Control Of Iodine Deficiency Disorders Research Articles

Iodine Status of Pregnant Women and Their Progeny in the Minho Region of Portugal

Iodine sufficiency is particularly necessary throughout pregnancy, given its recognized impact on psychomotor performance of the offspring. There are no recent reports about iodine status or supplementation in Portugal, a country that the International Council for Control of Iodine Deficiency Disorders considered, in 2004, to have probably reached iodine sufficiency. The objective of this study was to evaluate in the Minho region of Portugal the iodine status of women throughout pregnancy and after delivery, and of their offspring. Urinary iodine concentration (UI) was determined in 78 nonpregnant premenopausal women, in 140 pregnant women in the three trimesters of pregnancy and after delivery, and in their 142 offspring. Milk iodine concentration was determined at day 3 and 3 months after delivery. The thyroid volume was determined in women in the third trimester of pregnancy and 3 months after delivery and in infants at 3 months of age. Based on the World Health Organization criteria, both nonpregnant and pregnant women had iodine deficiency (ID), as documented by median UI of <75 microg/L and milk iodine concentration of <100 microg/L. Goiter was observed in 14% of the pregnant women. Concordant with the mother's ID, median neonatal UI was low (71 and 97 microg/L at 3 days and 3 months of age). Portuguese women of the Minho region have an inadequate iodine intake, which may compromise the potential for full psychomotor development of their progeny. These observations suggest that iodine supplementation should be implemented throughout pregnancy and lactation in Portugal.

Consumption of iodized salt among slum households of North-East Delhi, India

Sir, We conducted a household-based cross-sectional study in a purposively selected slum (population: 70 000) of North-East Delhi in August, 2008. The respondents comprised 230 adult females who were involved in cooking food. The sample size of 230 was derived using the following parameters: 50% prevalence, 95% confidence interval, ± 10% confidence interval width, design effect of one, and 5% non-response rate. As no prior estimates of levels of consumption of iodized salt in the studied slum were available, we assumed 50% prevalence. The slum, being large and heterogeneous, was divided into 10 strata. The 10 strata were also the 10 catchment areas of the ASHA workers. Twenty-three respondents were identified in each strata using systematic random sampling methodology. Using a pre-tested interview schedule, the following aspects were enquired from the respondents - background characteristics, type of cooking salt that they predominantly use; reasons for the same and awareness about the benefits of iodized salt. Iodine content of the cooking salt consumed was tested using a rapid iodine field-testing kit using similar standard procedures, used in the Third National Family Health Survey.(1) Most (209) households consumed packed refined salt. Only 21 households consumed unpacked crystalline salt (nonpowdered: 19; powdered: 2). The various reasons reported by households consuming crystalline salt (21) included ‘low cost’ (8), ‘since it tasted better’ (9) and ‘feeling it is pure and uncontaminated unlike refined salt’ (4). The value in parenthesis indicates the number of households. Out of those households consuming refined salt (209), 130 consumed it to save time and avoid the inconvenience of grinding crystalline salt, but opted for cheaper varieties owing to low purchasing power. Other reasons reported for consuming refined salt were as follows: better taste and appearance (45), free flowing (24), and influence of television advertisements (10). A total of 174 out of 230 households were consuming adequately iodized salt (≥15 ppm iodine) [Table 1]. Awareness about health benefits of iodized salt was extremely poor and seen in only 15 out of 230 respondents. Yet on the positive side, all 15 households who were aware of the benefits of consumption of iodized salt were consuming adequately iodized salt. Consumption of adequately iodized salt was higher among households consuming refined salt as compared to those consuming crystalline salt. However, even among households consuming refined salt (209), 36 households were consuming inadequately/non-iodized salt (<15 ppm iodine). Also, consumption of adequately iodized salt was higher in households where the household head was literate. Table 1 Levels of iodized salt consumption in sampled households Three important findings emerged from this study. Although three-fourth households of a north-east Delhi slum were consuming adequately iodized salt, the level of awareness regarding the benefits of consuming iodized salt among the studied population was extremely low. Even among those households consuming refined salt, nearly one-fifth households were not consuming adequately iodized salt. Studies carried out between 2002 and 2004 in Delhi have shown that 64-66% households consume iodized salt.(2,3) Thus, more pursuant efforts need to be made to generate awareness about the health benefits of iodized salt and to enhance demand and availability of iodized salt. Continued dialogue by state-level Iodine Deficiency Disorders (IDD) Control Cell with salt producers and traders and their periodic monitoring would increase production and market availability of adequately iodized salt. Regular community-based awareness activities on the benefits of iodized salt can be conducted through Anganwadi workers, auxillary nurse midwives, nongovernment organizations, self-help groups, and schools. Iodized salt is available at subsidized rate through Targeted Public Distribution System in Chattisgarh, Tamil Nadu, Gujarat, Rajasthan, Andhra Pradesh, Himachal Pradesh, Arunachal Pradesh, Sikkim, Tripura, and Karnataka.(4) Delhi State Government could consider this option to increase the access of iodized salt to the slum population of Delhi.

