Addition of microencapsulated iron to iodized salt improves the efficacy of iodine in goitrous,iron-deficient children: a randomized,double-blind,controlled trial

OBJECTIVE: In many developing countries, children are at high risk for both goiter and anemia. Iron (Fe) deficiency adversely effects thyroid metabolism and reduces efficacy of iodine prophylaxis in areas of endemic goiter. The study aim was to determine if co-fortification of iodized salt with Fe would improve efficacy of the iodine in goitrous children with a high prevalence of anemia. DESIGN AND METHODS: In a 9-month, randomized, double-blind trial, 6-15 year-old children (n=377) were given iodized salt (25 microg iodine/g salt) or dual-fortified salt with iodine (25 microg iodine/g salt) and Fe (1 mg Fe/g salt, as ferrous sulfate microencapsulated with partially hydrogenated vegetable oil). RESULTS: In the dual-fortified salt group, hemoglobin and Fe status improved significantly compared with the iodized salt group (P<0.05). At 40 weeks, the mean decrease in thyroid volume measured by ultrasound in the dual-fortified salt group (-38%) was twice that of the iodized salt group (-18%) (P<0.01). Compared with the iodized salt group, serum thyroxine was significantly increased (P<0.05) and the prevalence of hypothyroidism and goiter decreased (P<0.01) in the dual-fortified salt group. CONCLUSION: Addition of encapsulated Fe to iodized salt improves the efficacy of iodine in goitrous children with a high prevalence of anemia.     

Introduction of iodized salt to severely iodine-deficient children does not provoke thyroid autoimmunity: a one-year prospective trial in northern Morocco.

To determine if introduction of iodized salt induces thyroid autoimmunity in goitrous children, we conducted a prospective trial in iodine-deficient Moroccan schoolchildren (n = 323). Local salt was iodized at 25 microg iodine per gram of salt and distributed to households. Before introduction of iodized salt and at 10, 20, 40, and 52 weeks, we measured antithyroid peroxidase antibodies (TPO-Ab), antithyroglobulin antibodies (Tg-Ab), urinary iodine (UI), and thyroid hormones, and examined the thyroid using ultrasound. At baseline, median UI was 17 microg/L and the prevalence of goiter and hypothyroidism was 72% and 18%, respectively. Provision of iodized salt maintained median UI at 150-200 microg/L for the year (p < 0.0001). There was a significant increase in mean total thyroxine (T(4)) and a significant reduction in the prevalence of hypothyroidism (p < 0.001). There was a transient increase in the prevalence of detectable antibodies after introduction of iodized salt (p < 0.0001) with levels returning to baseline at 1 year. Only congruent with 1% of children had elevated TPO-Ab and none had elevated Tg-Ab over the course of the study, and no child with elevated TPO-Ab had abnormal thyrotropin (TSH) or T(4) concentrations. None developed clinical or ultrasonographic evidence of thyroid autoimmune disease and/or iodine-induced hypothyroidism or hyperthyroidism. Rapid introduction of iodized salt does not provoke significant thyroid autoimmunity in severely iodine-deficient children followed for 1 year.     

