Bilous І.І., Pavlovych L.B., Chornenka Zh.А., Bytsko N.I.

Higher State Educational Institution of Ukraine 

«Bukovinian State Medical University»

ASSESSING THE PREVALENCE OF THYROID DISEASE IN CHERNIVTSI REGION OVER THE LAST 5 YEARS.

           Diseases of the thyroid gland (TG) have drawn a lot of attention recently. On the one hand, this is due to the fact that it is TG that responds actively to geochemical environment, followed by the onset of some of thyroid diseases. On the other hand, in the current conditions the population remains alone with the adverse effects of the environment, as an effective experience of the international community in fighting iodine deficiency has not been implemented in Ukraine.

In general, diseases of the endocrine glands, particularly the thyroid pathology cause great social and economic loss that is determined by the cost of medical care and social security (due to disability, disablement, untimely death of patients).

Studying the prevalence of thyroid diseases was previously considered in terms of total endocrine sickness related to previous years. Unfortunately, the statistical analysis and probability of these changes were not considered. We have analysed the official statistics of Ministry of Health of Ukraine (analysis of endocrinology service of Chernivtsi region for the Ministry of Health of Ukraine) regarding the prevalence of adult and child population in thyroid pathology over the last 5 years between 2011 and 2015. The analysis of official statistics showed a high prevalence of endocrine diseases. According to these criteria the endocrine pathology is one of the leading in the structure of overall morbidity. Ukraine is characterized by an increase in the number of patients with various endocrinopathies, the most common among them are diabetes mellitus (DM) and thyroid diseases.

At the moment, we decided to concentrate our attention on the pathology of the thyroid gland, which was first described back in the second century BC by a Roman physician Galen and it occupies an important place among endocrine diseases after DM. The structure of thyroid diseases, included in official statistics, consists of euthyroid diffuse goiter, nodular goiter, hyperthyroidism, hypothyroidism, thyroiditis, thyroid cancer. Diffuse goiter is the most common pathology. Goiter is an enlargement of the TG above its normal size. Without touching  the age and sex features of the gland parameters, we note that its size is determined by palpation and ultrasound measurement of its volume. According to a current classification, WHO identifies the first and second degrees of goiter. In order to attract the attention of endocrinologists to the need for pharmacological treatment of this pathology in Ukraine, official statistics of diffuse goiter identifies the ІІ–ІІІ degree of goiter instead of the ІІ degree.

The area in which the prevalence of the first degree thyroid hyperplasia is 5% or more among children or 30% or more among adults is considered to be goiter endemic. Ukraine is an endemic area with low iodine in the environment. There is no region in Ukraine, where people do not feel the iodine deficiency, and Chernivtsi region is not an exception. Iodine deficiency is especially dangerous for pregnant women, resulting in an increased risk of having children with low birth weight, sensorineural deafness, spastic paralysis, cretinism as well as stillbirths and miscarriages. Iodine deficiency affects the mental development of older children significantly. 

Prevalence of endocrine thyroid disease

in Chernivtsi region over the last 5 years

 

Nosological

unities

 

Patients registered in 2011

Patients registered in 2012

Patients registered in 2013

Adults

Children under 17

Adults

Children under 17

Adults

Children under 17

Abs.number

on 100 th.

Abs.numbe

on 100 th.

Abs.numbe

on 100 th..

Abs.numbe

on 100 th.

Abs.numbe

on 100 th.

Abs.numbe

on 100 th.

Thyrotoxicosis E05

1134

158,4

8

4,3

1196

166,7

-

-

1272

176,6

-

-

Nodular goiter E04.1, 2.4, D34

3128

437,0

23

12,3

3445

480,3

-

-

3828

531,4

-

-

thyroiditis E06

2115

295,5

152

81,9

2152

300,0

-

-

2252

314,0

-

-

Hypothyroidism

1533

214,2

68

36,6

1631

227,3

-

-

1799

239,5

-

-

02-03 E, E89, incl. Рostoperative hypothyroidism

277

38,7

5

2,6

294

41,0

-

-

325

45,1

-

-

Simple goiter E01, E04

21477

3000,7

12034

6487,5

22918

3195,0

-

-

24346

3379,0

-

-

І degr.

16837

2352,5

11056

5960,2

18143

2529,3

-

-

19362

2687,0

-

-

ІІdegr. - ІІІ degr.

4640

648,3

978

527,2

4775

665,7

-

-

4984

691,9

-

-

Thyroid cancer C 73

313

43,7

6

3,2

256

35,6

-

-

267

37,0

-

-

hypoparathyroidism E20

17

2,3

1

0,5

16

2,2

-

-

17

2,3

-

-

hyperparathyroidism E21

1

0,1

0

-

3

0,41

-

-

3

0,4

-

-

Table 1

 

Table 1(extension)

 

Nosological

unities

Patients registered in 2014

Patients registered in 2015

Adults

Children under 17

Adults

Children under 17

Abs.number

0n 100 th.

Abs.number

0n 100 th.

