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New Reference Values for Thyroid Volume by Ultrasound in German Children and Adolescents From a Population-Based
Raphael Hirtz1,2,3, Roma Thamm4, Ronny Kuhnert4
1Department of Pediatrics and Center for Rare Diseases Ruhr CeSER, St. Josef Hospital, Ruhr University Bochum, 44791 Bochum, Germany.
Insights
New thyroid volume reference values for German children and adolescents show current World Health Organization (WHO) guidelines are too conservative. These updated thyroid ultrasound measurements are crucial for accurate diagnostics and health strategies in European populations.
Area of Science:
- Pediatric Endocrinology
- Diagnostic Imaging
- Public Health
Background:
- Establishing reliable thyroid ultrasound reference values is vital for accurate diagnostics and public health initiatives like iodine fortification.
- Current World Health Organization (WHO) total thyroid volume (Tvol) reference values (2004) are outdated, limited to specific age groups, and not representative of iodine-sufficient European populations.
Purpose of the Study:
- To derive current, sex-specific thyroid volume ultrasound reference values for German children and adolescents.
- To provide updated data for improved thyroid health assessment in pediatric populations.
Main Methods:
- Utilized data from the German national baseline study (KiGGS) from 2003-2006.
- Determined sex-specific reference values for total thyroid volume (Tvol) in 5559 thyroid-healthy participants aged 6-17 years.
- Applied the lambda-mu-sigma method, stratifying by age and body surface area.
Main Results:
- The 97th percentile for Tvol was 33.4% higher in boys and 28.5% higher in girls compared to WHO 2004 values.
- Findings align with other contemporary studies in German and European children.
- The study sample met WHO criteria for iodine sufficiency.
Conclusions:
- WHO reference values for total thyroid volume are overly conservative for German children and adolescents.
- These updated reference values may be applicable to other European countries with similar iodine supply histories.
- Revised thyroid volume data are essential for precise clinical interpretation and public health planning.
Context:
Reliable reference values for thyroid ultrasound measurements are essential to effectively guide individual diagnostics and direct population-level health care measures, such as iodine fortification programs. However, the latest reference values for total thyroid volume (Tvol) provided by the World Health Organization (WHO) in 2004 only apply to the 6- to 12-year-old age group and are limited to countries with a long history of iodine sufficiency, which does not reflect the situation in most European countries, including Germany.
Objective:
This study aims to derive up-to-date thyroid volume ultrasound reference values in German children and adolescents.
Methods:
Data from the baseline assessment of a nationwide study in German children and adolescents (KiGGS) conducted between 2003 and 2006 were used to determine sex-specific reference values for Tvol in thyroid-healthy participants aged 6 to 17 years by age and body surface area according to the lambda-mu-sigma method.
Results:
Data from 5559 participants were available for reference chart construction (2509 girls [45.1%]). On average, the 97th percentile is 33.4% and 28.5% higher than the corresponding WHO reference values for boys and girls, respectively. These findings are consistent with most other studies in German and European children and adolescents at a similar time of investigation. Notably, the sample used for this study was iodine-sufficient according to WHO criteria.
Conclusion:
The reference values provided by the WHO are overly conservative for this population and could potentially apply to other European countries with a similar history of iodine supply.
