × [weight (kg)0.425]
• WHR = waist circumference/hip circumference (cm)
• BF % = (1.2 × BMI) + (0.23 × age) – (x.8 × 1) – five.4 for males and (1.2 × BMI) + (0.23 × historic period) – (ten.8 × 0) – five.4 for females.
Statistical Methods
To describe the data, means ± standard deviations and percentages were used. The comparisons of thyroid volume in the two groups were performed using Student's t test. Multivariate analyses aimed at comparing the role of anthropometric parameters in thyroid volume were conducted using crude values and after taking into account collinearity between these values past mean-centering the variables, the process being carried out separately for men and women. Because of the dependence between BMI and BSA, which are both calculated from peak and weight, multivariate analysis was conducted by including anthropometric parameters merely by pair (2 by ii). Information were analyzed using SPSS® and SAS® for Windows.
Results
The thyroid gland volume was estimated in 21 men and 79 women (age: xviii-50 years). The characteristics of the study population are shown in table 1. The estimated average total thyroid volume was vi.half-dozen ml; it was nonsignificantly college in males (7.three ml) than in females (half dozen.iv ml).
Tabular array i
Anthropometric parameters by gender
| Whole population | Males | Females | pa | |
|---|---|---|---|---|
| Age, years | 38.2±0.nine | 39.6±2.0 | 37.9±1.0 | 0.4 |
| Weight, kg | 66.six±1.four | 77±4 | 63.8±i.iv | 0.0001 |
| Peak, m | 1.7±0.0 | 1.vii±0.02 | 1.vi±0 | <0.0001 |
| BSA, m2 | i.seven±0.02 | 1.ix±0.v | 1.7±0.02 | <0.0001 |
| BMI, kg/yardii | 24.iv±0.4 | 26.0±i.0 | 24.0±0.five | <0.05 |
| BF, % | 30.four±0.6 | 24.ii±ane.three | 32.1±0.six | <0.0001 |
| WHR, cm | 0.9±0.02 | 0.9±0.02 | 0.9±0.02 | 0.8 |
| Thyroid book, ml | vi.6±0.three | 7.3±0.3 | half-dozen.4±0.3 | 0.2 |
In the univariate assay, thyroid volume was positively linked to weight, summit, BMI, BSA and BF (table i). In this young developed population, no significant correlation was observed between thyroid volume and age.
In the multivariate analysis, when analyzing the role of anthropometric parameters two by ii, BSA was found to exist the only anthropometric parameter with a pregnant role in thyroid book. When taking into business relationship BSA, no other anthropometric parameter remained significantly correlated to thyroid volume (table 2).
Table 2
Anthropometric parameters and thyroid book
| Coefficient (95% CI)a | d.f.b | p value | |
|---|---|---|---|
| Model 1 | |||
| BSA: increase per cmii | 3.22 (–one.10 to seven.54) | 1 | 0.1 |
| BMI: increase per unit of measurement | 0.00 (–0.22 to 0.23) | 1 | 0.nine |
| Model two | |||
| BSA: increase per cm2 | 3.06 (0.73–5.36) | 1 | 0.01 |
| WHR: increase per unit of measurement | one.80 (–i.22 to 4.82) | 1 | 0.ii |
| Model 3 | |||
| BSA: increase per cm2 | 2.96 (0.48–v.44) | 1 | 0.02 |
| BF alphabetize: increment per unit | 0.03 (–0.06 to 0.xi) | one | 0.5 |
| Model 4 | |||
| BSA: increase per cm2 | 3.26 (0.94–5.54) | ane | 0.006 |
| Conicity index: increase per unit | 0.00 (–0.03 to 0.03) | 1 | 0.nine |
When analyzing the part of other parameters collected in the case-control study in a multivariate analysis including BSA, only BSA, claret group and smoking condition remained independently, and positively, correlated with thyroid book (table three; fig. 1). Ethnicity, gender and age did not significantly collaborate with the relationships between these parameters and thyroid volume, but the population included as well few men and was too homogenous concerning historic period for interaction tests to be powerful.
Thyroid volume equally a function of BSA.