Dampak Suplementasi Pil Besi Selenium Terhadap Status Hormon Tiroid Dan Kadar Hemoglobin Pada Wanita Usia Subur Di Daerah Gondok Endemik

The Effect of Combination of Iron and Selenium Supplementation on the Status of Thyroid Hormone and Haemoglobin Levels of Child Bearing Age Women In Endemic Goitre Area. Background: Iodine Deficiency Disorder (IDD) and Iron Deficiency Anemia (IDA) still considered as a public health problem in Indonesia. It is possible that some people in endemic goiter area not only suffering from IDD but also IDA, particulary among Childbearing Age Women (CBAW). Based on the national household survey (SKRT, 2001), it was reported that the prevalence of IDA among CBAW in Central Java, 22.4%, while in Cianjur District was 36.6%. Iron deficiency not only caused the decreament of hemoglobin value, but also decreased the Tyroxin (T4) and triiodotironin (T3) hormon syntesis. The trace element which has important role for iodine metabolism is selenium (Se). So far IDA and IDD control programme in Indonesia have been conducted separately, by means not integrated in strategy and not using combination of iron and selenium supplementation. Objectives: The main objectives of this study are to find out the possibilities of integrated solution of IDD and IDA. To determine the effect of combination iron and selenium supplementation to iodine status and Hb level of CBAW in the endemic goiter area. Methods: Study design was randomized control trial. The study was conducted in Cangkringan Subdistrict of Sleman District of D.I. Yogyakarta. A total of 96 CBAW were randomly assigned into 3 groups. Each group received different treatment, but before starting, all subjects were received pirantel for deworming. Group A (n=31) received 400 mg of iodine (2 capsules) + ferrosulfate (60 mg elemental iron + 0.25 mg of folic acid) + 420 ug of selenium (yeast selenium); group B (n=31) received 400 mg of iodine + ferrosulfate and group C (n = 34) received 400 mg of iodine only (control group). Two capsules of iodine were given once in the beginning of study to all subjects, while ferrosulfate and selenium were given twice a week for 16 weeks. Data of hormon thyroxin (serum T4) and Hb was collected before and after intervention. Data of socialeconomi and selenium were collected at the first of study. Results: It was revealed that before treatment there were no significant difference of the average of Hb levels and the median value of serum T4 amongs 3 groups of study (p> 0.05). After 16 weeks intervention there were thyroid hormone status improvement (serum T4) to all groups as follows: group A (100%), group B (80%) and group C (66.7%) respectively. Conclusions: After 16 weeks intervention of iron and selenium preparate to CBAW who had received iodine supplementation, was able to improve status of thyroid hormone (serum T4) higher than to those who received iodine only (33.3%). The increment of Hb levels of CBAW who received iron and selenium supplementation (group A) was lower than those who received iron only (group B). Keywords: Childbearing Age Women, IDD, IDA, anemia and selenium.

