Goiter In Children Research Articles

Diffuse Enlargement of the Thyroid Gland as a Result of the Impact of Adverse Factors on the Pituitary-thyroid Cystem of Children

The problem of diffuse goiter has attracted the attention of many researchers in recent years. The main reason for the formation of endemic goiter is iodine deficiency in the environment. Epidemiological studies conducted in recent years have shown that almost all regions of Kazakhstan are regions of endemic goiter with natural iodine deficiency. Some of them are characterized by an increase in the severity of endemic goiter. The reasons contributing to the progression of goiter endemicity are the cessation of iodine prophylaxis, the deterioration of the environmental situation and the social situation of a significant part of the population. The purpose of this work was to study the features of thyroid status in children with diffuse goiter. Material and methods There were 38 children under our supervision, 20 (main group) had diffuse (endemic) goiter (5 boys and 15 girls), 18 children (control group) - 5 boys and 13 girls, children in the control group were considered healthy. Results As a result of comparing indicators of the functional state of the pituitary-thyroid system in patients with diffuse goiter, a relatively increased level of thyroid-stimulating hormone is noted, which indicates the negative impact of diffuse goiter on the thyroid status of children. Conclusions As a result of the manifestation of diffuse goiter in children, metabolic disorders of the pituitary-thyroid system occur. Signs of thyroid deficiency are most often observed in children living in iodine-deficient areas. Bangladesh Journal of Medical Science Vol. 23 No. 04 October’24 Page : 1213-1218

Analysis of iodine nutritional status of children aged 8-10 years in Zhejiang Province from 2016 to 2021

Objective: To analyze the iodine nutrition status of children aged 8 to 10 years in Zhejiang Province from 2016 to 2021. Methods: A multi-stage stratified sampling method was used to select non-residential children aged 8 to 10 years from 90 counties in Zhejiang Province. A total of 114 103 children were included in the study from 2016 to 2021. Direct titration method and arsenic-cerium catalytic spectrophotometry were used to detect salt iodine content and urinary iodine level, respectively, to evaluate the iodine nutritional status of children. Ultrasound was used to detect thyroid volume and analyze the current prevalence of goiter in school-age children. Results: The age of 114 103 children was (9.04 ± 0.81) years old, with 50.0% of (57 083) boys. The median of iodine content M (Q1, Q3) in children's household salt was 23.00 (19.80, 25.20) mg/kg, including 17 242 non-iodized salt, 6 173 unqualified iodized salt, and 90 688 qualified iodized salt. The coverage rate of iodized salt was 84.89%, and the coverage rate of qualified iodized salt was 79.48%. The proportion of non-iodized salt increased from 11.85% in 2016 to 16.04% in 2021 (χ2trend=111.427, P<0.001). The median of urinary iodine concentration M (Q1, Q3) in children was 182.50 (121.00, 261.00) μg/L, among which the proportions of iodine deficiency, iodine suitability, iodine over suitability, and iodine excess were 17.25% (19 686 cases), 39.21% (44 745 cases), 26.85% (30 638 cases), and 16.68% (19 034 cases), respectively. The median of urinary iodine concentration in children in inland areas [M (Q1, Q3): 190.90 (128.80, 269.00) μg/L] was significantly higher than that in children in coastal areas [M (Q1, Q3): 173.00 (113.00, 250.30) μg/L] (P<0.001). From 2016 to 2021, a total of 39 134 ultrasound examinations were conducted, and 1 229 cases of thyroid enlargement were detected. The goiter rate was 3.14% (95%CI: 2.97%-3.32%). The incidence of goiter in children in coastal areas [3.45% (95%CI: 3.19%-3.72%), 641/18 604] was higher than that in children in inland areas [2.86% (95%CI: 2.64%-3.10%), 588/20 530] (P=0.001). Conclusion: From 2016 to 2021, the iodine nutrition level of children aged 8-10 years in Zhejiang Province is generally suitable, and the rate of goiter in children meets the limit of iodine deficiency disease elimination standards.

