Endemic Goiter and Its Relation to Iodine Content of Food

Summary1. A study is presented of 368 cases of thyreoid disease observed a t the Dunedin Hospital over a period of six and three‐quarter years.2. Simple and toxic goitre' occurred in approximately equal pro‐portion, but many of the simple cases presented features of “border‐line” toxicity.3. The difficulties of accurate classification, particularly in the toxic classes, are discussed and arguments advanced for the abandonment of the differentiation “primary”) and “secondary”4. The family history in all classes (least marked in the primary Graves's disease group) indicates the high family incidence of goitre in this district.5. The results of surgical treatment in toxic goitre are excellent and compare favourably with those in other important disease groups, such as biliary.6. The operation mortality in toxic cases was 3.770.7. An unduly high incidence of recurrent laryngeal nerve lesion 8. Poxt‐operative myxoedema in classical form was noted in three.8. Poxt‐operative myxoedema in classical form was noted in three cases out of 319 operations in all classes.9. Tetany occurred in three cases in the same series.10. Our biochemistry findings indicate that the blood iodine content is higher in primary Graves' disease than in simple goitre, and that the iodine content of blood, urine, fsces and gland are all lower than normal in simple goitres.11. Observation of our cases leads to the conclusion that the histological picture merely represents innumerable variations of one and the same pathological process of involution and hyperplasia. It is impossible accurately to correlate the pathological picture with the clinical classification. after operation is recorded. cases out of 319 operations in all classes.

Objective To investigate the status of iodine content and goiter rate of the residents in excessive iodine intaking areas in Dezhou of Shandong Province after ceasing supplementation of iodized salt. Methods In ten excessive iodine intaking counties (cities, districts) from 2013 to 2014, 300 residents were selected from each county (city, district) to examine their household salt iodine level. Five counties (cities, districts) were chosen as monitoring sites every year, which were divided in two groups according to water iodine levels (150 -300 and > 300 μg/L). One town that met the requirement in each group was chosen as a test site, one hundred children aged 8 -10 (50 male and 50 female) from each test site were selected to measure their household salt iodine level. If the household salt was confirmed a non-iodized salt, water samples and urine samples were collected. Water iodine and urinary iodine contents were measured by arsenic cerium catalytic spectrophotometry (WS/T 107-2006); thyroid volume was measured by B ultrasound. Results In 2013 and 2014, the rate of non-iodized salt was 96.1% (2 882/2 999) and 92.7% (2 781/3 000); goiter rate was 3.2% (16/506) and 24.7% (129/523) in Dezhou City. Totally 1 052 household drinking water samples were measured, the median of water iodine level was 221.8 μg/L (0.5 -1 073.6 μg/L). Totally 1 035 urine samples were measured, the median of urinary iodine level was 405.9 μg/L (19.3 -2 464.1 μg/L). In the two groups (water iodine was 150-300 and > 300 μg/L, respectively), the goiter rate was 11.6% (59/508) and 16.5% (86/521), the difference between them was statistically significant (χ2 = 4.86, P < 0.05). Urinary iodine level was proportional to household water iodine level (r = 0.475, P < 0.01). The median of children' s household water iodine level and median of children's urinary iodine level had a U curve relationship with goiter rate. Conclusions The measure of stopping to supply iodized salt in excessive iodine intaking areas in Dezhou is well implemented. Some monitoring sites have significant improvement. However, the harmful effects of excessive iodine intaking are still there in some areas. There is an U-curve relationship between water iodine level and goiter rate. At the same time, we should pay attention to iodine deficiency that might be caused by changing water iodine content. Key words: Iodine; Water; Urine; Thyroid

Selenium and iodine in soil, rice and drinking water in relation to endemic goitre in Sri Lanka