Are Australian children iodine deficient? Results of the Australian National Iodine Nutrition Study

To document the population iodine nutritional status in Australian schoolchildren. Cross-sectional survey of schoolchildren aged 8-10 years, based on a one-stage random cluster sample drawn from all Year 4 school classes in government and non-government schools in the five mainland Australian states of New South Wales, Victoria, South Australia, Western Australia and Queensland. The study was conducted between July 2003 and December 2004. 1709 students from 88 schools (881 boys and 828 girls), representing 85% of the estimated target number of students. The class participation rate was 65%. (i) Urinary iodine excretion (UIE) levels (compared with the criteria for the severity of iodine deficiency of the World Health Organization/International Council for the Control of Iodine Deficiency Disorders: iodine replete, UIE > or = 100 microg/L; mild iodine deficiency, UIE 50-99 microg/L; moderate iodine deficiency, UIE 20-49 microg/L; severe iodine deficiency, UIE < 20 microg/L); (ii) Thyroid volumes measured by ultrasound (compared with new international reference values). Overall, children in mainland Australia are borderline iodine deficient, with a national median UIE of 104 microg/L. On a state basis, NSW and Victorian children are mildly iodine deficient, with median UIE levels of 89 microg/L and 73.5 microg/L, respectively. South Australian children are borderline iodine deficient, with a median UIE of 101 microg/L. Both Queensland and Western Australian children are iodine sufficient, with median UIE levels of 136.5 microg/L and 142.5 microg/L, respectively. Thyroid volumes in Australian schoolchildren are marginally increased compared with international normative data obtained from children living in iodine sufficient countries. There was no significant association between UIE and thyroid volume. Our results confirm the existence of inadequate iodine intake in the Australian population, and we call for the urgent implementation of mandatory iodisation of all edible salt in Australia.

Iodine deficiency in pregnant women residing in an area with adequate iodine intake

Objective To prevent iodine deficiency disorders, the World Health Organization, United Nations Children's Fund, and International Council for the Control of Iodine Deficiency Disorders established that for a given population median urinary iodine concentrations (UIC) must be 100–199 μg/L in clinically healthy subjects and 150–249 μg/L in clinically healthy pregnant women. We evaluated whether in the urban area of Rome, Italy, where a salt iodination program (30 mg/kg) was introduced since 2005, an increased demand of iodine during pregnancy is guaranteed. Methods During 2006, 51 pregnant women at first trimester of a physiologic gestation were consecutively enrolled on presentation to evaluate UIC in morning spot urine samples. As controls, 100 age-matched clinically healthy non-pregnant women were evaluated. Results The median UICs were 182 μg/L (range 85–340 μg/L) and 74 μg/L (range 17–243 μg/L), respectively, in the control and pregnant groups. This difference was highly significant ( P < 0.001). In particular, the UIC was found to be lower than adequate in 4% of control women compared with 92% of pregnant women. This difference of occurrences was highly significant ( P < 0.001). Conclusion This observational study demonstrated that, despite the adequate supplementation of iodine intake, most pregnant women appear not to be protected against iodine deficiency. If confirmed in larger case studies, this finding claims the attention of relevant professionals to monitor iodine nutrition during gestation, assuming that ordinary supplementation of iodine intake seems to be sufficient only in non-gestational conditions.

Prevalence of Goiter in Children 6 to 12 Years of Age in Ethiopia

Iodine-deficiency disorders are a major public health problem in Ethiopia. In conjunction with implementing control programs, baseline information needs to be established. To investigate the distribution and degree of severity of iodine-deficiency disorders in terms of goiter prevalence, urinary iodine excretion (UIE) levels, and proportion of households with iodated salt in Ethiopia. A nationwide, community-based, cross-sectional study was conducted from February to May 2005 among 10,965 children aged 6 to 12 years. A multistage, proportional-to-population-size sampling method was used. Goiters were classified by the method recommended by the World Health Organization/UNICEF/International Council for the Control of Iodine Deficiency Disorders (WHO/UNICEF/ICCIDD), in which the thyroid gland is graded as 0 (normal), 1 (palpable goiter), or 2 (visible goiter); urinary iodine was determined by the wet digestion method; and salt samples were analyzed by a rapid test kit. The national total goiter weighted prevalence rate among children aged 6 to 12 years was 39.9% (95% confidence interval, 38.6% to 41.2%), representing more than 4 million children. The median UIE was 2.45 microg/ dL; 45.8% of children had UIE values of 2 microg/dL or less, and 22.8% had UIE values of 2.01 to 5.0 pg/dL. Only 4.2% of the households had iodated salt. According to the WHO/UNICEF/ ICCIDD classification, both goiter prevalence and UIE levels indicate that the whole country appears to be severely affected by iodine deficiency. Furthermore, the virtual absence of iodated salt in the households shows that currently there is no salt iodization program in the country. Dietary sources of iodine in Ethiopia are not dependable, and hence a sustainable universal salt iodization program needs to be implemented without delay.