Table 3
Predictive model for thyroid volume
| Coefficient (95% CI)a | d.f. | p value | |
|---|---|---|---|
| BSA: increment per cmii | 3.25 (0.95–5.54) | 1 | 0.006 |
| Blood group: B or AB/O or A | 1.62 (0.25–ii.98) | ane | 0.02 |
| Smoking status: always/never | 0.73 (–0.29 to 1.75) | 1 | 0.01 |
Give-and-take
Based on the measurements conducted in 100 controls from a case-control study carried out in a full general population, we have shown that BSA, rather than other anthropometric parameters, was the fundamental anthropometric parameter for predicting thyroid book. Thyroid volume increased with increasing BSA and was higher in current or sometime smokers than in controls who had never smoked and college in those with blood group AB or B than in others. No other parameter significantly interacted with these relationships.
Our study has some weaknesses, including the relatively small number (n = 100) of individuals and the homogeneity of the sample (by and large young developed women). On the other hand, the fact that anthropometric parameters have been measured in the control population of a case-control study is an reward.
In this study, the hateful total thyroid volume was half-dozen.six ml, a value like to the one estimated in 485 Nepalese individuals [one] and in 103 Sudanese healthy subjects [14] using ultrasound. In these two studies, the divergence between genders was similar to the 1 nosotros evidenced, but it was significant, due to a college number of patients. On the other hand, thyroid volume in our study was lower than in some other studies (table 4) [fifteen,16,17,18,19,20,21,22,23], in which thyroid volume, too measured using ultrasound, ranged generally from vii to 13 ml and was generally higher in men than in women.
Table four
Thyroid volume in healthy adults measured by ultrasonography reported in not-iodine-scarce populations
| First author [Ref.], year | Sample size, northward | Land | Men, ml | Women, ml |
| Gutekunst [eighteen], 1986 | 1,397 | Deutschland | 26.ix±17.0 | xvi.5±12.2 |
| 303 | Sweden | eleven.1±4.vii | 7.7±4.iii | |
| Berghout [19], 1987 | 50 | Kingdom of the netherlands | 13.2 [6.7–20.iv] | 8.two [two.vii–20.iii] |
| Wesche [xx], 1998 | 44 | The Netherlands | ten.3±iii.3 | six.9±ii.9 |
| Barrère [21], 2000 | 669 | France (nonsmokers) | 12.1 (eleven.6–12.6) | 8.half dozen (8.iii–eight.9) |
| Maravall [22], 2004 | 268 | Kingdom of spain | 9.nine (ix.1–10.6) | half dozen.six (6.2–6.ix) |
| Ivanac [fifteen], 2004 | 51 | Croatia | – | 10.7±ii.8 |
| Adibi [23], 2008 | 200 | Iran | 10.seven±iii.four | 7.7±two.vi |
| Nafisi Moghadam [17], 2011 | 314 | Islamic republic of iran | ix.i±two.v | 7.ix±3.2 |
Variations in thyroid book could be related to dietary iodine intake, other dietary components such as goitrogenic vegetables (cruciferous), ethnic origin and, according to our results, anthropometric characteristics. In Cuba, a cross-sectional epidemiological study of iodine in urine estimated that, overall, 6.5% of children were iodine deficient, this proportion being higher in populations living in the mountains than in those from the cities [24], as in our study, where subjects lived in Havana metropolis or in its surroundings. Dietary iodine intake may attune TSH production, which could therefore pb to thyroid enlargement [25], but this relation is not always evidenced [26].
In line with our results, most of the studies showed a higher, significantly [four] or not [1,27], thyroid volume in men than in women, this difference disappearing when adjusting for body weight [4].