A Meta-Analysis of the Prevalence of Children Goiter in High Water Iodine Areas of China.

Although there are now a large number of studies confirming that high iodine levels can cause goiter, there is controversy and a lack of quantitative data. A systematic search of PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang Database, and China Biomedical Database for literature on high iodine and goiter in children was performed with a time limit from January 2013 to October 2023. After screening the literature based on the inclusion criteria, extracting the literature data, and evaluating the risk of bias of the included studies, a single-arm meta-analysis was performed using R 4.0.4 software. Twenty-three studies with a total of 50,980 subjects were included. Meta-analysis showed that the prevalence of goiter among children in water-borne iodine-excess areas was 6.0% [95% CI (4.3%, 7.6%)], and subgroup analyses showed that the prevalence of goiter in children with water iodine 100.1-150 µg/L, 150.1-300 µg/L, and > 300 µg/L was 7.5% [95% CI (0.0%, 15.8%)], 5.5% [95% CI (3.1%, 8.0%)], and 10.2% [95% CI (6.7%, 13.6%)], respectively, and the difference was statistically significant (P < 0.01); The prevalence of goiter among children in the northern China (5.8% [95% CI (4.1%, 7.5%)]) was higher than that in the southern China (3.5% [95% CI (1.0%, 6.0%)]) (P < 0.01); the prevalence of goiter in children with urinary iodine levels 100-199 µg/L, 200-299 µg/L, and ≥ 300 µg/L was 2.4% [95% CI (1.9%, 2.9%)], 3.3% [95% CI (1.9%, 4.8%)], and 7.3% [95% CI (4.4%, 9.9%)], respectively, the difference was statistically significant (P < 0.01); the prevalence of goiter in children aged 8, 9, 10, 11, and 12 years old was 5.1% [95% CI (3.9%, 6.4%)], 8.0% [95% CI (4.0%, 11.9%)], 6.2% [95% CI (3.9%, 8.5%)], 5.5% [95% CI (0.0%, 13.2%)], and 5.4% [95% CI (0.0%, 15.1%)], and when age ≥ 9 years, the relationship between goiter prevalence and age showed a trend toward decreasing with age, but the relationship between different age was no statistical difference in the prevalence of goiter between ages. urinary iodine. The prevalence of goiter in children was higher in areas with high water iodine; the prevalence of goiter in children in the north was significantly higher than that in the south; the prevalence of goiter in children tends to increase with increased urinary iodine levels.

Effects of iodine status on thyroid volume and goiter in children living in an iodine-replete area.

Adequate iodine intake is essential for growing children, and thyroid volume (Tvol) is considered as an indicator of iodine status. We investigated Tvol and goiter using ultrasonography (US) and their association with iodine status in 228 6-year-old children living in Korea. Iodine status was assessed using urine iodine concentration (UIC) and categorized as deficient (<100 μg/L), adequate (100-299 μg/L), mild excess (300-499 μg/L), moderate excess (500-999 μg/L), and severe excess (≥1000 μg/L). Tvol was measured using US, and a goiter on the US (goiter-US) was defined as Tvol greater than 97th percentile value by age- and body surface area (BSA)-specific international references. The median Tvol was 2.4 mL, larger than the international reference value (1.6 mL). The age- and BSA-specific goiter-US rates were 25.9% (n = 59) and 34.6% (n = 79), respectively. The prevalence of excess iodine was 73.7% (n = 168). As iodine status increased from adequate to severe excess, the goiter-US rate significantly increased (P for trend <0.05). The moderate and severe iodine excess groups showed higher risk of goiter-US (adjusted odds ratio (aOR) = 3.1 (95% CI: 1.1-9.2) and aOR = 3.1 (95% CI: 1.2-8.3), respectively; age-specific criteria) than the iodine-adequate group. Excess iodine was prevalent in Korean children, and their Tvol was higher than the international reference values. Goiter rate was associated with iodine excess, which significantly increased in the moderate and severe iodine excess groups. Further studies are warranted to define optimal iodine intake in children.