Prevention and control of iodine deficiency in pregnant and lactating women and in children less than 2-years-old: conclusions and recommendations of the Technical Consultation

The Consultation reached a general consensus on several important issues. First, that universal salt iodisation‡ (USI) remains the key strategy to eliminate iodine deficiency disorders. Second, that where USI has been effective for at least 2 years, with salt adequately iodised and consumed by more than 90% of the population 1 , it can be reasonably expected that the iodine needs of women of child-bearing age and pregnant and lactating women are covered by their diet, and that the iodine stored in the thyroid gland is sufficient to ensure adequate hormone synthesis and secretion. Third, that iodised salt may not provide enough iodine to meet a child’s needs during complementary feeding, especially if the mother is only marginally iodine sufficient, unless complementary foods are fortified with iodine. It may be necessary therefore to give additional iodine to makesure that requirements are met until such time as the child starts to eat the normal family food. Finally, there was consensus that monitoring of both iodised salt quality and iodine nutrition are important to ensure that an optimal state of iodine nutrition is reached and then sustained. The Consultation made several specific recommendations concerning requirements, indicators and strategies to control iodine deficiency disorders in pregnant and lactating women, and in children less than 2-years-old.

Evaluation of endemic goiter prevalence in Bulgarian schoolchildren

Iodine deficiency is a major health problem worldwide. The environment of the Balkan countries, including Bulgaria, is distinguished for its low iodine content. In 1994, the strategies for the prevention and control of iodinedeficiency disorders were actualized in Bulgaria and universal salt iodization and supplementation for the risk population groups (schoolchildren, pregnant women) were introduced. The aim of this study was to assess the effectiveness of the iodine prophylaxis in schoolchildren, living in an endemic for goiter area after the introduction of salt iodization in Bulgaria. For this purpose, the goiter prevalence and iodine status in 483 schoolchildren (274 boys and 209 girls) aged between 8 and 15 yr, living in an endemic for goiter area in Bulgaria were evaluated. Despite the normalization of iodine supply, mild iodine deficiency on the basis of goiter prevalence (16.15%) and urinary iodine excretion was found. These data indicate the need for reevaluation of the national strategy for prevention of iodine deficiency.

Stability of Iodine in Salt Fortified with Iodine and Iron

Determining the stability of iodine in fortified salt can be difficult under certain conditions. Current methods are sometimes unreliable in the presence of iron. To test the new method to more accurately estimate iodine content in double-fortified salt (DFS) fortified with iodine and iron by using orthophosphoric acid instead of sulfuric acid in the titration procedure. A double-blind, placebo-controlled study was carried out on DFS and iodized salt produced by the dry-mixing method. DFS and iodized salt were packed and sealed in color-coded, 0.5-kg, low-density polyethylene pouches, and 25 of these pouches were further packed and sealed in color-coded, double-lined, high-density polyethylene bags and transported by road in closed, light-protected containers to the International Council for the Control of Iodine Deficiency Disorders (ICCIDD), Delhi; the National Institute of Nutrition (NIN), Hyderabad; and the Orissa Unit of the National Nutrition Monitoring Bureau (NNMB), Bhubaneswar. The iodine content of DFS and iodized salt stored under normal room conditions in these places was measured by the modified method every month on the same prescribed dates during the first 6 months and also after 15 months. The iodine content of DFS and iodized salt stored under simulated household conditions was also measured in the first 3 months. After the color code was broken at the end of the study, it was found that the DFS and iodized salt stored at Bhubaneswar, Delhi, and Hyderabad retained more or less the same initial iodine content (30-40 ppm) during the first 6 months, and the stability was not affected after 15 months. The proportion of salt samples having more than 30 ppm iodine was 100% in DFS and iodized salt throughout the study period. Daily opening and closing of salt pouches under simulated household conditions did not result in any iodine loss. The DFS and iodized salt prepared by the dry-mixing method and stored at normal room conditions had excellent iodine stability for more than 1 year.

