The Status Of Thyroid Diseases In Medical Staff Of A Hospital And Risk Factors

ObjectiveIn recent years,the incidence spectrum of thyroid disease has changed a lot in China,especially with the popularization of physical examination,the detection rate of thyroid nodules in Chinese population is increasing.The factors of thyroid nodule were female,age,overweight and obesity,iodine nutrition level and so on.In particular,the relationship between iodine nutrition and thyroid nodules is the focus of research.At present,some people mistakenly think that"iodine salt"can lead to thyroid nodules,and take the initiative to eat non iodine salt,which affects the prevention and treatment of IDD.At present,there are few researches on grass-roots medical staff,and the causes of the disease need to be further explored.The purpose of this study is to understand the prevalence of thyroid nodules in grass-roots medical workers,to master the thyroid volume and thyroid prevalence of grass-roots medical workers,to explore the related risk factors of thyroid nodules in grass-roots medical workers,so as to improve the awareness of prevention and treatment of thyroid gland diseases in grass-roots medical workers,and to protect life and health.Method1.Questionnaire survey:There was no significant difference between the male and female proportion and the overall proportion（χ²=0.907,P＞0.05）,and the sampling was representative.the survey includes four parts.The first part is the basic information of the respondents,including name,gender,nationality,native place,contact number,date of birth,height,weight,education background,whether they are engaged in radiation health work,have a history of type 2 diabetes mellitus,whether the living environment has chemical pollution,ionizing pollution,whether the head and neck have received radiation examination and treatment,whether they have taken iodine containing drugs,vitamins and minerals,and Other health food,whether the lineal relatives（parents,grandparents,grandparents,brothers and sisters）have cancer,whether the lineal relatives have thyroid disease（hypothyroidism,hyperthyroidism,goiter/nodule）and birth weight.The second part includes smoking and drinking.The third part is the diet,including the frequency of kelp and laver consumption in the past year,the taste of drinking water and meal,whether to eat iodized salt.The fourth part includes sports,emotion and living habits.Previous studies have shown good reliability and validity^[1-3].2.General examination:The height,weight and dental fluorosis were screened by public health practitioners.BMI was calculated according to height and weight.3.Blood biochemical indexes:the five indexes of thyroid function include free triiodothyronine（FT₃）,free thyroxine（FT₄）,thyrotropin（TSH）,thyroglobulin antibody（TGAb）,thyroperoxidase antibody（TPOAb）.The examination results showed that the disease was determined by the deputy chief physician of internal medicine.4.Urine biochemical index test:detect the urine iodine level.10 ml urine was collected from the middle part of the morning urine of the investigator on an empty stomach（no food,water or quiet state in the morning）.The urine was stored in a clean polyethylene plastic urine cup and sealed in a refrigerator.The urinary iodine was determined by as CE catalytic spectrophotometry（WS/T 107.1-2016）.5.Thyroid ultrasonography:Toshiba ta700 color Doppler detector was used.The length,width and thickness of the two lobes of thyroid gland were monitored.If there is thyroid nodule,the echo of solid particles,nodule location and quantity,nodule size and nodule nature（cystic,solid,cystic solid,calcification）shall be examined.Result1.There are 286 medical workers in a hospital,including 49 male medical workers,237 female medical workers.The detection rate of thyroid nodule is 58.04%,that of male is 42.90%,and that of female is 61.20%The detection rate of thyroid nodule in male medical workers was lower than that in female medical workers.The difference between male and female was statistically significant（χ²=5.599,P<0.05）.2.In a hospital,the detection rate of single thyroid nodule was 22.03%,in which the detection rate of single thyroid nodule was 20.41%in men and 22.36%in women.The detection rate of single thyroid nodule in male medical workers was lower than that in female medical workers.Chi square test was carried out between the two genders,and the difference was not statistically significant（χ²=0.054,P>0.05）.3.In a hospital,the detection rate of multiple thyroid nodules was 36.01%,that of male was 22.45%,and that of female was 38.82%.The detection rate of single thyroid nodule in male medical