我国碘缺乏病高危地区重点调查结果分析

目的 调查我国碘缺乏病高危地区新发地方性克汀病(地克病)和地方性甲状腺肿(地甲肿)的流行现况,了解高危地区碘盐覆盖率较低的原因,有针对性地提出防治对策.方法 以县为单位,在西藏、青海、新疆、甘肃、宁夏、四川、海南、重庆、云南、广西、内蒙古11个省份的碘盐监测盲区(高危县)采取单纯随机抽样方法选择调查乡,在其他高危县按照典型调查原则以乡为单位选取调查点,进行10岁以下新发地克病病例搜索;对8～10岁儿童采用B超法检测甲状腺大小,采用中国瑞文测验(农村修订版)检测智商;对育龄妇女开展人户调查和采集家中盐样,盐碘测定采用半定量法,统计居民户碘盐覆盖率;采集8～10岁儿童和育龄妇女尿样,尿碘测定采用砷铈催化分光光度法;全部结果采用Epi Iinfo 6.0软件进行分析.结果 在101个高危县中搜索出地克病线索病例4122人,其中确诊地克病249例.儿童甲状腺肿大(甲肿)率为8.28%(4434/53 541),44个县儿童甲肿率在5%～20%,5个县儿童甲肿率在>20%～30%,3个县儿童甲肿率>30%.儿童智商均值为85.44,智商<70的儿童占16.52%(8713/52 745).儿童尿碘中位数为154.69;μg/L、尿碘<50μg/L的比例为17.26%(9069/52 558),有25个县的儿童尿碘中位数<100μg/L;育龄妇女尿碘中位数为107.14μg/L、尿碘<50μg/L的比例为27.50%(3722/13 534),有46个县家庭主妇尿碘中位数<100μg/L.居民户的碘盐覆盖率为77.85%(13 150/16 891),西藏、海南、青海碘盐覆盖率较低,分别为52.80%(1585/3002)、44.72%(631/1411)、72.82%(1850/2506).西藏、四川、海南、甘肃、青海居民户中>10%的人认为购买碘盐不方便,有71.39%(7652/10 719)的家庭食用土盐,土盐每公斤的平均价格(0.30～1.20元)低于碘盐(1.20～3.00元).结论 碘缺乏病高危地区存在发生地克病和地甲肿的危险,应在这些地区开展碘缺乏病监测,降低碘盐价格,提高碘盐覆盖率,对特需人群要尽快实施应急补碘,建立消除碘缺乏病的长效机制.     

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。     

The effects of vitamin A deficiency and vitamin A supplementation on thyroid function in goitrous children

In developing countries, children are at high risk for both the iodine deficiency disorders (IDD) and vitamin A deficiency (VAD). The study aim was to determine the effects of VAD and vitamin A (VA) supplementation on thyroid function in an area of endemic goiter. In a double-blind, randomized, 10-month trial, Moroccan children with IDD and VAD (n = 138) were given iodized salt and either VA (200,000 IU) or placebo at 0 and 5 months. At 0, 5, and 10 months, measurements of VA status and thyroid function were made. At baseline, increasing VAD severity was a predictor of greater thyroid volume and higher concentrations of TSH and thyroglobulin (P < 0.001). In children with VAD, the odds ratio for goiter was 6.51 (95% confidence interval, 2.94, 14.41). VAD severity was also a strong predictor of higher concentrations of total T(4) (P < 0.001); the odds ratio for hypothyroidism in VAD was 0.06 (95% confidence interval, 0.03, 0.14). During the intervention, mean thyroglobulin, median TSH, and the goiter rate significantly decreased in the VA-treated group compared with those in the placebo group (P < 0.01). The findings indicate that VAD in severely IDD-affected children increases TSH stimulation and thyroid size and reduces the risk for hypothyroidism. This effect could be due to decreased VA-mediated suppression of the pituitary TSHbeta gene. In IDD- and VAD-affected children receiving iodized salt, concurrent VA supplementation improves iodine efficacy.     

高碘地区儿童碘营养影响因素和甲状腺肿大及结节的流行特征

目的了解高碘地区停供碘盐前儿童碘营养的影响因素和甲状腺肿大和结节的状况。方法采用单纯随机法在河北省衡水市水碘中位数在200～300μg/L高碘乡(镇)中随机抽取3个进行调查。结果在3个乡(镇)共采集测定8～10岁儿童1次即时尿样326份,尿碘中位数在478.4～571.3μg/L之间,尿碘含量>300μg/L尿样所占比例在77.9%～86.6%之间。12个村儿童的尿碘中位数与其所在村的水碘中位数成正相关(Spearsman,R=0.79,P=0.002),而与盐碘中位数不相关(Spearsman,R=-0.17,P=0.6)。儿童尿碘中位数与水碘中位数成直线相关(R=0.83,F=22.0,P=0.001),直线回归方程为:尿碘=318.1+0.829*水碘。在3个乡(镇)共用B超检测8～10岁儿童452名,甲状腺肿大37例,肿大率为8.2%;不同性别和年龄组甲状腺肿大率无显著差异。在其中2个乡共发现甲状腺结节15例,平均检出率为5.6%,不同性别和年龄组甲状腺结节检出率无显著差异。结论高碘地区儿童碘营养过剩主要由高水碘造成,碘盐加重了这种状况;存在甲状腺肿大流行,甲状腺结节的检出率也较高。甲状腺结节的成因和发生强度有待于进一步研究。     

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.     