Objective To observe the high iodine induced thyroid goiter condition, iodine nutritional status and coverage rate of non-iodized salt in high water iodine areas. Methods The household non-iodized salt was monitored in counties (cities, regions) of high water iodine areas and high iodine diseased areas in Tianjin, Hebei, Shanxi, Jiangsu, Anhui, Shandong, Henan and Shaanxi provinces. Among the monitoring sites, where the water iodine were 150-300 μg/L or higher than 300 μg/L, 50% of the them were selected to investigate the water iodine, children urinary iodine and thyroid volume of children in high iodine counties. Results Household edible salt was monitored in 110 counties of 8 provinces, with a total of 25 597 salt samples. The number of non-iodized salt was 24 640, and the coverage rate of non-iodized salt was 96.3%. After being weighted based on the population of counties, the coverage rate of non-iodized salt was 96.9%. In all, 73 survey areas include 183 663 people, 64 monitoring sites (87.7%) where the water iodine level were higher or equal to 150 μg/L and the median of water iodine was 250.8 μg/L. Totally 5 991 children aged 6-12 were measured thyroid volume, the total goiter rate was 6.2%, the children thyroid goiter rate was higher than 5% in Hebei, Shanxi, Henan, Tianjin and Shandong provinces. Totally 4 618 children were detected urinary iodine, the median urinary iodine concentration was 373.0 μg/L, and the children median urinary iodine concentration was exceeded 300 μg/L in Tianjin, Hebei, Shanxi, Jiangsu and Shandong provinces. The children urinary iodine concentration and goiter rate increased gradually with increasing of water iodine content. Conclusions The non-iodized salt coverage rate is high in high water iodine areas, most monitored areas have changed drinking water sources, but the median water iodine concentration is still higher than 150 μg/L. Children median urinary iodine concentration is higher than 300 μg/L, iodine is in a excessive status. The children total goiter rate is higher than 5%. Some countermeasures are proposed to search low iodine water, change water sources, do health education, and add other surveillance measures, such as thyroid function detection on target groups, and so on. Key words: Drinking water; Iodine, excess; Urine; Goiter

Objective To investigate the nutritional status of iodine among residents and the goiter disease of children in high water iodine areas in Shanxi Province, and to provide a scientific basis for establishment of long-lasting control strategies and measures. Methods In 2012, according to the historical monitoring data, in the 10 high water iodine counties (citys, districts), one town was selected based on its location (east, west, south, north and middle) in each county (citie, district). In county (city, district) with 5 townships or less, all townships were selected. Four villages were selected in each township and fifteen residents in each village were selected to test salt iodine level. In five high water iodine counties (city, district), one or two high water iodine villages were selected, water samples were collected and the iodine content was measured; one hundred students aged 8-10 years old were chosen to examine their thyroid size. Thirty children were chosen from above students to collect their urine samples and to determine the iodine content. Results In 10 high water iodine counties (citys, districts), 1 680 salt samples were tested. The rate of non-iodized salt was 85.2% (1 432/1 680); in six villages of five high water iodine counties (citys, districts), the median of urinary iodine of 256 children aged 8 to 10 was 487.2 μg/L; in three villages which had improved the quality of water, the median of urinary iodine was 271.0 μg/L; other three villages which had not improved the quality of water, the median of urinary iodine was 692.6 μg/L. In those villages which had not improved the quality of water, urinary iodine of children ≥300 μg/L accounted for 85.8% (139/162); in those villages which had improved the quality of water, high urinary iodine of children accounted for 41.5% (39/94),and the difference was statistically significant (χ2 = 53.06, P < 0.05). The thyroid was investigated among 591 children aged 8-10 years old, and the goiter rate was 6.6% (39/591). In those villages which had improved the quality of water, the goiter rate of children was 3.8% (11/291), but in villages which had not improved the quality of water, the goiter rate of children was 9.3% (28/300), and the difference was statistically significant (χ2 = 6.52, P < 0.05). Conclusion The iodine nutrition level of residents in high water iodine areas in Shanxi is excessive, children's goiter disease has not been effectively controlled; water improvement to reduce iodine is the basic way to control the disease of high iodine. Key words: Iodine; Drinking; Urine; Thyroid gland; Salts; Data collection