Smaller Thyroid Gland Volume with High Urinary Iodine Excretion in Japanese Schoolchildren: Normative Reference Values in an Iodine-Sufficient Area and Comparison with the WHO/ICCIDD Reference

Iodine deficiency disorders (IDDs) are serious global public health problems and approximately 2 billion people are at risk of IDD complications. Urine iodine and thyroid size by ultrasound in school-age children are important indicators for assessing IDD in a population. Interpretation of sonographically measured thyroid volume requires valid reference criteria from iodine-sufficient populations, and in 2003 WHO (World Health Organization)/ICCIDD (International Council for the Control of Iodine Deficiency Disorders) proposed new international reference values for thyroid volume in children aged 6-12 years. To establish a normative reference of thyroid volume and characterize the current status of iodine nutrition in Japanese schoolchildren in Tokyo, where iodine deficiency has never existed, a total of 654 subjects aged 6-12 years (317 girls and 337 boys) in three primary schools were enrolled in the study in 2002. Thyroid volume was determined by using the standardized method recommended by WHO/ICCIDD and the iodine concentration in spot urine samples and the anthropometric measurements were evaluated. Thyroid volume was positively correlated with the children's age, height, weight, or BSA. Regardless of gender the computed median and 97th percentile thyroid volumes based on age or BSA in Japanese children were generally lower than the corresponding values recently reported in iodine-sufficient areas, although these values were slightly higher (5-13%) than those in the 2003 WHO/ICCIDD international reference. The computed median value of urinary iodine concentration was 281.6 microg/L (303.7 microg/gCre) and extremely high values exceeding 1,000 microg/L were found in 16% of the subjects. The present study clearly indicated a high iodine intake in Japanese schoolchildren and also established reference values for thyroid volume that might be applicable to countries in the Far East as a population-specific local reference.

Iodine Nutrition in the Adult Population of Galicia (Spain)

To identify the current state of iodine nutrition in the adult population of Galicia (Spain), which is considered iodine sufficient based on results from studies carried out on schoolchildren. Urinary iodine concentration (UIC) and its relationship with different socio-demographic variables were assessed. A cross-sectional study was carried out on the population aged above 18 years in the Autonomous Community of Galicia (Spain) during 2004. The UICs were determined in an isolated urine sample using Dunn's colorimetric method. Iodine status was based on World Health Organization/International Council for the Control of Iodine Deficiency Disorders (WHO/ICCIDD) UIC. A total of 2877 urine samples were taken. Median UIC for the total Galician population was 75.6 microg/L. About 30% of the population showed a UIC below 50 microg/L. Educational level, place of residence (coast vs. inland), and consumption of iodized salt were independent variables associated with the iodine nutrition of the adult population of Galicia. There is "mild" iodine deficiency (WHO) in the adult population of Galicia, which affects all the groups analyzed and which is particularly significant in the group of women of a fertile age. The data obtained on the state of iodine nutrition in school-age populations cannot be extended to the adult population.

Assessment of the success of implementation of new rule book on salt iodination in Federation of Bosnia and Herzegovina

The aim of this study was to determine the success of an increase in the level of salt iodization which was increased to 20-30 mg iodine per kilo of salt, 2 yr after the introduction of the new mandatory salt iodination. This prospective study was performed at level of Federation of Bosnia and Herzegovina (FBH). We singled out 60 cluster school-based surveys (6 cluster surveys in each canton) with equal representation of urban and rural areas. Within each cluster, between 10 to 30 subjects (both males and females) aged 11, 12, 13 and 14 were randomly selected. The study included a total of 962 schoolchildren. The mean iodine level per 1 kg of salt for whole FBH was 21.4+/-5.2. It ranged from 2.1 to 41.3 mg/kg. A significant improvement in urinary iodine excretion medians was detected in the current survey in all cantons and on the entire territory of FBH, compared to results from a previous study conducted in 1999. The urinary iodine excretion in schoolchildren in the whole FBH varied from 50.6 to 303.8 mug/l with a median of 139.5 mug/l. Values of urinary iodine <100.0 mug/l were found in 15.9% of samples of schoolchildren, whereas no values <50.0 mug/l were found. In conclusion, the results of the study indicate that increased iodine supplementation of salt in 2001 was successful and that FBH is presently iodine sufficient. In the future, however, program for monitoring of iodine prophylaxis has to have two major aims: firstly, control of iodine content in salt at different levels especially at retail shops and at imported salt and secondly, iodine deficiency disorders control. Also, a periodic measurement of urinary iodine excretion needs to be planned together with the neonatal TSH screening and the establishment of a notification system for cases of hyperthyroidism.

