Silent iodine prophylaxis in Western Europe only partly corrects iodine deficiency; the case of Belgium

OBJECTIVE: Belgium is one of the Western European countries in which no program of iodine-deficiency correction using iodized salt has been implemented, in spite of well-documented mild iodine deficiency. In 1995, the median urinary iodine concentration was 55 microg/l (normal: 100-200) and the prevalence of goiter was 11% (normal: below 5%) in representative samples of schoolchildren aged 6-12 years. Based on these results, the authors of the present study and others had emphasized to health professionals and to the public the necessity for iodine supplementation. The objective of this study was to evaluate as to whether these efforts had resulted in an improvement in the status of iodine nutrition. DESIGN: We performed a national survey of the status of iodine nutrition in Belgium based on the determination of thyroid volume, obtained by ultrasonography, and urinary iodine concentrations in schoolchildren. METHODS: A mobile van equipped with an ultrasound instrument, a computer and a deep-freeze visited 23 schools selected from across the country. The sample included 2855 schoolchildren (1365 boys and 1490 girls) aged 6-12 years. RESULTS: The results show a homogeneous situation in the whole country, with a median urinary iodine concentration of 80 microg/l and a goiter prevalence of 5.7%. Urinary iodine slightly decreases with age in girls and reaches a critical value of 59 microg/l at the age of 12 years, together with a goiter prevalence of 18.4%. CONCLUSION: Iodine nutrition has improved slightly in Belgium but mild iodine deficiency continues, with public-health consequences. The improvement indicates silent iodine prophylaxis, as no official salt-iodization measures have been taken. Silent iodine prophylaxis only partly corrects iodine deficiency in Western Europe. Active measures, including the implementation of a program of salt iodization, are urgently required.     

Thyroid autoimmunity is associated with higher urinary iodine concentrations in an iodine-deficient area of Northwestern Greece.

Northwestern Greece was identified in the 1960s for its high prevalence of endemic goiter and iodine deficiency. Although iodized salt has been commercially available since then, a recent epidemiological survey of 3916 schoolchildren found that low-grade goiter is still prevalent in endemic proportions (21%). The aim of this study was to further assess the cause of goiter and the severity of iodine deficiency in children from this endemic area of Greece. Of the 800 children with clinically detectable goiter, 97 children (60 girls and 37 boys, 8-15 years) were recruited for determination of urinary iodine excretion, as well as assessment of thyroid volume and function and detection of antithyroid antibodies. The median urinary iodine concentration was 8.4 microg/dL, indicative of a mild iodine deficiency. Thyroid function was normal in all but 11 children who had subclinical hypothyroidism. Sixteen children (16.5%), including all those with subclinical hypothyroidism, were positive for antithyroid antibodies. Their median urinary iodine concentration (20.6 microg/dL) was higher compared to children who were negative for antibodies (7.4 microg/dL; p<0.001). The mean thyroid volume by ultrasonography (12.2+/-4.1 mL) was above the upper limit of normal for this age group. Thyroid volume was inversely related to the urinary iodine content in the children with negative antithyroid antibodies. Iodine deficiency is still prevalent in northwestern Greece although of mild severity and constitutes the primary cause of goiter among schoolchildren. However, it appears that autoimmune thyroiditis is emerging as a frequent cause of goiter in those children with sufficient iodine intake.     

Thyroid volumes and urinary iodine in German school children.

Several recently published investigations showed a significant improvement in the iodine supply of the German population, but so far Germany is still considered an iodine deficient country. However most of the studies presented do not meet the epidemiological criteria established by WHO, UNICEF and ICCIDD and may therefore suffer from a selection bias with respect to goiter prevalence estimates. School children, owing to their easy recruitment, representativeness of different socio-economic classes and high vulnerability of Iodine deficiency disorders (IDD), are one of the best target groups for surveillance of IDD. In this field study a total of 591 children were investigated. The total sample included 268 females and 323 males aged 7-17 years. The following data were collected: thyroid size by ultrasound, urinary iodine concentration in a first-morning spot urine, weight, height, sex and age. The median urinary iodine concentration of the children was 183 microg/L. The proportion of samples with concentrations below 100 microg/L or below 50 microg/L was 15.4% and 4.3% respectively. Urine samples with high iodine concentrations were also found amounting to 17.3%. Almost all families (97%) declared to use iodized kitchen salt and 19.6% of all children are taking regularly iodine tablets. Application of the WHO/ICCIDD thyroid volume references to the German children resulted in a goiter prevalence of 0.2%, using either age/sex-specific or body surface area (BSA)/sex-specific cut-off values. Comparison with the P97 values of the original normative data of Gutekunst and Martin-Teichert however gives a goiter prevalence of 3% as expected. The thyroid volumes of the children in our study appear comparable with those reported recently for iodine sufficient children from Switzerland and for iodine replete Berlin children and for children with sufficient iodine supply in the region of Leipzig, so that Germany probably has no longer to be considered an iodine deficient country. Our own study and the most recently published studies on iodine replete children give rise to the supposition that the WHO/ICCIDD recommended thyroid volume references are too high.     