Objective To investigate resident iodine nutrition level in waterborne high iodine areas and prevalence of high iodine goiter in Shanxi Province. Methods In 2014, in Shanxi Province, in all the 10 high iodine counties (cities, districts), the jurisdiction area of each county (city, district) was divided into two blocks, high iodine and not high iodine districts, and in high iodine area of each county (city, area) according to their sub-area positions of east, south, west, north and center, a township was randomly selected (if the number of high iodine area in iodine excessive township ≤5, all townships were selected); four administrative villages in each monitoring township were randomly selected; in each administrative village, the edible salt samples of 15 randomly selected households were collected for detection of iodine content. Five counties (cities, districts) were selected from the province's 10 high iodine counties (cities, districts), water iodine content of 3 counties (cities, districts) was 150-300 μg/L, and 2 were > 300 μg/L, one administrative village was selected from each county (city, area), household drinking water samples were collected to detect iodine content; and 100 elementary school children aged 8-10 were selected from the village where the monitoring stations located in for thyroid volume ultrasound measurement, and 30 of them were randomly selected for urinary iodine content detection. Results ① In the 10 high iodine counties (cities, districts), 1 680 households salt samples were detected, and the rate of no iodine salt samples was 89.2% (1 499/1 680). ②Fourteen water samples were collected in 5 counties (cities, districts), and the water iodine content was 155.7-467.3 μg/L. ③ In the five high iodine counties (cities, districts), 197 urine samples were collected from children aged 8 to 10. The median of urinary iodine was 466.5 μg/L; the median urinary iodine was 650.1 μg/L in water iodine≥300 μg/L children group which was significantly higher than that of the group with 150-300 μg/L water iodine content 332.5 μg/L (Z =-6.164,P < 0.05); urinary iodine level of children and the water iodine of the corresponding village was positively correlated (r = 0.543,P < 0.05). ④ In the five high iodine counties (cities, districts), 543 children aged 8-10 were measured with their thyroid volume, the thyroid goiter rate was 6.8%(37/543); the goiter rate of water iodine≥ 300 μg/L children group was [9.0%(28/311)] which was significantly higher than that in the iodine content of drinking water 150-300 μg/L group [3.9%(9/232), χ2 = 5.494,P < 0.05]. Conclusion The measurement of stopping iodized salt supply in high iodine areas in Shanxi Province is well implemented, iodine nutrition level and thyroid goiter rate in those areas are still too high, high iodine intervention measures can be focused on changing of the drinking water. Key words: Iodine; Nutrition; Thyroid; Data collection

Goitre, that’s enlargement of thyroid gland, and cretins had been known inIndonesia for long time, especially in areas around active vulcanoes. In areaswhere goitre is prevalence, cretinism is also common. This paper studied goitreprevalence to estimate the magnitude of cretinism and developmental deficit dueto iodine deficiency. Data set from National Mapping Survey 1996/1998 were usedfor analyses. Data set from Evaluation on Intensified Iodine Deficiency ControlProject 2003 were also used for comparison in the changes of goitre and urinaryiodine concentration. Epidemiological modelling was construct to estimate cretinand developmental deficit due to iodine deficiency. Prevalence of goitre in areaswith endemic goitre were not changes after five years intensive control program.Median urinary iodine concentration changed quite significantly. Around 0.33% ofpeople living in endemic goitre area (TGR> 5.0%) were estimated to suffer fromcretin and 0.9% were suffering from milder developmental deficit. Around 0.33%of baby born in areas with endemic goitre were cretin and 0.099% were bornwith milder developmental deficit. The higher the goitre prevalence the more thenumber of cretin and milder development deficit de to iodine deficiency.