HIPERTIROIDI SUBKLINIK DI DAERAH 'REPLETE' ENDEMIS DEFISIENSI IODIUM

ABSTRACT Background. The evaluation of national program of iodine deficiency disorder (IDD) control in Indonesia revealed that people consumed excess of as measured by urine iodine concentration. The effect of excessive iodine consumption on hemotological features including the development of subclinical hypothyroidism has not been reported in scientific journals yet. Objective. This study aimed toevaluate the correlation of the excessive iodine consumption and hematological features of child bearing age mothers especially in replete iodine deficiency area. Design. Three districts of which formally known as endemic iodine deficiency areas were identified. A total 239 chlid bearing age mothers 17 to 35 years old with strictly inclution participated in this studies. Blood spicemen of eligible participants as much as 2-3 mL was drawn. Thyrotropin hormone (TSH) and free thyroxine (fT4) were performed using third generation of TSH assay (known as sensitive TSH assay) from ILSI certified labolatory. Casual urine sample also collected from school age children (6-12 years of age) as many as 40 samples in each subdistrict to confirm the endemicity of iodine deficiency area based on urine iodine concentration. For analysis purposed, sub-clinical hypothyroidism defined as serum TSH concentration less than 0.4 mU/L. Result. The study found proportion of excess iodine consumption totally was 22.5 percent and varied among three studied area. Participants who developed overt hyperthyroidism found 1.7 percent and sub-clinical hyperthyroidism as much as 9.4 percent. Amongst the three districts, two districts very high in proportion of sub clinical hyperthyroidism. Conclution. I odine consumption was excessed and lead to adverse effects. Studies on the amount of salt consumption, the humidity, and the length of salt preservatioan at household every area urgently need to do. [Penel Gizi Makan 2007, 30(1): 13-24] Keywords : excess in iodium consumption, TSH, fT4, sub-clinical hypothyroidism, replete endemic deficiency area

Status of iodine nutrition in Bulgarian schoolchildren – results from strategies for prevention and control of iodine deficiency disorders

Status of iodine nutrition in Bulgarian schoolchildren – results from strategies for prevention and control of iodine deficiency disorders

Are Australian children iodine deficient? Results of the Australian National Iodine Nutrition Study

Objective: To document the population iodine nutritional status in Australian schoolchildren. Design and setting: Cross-sectional survey of schoolchildren aged 8–10 years, based on a one-stage random cluster sample drawn from all Year 4 school classes in government and non-government schools in the five mainland Australian states of New South Wales, Victoria, South Australia, Western Australia and Queensland. The study was conducted between July 2003 and December 2004. Participants: 1709 students from 88 schools (881 boys and 828 girls), representing 85% of the estimated target number of students. The class participation rate was 65%. Main outcome measures: (i) Urinary iodine excretion (UIE) levels (compared with the criteria for the severity of iodine deficiency of the World Health Organization/ International Council for the Control of Iodine Deficiency Disorders: iodine replete, UIE � 100 μg/L; mild iodine deficiency, UIE 50–99 μg/L; moderate iodine deficiency, UIE 20– 49 μg/L; severe iodine deficiency, UIE < 20 μg/L); (ii) Thyroid volumes measured by ultrasound (compared with new international reference values). Results: Overall, children in mainland Australia are borderline iodine deficient, with a national median UIE of 104 μg/L. On a state basis, NSW and Victorian children are mildly iodine deficient, with median UIE levels of 89 μg/L and 73.5 μg/L, respectively. South Australian children are borderline iodine deficient, with a median UIE of 101 μg/L. Both Queensland and Western Australian children are iodine sufficient, with median UIE levels of 136.5 μg/L and 142.5 μg/L, respectively. Thyroid volumes in Australian schoolchildren are marginally increased compared with international normative data obtained from children living in iodine sufficient countries. There was no significant association between UIE and thyroid volume. Conclusion: Our results confirm the existence of inadequate iodine intake in the Australian population, and we call for the urgent implementation of mandatory