Goiter prevalence and urinary iodine status in urban and rural/mountain areas of Piedmont region

Piedmont region was reported in the 70s as a mild iodine-deficient area with a goiter prevalence > 10%. This study aimed at characterizing the current status of iodine deficiency in Piedmont, with special attention to putative differences between urban and rural/mountain areas. A cross-sectional, observational study was performed according to the surveillance methods for iodine deficiency disorders recommended by the World Health Organization (WHO). Ultrasound local thyroid volume reference values and median urinary iodine concentration were obtained in 2178 schoolchildren aged 11-15 yr, resident in Piedmont region for more than 5 yr to assess both goiter prevalence and iodine intake. Anamnestic and anthropometric data, thyroid volume by both bimanual palpation and ultrasound were assessed, and spot urinary iodine samples were collected. The median urinary iodine concentration was 115.8 microg/l and the prevalence of goiter 3.1%, indicating this area as iodine-sufficient. Nevertheless, 39% of the schoolchild population had urinary iodine levels < 100 microg/l and 6.8% < 50 microg/l. No differences in goiter prevalence and median urinary iodine excretion were observed between urban and rural/ mountain populations. In conclusion, Piedmont is now an iodine-sufficient region. As no programs of salt iodization have been carried out in the last 30 yr, a silent iodine replacement has occurred. Despite a sufficient median urinary iodine excretion, a program of iodine prophylaxis is strongly recommended due to a large part of iodine-deficient population.     

Thyroid volumes in a national sample of iodine-sufficient swiss school children: comparison with the World Health Organization/International Council for the control of iodine deficiency disorders normative thyroid volume criteria

OBJECTIVE: The determination of goiter prevalence in children by thyroid ultrasound is an important tool for assessing iodine deficiency disorders. The current World Health Organization/International Council for the Control of Iodine Deficiency Disorders (WHO/ICCIDD) normative values, based on thyroid volume in iodine-sufficient European children, have recently been questioned, as thyroid volumes in iodine-sufficient children from the USA and Malaysia are smaller than the WHO/ICCIDD reference data. Our objective was to describe ultrasonographic thyroid volumes in a representative national sample of iodine-sufficient Swiss school children, and to compare these with the current reference data for thyroid volume. DESIGN AND METHODS: A 3-stage, probability proportionate-to-size cluster sampling method was used to obtain a representative national sample of 600 Swiss children aged 6-12 years. The following data were collected: thyroid size by ultrasound, urinary iodine concentration, weight, height, sex and age. RESULTS: The median urinary iodine concentration (range) of the children was 115 microgram/l (5-413). Application of the WHO/ICCIDD thyroid volume references to the Swiss children resulted in a prevalence of 0%, using either age/sex-specific or body surface area (BSA)/sex-specific cut-off values. Upper limits of normal (97th percentile) of thyroid volume from Swiss children calculated using BSA, sex and age were similar to those reported in iodine-sufficient children in the USA, but were 20-56% lower than the corresponding WHO/ICCIDD references. CONCLUSIONS: Swiss children had smaller thyroids than the European children on which the WHO/ICCIDD references are based, perhaps due to a residual effect of a recent past history of iodine deficiency in many European regions. However, there were sharp differences between our data and a recent set of thyroid volume data in Swiss children produced by the operator and equipment that generated the WHO/ICCIDD reference data. This suggests that interobserver and/or interequipment variability may contribute to the current disagreement on normative values for thyroid size by ultrasound in iodine-sufficient children.     