Although endemic goiter has been shown to have a high prevalence in Turkey, little is known about the concentration of urinary iodine, plasma selenium (Se), copper (Cu), and zinc (Zn) in these patients. We studied on 140 male patient with endemic goiter (mean age: 22.2 +/- 0.19 yr) and 140 healthy male subjects (mean age: 21.8 +/- 0.28 yr). Daily urinary iodine excretion was determined by the ionometric method. Plasma Se, Zn, and Cu were determined by using atomic absorption spectrometry. Daily urinary iodine excretion was found to be significantly lower in the patient group (38.7 +/- 2.26 microg/d) than that of controls (50.73 +/- 2.56 microg/day, p = 0.001). Plasma Zn concentrations were also found to be significantly lower in the patient group (1.04 +/- 0.03 microg/mL) than that of controls (1.16 +/- 0.02 microg/mL, p = 0.001). No significant difference was determined in Se and Cu concentrations between the patient and control groups. Our study shows that a moderate iodine deficiency exists in both patients with endemic goiter and control subjects, which indicates the important role of iodine deficiency in the etiopathogenesis of endemic goiter in Turkey. Zinc deficiency may also contribute to the pathogenesis of endemic goiter. However, Se and Cu do not seem to have any role in the etiopathogenesis of endemic goiter in Turkey. A community-based iodine fortification program throughout the country may be proposed to take over the problem, which also can prevent the contributing effects of other element deficiencies that occur when iodine deficiency is the prevailing factor.

Objective: to find out prevalence of goitre in primary school children; to compare prevalence with previous survey; to determine median urinary iodine concentration; to assess level of iodine in salt samples at household and retail shop level; and to study profile of salt sold at retail shops. Material and Methods : 30 cluster survey study in primary schools of Kutch district. Children studying in 1st to 7th Standard. Total 70 students including five boys and five girls from 1st to 7th standard present in class on the day of visit were selected randomly for Goitre examination, so, total 2100 students were examined in schools. Urine sample was collected from one boy & one girl from each standard in each cluster. From community, 28 students including two boys and two girls from each standard in same age group were examined and also salt samples were tested from their households. From each village, one retail shop was visited and salts were purchased and tested for iodine on the spot with spot kit. Results: Total Goitre Rate was found 11% among primary school children compared to 1.2% in year 2000. As the age increases the Goitre prevalence also increases except in age of 8 years. Median urinary iodine excretion level was found 110 µg/L. Iodine level >15 ppm was found in 92% salts samples tested at household level. Conclusion: Present study showed mild goitre prevalence in primary school children in Kutch district of Gujarat state due to inadequate iodine intake or content from salt at household level.

Objective To master the level of iodine nutrition among population in Jiangxi province,and to provide a scientific basis for establishing the strategy for prevention and control of iodine deficiency disorders (IDD).Methods Retrospective method was adopted to analyze the goiter rate and frequency distribution of urinary iodine of children aged 8-10,the qualified rate of iodized salt,the coverage rate of iodized salt and the consumption rate of qualified iodized salt in residents of Jiangxi province from 1995 to 2010.The method of correlation analysis was used to analyze the relationship between goiter rate of children (by palpation) and the qualified rate of iodized salt,iodized salt coverage rate and residents consumption rate of qualified iodized salt.Results The goiter rates (measured by the method of palpation) of children aged 8-10 were down from 40.17％(482/1200) in 1995 to 0.80％(16/2000) in 2010(x2 =4.864,P＜ 0.05).The median of urinary iodine of children was higher than 200 μg/L; the proportion of people whose urinary iodine content higher than 300 μg/L was above 25.00％ and the highest propoaion was up to 58.01％ (210/362) between 1995-2010.The minimum median of salt iodine was 17.77 mg/kg in 1995,and 29.30-39.10 mg/kg in other years.The qualified rates of iodized salt,the iodized salt coverage rates and the consumption rates of qualified iodized salt increased from 43.58％(452/1037),86.42％(1037/1200) and 37.67％(452/1200) in 1995 to 97.95％ (1916/1956),99.95％(1956/1957) and 97.90％(1916/1957) in 2010,respectively; there was a growth trend over the years(x2 =5.240,6.118,5.631,all P ＜ 0.05).The goiter rates of children were related to the qualified rates of iodized salt,the iodized salt coverage rates and the consumption rates of qualified iodized salt,and the correlation coefficient(r) was-0.833,-0.881 and-0.918 (all P ＜ 0.05),respectively.Conclusions The level of iodine nutrition among residents in Jiangxi province has already gone beyond the appropriate level,and the iodine concentration in salt should be cut to ensure the appropriate iodine nutrition level among people. Key words: Iodine; Goiter, endemic; Urine; Salts; Outcome assessment

