| Background and objectivesThyroid nodule was one or more abnormal masses in the thyroid caused by genetic,environmental and other reasons.There was few of report on the prevalence of thyroid nodules and epidemiological feature in pre-adolescent and adolescent students.In the Guidelines for the Management of Thyroid Nodules and Differential Thyroid Carcinoma in Children(issued in2015),the United States clearly pointed out that the thyroid gland of children was by no means a miniature version of the adult when they were growing and developing.This study aimed to investigate the prevalence and distribution characteristics of thyroid nodule among minors aged8-17 in Jiangsu Province,and explored the main influencing factors of thyroid nodule among minors,so as to provide clues for the prevention and early diagnosis of thyroid disease among minors.Methods1.68 schools in 11 counties(cities and districts)were selected as survey points.students aged8-17years were selected as survey subjects by taking the median urinary iodine of all counties and districts in Jiangsu Province from 2015 to 2019,B-ultrasound examination was performed on all respondents’neck.The total prevalence of thyroid nodule among underage students was calculated according to B-ultrasound examination results.The epidemiological distribution characteristics of thyroid nodules in counties,schools,urban and rural areas,coastal and inland areas,gender,age and so on were analyzed.2.All the students who completed B-ultrasound examination were extracted to collect the student’s basic information,geographical environment,past medical history,diet and nutrition,small environment,learning schedule information by questionnaire survey,One-time randomurine sample,drinking water sample,salt sample of students were collected at the sametime.The value of urine iodine,water iodine and salt iodine were detected in laboratory,and the site of height and weight were measured.According to the results of B-ultrasound examination,the students were divided into nodule group and no nodule group,and univariate analysis was conducted on the influencing factors of thyroid nodule.3.Screening Scale for Childhood Anxiety Associated Disorders(for children 8 to 17 years and younger)or named Scared Scale.The students who completed B ultrasonic examination and grade up fifth grade were choose to do SCARED scale questionnaire investigation.Then different psychological evaluation of thyroid nodule prevalence was calculated according to the results of SCARED rating scale,and chi-square analysis of various psychological factors with thyroid nodules were associated.At last the relationship between the different degree of anxiety and thyroid nodule were studied.4.The influential factors with statistical differences were sorted out and analyzed according to the results of univariate and SCARED scale analysis of thyroid nodule,and the included factors to be studied were selected for the multivariate Logistic regression model.The model was established by stepping-regression method,and the independent influential factors of thyroid nodule were further analyzed.Results1.The prevalence and epidemiological distribution of thyroid nodule:8229 students were investigated,and the prevalence of thyroid nodule was 29.94%.The prevalence rate was 32.83%for female students and 27.03%for male students,and the difference was statistically significant(x~2=32.737,P<0.001).The prevalence rate ranged from 26.80%to 33.57%among 8to 17 years old,with the lowest prevalence rate at 8 years old and the highest at 11 years old(x~2=15.705,P=0.073).The prevalence rate ranged from 19.53%to 40.97%in different counties,and the difference was statistically significant(x~2=337.215,P<0.001).The prevalence rate ranged from 4.17%to 74.07%in different schools,and the difference was statistically significant(x~2=617.919,P<0.001).The prevalence rate of thyroid nodule was 29.20%in rural areas,35.30%in suburban areas and 27.67%in downtown areas,with statistical significance(x~2=30.617,P<0.001).The prevalence rate was 31.03%in inland and 26.37%in coastal areas,and the difference was statistically significant(x~2=15.182,P<0.001).There was no significant correlation between the median urinary iodine and the prevalence of thyroid nodule(p>0.05).2.Univariate analysis results:Height(x~2=70.947,P=0.01),individual urinary iodine(continuous variable)(Z=3.43,P<0.001),gender(x~2=32.737,P<0.01),grade by group(x~2=17.754,P=0.003),iodine nutrition(x~2=59.175,P<0.001),water iodine(continuous variable)(Z=4.67,P<0.001),water iodine by group(x~2=70.947,P<0.001),coastal or inland(x~2=15.182,P<0.001),urban and rural distribution(x~2=30.617,P<0.001),nearby chemical plant(x~2=6.225,P=0.013),alt iodine(continuous variable)(Z=-4.19,P<0.001),solid snack consumption(x~2=11.082,P=0.004),sleep duration(x~2=9.398,P=0.024)and weariness score(x~2=4.232,P=0.04)were significantly correlated with thyroid nodules of juvenile students.3.4492 valid SCARED questionnaires were collected,and the mean value of the total score was18,the standard deviation was 11,the minimum value was 0,and the maximum value was 82;The mean value of acute anxiety score was 5,the standard deviation was 4,the minimum value was 0,the maximum value was 26;The mean of chronic anxiety score was 4,the standard deviation was 3,the minimum value was 0,and the maximum value was 18;The mean value of separation anxiety score was 4,the standard deviation was 3,the minimum value was 0,and the maximum value was 16;The mean value of social fear score was 5,the standard deviation was 3,the minimum value was 0,and the maximum value was 14;The mean of weariness score was 1,the standard deviation was 1,the minimum value was 0,and the maximum value was8;The chi-square test results showed that the score of study weariness was significantly correlated with thyroid nodules(x~2=4.232,P<0.05).The prevalence of thyroid nodules without study weariness was 30.94%,the prevalence of thyroid nodules with study weariness was27.20%.Total score,acute anxiety,chronic anxiety,separation anxiety and social phobia had no statistical significance with thyroid nodule(x~2=0.865,P=0.352;x~2=0.976,P=0.323;x~2=1.023,P=0.312;x~2=0.538,P=0.30.463;x~2=0.445,P=0.505).4.Multivariate Logistic regression analysis results:gender(OR=1.441,P<0.001),height(OR=1.007,P=0.023),weariness score(OR=0.814,P=0.020),iodine of nutrition(OR=1.001,P=0.024)were significantly correlated with thyroid nodule of juvenile students.It may be an independent influencing factor of thyroid nodule in minor student.conclusions1.The external environmental water iodine was deficient good and high in Jiangsu Province.The median of urinary iodine in this study was237.3g/L,and the iodine level was sufficient.After the supply of iodized salt was stopped in the area with high water iodine content,the median urinary iodine was still in excess level,that should be paid more attention.2.The prevalence rate of thyroid nodule for underage students aged 8-17 years in Jiangsu Province was 29.94%.The prevalence rate of females was higher than males.The rate of rural areas was higher than urban areas,and that in inland areas was higher than that in coastal areas.3.In this study,it was found that there was no significant correlation between the median urinary iodine and the prevalence of thyroid nodules in the population based on the county area.Further analysis suggested that juvenile females had a greater risk of thyroid nodules,and excessive iodine nutrition(median urinary iodine>300μg/L)may increase the risk of thyroid nodules.Adefficiency of iodine nutrition(median urinary iodine of 200-299μg/L)may be a protective factor for thyroid nodules.Height and school weariness may be related to thyroid nodules. |
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