Introduction: Aim: it is known that environmental factors are involved in the development of goiter. A high number of goitrous patients was identified among patients attending the general medicine outpatients in a mountainous region in Albania. We examined possible associations of thyroid enlargement with nutritional factors.
Methods: One hundred and twelve consecutive patients (mean age 52.8±12.1, 104 female) attending the outpatients of the General Military Hospital of Gyrocaster, Southwestern Albania, who either took thyroxine (n=27) or were suspected to have thyroid disease based on symptoms and physical examination were studied. Thyroid parameters and selenium levels were determined. The type and frequency of food consumption was recorded; thyroid ultrasound was performed.
Results: Thyroid volume was above median (20.35 ml) in 51% of patients. Thyroid volume correlated negatively with the frequency of lamb and goat meat and vegetables consumption (P=0.01). Mean thyroid volume was significantly lower in those eating lamb or goat >1 times a week (21.4±13.3 vs 31.9±23, P<0.01). There was no association between current selenium levels and thyroid volume. All consumed food was home produced. The association of thyroid volume with lamb meat consumption was independent of sex, educational status or occupation (P=0.004, multivariate analysis). Forty-three percent had TSH<0.3 μU/ml (those on thyroxine were excluded). In this group, log TSH correlated negatively with thyroid volume and fT4 levels (P=0.008), indicating the presence of autonomy (TSHRab found positive in two subjects).
Conclusions: Nutritional factors appear to be involved in the development of goiter in Southwestern Albania. No role of selenium deficiency was found. The higher consumption of lamb and goat meat and vegetables, all non-industrialized, appears to be protective. One cannot exclude the possibility that this finding reflects better socioeconomic status, although this was not identified. Unrecognized subclinical hyperthyroidism probably due to thyroid autonomy is quite common.