2008年浙江省舟山市海岛地区甲状腺疾病流行病学调查

目的 调查浙江省舟山市海岛地区食用非加碘盐的居民患甲状腺疾病状况及致甲状腺疾病的相关影响因素.方法 2008年在浙江省舟山市岱山县对737名食用非加碘盐的居民进行流行病学问卷调查、甲状腺B超检查、甲状腺功能及尿碘测定;同时抽查了183名8～10岁儿童(均为食用非加碘盐居民的子女)的尿碘.结果 舟山市岱山县食用非加碘盐的居民尿碘中位数(MUI)为122.2 μg/L,8～10岁儿童MUI为123.7μg/L;甲状腺肿、甲状腺癌、甲状腺功能亢进(简称甲亢)、亚临床甲状腺功能亢进(简称亚临床甲亢)和亚临床甲状腺功能减退(简称亚临床甲减)的患病率分别为39.9%、0.4%、0.4%、0.7%和0.8%.logistic回归分析显示,甲状腺肿患病率无性别差异(P>0.05),而年龄是甲状腺肿发生的危险因素(P<0.05);甲状腺肿、甲亢患病情况与饮食史、吸烟史、饮酒史、饮茶史、尿碘水平均无明显相关关系(P均>0.05).结论 舟山市海岛地区食用非碘盐居民碘摄入适量,但甲状腺肿和甲亢患病率较高.     

2009年甘肃省碘缺乏病调查结果分析

目的 掌握甘肃省碘缺乏病防治现状,为制订碘缺乏病的防治措施提供依据.方法 2009年,在甘肃省14个市(州),每个市(州)抽取1个达标县(市、区、旗),并按东、西、南、北、中5个方位各抽取1个乡(镇、街道),不足5个乡时全部抽取;在所抽取的每个乡(镇、街道),各抽取1个村,进行居民户碘盐情况及碘盐销售网络调查.同时在每个村抽取1所小学,进行儿童尿碘、甲状腺、智商检查及碘缺乏病知晓状况调查.结果 共检测1420份食用盐,加权碘盐覆盖率为99.53%,加权合格碘盐食用率为98.15%.共对1761名8～10岁儿童检测尿碘,中位数为225.87μg/L,在14个县中,有5个县儿童尿碘处于适宜水平,7个县超过了碘适宜水平.2个县处于碘过量水平.共对3051名8～10岁儿童进行甲状腺检查,加权甲状腺肿大率为1.9%,只有红古区儿童加权甲状腺肿大率大于5%,为5.3%.共对2815名8～10岁儿童进行智商检测,平均智商为105.3,除卓尼县和康乐县之外,其余各县儿童智商均在100以上.碘缺乏病知晓调查平均分为3.2分.知道缺碘不聪明的占57.08%(1229/2153),知道缺碘致甲状腺肿大的占71.76%(1544/2153),知道碘盐是最好的防治方法的占68.04%(1465/2153),向家人讲述碘盐好处的占61.82%(1331/2153).共凋查了87个乡(镇)102个村的食盐销售情况,每个乡(镇)都有一个碘盐代销点,每个村至少有1个碘盐零售店,但73.5%(75/102)的零售店无销售许可证.结论 甘肃省碘缺乏病防治取得了显著进展,合格碘盐食用率达到国家消除标准,甲状腺肿大率明显下降,大多数县儿童尿碘处于"大于适宜水平",碘盐销售网络基本健全,但各县碘缺乏病健康教育工作进展不平衡.