江苏省2001年8～10岁学龄儿童碘营养状况监测

为掌握江苏省8－10岁学龄儿童碘营养状况，保障可持续消除碘缺乏病（IDD）目标的实现，我省对30个抽样点进行了调查，结果1160名目标人群尿碘中位数中333．7μg/L，甲状腺肿大率触诊法为2．8％，B超法为1．4％，表明江苏省已处于可持续消除碘缺乏病的发展阶段，人群碘营养状况达到较高水平。     

Iodine supplementation in Austria: methods and results.

Until 1963 Austria was an extremely iodine-deficient area with low iodine intake and high goiter prevalence. Therefore, for the first time in 1963, salt iodination with 10 mg of potassium iodide per kilogram of salt was introduced by federal law. Twenty years after this salt iodination, however, investigations in schoolchildren demonstrated iodine deficiency grade I to II according to the World Health Organization (WHO) (urinary iodine excretion, 42-75 microg/g Crea) and goiter prevalence of far more than 10%. In 1990, salt iodination was increased to 20 mg of potassium iodide per kilogram of salt. In 1994, further investigations in schoolchildren demonstrated an increase of urinary iodine excretion (121 microg/g Crea) and a reduction of goiter prevalence below 5%, with the exception of pupils ages 14-19 (12%). In the year 2000, 10 years after the increase of salt iodination in Austria, 430 nonselected adult inhabitants of three communities in Carinthia (a county of Austria) were investigated for iodine excretion, goiter prevalence, and prevalence of thyroid autoantibodies. This study demonstrated that although iodine supply is sufficient now in Austria (males, 163.7 microg of Crea; females, 183.3 microg of iodine per gram of Crea), goiter prevalence is still high in the elderly, who lived for a longer period of iodine deficiency (34.3% in women and 21.3% in men), whereas goiter prevalence in younger people up to age 40 years is below 5%. It could also be shown that the percentage of thyroid autoantibodies is now as high as in other countries with sufficient iodine supply (3.19% in males, 5.17% in females). In addition to the changes of urinary iodine excretion and goiter prevalence because of salt iodination, changes of incidence in hyperthyroidism and histologic types of thyroid cancer are discussed in this paper. In conclusion, the introduction of salt iodination led to an improvement in iodine supply with a marked reduction of goiter prevalence in people who were born after 1963, but also to an increase in hyperthyroidism and autoimmune thyroid diseases as well as changes in histologic types of thyroid cancer.     

广西2011年碘缺乏病监测结果分析

目的了解广西碘缺乏病防治工作现况,为制定预防控制策略提供科学依据。方法采用PPS法抽取30个县、区开展病情监测;在未开展病情监测的79个县、区进行人群碘营养监测;在全区109个县、区开展系统地饮用水水碘监测。结果病情监测,碘盐覆盖率为99.43%,合格碘盐食用率为93.54%,8~10岁儿童甲肿率为0.33%,尿碘中位数236.60μg/L,孕妇和哺乳妇女尿碘中位数均为131.00μg/L;人群碘营养监测,8~10岁儿童尿样7 838份,尿碘中位数241.77μg/L,〈50μg/L的比例为2.76%,〉300μg/L比例33.50%;饮用水水碘监测,全区4 968份居民生活饮用水水碘检测,〈10μg/L占84.74%,10~150μg/L占14.94%,〉150μg/L占0.32%。结论广西属于缺碘地区,普及碘盐防治碘缺乏病的效果得到进一步夯实,人群碘营养总体上在适宜范畴,但处于一种大于需要量的状态,需要对我区食盐加碘含量进行科学调整。     

舟山海岛孕妇碘营养状况调查与分析

目的了解舟山海岛孕妇碘营养状况,为制定和完善科学补碘提供依据。方法抽取舟山市2个县、区中2个居委会（村）的105名当地不同孕期的常住居民,共采集碘盐、水样、尿样分别进行盐碘、水碘、尿碘浓度检测,并对调查对象开展甲状腺超声检查,采集血样进行甲状腺功能检测。结果盐碘浓度的中位数为0mg/kg、均数10．21m∥kg,合格碘盐食用率为17．47％;水碘浓度均数为11．55μg∥L;尿碘中位数为98．72μg∥L;甲状腺超声检查总异常率35．53％;甲状腺功能总异常率为58．10％。结论舟山海岛孕妇的尿碘水平明显低于wH0／uNIcEF／IccIDD推荐的标准,甲状腺超声检查异常率、甲状腺功能异常率明显高于全省水平。     