Role of FNA in the medical management of minimally enlarged thyroid

Fine-needle aspiration (FNA) of thyroid is a cost-effective and simple diagnostic tool in the initial screening of patients with thyroid nodules. But, its role in a clinically normal thyroid or a minimally enlarged thyroid in a symptomatic patient suspected of having thyroid dysfunction is unknown. With our 2-yr experience in a setup of a tertiary health care hospital in a developing country, we have aimed to implement a management protocol using FNA thyroid done without ultrasound guidance and TSH estimation done during the same visit in symptomatic patients suspected of having thyroid pathology but presenting with no goiter or having minimally enlarged thyroid with no palpable nodules. The thyroid enlargement in 172 cases were graded with the criteria endorsed by WHO, Pan American Health Organization, and International Council for Control of Iodine Deficiency Disorders into grade 0, 1, and 2. The cases were evaluated cytologically and correlated with TSH values according to the algorithm formulated by the authors. FNA was diagnostic in 86.6, 98, and 100% in grade 0, 1, and 2 goiters, respectively. 52.3% (n = 90), 19.8% (n = 34), 16.9% (n = 29) of cases were diagnosed as Hashimoto's thyroiditis (HT), colloid goiter (CG), and lymphocytic thyroiditis (LT). Sixteen had a combination of LT and CG (n = 6), HT and CG (n = 6), papillary carcinoma (n = 2), and diffuse hyperplasia (n = 2). No statistically significant difference (P = 0.4586) was noted between the groups of patients with grade 0 and grade 1-2 goiter, who underwent FNAC. 38.95% of patients (n = 67) with TSH values greater than 10 microIU/ml and considered hypothyroid showed features of HT/LT at FNA. 23.83% (n = 41) having TSH values between 5 and 10 microIU/ml (subclinical hypothyroidism) also showed features of HT/LT at FNA. Both groups were treated with thyroxine. 35.46% (n = 61) of cases with TSH values within normal range (0.5-5.1 microIU/ml) and considered euthyroid showed a spectrum of lesions at cytology other than HT and LT. They are being followed up to detect them at an early stage of subclinical hypothyroidism. Only 13 cases (7.5%) who were serologically euthyroid showed HT/LT and are being followed-up. Thus, the authors advocate FNA of the thyroid as a single simple cost-effective office procedure in the medical management of all nonpalpable/minimally enlarged thyroid in patients suspected of having thyroid pathology and/or in combination with TSH values. FNA helps in early detection of subclinical hypothyroidism, which is of utmost importance in pregnant women and further makes possible availability of baseline values for future reference. With the implementation of this protocol of FNA thyroid without imaging, we affirm that the practice of cytology which differs in different geographic areas and from country to country depending on economy and availability of infrastructure can be made more user-friendly.

Towards the global elimination of brain damage due to iodine deficiency—the role of the International Council for Control of Iodine Deficiency Disorders

762 International Council for Control of Iodine Deficiency Disorders, C/Centre for Health Promotion, Women’s and Children’s Hospital, 72 King William Road, North Adelaide, SA 5006, Australia. E-mail: iccidd@a011.aone.net.au made up of scientists and public health professionals from a range of disciplines available to assist national programmes; (iii) The development of effective national programmes through the UN System.