Papillary thyroid cancer in children. Clinical cases

Thyroid cancer (TC) is the most common endocrine tumor in pediatric patients. Papillary carcinoma accounts for the highest rate among differentiated TCs (80—90%). Papillary thyroid cancer in children is clinically different from this pathology in adults. In comparison with adults, papillary thyroid cancer in children is diagnosed at later stages and is associated with a more aggressive course of the disease. Despite the high frequency of metastases and recurrences of papillary thyroid cancer in children, the prognosis remains favorable. In Ukraine, 10 years after the accident at the Chernobyl nuclear power plant, the average incidence rates of papillary thyroid cancer among children of all ages gradually decreased, but since 2010—2011, a negative trend towards an increase in the number of new cases of pathology, especially children under 14 years of age, has been restored. Several studies suggest that the increase in the incidence of papillary thyroid cancer is only partially explained by the increase in the number of preventive examinations performed, as there is also an increase in the detection of large tumors and the diagnosis of advanced stages of the disease.Over the past 14 years, 759 children aged 3 to 18 from all regions of Ukraine were operated in the clinic of the Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukraine (Center). From them, based on the results of histopathological examinations, papillary thyroid cancer was diagnosed in 290 (38.2%) children (including 73.45% girls and 26.55% boys). In most cases, the disease was diagnosed during adolescence, except for isolated cases among children of primary school and preschool age. The paper presents two clinical cases.Annual preventive thyroid ultrasound investigation is required for early diagnosis of nodular goiter, including malignant thyroid tumors, especially in children with a burdened family history of these tumors. Any nodular goiter in children should be considered potentially malignant until its benign nature is proven by appropriate qualified investigations. To ensure proper and timely verification of malignant thyroid tumors in pediatric patients, to avoid unjustified (insufficient or excessive) surgical treatment of children with thyroid tumors, such patients should be referred to medical institutions with modern diagnostic capabilities and expert‑level surgical experience in the treatment of children with nodular goiter and malignant thyroid tumors.

Assessment of Sustainable Elimination Criteria for Iodine Deficiency Disorders Recommended by International Organizations.

Enormous efforts have been made to evaluate the worldwide prevention and control of iodine deficiency disorders (IDDs). This study evaluated China's achievements in IDD prevention and control against WHO criteria for sustainable elimination of IDD. The study sample consisted of 556,390 school-aged children and 271,935 pregnant women enrolled in the 2018 China National IDD Surveillance. As a result, at the national level, median urine iodine concentration (MUIC) was 206.1 and 163.5 μg/l in children and in pregnant women, respectively. The proportion of households consuming adequate iodized salt (PHCAIS) was 90.2%. The prevalence rates of goiter in children and thyroid disease in pregnant women were 2.0 and 0.8%, respectively. MUIC showed significant non-linear increasing trends with increasing PHCAIS in both children and pregnant women. The prevalence of thyroid disease in pregnant women had a sharp decreasing trend with increasing PHCAIS. Of note, the prevalence of goiter in children and thyroid disease in pregnant women against MUIC both presented as significant U-shaped curves, with the lowest prevalence at 100–300 μg/l of MUIC in children and 150–250 μg/l in pregnant women. PHCAIS, MUIC, and the programmatic indicators at the national level were all above their cut-offs proposed in the 2007 Criteria. Evaluation by adding the prevalence of goiter (<5%) yielded the different results at the county level. Sustainable elimination of IDD has been achieved nationally. 2018 Chinese surveillance data support the expansion of global cut-offs for optimal iodine status in school-age children from 100–199 to 100–299 μg/l as recommended by others and the lower limit of MUIC (150 μg/l) in pregnant women also seems justified. Inclusion of goiter prevalence <5% in our analysis reduced the number of municipalities and counties which had achieved sustainable elimination of IDD.