workers was lower than that in female medical workers.Chi square test was carried out between male and female to check whether they had multiple thyroid nodule.The difference was statistically significant（χ²=4.722,P<0.05）.4.The number of medical staff with nodules≥10 mm was 31,accounting for18.67%.Among them,4 patients with thyroid nodule≥10 mm accounted for 19.05%of male patients,27 patients with thyroid nodule≥10 mm accounted for18.62%of female patients.There was no significant difference between the two genders（χ²=0.000,P＞0.05）.There were 12 patients with calcification in a hospital,accounting for 7.23%of the patients.Among them,2 of the male patients with thyroid nodule had calcification,accounting for 9.52%of the male patients,and 10 of the female patients with thyroid nodule had calcification,accounting for 6.90%of the female patients.There was no significant difference between the two genders（χ²=0.000,P＞0.05）.5.According to the results of thyroid hormone test,the prevalence of autoimmune thyroiditis was the highest,19.14%,followed by subclinical hypothyroidism,7.26%.The third is subclinical hyperthyroidism and hypothyroidism,with the prevalence of0.66%.6.There were 49 male medical workers,1 with goitre,and the goitre rate was 2.04%.There were 237 female medical workers,3 with goitre.The goitre rate was 1.27%.The goiter rate of male medical workers was higher than that of female medical workers.7.To analyze the influencing factors of thyroid nodule in a hospital.Univariate analysis showed that there were statistical differences in different gender,age groups and different urinary iodine level groups（P<0.05）,but no differences between radiology and non Radiology（P>0.05）.Multivariate logistic analysis showed that the risk factors of thyroid nodule were female,old age and urinary iodine deficiency and excess（P=0.027,OR（95%CI）=2.113（1.090～4.095）;P<0.001 OR（95%CI）=1.643（1.276～2.115）;P=0.041,OR（95%CI）=1.988（1.027～3.845）;P=0.001,OR（95%CI）=3.196（1.563～6.535））.8.Single factor and multi factor Logistic regression analysis were used to analyze the influencing factors of thyroid disease in a hospital.It was found that 51.6%of the pollution group and 23.1%of the non pollution group had factories（chemical plant,printing and dyeing plant,battery plant,electronic waste dump,smelter,paper mill,radio transmitting station,high voltage transmission line and other polluting factories）nearby their home（within 30 meters）.The difference between the two groups was statistically significant（χ²=11.584,P＜0.001）.Conclusion1.The overall prevalence of thyroid nodules in medical staff of a medical institution is at a high level.The detection rate of male thyroid nodule,single nodule and multiple nodule is lower than that of female.Therefore,as a high incidence group,female should be paid more attention to,and more attention should be paid to work system and work and rest arrangement.2.The proportion of male nodules≥10 mm in a hospital is higher than that of female;the proportion of male nodules calcification in a hospital is higher than that of female.Because of different physiological conditions and work and rest,male patients are more likely to have thyroid nodules≥10 mm and nodules calcification.3.The prevalence of autoimmune thyroiditis and subclinical hypothyroidism of medical staff in a hospital is relatively high.We should reexamine five items of thyroid function regularly,take medicine according to the doctor’s orders,treat thyroid related diseases,and control the further development of the disease.4.Among the medical workers in a hospital,the goiter rate of male is higher than that of female,so we need to improve our understanding of salt iodization;5.The detection rate of thyroid nodule in medical workers in a hospital is higher than that in some inland and coastal areas.Female,older,lack and excess of urinary iodine are the influencing factors of thyroid nodule.Female,elderly and people whose urinary iodine level is not in a proper range should improve their awareness of thyroid nodule Attention to adenoid diseases,reasonable consumption of iodized salt,so as to play a role in prevention and health care of thyroid nodules.6.The influencing factors of thyroid disease of medical staff in a hospital are the pollution of living environment.When choosing the living environment,we should avoid the construction facilities such as chemical plant,printing and dyeing plant,battery plant,electronic waste yard,smelter,paper mill,radio transmitting station,high-voltage power transmission line and other polluting factories,strengthen the environmental pollution control and create a good and healthy living environment.