Thyroid book is well known to increase when increasing any anthropometric parameters, such as weight, height, BMI or BSA [iv,xv,21,28,29]. In our study, the all-time predictor of thyroid volume was BSA, in line with several other studies [1,v,15,21]. In children, besides, although less documented than in adults, thyroid volume has been found to increase with increasing anthropometric measures [half-dozen,7,8]. In line with our finding in adults, BSA was found to exist the best predictor of thyroid volume, and it was recommended to use this benchmark in order to evaluate the constitutional characteristics of child development [8]. In several studies, BSA is also the best anthropometric parameter for predicting thyroid cancer risk [27,31,32]. All the same, in most studies, obesity is used every bit a predicting parameter. Hence, the mechanisms whereby obesity increases the take chances of thyroid cancer are non articulate and may be very circuitous with a synergistic activity of different factors. Thyroid cancer hazard may be mediated past hormonal changes and inflammation that result from adiposity [35,36,37]. The hypothesis is that obesity leads to hypoadiponectinemia, a proinflammatory state, and insulin resistance, which, in turn, leads to high circulating insulin and insulin-like growth factor-1 levels, thereby peradventure increasing the adventure for thyroid cancer. Thus, insulin resistance mayhap plays a pivotal role in the observed association betwixt obesity and thyroid cancer, potentially leading to the development and/or progression of thyroid cancer through its interconnections with other factors including insulin-like growth factor-1, adipocytokines/cytokines and thyroid-stimulating hormone [37].
Our finding of a higher thyroid book in smokers than in nonsmokers is in line with what was observed in other studies [2,38,39,40]. In the large French cohort SUIVIMAX [21], thyroid volume was significantly greater in current smokers and in sometime smokers than in nonsmokers, both in men and in women. In fact, this finding could announced to be surprising because smoking reduces the risk of goiter [two] and of thyroid cancer [40], this latter relationship having been confirmed in the Cuban case-command study [xi]. This greater thyroid volume could be acquired by competitive inhibition of thyroidal iodide uptake past thiocyanate [40]. Smoking is associated with a decrease in serum TSH and a rising in serum FT4 and FT3 induced by activation of the sympathetic nervous system. It has been hypothesized that this issue is larger in iodine deficiency areas [xl,41,42], which has been confirmed in some studies, simply non in all [21].
In addition to dietary iodine intake and the consumption of cruciferous vegetables which are known to influence the book of the thyroid [43,44], other environmental or dietary exposures may influence thyroid book, especially exposure to pollutants. For instance, long-term exposure to high nitrate intake by drinking water and home-made meals from local products has been shown to issue in an increased thyroid volume and an increased frequency of signs of subclinical thyroid disorders (thyroid hypoechogenicity by ultrasound, increased TSH level and positive anti-thyroid peroxidase) [45], merely this relation was non plant in another study where the level of alimentary nitrate intake was lower [46]. Interactions with dietary iodine intake may too exist [46]. A high exposure to polychlorinated biphenyls is also related to an increase in thyroid volume [47].
No other written report has investigated the relation betwixt blood grouping and thyroid book. Therefore, our results need to be confirmed. Even so, in the case-control study, we evidenced a significant reduction in the risk of DTC associated with claret group B when compared to blood type O [12]. This association had not been reported before; nevertheless, several studies reveal that there is an inherited element in the susceptibility to or protection against different types of head and neck cancer linked to blood groups [48,49,fifty].
In our study, we did not examination the association between thyroid book and the risk of thyroid cancer because subjects belonged merely to the control group. To our knowledge, the direct relation between thyroid volume and DTC risk has never been reported; however, it could even be a confounding gene, as a direct correlation of some anthropometric factors such as summit, BMI and obesity with thyroid cancer and, in turn, with thyroid volume has previously been reported.
Conclusions
Specific reference values of thyroid volume as a part of BSA could be used for the evaluation of thyroid book in clinical practice. The relation betwixt BSA and thyroid volume is coherent with what is known about its relation with thyroid cancer hazard, merely the same is not true about the relation between thyroid volume and smoking addiction.
Disclosure Statement
The authors ostend that in that location are no commercial associations that might create a conflict of interest in connection with this article.
Acknowledgements
This report was supported past the INSERM and La Ligue Nationale Contre le Cancer in France and the Region Ile de France. C.X. received a grant from the Region Ile de France, and Y.R. received a grant from the Fondation de French republic.
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What Is The Normal Size Of A Woman's Thyroid Gland,
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404892/
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