Total Insights on Goiter in Children: A Mini-review

Background: Thyroid disorder is one of the main endocrine problems in childhood. In children with thyroid disorders, goiter is common. Objectives: In this mini-review, the authors aimed to present total insights on goiter in children. Methods: This is a mini-review about total insights on goiter in children. This review included articles assessing goiter in children. Web of Science, PubMed, and Google Scholar were investigated to find appropriate articles regarding goiter in children from 1988 to 2021. The keywords were thyroid, goiter, hyperthyroidism, hypothyroidism, and thyroid nodule. The authors included all study types assessing the pathophysiology, evaluation, and treatment of goiter in childhood. Results: Through taking the medical history and performing a physical examination, clinicians can differentiate types of goiter, including diffuse or nodular toxic or non-toxic, which can present themselves in euthyroid, hypothyroid, and hyperthyroid states. When taking a medical history, clinicians have to ask patients about their food intake, place of residence, and nutrient deficiencies to abstain from goitrogens. Diverse treatment methods are required for goiter in euthyroidism, hypophyroidism, and hyperthyroidism. In patients with euthyroidism, whenever there is iodine deficiency, a history of irradiation to the neck, or Hashimoto’s disease, suppressive therapy is needed. Both clinical and subclinical hypothyroidism need levothyroxine. Besides, in hyperthyroidism, antithyroid drugs, iodine therapy, or surgery are needed. Both clinical and subclinical hypothyroidism need levothyroxine. Conclusions: In hyperthyroidism, antithyroid drugs, iodine therapy, or surgery are needed. Based on the importance of managing goiter in children, clinicians have to consider food intake, vitamin deficiency, and iodine status in these patients.

Clinical effect of methimazole combined with selenium in the treatment of toxic diffuse goiter in children.

BACKGROUNDThe incidence of toxic diffuse goiter (Graves’ disease) is higher in adolescents and preschool-aged children, with an upward trend. The incidence at 6–13 years of age is approximately 11.0%, and the incidences in men and women are 7.8% and 14.3%, respectively.AIMTo explore the clinical effect of methimazole combined with selenium in the treatment of toxic diffuse goiter (Graves’ disease) in children and its effect on serum anti-thyroglobulin antibody (TRAb) and anti-thyroid peroxidase antibody (TPOAb).METHODSA total of 103 children with Graves’ disease treated in our hospital from January 2018 to June 2021 were divided into a traditional group and a combined group (15-20 mg methimazole orally given to children) and a combined group (50 µg selenium added on the basis of traditional treatment) according to different treatment methods to explore the therapeutic effects of the two methods and to observe the changes in thyroid volume and serum TRAb, TPOAb, free thyroxine (FT4) and inflammatory factor levels before and after treatment. The time taken for FT4 to return to normal was compared between the two groups.RESULTSTreatment was significantly more effective in the combined group than in the traditional group (P < 0.05). The thyroid volumes of the children in the two groups was measured before and after treatment. Thyroid volume decreased significantly after treatment in both groups, and the thyroid volume was significantly lower in the combined group than in the traditional group (P < 0.05). The serum levels of interleukin-6 (IL-6), IL-8, TRAb, TPOAb and FT4 in the two groups were detected before and after treatment. The levels of IL-6, IL-8, TRAb, TPOAb and FT4 were significantly lower in the combined group than in the traditional group (P < 0.05). Follow-up of the children in the two groups showed that compared with the traditional group, it took less time for children in the combined group to return to the normal level (P < 0.05).CONCLUSIONMethimazole combined with selenium can effectively treat Graves’ disease in children, reduce the expression of TRAb, TPOAb, FT4 and inflammatory factors, and improve the curative effect. Thus, the combined treatment warrants further clinical research.

Causes of goiter in children attending Assiut University Children Hospital

Causes of goiter in children attending Assiut University Children Hospital

Relationship between water iodine and children's goiters.