Abstract：

Objective To master the status in control of iodine deficiency disorders (IDD) in Gansu province and to provide the basis for development of control strategies. Methods One county which reached the national standardization of IDD elimination was selected randomly from each of 14 cities of Gansu province in 2009, then one town was selected respectively from five directions (east, south, west, north, and central) of the above selected counties. One village was chosen from every town which was selected for investigating household iodized salt and iodized salt sales network. At the same time the thyroid of children was examined, their urinary iodine (UI) was determined, the intelligence quotient(IQ) values of children were measured and health education was surveyed in one primary school which was chosen in each of the selected town. Results A total of 1420 edible salt samples were tested;the weighted iodized salt coverage rate and the weighted qualified iodized salt rate were 99.53% and 98.15 respectively. Urine samples were collected from 1761 children included in the study. The urinary iodine median was 225.87 μg/L. The urinary iodine medians were at optimal levels in five counties, over the optimal levels in seven counties and at excessive levels in two counties. A total of 3051 children aged 8 - 10 were randomly selected for thyroid examination. The weighted thyroid goiter rate(TGR) of children was 1.9%, and TGR was higher than 5% only in Hoaggu county. IQ of 2815 children was tested and the mean IQ was 105.3, except for the country of Zhuoni and Kangle, the mean IQ of other counties were over 100. The average score of health education was 3.2.Children of 57.08% (1229/2153) knew that iodine deficiency could lead to mental retardation, 71.76% (1544/2153) knew that iodine deficiency could cause thyroid goiter, 68.04%( 1465/2153 ) knew that eating iodized salt was the best method for IDD prevention and control and 61.82%(1331/2153) informed their families of the benefits of eating iodized salt. Each town had one agency selling iodized salt and each village had one more retail store with iodized salt, but 73.5%(75/102) of the stores without license for the sales. Conclusions Great progress has been made on the prevention and control of IDD in Gansu province. The qualified iodized salt consumption rate has reached the national standard for IDD elimination, TGR has decreased markedly, the urinary iodine levels in more counties are over the optimal levels and iodized salt distribution network is basically sound. But progress in health education is uneven.     

云南省彝良县碘缺乏病高危监测结果分析

目的了解云南省碘缺乏病高危地区新发地方性克汀病、地方性甲状腺肿流行现况、人群碘营养状况及防治措施落实情况,查找影响我省高危地区碘盐覆盖率的原因,研究并提出有针对性的防治策略和措施。方法 2008、2010年在碘盐覆盖率<80%的彝良县抽取3个乡实施高危地区监测,监测内容包括搜索疑似地克病病例,检测8～10岁儿童甲状腺容积,检测8～10岁儿童和育龄妇女的尿碘浓度,入户调查和采集家中盐样进行半定量检测,调查被监测乡、村实施碘盐供应、碘油投服等防治措施情况。结果 2008、2010年两次监测都未发现疑似地克病;育龄妇女尿碘中位数分别为184.14μg/L、247.12μg/L,儿童尿碘中位数分别为204.72μg/L、282.96μg/L;2008与2010年结果比较,碘盐覆盖率由84.17%上升至99.17%,儿童和育龄期妇女尿碘中位数均有明显升高,8～10岁儿童甲肿率(触诊法)由19.34%下降至6.25%。结论我省高危地区碘缺乏病监测、防治措施及时有效,今后应不断巩固碘缺乏病防治成果;该地区居民碘营养已处于超适宜状态,应适当下调盐碘含量。     