Towards the Global Elimination of Brain Damage Due to Iodine Deficiency: A Global Program for Human Development with a Model Applicable to a Variety of Health, Social, and Environmental ProblemsTowards the Global Elimination of Brain Damage Due to Iodine Deficiency: A Global Program for Human Development with a Model Applicable to a Variety of Health, Social and Environmental Problems. Hetzel

ThyroidVol. 15, No. 3 Book ReviewTowards the Global Elimination of Brain Damage Due to Iodine Deficiency: A Global Program for Human Development with a Model Applicable to a Variety of Health, Social, and Environmental ProblemsPeter LaurbergPeter LaurbergSearch for more papers by this authorPublished Online:22 Mar 2005https://doi.org/10.1089/thy.2005.15.300AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Towards the Global Elimination of Brain Damage Due to Iodine Deficiency: A Global Program for Human Development with a Model Applicable to a Variety of Health, Social, and Environmental Problems." , 15(3), p. 300FiguresReferencesRelatedDetails Volume 15Issue 3Mar 2005 InformationCopyright 2005, Mary Ann Liebert, Inc.To cite this article:Peter Laurberg.Towards the Global Elimination of Brain Damage Due to Iodine Deficiency: A Global Program for Human Development with a Model Applicable to a Variety of Health, Social, and Environmental Problems.Thyroid.Mar 2005.300-300.http://doi.org/10.1089/thy.2005.15.300Published in Volume: 15 Issue 3: March 22, 2005PDF download

Iodine status as determined by urinary iodine excretion in Lesotho two years after introducing legislation on universal salt iodization

Objective Mildto severe iodine deficiency has been documented in Lesotho since 1960.To eliminate the persisting iodine deficiency, legislation on universalsalt iodization was introduced in 2000 as a long-term public healthintervention strategy. We assessed the urinary iodine status of schoolchildren and women of child-bearing age in Lesotho 2 y afterthe introduction of legislation on universal saltiodization. Methods A31-cluster national survey was conducted in 2002 by using theproportion to population size method. In each cluster, 30 women ages 15to 30 y and 30 primary school children ages 8 to 12y were randomly selected to provide urine samples for urinary iodineanalysis. Data were interpreted according to criteria of the WorldHealth Organization, United Nations Children's Fund, andInternational Council for Control of Iodine Deficiency Disorders(2001). Statistical analysis was performed usingSAS. Results Weanalyzed 912 urine samples from children and 924 from women. The medianurinary iodine concentrations were 214.7 μg/L for children and280.1 μg/L for women, indicating more than adequate iodineintake. Median iodine concentration was higher in the lowlands (256.0μg/L in children and 329.9 μg/L in women) than in themountains (99.30 μg/L in children and 182.6 μg/L inwomen). Analysis of the distribution of the data showed values below 50μg/L in 10.1% of children and in 9.8% of women. Inaddition, 21.5% of children and 17.9% of women hadurinary iodine excretion values below 100 μg/L. In contrast,36% of children and 47.2% of women had urinary iodineconcentrations in excess of 300μg/L. Conclusion Results of urinary iodineexcretion measurements indicated that iodine deficiency has beeneliminated as a public health problem in Lesotho. However, the highmedian urinary iodine concentration of women in the lowlands indicatedthe possibility of a risk of iodine-induced hyperthyroidism invulnerablepeople.

Doppler evaluation of pediatric goiter: Effect of mandatory iodination

The aim of this study was to evaluate the hemodynamic status of the thyroid in children with goiter after the use of iodinated dietary salt for 3 years in a region of endemic iodine deficiency. Sixty-six children between 7 and 12 years of age were included in the study. Three groups were constituted according to sonographically measured thyroid volume and urinary iodine excretion levels. Group 1 included 11 children with thyroid volumes greater than the 97th percentile according to age and sex criteria suggested by the World Health Organization International Council for Control of Iodine Deficiency Disorders and urinary iodine level lower than 100 microg/l. Group 2 included 30 children with thyroid volumes greater than the 97th percentile and urinary iodine level equal to or higher than 100 microg/l. The control group included 25 children who had normal thyroid volume and urinary iodine level. All children were examined by thyroid duplex sonography. Peak systolic velocity (PSV) and resistance index (RI) were measured in the inferior thyroid artery bilaterally. PSV in group 1 was significantly higher than in group 2 and in the control group (P < 0.05 and P < 0.01, respectively). There was no significant difference between the PSV of group 2 and the control group. The RI in groups 1 and 2 was significantly lower than in the control group (P < 0.01 and P < 0.01, respectively). There was no significant difference between the RIs of group 1 and group 2. These findings suggest an effect of iodination on thyroid hemodynamics before the size of the hyperplastic thyroid returned to normal, in keeping with normalization of the urinary iodine level.