Excessive iodine can lead to goiters. However, the relationship between the water iodine concentration (WIC) and goiter rate (GR) is unclear. This study aims to explore the factors that influence children's GR in areas with high WIC and analyse the threshold value of the GR increase associated with the WIC. According to the monitoring of the areas with high WIC in China in 2018-2020, a total of 54050 children in eight high water iodine provinces were chosen. Drinking water, urine and edible salt samples of children were collected. The thyroid volume (Tvol) was measured. A generalised additive model (GAM) was used to analyse the relationship between the WIC and GR in children. Among the 54050 children in areas with high WIC, the overall GR was 3·34 %, the median of water iodine concentration was 127·0 µg/l, the median of urinary iodine concentration was 318 µg/l and the non-iodised salt coverage rate (NISCR) was 63·51 %. According to the GAM analysis results, water iodine and urinary iodine are factors that influence the Tvol and GR, while the NISCR affects only the GR. When the WIC was more than 420 µg/l or the urinary iodine concentration was more than 800 µg/l, the GR increased rapidly. When the NISCR reached more than 85 %, the GR was the lowest. Thus, in areas with high WIC, WIC more than 420 µg/l may increase the risk of goiter, and the NISCR should be increased to over 85 % to avoid goiters in children.

Thyroid Disorders.

Thyroid Disorders.

Iodine Deficiency Disorders: Current State of the Problem in the Republic of Crimea

Background: The article presents the results of a control and epidemiological study conducted in September 2020 by specialists of the Federal State Budgetary Institution «NMIC of Endocrinology» of the Ministry of Health of Russia, aimed at assessing the current state of iodine provision in the population of the Republic of Crimea. The study in Crimea is part of a number of activities and work carried out on behalf of the Ministry of Health of the Russian Federation within the framework of state assignments «Scientific assessment of the need for additional regulatory legal and other measures to eliminate iodine deficiency in pilot regions with severe iodine deficiency» and «Epidemiological and molecular-cellular characteristics of tumor, autoimmune and iodine deficiency thyropathies as a basis for prevention of complications and personalization of treatment.The data obtained reflect the state of the problem of iodine consumption on the territory of the Crimean Peninsula and indicate the relevance of the adoption of a regional preventive program aimed at eliminating iodine deficiency in the diet of the population and related diseases.Aim: Assessment of iodine supply of the population of the Republic of CrimeaMaterials and methods: The research was carried out in secondary schools of four districts of the Republic of Crimea — in the years. Simferopol, Belogorsk, Bakhchisarai and Saki.The volume of the study — 356 schoolchildren of 8-10 years old, all were completed: taking anamnesis and anthropometric parameters (height, weight), examination by an endocrinologist with palpation of the thyroid gland (thyroid gland), ultrasound examination of the thyroid gland (thyroid ultrasound), obtaining single portions of urine and samples of table salt (5-10 grams), which is used daily in the diet in their families. The measurements of the height and weight of the children by the standard method were carried out during the examination by a specialist. Thyroid ultrasound was performed in the supine position using a portable LOGIQe ultrasound machine (China) with a 10-15 MHz multifrequency linear transducer. All urine samples (n = 356) in disposable Eppendorf microtubes were immediately frozen at a temperature of minus 20-25°! for further determination of the concentration of iodine in urine using the cerium-arsenite method (based on the clinical diagnostic laboratory of the Federal State Budgetary Institution NMITs endocrinology «of the Ministry of Health of Russia). A qualitative study for the presence of potassium iodate in food table salt samples (n = 203) was carried out on site by the express method.Informed consent was obtained from all parents / guardians of children for the examination and processing of personal data. The permission of the local ethical committee of the Federal State Budgetary Institution «NMIC of Endocrinology» of the Ministry of Health of Russia was received on March 25, 2020, No. 5.Results: According to the results of a survey of 356 children of primary school age, the median concentration of iodine in urine (mCIM) is 97 pg / l and varies from 78 to 98 pg / l in the surveyed areas, the proportion of urine samples with a reduced iodine concentration was 51.2%. The share of iodized salt use in the families of schoolchildren was 12.3% (values range from 10% to 15%). The average incidence of goiter in children according to ultrasound data is 9.5% (range of values from 1.7% to 16.3%).Conclusion.The indicator of the median concentration of iodine in urine indicates an insufficient iodine supply of the population of the Republic of Crimea.The prevalence of goiter in children of primary school age according to the ultrasound examination of the thyroid gland corresponds to the mild severity of iodine deficiency in the mild degree of goiter endemic in the region.The share of households using iodized salt is extremely low and amounts to 12.3%, which does not meet the WHO recommendations for regions with natural iodine deficiency (from 90% or more).