2007年重庆市璧山县与云阳县8～10岁儿童碘缺乏病病情分析

目的 了解重庆市璧山县与云阳县8～10岁儿童碘缺乏病病情.方法 选择重庆市璧山县、云阳县为调查县,采用多级整群随机抽样方法.每个县各抽取3所小学,检测8～10岁学龄儿童甲状腺肿大情况及尿碘、家庭食用盐含碘量,分析甲状腺肿大率与尿碘、盐碘的关系.结果 共调查556名儿童,触诊与B超法检查的甲状腺肿大率分别为10.79%(60/556)、9.53%(53/556),尿碘中位数为261.24 μg/L,盐碘中位数为34.11mg/kg;不同尿碘、盐碘水平下,儿童甲状腺肿大率比较差异无统计学意义(X~2值分别为0.9145、1.3453,P均>0.05).结论 重庆市璧山县与云阳县儿童尿碘水平偏高,可以考虑下调食盐加碘量.     

Sustainable control of iodinedeficiency in Iran: beneficial results of the implementation of the mandatory law on salt iodization

Iodine deficiency disorders (IDD) were prevalent in the Islamic Republic (IR) of IRAN before 1989, when the national salt iodization program with 40 mg l/k of salt was initiated. Despite a comprehensive IDD control program, less than 50% of the households in rural areas consumed iodized salt by 1994. A law for the mandatory production of iodized salt for households was passed in 1994. The purpose of this study was to evaluate goiter status and urinary iodine excretion 2 yr after this law was implemented. In each of 26 provinces, 30 groups of 40 schoolchildren, total 36,178, were examined for goiter and classified according to World Health Organization (WHO) classification. Urinary iodine excretion was measured in 2,917 children by digestion method. Goiter was endemic in all provinces, but the majority were small (grade 1) goiter. Median urinary iodine was 20.5 microg/dl 85.1% had urinary iodine > or =10 microg/dl. Median urinary iodine was above 13 microg/dl in all 26 provinces. In all provinces the percentage of schoolchildren with urinary iodine <5 microg/dl was less than 16%. In nine provinces the median urinary iodine was between 13 to 20 microg/dl; urinary iodine of their schoolchildren was <5 microg/dl in 10.8% and <2 microg/dl in 6-9%. No significant difference was observed between boys and girls or children of rural and urban regions in urinary iodine excretion. We conclude that 7 yr after the beginning of salt iodization and 2 yr following mandatory iodized salt consumption, urinary iodine excretion is adequate in schoolchildren; considering the data of the percent of households consuming iodized salt and programmatic setting of the IDD program, The IR of Iran has reached a sustainable control program for iodine deficiency.     

Thyroid volume and urinary iodine excretion in the schoolchild population of a Northwestern Italian sub-Alp metropolitan area

Iodine deficiency is recognised as a major preventable public-health worldwide problem. The aim of this study is to assess local reference values for thyroid volume, and give a snapshot of the epidemiology of goiter and iodine nutritional status of the Turin schoolchild population. Sonographic thyroid volume and median urinary iodine excretion were obtained in 1067 schoolchildren aged 11-15 yr resident in Turin for more than 5 yr to assess both goiter prevalence and iodine intake. All the subjects were asked to fill in a questionnaire about their life habits. Anamnestic and anthropometric data, thyroid volume by both bimanual palpation and ultrasonography were assessed, and spot urinary iodine samples were collected. The results show that the median urinary iodine concentration is 113.1 microg/l and the prevalence of goiter <5%, indicating this area as iodine-sufficient. Nevertheless, 40.5% of the schoolchild population has urinary iodine levels lower than the cut-off level recommended as iodine-sufficiency. Interestingly, the high relative prevalence of ultrasound features of autoimmune thyroid disease suggests autoimmune-thyroiditis as a frequent thyroid disease in Turin schoolchildren. As no active programs of salt, milk or water iodisation have ever been carried out, a silent iodine prophylaxis has probably occurred in the city. Despite a sufficient median urinary iodine excretion, a focused program of iodine prophylaxis should be developed due to the presence of a large rate of iodine-deficient population.     