Adaptive mechanisms to iodine deficiency in endemic goiter in misiones, Argentina

Iodine deficiency disorders (IDD) are major public health problems in India, including Gujarat. Narmada district is a tribal area. The present study was conducted to estimate the prevalence of goitre in primary school children; to determine median urinary iodine concentration; to assess level of iodine in salt samples at household and retail shop level; and to study profile of salt sold at retail shops in Narmada district, Gujarat. 30 cluster survey method was used for the study in primary schools of Narmada District. Children studying in 1st to 7th standard were used in this study. A total of 70 students including five boys and five girls from 1st to 7th standard present in class on the day of visit were selected randomly for Goitre examination, so, total 2100 students were examined in schools. Urine sample was collected from one boy & one girl from each standard in each cluster. From community, at least 28 students including two boys and two girls from each standard in same age group were examined and also salt samples were tested from their households. So, total 2100 students were examined in schools and 858 students were examined out of schools in the selected villages. From each village, one retail shop was visited and salts were purchased and tested for iodine on the spot with spot kit. Goitre prevalence was found 18.1% among primary school children including grade 1 - 12.4% and grade 2 - 5.7%. As the age increases the Goitre prevalence also increases except in the age group of 9 years. Median urinary iodine excretion level was found 110 µg/L. Iodine level >15 ppm was found in 93.7% salt samples tested at household level. Present study showed mild Goitre prevalence in primary school children in Narmada District of Gujarat and iodine content of salt found adequate at household level. Key words: Goitre survey, IDD, prevalence, primary school children, household level.

Objective To investigate the occurrence of new cretinism cases and the prevalence of endemic goiter, and the reason of lower coverage rate of iodized salt in the iodine deficiency disorders(IDD) high-risk areas of China, so as to put forward target prevention measures for these areas. Methods A hundred and one counties from 11 provinces(autonomous regions, municipality), such as Tibet, Qinghai, Xinjiang, Gansu, Ningxia, Sichuan, Hainan, Chongqing, Yunnan, Guangxi, Inner Mongolia, were chosen into the survey by simple random sampling. In the counties of high risk, typical sampling principle was used. In the selected townships, searching for new cretinism cases were carried out in the children under 10 years old, the thyroid volume of children aged 8-10 years old were determined by B-ultrasonography methods and their urinary iodine (UI) were determined by As3-Ce catalytic spectrophotometry, the intelligence quotient(IQ) values of children aged 8-10 years old were measured by the combined Raven Test in China. In the household survey, the housewives were asked to fill in the questionnaire, the iodized salt coverage rates and the UI levels of child-bearing age women were investigated, the salt iodine content was determined using self-quantitative kit. Epi Info software was used to analyze the determination results. Results In the 101 high-risk counties, 249 were diagnosed as new cretinism cases from 4122 suspected cases searched. The goiter rate of children aged 8-10 years old by B-ultrasound was 8.28% (4434/53 541), 44 counties had goiter rates in the range of 5%-20%, 5 counties had goiter rates in the range of 20%-30%, and 3 counties had goiter rates of 30%. The mean IQ of children was 85.44, and the percentage of IQ value less than 70 was 16.52%(8713/52 745). The median urinary iodine(MUI) of children was 154.69 μg/L, the percentage of UI less than 50 μg/L was 17.26% (9069/52 558). Twenty-five counties had a MUI of children less than 100 μg/L. The MUI of housewives was 107.14 μg/L, the percentage of UI less than 50 μg/L was 27.50% (3722/13 534). MUI of housewives in 46 counties were less than 100.0 μg/L. The coverage rate of iodized salt at household level was 77.85%(13 150/16 891). The coverage rate of iodized salt was 52.80%(1585/3002), 44.72% (631/1411) and 72.82% (1850/2506) in Tibet, Hainan and Qinghai, respectively. More than 10% residents of Tibet, Sichuan, Hainan, Gansu and Qinghai complained that iodized salt was not convenient to buy. There were 71.39%(7652/10 719) of observed people ate crude salt. The average price of crude salt price(0.30-1.20 Yuan/kg) was lower than iodized salt(1.20-3.00 Yuan/kg). Conclusions In these IDD high-risk areas, the risk of endemic goiter and cretinism prevalence is threatening. The IDD monitoring should be carried out successively in these high-risk areas. The prevention measures, increasing iodized salt coverage rate and establishing the sustainable mechanism for eliminating IDD should be strengthened. Emergent iodine fortification measure for high risk region people should be implemented as soon as possible, a long term effective mechanism of eliminating IDD should be established. Key words: Iodine; Deficiency diseases; Goiter, Endemic; Data collection