Abs.number

0n 100 th.

Abs.number

0n 100 th.

Thyrotoxicosis E05

1335

185,2

-

-

1424

197,3

12

6,5

Nodular goiter E04.1, 2.4, D34

4358

604,7

-

-

4812

666,9

38

20,5

Thyroiditis E06

2424

336,3

-

-

2633

364,9

218

117,6

Hypothyroidism

1882

261,1

-

-

2151

298,1

71

38,3

02-03 E, E89, incl. postoperative hypothyroidism

356

49,4

-

-

371

51,4

3

1,6

Simple goiter E01, E04

25719

3568,6

-

-

26933

3732,5

12937

6981,3

І degr.

20528

2848,3

-

-

5364

743,4

956

515,9

ІІdegr. - ІІІ degr..

5191

720,3

-

-

425

58,9

3

1,6

Thyroid cancer C 73

377

52,3

-

-

19

2,6

2

1,1

Нypoparathyroidism E20

18

2,5

-

-

6

0,8

-

-

Нyperparathyroidism E21

7

0,9

-

-

8

1,1

-

-

 

The structure of endocrine pathology in the adult population of Chernivtsi region is dominated by thyroid disease.The structure of endocrine diseases is shown in Fig.1 Fig. 1 The structure of endocrine pathology in the adult population of Chernivtsi region.

It should be noted that euthyroid diffuse goiter and DM are the most common diseases. And if we take into consideration the fact that thyroid diseases also include hyperthyroidism, hypothyroidism, thyroiditis and cancer of the gland, it can be argued that thyroid diseases account for nearly half of all endocrinopathies.

Unlike the initial stage of the first degree goiter, that of the II degree defies regression immediately after improving the iodine status. We need at least 5 years for the positive trend to reduce the incidence of this stage of goiter to manifest itself. In previous years there was a gradual shift in the cases of I degree goiter to the II degree, indicating a lack of preventive work to eliminate IDD and, therefore, an inadequate intake of dietary trace element iodine, but even now the prevalence of the I-II degree goiter does not allow to say that the residents of Bukovyna consume enough dietary iodine. The prevalence of thyroid endocrine pathology in the adult population of Chernivtsi region is presented in Fig.2.1. and 2.2.

Fig.2.1.

 

Fig.2.2.

 

Fig. 2.1. and 2.2. The prevalence of thyroid diseases among adults  in Chernivtsi region (on 100 thousand people)

        Iodine prophylaxis in the region covers 70% of the population. Preventive maintenance is carried out in three areas: mass (the use of iodized salt, milk and bread), group (is made with drugs of potassium iodide in special risk groups (children, adolescents, pregnant women)), individual (by a doctor’s prescription  and as an autotherapy).

In general, diseases of the endocrine glands, particularly the thyroid pathology cause great social and economic loss that is determined by the cost of medical care and social security (due to disability, disablement, untimely death of patients).

References

1. Delange F. Iodine deficiency in Europe // Thyroid International. - 1994. - № 3. - P. 8.

2. Zimmermann M.B., Hess S.Y., Molinari L. et al. New re-ference values for thyroid volume by ultrasound in iodinesufficient schoolchildren: a World Health Organization/Nutrition for Health and Development Iodine Deficiency Study Group Report // Am. J. Clin. Nutrit. -  2004. - Vol. 79. - P. 231-237.

3. Митник З.М. та ін. Стан ендокринологічної служби України в 2007 р. та перспективи розвитку медичної допомоги хворим з ендокринною патологією // Статистично-аналітичний довідник МОЗ України та Українського науково-практичного центру ендокринної хірургії, трансплантації ендокринних органів і тканин. - К., 2008. - 49 с.

4.Цифровий звіт ендокринологічної служби в Чернівецькій області  за  2011-2015 рр., Обласна комунальна установа «Чернівецький обласний ендокринологічний центр», 2011–2015 рр.

4. Петри А., Сэбин К. Наглядная статистика в медицине: Пер. с англ. - М.: ГЭОТАР-Мед, 2003. — 144 с.

5. Delange F. Iodine deficiency in Europe // Thyroid International. - 1994. - № 3. - P. 8.

6. Tronko N., Bogdanova T. Thyroid cancer in children and adolescents. Health effects of Chornobyl accident / Ed. by A. Vozianov, V. Bebeshko, D. Basyka, A. Chumak. - Kyiv: DIA Ltd, 2003. - P. 60-68.

7. Кравченко В.І., Ткачук Л.А., Турчин В.І. та ін. Споживання йодованих продуктів та стан йодної забезпеченості населення України // Доп. НАН України. - 2005. - № 10. - С. 188-194.

8. Звіт «Про національне дослідження вживання населенням харчових мікронутрієнтів». - К.: Прем’єр Медіа, 2004. - 64 с.

9. Оцінювання йододефіцитних захворювань та моніторинг їх усунення: Пер. з англ. / Під ред. В.І. Кравченка. - К.: К.І.С., 2008. - 104 с.