Normal values for thyroid ultrasonography, goiter prevalence and urinary iodine concentration in schoolchildren of the Veneto Region, Italy

Goiter prevalence in school-age children and median urinary iodine concentration (UIC) are the main indicators of iodine deficiency in a population. In areas of mild iodine deficiency, where goiters are small, ultrasound is preferable to physical examination to estimate goiter prevalence. The World Health Organization (WHO) has adopted thyroid volume ultrasonography results from a survey of European schoolchildren as an international reference, but these values have recently been questioned. The aims of the study were: a) to determine regional normal echographic reference values of thyroid volume in children aged between 11 and 14 yr in the Veneto Region, in North-East Italy; b) to determine goiter prevalence by physical and ultrasonographic examination; c) to determine UIC in this section of the population. A cross-sectional study was carried out on 1730 schoolchildren, aged between 11 and 14, living in towns in low-lying areas, in the valleys of the pre-Alps and in the mountains between 600 and 1200 m. Thyroid volume was evaluated by inspection and palpation using the WHO criteria. In 560 children thyroid volume was determined by ultrasound. UIC was measured in 1368 children. On physical examination a grade I goiter was found in 7.5% of children. No goiter grade II or grade III was found. The regional thyroid volume reference values by ultrasonography were similar, or slightly lower (5-20%), to the corresponding WHO reference values. Mean UIC was 148 +/- 110 microg/l, with no difference between lowlands and uplands; UIC values less than 100 microg/l were found in about 30-35% of the children. UIC was higher in children using iodized salt than in non-users. No correlation was found between thyroid volume by ultrasonography and UIC. Thyroid volume was found to be bigger in upland children than in those in low-lying areas, probably because of low iodine intake in people living in the mountains in previous generations. This data show that Veneto is not a iodine-deficient area, with no presence of endemic goiter. However, the great number of children with a UIC of less than 100 microg/l also suggests the use of iodized salt in the Veneto Region.     

2007-2008年内蒙古自治区碘缺乏病高危地区病情及碘营养现状调查

目的 了解内蒙古碘缺乏病高危地区是否存在新发地方性克汀病病例,掌握地方性甲状腺肿(简称甲肿)流行现况及综合防治措施落实情况,为制订碘缺乏病的防治策略提供依据.方法 2007-2008年,在内蒙古历史地克病流行严重的松山区、克什克腾旗、喀喇沁旗,扎赉特旗、卓资县,凉城县、清水河县、和林县、东胜区、准格尔旗、伊金霍洛旗等11个旗(县、区),对10岁以下儿童进行新发地克病病例搜索;每个旗(县、区)选择3～5个乡,每个乡选择3～5个村小学,每所小学选择120～200名8～10岁儿童,进行甲状腺检查、智商和尿碘检测;每个乡选择2个村,每个村选择30个居民户,检测家庭主妇尿碘及家中食用盐含碘量情况.结果 11个项目旗(县、区)共搜索出56例疑似新发地克病病例,无确诊病例.触诊法和B超法检查8～10岁甲状腺,甲肿率分别为5.2%(309/5922)、4.3%(252/5922);8～10岁儿童尿碘中位数为241.5μg/L,尿碘为100.0～300.0 μg/L占65.9%(3901/5920).其中9个项目旗(县、区)的尿碘中位数在200.0～300.0μg/L,尿碘<50.0μg/L所占的比例>5%的旗(县、区)为0,<100.0μg/L所占的比例>10%的有1个.家庭主妇的尿碘中位数为225.6μg/L,<50.0μg/L占2.2%(35/1597).<100.0 μg/L所占比例>10%的旗(县、区)有4个.调查的2109户居民中有97.45%(2055/2109)的存食用碘盐,有2.55%(54/2109)的居民食用无碘盐.结论 调查的11个项目旗(县、区)儿童甲肿率降至10%以下,未发现新发克汀病病例,防治成绩显著;儿童和育龄妇女碘营养水平基本适宜;碘盐覆盖率高、销售网络比较健全、价格合理、购买方便,食盐加碘为主消除碘缺乏病防治措施得到有效的落实,儿童的智力得到有效保护.碘缺乏病健康教育仍然是防治工作中的一个薄弱环节,亟待加强.