Moderating Role of TSHR and PTPN22 Gene Polymorphisms in Effects of Excessive Fluoride on Thyroid: a School-Based Cross-Sectional Study.

We aimed to investigate the relationship between the effects excessive of fluoride on thyroid health in children and the moderating role of thyroid stimulating hormone receptor (TSHR) or protein tyrosine phosphatase nonreceptor-22 (PTPN22) gene polymorphisms. Four hundred thirteen children (141 with dental fluorosis and 198 boys) were enrolled from both historical endemic and non-endemic areas of fluorosis in Tianjin, China. The fluoride exposure levels, thyroid health indicators, and TSHR (rs2268458) and PTPN22 (rs3765598) polymorphisms were examined. Multiple logistic models were applied to evaluate the relationship between dental fluorosis and thyroid abnormalities. Children over 9 year old with dental fluorosis have lower FT4 and TGAb levels and thyroid volume and higher TPOAb levels (all P < 0.05). In overall participants, children with dental fluorosis were more likely to have thyroid antibody single positive issues (adjusted P = 0.039) and less likely to have a goiter according to age or body surface area (age or BSA) (adjusted P = 0.003); In the TSHR (rs2268458) SNP = CC/CT or PTPN22 (rs3765598) SNP = CC subgroup, dental fluorosis may cause thyroid antibody single positive (adjusted P = 0.036; adjusted P = 0.002); in the TSHR (rs2268458) SNP = TT or PTPN22 (rs3765598) SNP = CC subgroup, dental fluorosis may protect children from goiter (age or BSA) (adjusted P = 0.018; adjusted P = 0.013). Excessive fluoride may induce thyroid antibody single positive and reduce goiter in children. Heterogeneity exists in the relationship between excessive fluoride and thyroid antibody single positive or goiter issues across children carrying different TSHR (rs2268458) or PTPN22 (rs3765598) genotypes.

