{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T16:20:31Z","timestamp":1778602831593,"version":"3.51.4"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2018,7,2]],"date-time":"2018-07-02T00:00:00Z","timestamp":1530489600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Context<\/jats:title><jats:p>To study the prevalence of thyroid dysfunction in a very large unselected population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine the prevalence of abnormal thyroid function and evaluate potential modulatory factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and Setting<\/jats:title><jats:p>The Estudio de Atenci\u00f3n Primaria de Navarra, The <jats:styled-content style=\"fixed-case\">APNA<\/jats:styled-content> Study, is a cross\u2010sectional study conducted in northern Spain. It involved 303\u00a0883 people, of 20\u00a0years of age and older, who live in the Navarra region. Participants are covered by the public healthcare system and medical records are digitalized.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>The information was gathered from e\u2010registered data regarding serum thyrotropin (<jats:styled-content style=\"fixed-case\">TSH<\/jats:styled-content>), thyroid hormones, thyroid antibody concentration and clinical context. Measurements were logged (demographic information and potential thyroid function modulatory factors).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Serum <jats:styled-content style=\"fixed-case\">TSH<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">mU<\/jats:styled-content>\/L) normal range was established at 0.7\u20104.28. At the time of the study, 87% of the Navarra population had a <jats:styled-content style=\"fixed-case\">TSH<\/jats:styled-content> level within the normal range. Mean serum <jats:styled-content style=\"fixed-case\">TSH<\/jats:styled-content> in euthyroid individuals was higher in women (2.15) than in men (1.96) (<jats:italic>P\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>.001) and higher in the obese with body mass index (<jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content>) \u226530\u00a0kg\/m<jats:sup>2<\/jats:sup> (2.12) as compared to the non\u2010obese <jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content> &lt;30\u00a0kg\/m<jats:sup>2<\/jats:sup> (2.06) (<jats:italic>P\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>.001). Mean <jats:styled-content style=\"fixed-case\">TSH<\/jats:styled-content> for the entire population was 1.9. The native Spanish population had statistically significantly lower <jats:styled-content style=\"fixed-case\">TSH<\/jats:styled-content> (1.87) than non\u2010native Spanish (2.15) (<jats:italic>P\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>.001). Additionally, we observed that serum <jats:styled-content style=\"fixed-case\">TSH<\/jats:styled-content> levels decreased with age and an increase in the prevalence of hypothyroidism in the elderly and among people with low\u2010income levels. The prevalence of thyroid dysfunction in Navarra was 12.3%. The prevalence of hypothyroidism (or high <jats:styled-content style=\"fixed-case\">TSH<\/jats:styled-content>) in the population was 8.8% (13.3% in women, 4.2% in men), and the prevalence of hyperthyroidism (or low <jats:styled-content style=\"fixed-case\">TSH<\/jats:styled-content>) was 4.3% (5.6% in women, 3.0% in men).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Nearly 15% of the general population suffers from biochemical thyroid dysfunction. The serum <jats:styled-content style=\"fixed-case\">TSH<\/jats:styled-content> level appears to be influenced by sex, <jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content>, age, ethnic origin and socio\u2010economic status.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.13764","type":"journal-article","created":{"date-parts":[[2018,6,12]],"date-time":"2018-06-12T07:09:26Z","timestamp":1528787366000},"page":"367-375","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Prevalence of thyroid dysfunction in a Large Southern European Population. Analysis of modulatory factors. The <scp>APNA<\/scp> study"],"prefix":"10.1111","volume":"89","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8552-3331","authenticated-orcid":false,"given":"Silvia","family":"Santos Palacios","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Nutrition Cl\u00ednica Universidad de Navarra University of Navarra  Pamplona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda","family":"Llavero Valero","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nutrition Cl\u00ednica Universidad de Navarra University of Navarra  Pamplona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Brugos\u2010Larumbe","sequence":"additional","affiliation":[{"name":"Department of Health Science Public University of Navarra  Pamplona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan J.","family":"D\u00edez","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Hospital Universitario Puerta de Hierro  Majadahonda Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco","family":"Guill\u00e9n\u2010Grima","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine Cl\u00ednica Universidad de Navarra University of Navarra  Pamplona Spain"},{"name":"IdiSNA (Instituto de Investigaci\u00f3n en la Salud de Navarra)  Pamplona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan C.","family":"Galofr\u00e9","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nutrition Cl\u00ednica Universidad de Navarra University of Navarra  Pamplona Spain"},{"name":"IdiSNA (Instituto de Investigaci\u00f3n en la Salud de Navarra)  Pamplona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,7,2]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-2409"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/ncpendmet0896"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clim.2017.07.001"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03344958"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2011.04044.x"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2010.03855.x"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1138-3593(08)75204-3"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2016.0353"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-010-9397-2"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.1977.tb01340.x"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.84.2.561"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.1999.00816.x"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2003-032089"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2007.03051.x"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.87.2.8182"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.4.526"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2016.0229"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2012.0205"},{"key":"e_1_2_5_20_1","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1001\/jama.1979.03300030019013","article-title":"The aging thyroid: increased prevalence of elevated serum thyrotropin levels in the elderly","volume":"242","author":"Sawin CT","year":"1979","journal-title":"JAMA"},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1530\/eje.0.1430639"},{"key":"e_1_2_5_22_1","doi-asserted-by":"publisher","DOI":"10.1089\/105072502761016458"},{"key":"e_1_2_5_23_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2003-44707"},{"key":"e_1_2_5_24_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2007-1499"},{"key":"e_1_2_5_25_1","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1001\/archinte.1990.00390160053012","article-title":"Thyroid dysfunction in adults over age 55\u00a0years. 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