Abstract：

Objective To investigate new cases of endemic cretinism in high-risk areas of Inner Mongolia, the prevalence of endemic goiter, the implementation of comprehensive measures, and to provide scientific basis for developing control strategies against iodine deficiency disorders (IDD). Methods In 2007 and 2008, a search for new cretin cases was conducted among children under the age of 10 in 11 historical serious epidemic cretinism prevalent areas of Songshan district, Keshiketeng qi, Kalaqin qi, Zhalaite qi, Zhuozi county,Liangcheng county, Qingshuihe county, Helin county, Dongsheng district, Zhungeer qi and Yinjinhuoluo qi. Three to 5 towns were selected in each qi(county, district) and 3 to 5 village primary schools were selected in each town.One hundred and twenty to 200 children aged 8 to 10 were selected in each school to inspect thyroid by B ultrasound and palpation and to test intelligence and urinary iodine. Two villages were selected in each town and 30 households were selected to determine urinary iodine of housewives and salt iodine. Results A total of 56 cases of suspected cases of endemic cretinism were found from the 11 counties but no case was confirmed. The goiter rate of children aged 8 to 10 was 5.2% (309/5922) by palpation and 4.3% (252/5922) by B-ultrasound. The median urinary iodine of children aged 8 to 10 was 241.5 μg/L, and urinary iodine was 100 to 300 μg/L, accounted 65.9%(3901/5920). Median urinary iodine of the 9 Qis(counties, districts) was in the range of 200 and 300μg/L.Higher than 5% of the 11 Qis(counties, districts) with urinary iodine lower than 50 μg/L was zero. Higher than 10% of the 11 Qis(counties, districts) with urinary iodine lower than 100 μg/L was 1. The median urinary iodine of housewives was 225.6 μg/L, and lower than 50 μg/L accounted for 2.2%(35/1597). Higher than 10% of the 11 Qis(counties, districts) with urinary iodine lower than 100 μg/L was 4. A total of 2109 households were investigated and 97.45%(2055/2109) of them ate iodized salt and 2.55%(54/2109) of them ate non-iodized salt. Conclusions In the 11 investigated counties, goiter rate of children has decreased to less than 10%, and no new cretin was found. It could be concluded that the fulfillment of prevention and control of IDD is effective. The iodine nutrition of children and women of childbearing age is in an adequate level. The coverage rate of iodized salt has maintained at a higher level, the sales network is sound, the salt price is reasonable and salt is easy to get and the children's intelligence is protected effectively. But, the health education about IDD is still weak, need to be reinforced.     

Determination of iodine concentration in urine by isotope dilution analysis and thyroid volume of school children in the west coast of Turkey after mandatory salt iodization

OBJECTIVE: This study was designed to evaluate iodine deficiency status in children 6-12 years in the west coast (Aegean Region) of Turkey after 5 years of mandatory iodine prophylaxis. A total of 2300 children from 72 populations (rural and urban area) were evaluated with urinary iodine excretion and thyroid volume. DESIGN: Cross-sectional, observational study designed and performed according to surveillance methods for iodine deficiency disease (IDD) prevalence recommended by WHO/UNICEF/ICCIDD. SUBJECTS: The study population consisted of 2300 school children age ranging from 6 to 12 years. The children were selected by multiple stage randomization from 91 primary schools of 76 zones (91 clusters). Information about the use of iodized salt was obtained from the families. MEASUREMENTS: Data on the following were collected: birth date, sex, weight, height, thyroid size by palpation and ultrasonography; and urinary iodine by isotope dilution analysis method. Thyroid volumes above 97th percentile according to the WHO/ICCIDD by age and body surface area (BSA) were accepted as goitre. RESULTS: Iodized salt consumption was 51.7%. The prevalence of goitre determined by palpation was 12.1% and by ultrasound based on BSA and age were 9.8% and 5.5%, respectively. Median urinary iodine was 53 (2-142) microg/l. CONCLUSION: Mild to severe degree of iodine deficiency was detected in the west coast of Turkey.     