Background & Objectives: Iodine Deficiency Disorder (IDD) is the most common endocrine disorder in the world. It is estimated that about 1.5 billion people are in iodine deficiency state. Many studies have shown the high prevalence of endemic goiter and iodine deficiency in Iran. For control of this health problem salt iodinization is the best accepted strategy in the world. The main objective of this study is to determine the efficacy of iodide salt after 9 years of iodide salt consumption. Materials and methods: In a quasi-experimental study 637 primary school children were examined clinically for goiter based on WHO classification, and their urine was evaluated for iodine per gram creatinine. Results: 94 students (14.7%) including 50 males (15.38%) and 44 females (14.1%) had goiter, with no significant difference between two sexes. The most common grade of goiter was 1a. Compared with a previous report in 1992, there was no significant increase in goiter prevalence but increase in urine iodine was statistically significant (P<0001). Discussion : Despite increase in urine iodine concentration, the rate of goiter is not decreased. It seems that salt iodinization and iodine consumption should be increased.

Objective To investigate the situation of iodized salt practicing measures, the nutritional status of iodine and the trend of iodine deficiency disorders in Futian District of Shenzhen City, and to evaluate the effectiveness of preventive measures. Methods Every year from 2011 to 2015 in Futian District, five sub-districts were selected according to their position of the east, the west, the south, the north and the center, one school was selected in each sub-district, then sixty students were selected from each school to detect iodine content of their household salt samples; over twenty children (half males and half females) aged 8-10 of those sixty students were selected randomly to measure their thyroid volumes and detect their urinary iodine content; one or two drinking water samples were collected in each sub-district to test iodine content. Thyroid volume was examined by ultrasound method; the salt iodine was tested by the method of direct titration; iodine content in urine and drinking water samples was tested by arsenic cerium catalytic spectrophotometry. Results Between 2011 and 2015, totally one thousand four hundred and eighty-eight edible salt samples were tested. The iodized salt coverage rate, the qualification rate of iodized salt and the consumption rate of qualified iodized salt was 96.1% (1 430/1 488), 99.2% (1 419/1 430), and 95.4% (1 419/1 488), respectively. Four hundred and sixty-one children aged 8-10 were examined; nine children were diagnosed goiter, and the goiter rate was 1.95%. A total of 661 children urine samples were collected. The median urinary iodine was 229.5 μg/L; urinary iodine in 100-199 μg/L accounted for 29.8% (197/661), and in 200-299 μg/L accounted for 31.0% (205/661). Forty-eight drinking water samples were tested, the iodine content of the drinking water was 10.3-22.1 μg/L, and the median water iodine was 16.8 μg/L. Conclusions The iodine deficiency disorders surveillance indicators in Futian District of Shenzhen City all meet the national standards for elimination of the disease. Yet, the level of iodine nutrition needs to be further observed, and both the iodized salt market supervision and the health education should be strengthened. Key words: Iodine; Deficiency diseases; Salts; Urine; Goiter