Selenium and goiter prevalence in borderline iodine sufficiency

DESIGN: Selenium (Se) is required for the biosynthesis of selenocysteine-containing proteins. Several selenoenzymes, e.g. glutathione peroxidases and thioredoxin reductases, are expressed in the thyroid. Selenoenzymes of the deiodinase family regulate the levels of thyroid hormones. For clinical investigators, it is difficult to determine the role of Se in the etiology of (nodular-)goiter, because there are considerable variations of Se concentrations in different populations as reflected by dietary habits, bioavailability of Se compounds, and racial differences. Moreover, most previous clinical trials which investigated the influence of Se on thyroid volume harbored a bias due to the coexistence of severe iodine deficiency in the study populations. METHODS: Therefore, we investigated the influence of Se on thyroid volume in an area with borderline iodine sufficiency. First, we investigated randomly selected probands for urinary iodine (UI) and creatinine excretion in spot urine samples and determined the prevalence of goiter and thyroid nodules by high-resolution ultrasonography. After this, we determined urinary Se excretion (USe) in probands with goiter as well as in matched probands without goiter. Adjustments between the two compared groups were made for age, gender, history of thyroid disorders, smoking, and UI excretion. RESULTS: The mean USe and UI rates of all 172 probands were 24 micro g Se/l or 27 micro g Se/g creatinine and 96 micro g I/l or 113 micro g I/g creatinine indicating borderline selenium (20-200 micro g/l) and iodine (100-200 micro g/l) sufficiency of the study population. Probands with goiter (n=89) showed significantly higher USe levels than probands with normal thyroid volume (n=83; P < 0.05). USe rates were not influenced by present smoking or pregnancy. CONCLUSIONS: In our investigation, USe was not an independent risk factor for the development of goiter. The higher USe in probands with goiter in comparison with probands with normal thyroid volume is most likely a coincidence. Se does not significantly influence thyroid volume in borderline iodine sufficiency because the iodine status is most likely the more important determinant.     

The effectiveness of oral iodized oil in the treatment and prophylaxis of endemic goiter

In a longitudinal study carried out for 2 yr in the Darfur region, western Sudan, 2316 school children received a single dose of 2 capsules of iodized oil (400 mg iodine) orally, and 1161 school children received 1 ml of the same preparation im (475 mg iodine); 2393 school children served as controls. One year after treatment, goiter prevalence was reduced from 67.0% to 36.0% among the children who had received oral iodized oil and from 71.0% to 42.0% in those who received it im. The prevalence in the control group did not change. The prevalences in each group were approximately the same 2 yr after treatment. Urinary iodine excretion increased after treatment and remained significantly higher than the initial value during the trial. In subjects from rural Darfur, serum T4 levels were increased 1 yr after treatment with oral iodized oil (P less than 0.001) and im iodized oil (P less than 0.01), and remained high in the former (P less than 0.05) but not in the latter. This increase was accompanied by reduction of serum T3 and TSH levels. Sialadenitis occurred in 3.7% of the children who received oral iodized oil. Thyroid antibodies were not detected before treatment, but microsomal antibodies were detected in 2 of the 128 subjects studied who received iodized oil orally. Comparable results occurred when oral and im iodized oil were given to 841 individuals covering a wider age range. It is concluded that a single oral dose of iodized oil is effective in the correction of iodine deficiency, reducing the goiter size and preventing the recurrence of goiter for at least 2 yr.     

Goiter persistence after iodine replenishment, the potential role of selenium deficiency in goitrous schoolchildren of Semirom, Iran.

BACKGROUND: Despite long-standing iodine supplementation in Iran, the prevalence of goiter remains high in some areas. This suggests other nutritional deficiencies may be considered as responsible factors of goiter persistence. Therefore, we assessed the prevalence of selenium deficiency in children living in a mountainous area in Iran to evaluate its correlation with goiter. METHODS: In this cross-sectional study, 1828 students from the 108 primary schools of urban and rural areas of Semirom in central Iran were selected by multistage random cluster sampling. After obtaining written consent from their parents, the children were examined for goiter grading. Grade 2 goitrous children (108 cases) were compared with non-goitrous children (111 children) as control group for serum selenium concentration. RESULTS: Overall, 36.7% of 1828 students had goiter. The mean and median urinary iodine excretion level was 19.3 and 18.5 mug/dl respectively. This was within normal limits. Of 219 evaluated cases, 109 children had selenium deficiency. Mean serum levels of selenium in the goitrous and control groups were 62.7 mug/l and 60.8 mug/l, respectively (p=0.42). There was a borderline significant difference of the goiter prevalence in selenium deficient and selenium sufficient subjects (40.8% vs. 54.3%, p=0.037).Twelve children had clinical or subclinical hypothyroidism. The mean (SD) serum selenium concentration of euthyroid and hypothyroid students were 61.9 (17.2) mug/l and 66.4 (11.9) mug/l respectively (p=0.35). CONCLUSION: In the area studied, selenium deficiency cannot explain high prevalence of goiter and other responsible factors should be investigated. Selenium deficiency may also have mild borderline significant protective effects on thyroid function and goiter.     