舟山海岛居民碘营养状况调查与分析

目的了解舟山市人群碘营养状况,为制定和完善科学补碘策略提供依据。方法随机抽取舟山市2县区中2个居委会（村）419名当地常住居民,共采集60份碘盐、7份水样、412份尿样分别进行盐碘、水碘、尿碘浓度检测,并对调查对象开展甲状腺超声检查,采集血样进行甲状腺功能检测。结果盐碘浓度的中位数为1．72mg／kg,仅有21份为合格碘盐,合格碘盐食用率为35％;水碘浓度均数为12．00μg/L;尿碘中位数为126．76μg/L;甲状腺异常73人,总异常率20．28％;甲状腺功能异常人数132人,总异常率为31．50％。结论舟山市居民的尿碘水平处于较适宜的水平,孕妇的尿碘水平明显低于WHO／UNICEF／ICCIDD推荐的标准。人群甲状腺异常率略高于省内平均水平,甲状腺功能异常率与全省水平无明显差异。     

Evaluation of goiter endemia by ultrasound in schoolchildren in Val Sarmento (Italy).

Ultrasonography is an excellent and objective method for assessing thyroid volume, especially in children where clinical evaluation is inaccurate. The aim of this study was to evaluate the presence of goiter by thyroid ultrasound and palpation in 244 schoolchildren, 6 to 14 years old, living in some rural villages of Val Sarmento, a mountain area of Basilicata, Italy. In 1996 we revealed the presence of endemic goiter in 25% of the schoolchildren evaluated by palpation, according to World Health Organization (WHO) criteria, and in 15.9% of the schoolchildren evaluated by ultrasonography (7.5 MHz linear probe). The median urinary iodine excretion, taken from an extemporaneous sample of the first urines in the morning, was 62.2 microg/l. This study includes Val Sarmento, an area with mild-moderate grade (Grade I) of iodine deficiency, suggesting the need for iodine prophylaxis. Furthermore, it proves that the measurement of thyroid volume by ultrasonography is an essential instrumental method for a correct epidemiological study of endemic goiter, particularly in areas where there is mild iodine deficiency.     

Attention to the hiding iodine deficiency in pregnant and lactating women after universal salt iodization: A multi-community study in China

BACKGROUND: Monitoring of iodine nutrition depends chiefly on the urinary iodine concentration in representative samples from the population. International groups have recommended school-age children as a convenient group for surveys, because of their accessibility and young age, but the relevance of this group to others, especially pregnant women, is not well established. OBJECTIVE: The purpose was to compare different approaches to assessing iodine nutrition within communities, especially for pregnant and lactating women. DESIGN: In an urban and a rural site from each of the 11 Chinese provinces, covering a wide geographic and socioeconomic range, we measured the iodine content of household salt and drinking water, the thyroid volume in school children, and the urinary iodine concentration in five population subsets; in some sites we also assessed iodine in breast milk and thyroid size in adult women. RESULTS: The median urinary iodine concentrations for pregnant and lactating women were well below those of the schoolchildren from the same community in most study sites, the difference between medians, at overall level, being about 50 microg/l for the pregnant and 40 microg/l for the lactating, respectively. When ranked by median urinary iodine concentrations at overall level, the order of the groups was: all infants, schoolchildren, women of childbearing age, lactating women and pregnant women in both urban and rural sites. This relative distribution was constant among the study sites. From it, we derived a relationship to predict the median values for other groups, based on the data of schoolchildren. The median iodine content of salt was 30.9 ppm in urban sites and 31.3 ppm in rural sites, respectively, close to the nationally mandated 35 mg/kg. Water had low iodine content (3.7 microg/l) in both urban and rural sites except in a rural site from Tianjin. Ultrasonography showed that 6.5% of 1329 children in urban sites and 5.3% of 1431 children in rural sites had thyroid enlargement. Breast milk had a median iodine content of 135.9 microg/l in the urban and 157.5 microg/l in the rural. The goiter prevalence by palpation was low (2.0%) among all women examined (3367), but higher in pregnant women (2.7%) than in lactating women or other adult women. CONCLUSIONS: An effective iodized salt program has brought iodine sufficiency to most of China, but pregnant women in some areas may still risk deficiency and need further supplements. We suggest other countries and international agencies pay more attention to pregnancy, where iodine deficiency has its worst consequences.     