Nodular toxic goiter in children: clinical features, morphological variants

ОБОСНОВАНИЕ. Токсический узловой зоб (ТУЗ) — редкое заболевание, при котором причиной гипертиреоза является наличие узла или узлов, автономно секретирующих гормоны щитовидной железы. У детей и подростков данное состояние встречается крайне редко — в 5–7,5% всех случаев узлового зоба. Терапия ТУЗ направлена на купирование симптомов гипертиреоза с учетом злокачественного потенциала узлового образования. В доступной литературе отсутствуют данные о клиническом течении, сравнительных результатах цитологических и гистологических данных пациентов с ТУЗ, дебютировавшим в детском возрасте.ЦЕЛЬ. Анализ особенностей клинического течения, сравнение результатов цитологического и гистологического исследований ТУЗ у детей и подростков.МАТЕРИАЛЫ И МЕТОДЫ. Ретроспективное одноцентровое исследование 21 пациента с одноузловым токсическим зобом, госпитализированных в ФГБУ «НМИЦ эндокринологии» Минздрава России в период с января 2016 г. по декабрь 2019 г.РЕЗУЛЬТАТЫ. Средний возраст на момент обследования составлял 13,9 года. У 13 пациентов (65%) отмечался манифестный тиреотоксикоз, у 7 (35%) — субклинический гипертиреоз. Больше половины детей — 57,1% (n=12) не получали тиреостатической терапии. Цитологическая картина у 11 пациентов (61,1%) соответствовала доброкачественным изменениям (узловой коллоидный зоб или аденоматозный зоб) — Bethesda II, у 4 пациентов — фолликулярной опухоли — Bethesda IV, у 4 детей исследование оказалось неинформативным. 19 пациентам (90,5%) было проведено хирургическое лечение (гемитиреоидэктомия). Фолликулярная аденома по результатам гистологического исследования встречалась у 44,4% детей с ТУЗ при доброкачественных результатах тонкоигольной аспирационной биопсии (Bethesda II) и в 50% — при выявлении фолликулярной неоплазии (Bethesda IV).ЗАКЛЮЧЕНИЕ. Впервые в Российской Федерации проведен сравнительный анализ характеристик цитологического и гистологического исследования у детей с ТУЗ. Показательно, что только в 10,5% (n=2) случаев соответствовали цитологические и морфологические результаты. Выбор тактики радикального лечения должен учитывать высокую частоту несовпадений гистологических и морфологических исследований.

Not that simple goiter

The year 2020 marks the centenary of the publication of a classic study by American physicians D. Marine and O. Kimball on the effectiveness of endemic goiter prevention in children in Akron, Ohio. Although goiter has been known from immemorial times, there is still a problem with determining the normal size of the thyroid gland, without which the diagnosis of goiter remains extremely subjective. For example, in Sweden over the past 20 years, not a single case of endemic goiter has been registered, which is not surprising: the country eliminated this pathology decades ago, and the median urinary iodine concentration indicates the optimal iodine intake. Cases of sporadic goiter in children in Sweden are also rare — no more than 6–8 per year. But in Belarus, with the same population (about 10 million), about 2900 cases of goiter in children, both endemic and sporadic, are recorded annually despite the fact that, due to the extensive use of iodized salt since the beginning of the 2000s, there is no iodine deficiency. The incidence of goiter in children, however, having decreased many times over the past 20 years, remains 3 times higher than in Russia, where iodine prophylaxis, if carried out on a limited scale. From the experience of Belarus, Sweden and Russia, we see that the main thing when assessing data on the incidence of goiter and other thyroid diseases associated with iodine deficiency should be not absolute numbers, but the trend of these indicators over the past years. This information should be more actively used by endocrinologists in Russia to assess the effectiveness of preventive measures both at the regional and federal levels.

Detection of autoimmune thyroiditis in children with goitre attending the pediatric department of a tertiary care hospital in Chennai.

Introduction: Goitre is a common problem among children. The incidence of autoimmune thyroiditis is on the rise. This study is intended to evaluate all goitrous children with Thyroid profile and to look for autoimmunity. AIM To detect autoimmune thyroiditis in children less than 15 years of age with goitre. Objectives: To screen for thyroid dysfunction. To detect autoimmunity by antithyroid antibodies and FNAC. Materials and methods: 107 Children with goitre attending the Paediatric Department of ESIC Medical College and PGIMSR were included. Relevant history and physical examination findings were documented in a preset proforma. Thyroid function tests, anti TPO antibody and FNAC of the thyroid gland were done. The results were analysed statistically. Observations and Results: Out of 107 children, 10 had evidence of hypothyroidism. Anti TPO antibodies were detected in 11, while 8 had FNAC evidence of autoimmune thyroiditis. While all the FNAC positive cases had hypothyroidism only 8/11 antibody positive cases had evidence of thyroid dysfunction. Three cases with neither evidence of hypothyroidism nor FNAC positivity had antibody positivity. On comparing antibody positivity with FNAC in the detection of autoimmunity, we inferred that antibody positivity can be used as a diagnostic tool. Conclusion: Prevalence of autoimmunity was 7.5% by FNAC and 10.3% by anti TPO antibodies. Hypothyroidism was detected in 9.34% of goitres. Few cases of AIT may not have hypothyroidism, may require serial TFT. Anti TPO antibody positivity is an effective, less invasive indicator for detecting AIT in children, compared to FNAC which is the gold standard.