Treatment of iodine deficiency in school-age children increases insulin-like growth factor (IGF)-I and IGF binding protein-3 concentrations and improves somatic growth

CONTEXT: Iodine deficiency in utero impairs fetal growth, but the relationship between iodine deficiency and postnatal growth is less clear. OBJECTIVE: The objective of the study was to determine whether iodine repletion improves somatic growth in iodine-deficient children and investigate the role of IGF-I and IGF binding protein (IGFBP)-3 in this effect. DESIGN, PARTICIPANTS, AND INTERVENTIONS: Three prospective, double-blind intervention studies were done: 1) in a 10-month study, severely iodine-deficient, 7- to 10-yr-old Moroccan children (n = 71) were provided iodized salt and compared with children not using iodized salt; 2) in a 6-month study, moderately iodine-deficient, 10- to 12-yr-old Albanian children (n = 310) were given 400 mg iodine as oral iodized oil or placebo; 3) in a 6-month study, mildly iodine-deficient 5- to 14-yr-old South African children (n = 188) were given two doses of 200 mg iodine as oral iodized oil or placebo. At baseline and follow-up, height, weight, urinary iodine (UI), total T4 (TT4), TSH, and IGF-I were measured; in Albania and South Africa, IGFBP-3 was also measured. RESULTS: In all three studies, iodine treatment increased median UI to more than 100 microg/liter, whereas median UI in the controls remained unchanged. In South Africa, iodine repletion modestly increased IGF-I but did not have a significant effect on IGFBP-3, TT4, or growth. In Albania and Morocco, iodine repletion significantly increased TT4, IGF-I, IGFBP-3, weight-for-age z scores, and height-for-age z scores. CONCLUSION: This is the first controlled study to clearly demonstrate that iodine repletion in school-age children increases IGF-I and IGFBP-3 concentrations and improves somatic growth.     

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.     

Prevalence of goiter among schoolchildren from Gorgan, Iran, a decade after national iodine supplementation: association with age, gender, and thyroperoxidase antibodies

BACKGROUND: One decade after universal salt iodization in Iran, goiter prevalence, urinary iodine concentration (UIC) and thyroperoxidase antibody (TPOAb) values were assessed among schoolchildren in Gorgan, Iran. METHODS: From 2003-2004, 500 girls and 900 boys aged 7-11 yr were evaluated for goiter by palpation. UIC was measured in 183 randomly-selected goitrous children. Serum TSH, T4, and TPOAb were measured in 53 goitrous and 30 non-goitrous children with adequate UIC. RESULTS: Goiter was detected in 370 (26.4%) children. Goiter was present in 31% of girls and 17% of boys age 9 (p<0.012); 37% of girls and 20% of boys age 10 (p<0.003); and 52% of girls and 19% of boys age 11 (p<0.0001). Median (range) UIC for all goitrous children sampled was 190 (20-600) microg/l; 220 (30590) in boys and 170 (20-600) in girls (p=0.001). Eight point seven percent of goitrous children and 22% of goitrous girls aged 10-11 had UIC<100 microg/l, while 47% of the goitrous children had UIC> or =200 microg/ l. TPOAb was present in 52.8% of goitrous children and 10% of non-goitrous children (p=0.0001). TPOAb was present in 53.9% of 10-11 and 22.7% of 7-9 yr old goitrous and non-goitrous children (p=0.003) with adequate UIC. Median (range) TSH was 2.9 (0.3-10.9) mlU/I in TPO-positive and 1.8 (0.5-4.1) in TPO-negative children (p=0.001). CONCLUSIONS: Gorgan, Iran, is an iodine-sufficient area and almost half of schoolchildren have more than adequate UIC. TPOAb is associated with endemic goiter. Despite sufficient UIC overall, some school-aged girls remain at risk of iodine deficiency.     