天津市食盐加碘后甲状腺肿大率与碘营养状况的调查

目的：调查和研究食盐加碘后天津市居民的甲状腺肿大率和碘营养状况,方法：在6个区共调查居民31530人,7－14岁在校儿童4415人,对调查对象进行甲状腺肿大率,尿碘浓度,食盐碘含量等项目的调查。结果：（1）食盐加碘后天津市居民的平均甲状腺肿大率为5．5％,8－10岁儿童平均甲状腺肿大率为19．7％,甲状腺肿大率较食盐加碘以前有了明显下降,但下降的速度较缓慢,（2）天津市食盐加碘以后各区居民的平均尿碘中位数为287．2ug/L,各区儿童尿碘中位数平均为271．6u/L,证明总体人群碘营养充足,（3）天津市居民总体盐碘含量超过20mg/kg水平,各区居民户盐含碘量有9．9％－41．1％超过60mg/kg,说明碘盐的含碘是偏高是一个新的现象。结论：经过3年左右的食盐加碘防治工作,天津市碘缺乏情况已得到控制。     

2009年四川省雅安市消除碘缺乏病调查结果评价

目的 评估四川省雅安市实现消除碘缺乏病目标情况,掌握全市碘缺乏病防治现状.方法 2009年,按照<四川省实现消除碘缺乏病目标县级考核评估方案>开展县级考评.以县为单位,对8个县(区)的防治资料进行综合评分,并统计分析居民户碘盐监测数据;按东、西、南、北、中5个方位各抽取1个乡(镇),每个乡(镇)各抽取1所小学,每所学校抽取80名8～10岁儿童,触诊法(WS 276-2007)检查甲状腺;收集其中20名8～10岁儿童尿样,砷铈催化分光光度法(WS/T 107-2006)检测含碘量:同时抽取30名5年级学生和该校附近10名家庭主妇,进行碘缺乏病知识问卷调查.结果 8个县(区)资料评分平均为89.96分,范围为85.42～92.90分;居民户碘盐覆盖率为100.00%(2328/2328),碘盐合格率为97.98%(2281/2328),合格碘盐食用率为97.98%(2281/2328);8～10岁儿童甲状腺肿大率为0.91%(33/3620);800名8～10岁儿童尿碘中位数为235.85μg/L,且<50μg/L的占1.50%(12/800);5年级学生和家庭主妇碘缺乏病防治知识问卷调查及格率分别为92.33%(1131/1225)、94.3%(397/421).结论 雅安市以县为单位全部实现消除碘缺乏病目标,但碘缺乏病与碘营养过剩趋势并存,今后应注意每日碘盐食用量的问题,需科学补碘才能持续消除碘缺乏病.

Abstract：

Objective To evaluate the investigation outcome of eliminating iodine deficiency disorders(IDD)in Ya'an city of Sichuan province,and to master the current situation of IDD in the whole city.Methods In 2009,according to"Counties'Assessment Guideline in Sichuan for Implementing the Measure to Eliminate Iodine Deficiency Disorders",assessments were conducted.At county level,composite score was given to collected data of the eight counties(districts)and monitoring data of household iodized salt were statistically analyzed.A township (town)was randomly selected by east,west,south,north and center locations,respectively.One primary school was randomly selected in each selected township(town),eighty children aged 8 to 10 in each selected school were checked of their thyroid by palpation(WS 276-2007)and urinary iodine level of20 children among them was measured by As3+_Ce4+ catalytic spectrophotometry(WS/T 107-2006).Thirty fifth-grade students and 10 housewives lived around school were asked to take a questionnaire survey.Results Average score of the 8 counties(districts)was 89.96,ranged from 85.42 to 92.90.The coverage rate of iodized salt of household was 100.00%(2328/2328),rate of qualified iodized salt was 97.98%(2281/2328).and consumption rate of qualified iodized salt reached 97.98%(2281/2328).The goiter rate of children aged 8-10 was 0.91%(33/3620),median urinary iodine was 235.85μg/L,and 1.50%(12/800)of child's urinary iodine was less than 50μg/L.The rate of passing a knowledge questionnaire survey of the fifth-grade students and women was 92.33%(1 131/1225)and 9413%(397/421),respectively.Conclusions Ya'an city in Sichuan province has reached the goal of eliminating iodine deficiency.disorders,but there is a coexist trend of IDD and iodine excess.They should pay attention to the daily consumption of iodized salt in the future;sustained elimination of IDD can be reached only by iodine supplementation scientifically.