福建省龙岩市碘缺乏病病情监测结果分析

目的 了解福建省龙岩市碘缺乏病病情现状,评价防治措施效果,为制订防治策略提供依据.方法 2006和2007年期间,在福建省龙岩市7个县(市、区),每个县(市、区)按容量比例概率抽样法(PPS)确定30所小学,每所小学抽取40名8～10岁学生,进行甲状腺触诊检查,同时抽取7名学生采集尿样和家中盐样,进行尿碘及盐碘测定,计算甲状腺肿大率、尿碘中位数、合格碘盐食用率、碘盐覆盖率、碘盐合格率和非碘盐率.结果龙岩市8～10岁儿童甲状腺肿大率为0.94%(79/8438),尿碘中位数为259.12μg/L,合格碘盐食用率为97.86%(1462/1494),碘盐覆盖率为99.46%(1486/1494),碘盐合格率为98.38%(1462/1486),非碘盐率为0.54%(8/1494).结论 龙岩市的碘缺乏病防治工作达到国家消除碘缺乏病标准.     

Reappraisal of the risk of iodine-induced hyperthyroidism: an epidemiological population survey

The occurrence of iodine-induced hyperthyroidism (IIH) has been reported after iodine supplementation from clinics and hospitals, but not following an epidemiologic survey. We studied the prevalence of thyroid derangement in a population following iodine supplementation. One yr after more than 75% of the population had been consuming 40 ppm iodized salt; information regarding history of endemic goiter and iodized salt production, distribution, consumption and monitoring were collected in four cities of the Islamic Republic of Iran. A total of 6048 subjects were randomly selected. All subjects were assessed for size of goiter, and urinary iodine and serum T4, T3, TSH, anti-thyroglobulin and anti-thyroperoxide were measured. Before iodine supplementation, all four cities were areas of endemic goiter. The rate of household consumption of iodized salt was 50, 75 and 90% in 1994, 1995 and 1996, respectively. Ninety-one percent of the salt samples contained 15-55 ppm iodide. Total goiter rate was 57, 62 and 68%; median urinary iodine was 188, 197 and 190 microg/l in the age groups of 6-18, 19-40 and >40 yr, respectively. Prevalence of clinical and subclinical hyperthyroidism was 0.34 and 0.41 and those of clinical and subclinical hypothyroidism were 0.51 and 1.07%, respectively. Nine point eight and 18% in the 19-40 yr age group and 17.6 and 25.6% in >40 yr old subjects had positive anti-thyroperoxidase and anti-thyroglobulin, respectively. This systemic epidemiologic study in an iodine deficient population showed that, following a well-executed iodine supplementation program, the occurrence of IIH is rare.     

沧州市碘缺乏病高危地区监测报告

目的了解我市连续两年碘盐覆盖率低于80%地区的居民碘营养状况。方法根据《全国碘缺乏病监测方案（试行）》要求,B超法检测8～10岁儿童甲状腺容积;尿碘检测采用砷铈催化分光光度测定法;盐碘检测：现场进行半定量检测。结果 8～10岁儿童1 500人,甲状腺肿大45人,甲状腺肿大率3.00%;8～10岁儿童尿1 431份,尿碘中位数为206.77μg/L;育龄妇女采尿362份,尿碘中位数196.10μg/L。结论 2007年～2008年连续两年碘盐覆盖率低于80%的县,目前尚未造成人群碘营养不足。     

Iodized oil treatment for endemic goiter does not induce the surge of positive serum concentrations of anti-thyroglobulin or anti-microsomal autoantibodies

Forty-three goitrous patients (grade II and III, WHO classification), living in areas of chronic iodine deficiency, were treated with an injection of iodized oil (470 mg iodine). Serial measurements of serum thyroid hormone levels after the therapy revealed increasing concentrations of both hormones, with a significantly lower serum T3/T4 ratio, and progressively significantly lower serum TSH mean values. Serum Tg mean value, initially elevated (58 +/- 9 ng/ml), decreased after 6 months and returned to the normal range at 36 months of therapy. In none of the examined patients (except for one subject with positive autoantibodies before therapy), it was observed the surge of positive anti-thyroglobulin or anti-microsomal autoantibodies after the iodized oil. We conclude that iodized oil therapy does not induce an abnormal autoimmune reaction in endemic goiter patients.