Adıyaman ilinde guatrla başvuran çocuk hastalarda etiyolojik dağılım ile klinik ve laboratuvar özellikler

Aim: The most common cause of goiter in developed countries is autoimmune diseases, while the most common cause in developing countries is iodine deficiency. We aimed to evaluate the clinical and laboratory results and etiological and demographic characteristics of cases presenting with goiter. Materials and Methods: Seventy-five patients aged between 5 and 17 years presenting with goiter between October 2016 and January 2019 were included in the study. Results: 90.7% (68) of children with goiter were female and 9.3% (7) male, the rate of goiter being 9.7-fold higher among girls. In terms of etiology, 43 patients (57.3%) were diagnosed with iodine deficiency, 25 (33.3%) with Hashimoto’s thyroiditis (HT), five with Graves’ disease (6.7%), and two (2.7%) with thyroid hormone resistance (THR). Mean ages were 13.7±2.1 years in the iodine deficient cases, 13.7±2.7 in the HT group, 14.3±1.4 in the Graves’ disease patients, and 8.2±2.3 in the patients with THR. The highest mean urinary iodine level among iodine deficient patients was 45±27.1 (12.10-84.13) μg/L in Adıyaman center, while the lowest value was determined in Gerger district at 16.8±3.1 (14.27-20.25) μg/L, and 11 patients were diagnosed with mild iodine deficiency, 20 with moderate deficiency, and 12 with severe deficiency. Conclusion: Iodine deficiency was the most common cause of goiter in children in the province of Adıyaman, followed by autoimmune thyroid gland diseases such as Graves’ disease and HT. This study shows that iodine deficiency remains still as a problem in our province.

Treatment of diffuse euthyroid goiter in children

High prevalence of diffuse euthyroid goiter and inefficiency of conservative treatment aimed at normalization of thyroid volume necessitate search for optimal methods of treatment.&#x0D; Results of thyroxin and potassium iodide (antistrumin) therapy of 110 children with diffuse toxic goiter, living in a region with medium-grave iodine deficiency, are analyzed. The diagnosis was verified by clinical data, ultrasonic examinations, and hormone measurements.&#x0D; Changes in the volume of the thyroid under the effect of thyroxin and antistrumin therapy could be variously directed: the involved thyroid might enlarge, shrink, or not change at all. Therapeutic effects of thyroxin and antistrumin on the degree of thyroid decrease and incidence of positive results after 6-month therapy were virtually the same.&#x0D; Thyroxin in a daily dose of 2.0-2.5 \xg/kg promoted a decrease and normalization of the thyroid size. Efficacy of thyroxin significantly increased if it was used longer than for 6 months.&#x0D; Potassium iodide (antistrumin) in a weekly dose of 2000 pg (equivalent to daily 200 pg iodine) led to decrease of goiter size and normalization of the thyroid volume. The best results were observed after a no more than 6-month course of treatment. A longer course brought about a tendency to a higher incidence of untoward effects (enlargement of the thyroid).

The effect of 17 years of increased salt iodization on the prevalence and nature of goiter in Croatian schoolchildren.

Background High goiter prevalence caused by iodine deficiency (medium content 5.6 mg potassium iodide [KI]/kg of salt, median urine iodine concentration [UIC] 68 μg/L) in Croatia was observed in 1991 and 1995 when salt was iodized with 10 mg KI/kg. A new regulation introduced in 1996, specified 25 mg KI/kg of salt resulting in an increase of median UIC to 248 μg/L. Afterwards, goiter prevalence was only assessed in two small studies. Methods In this study, we investigated the prevalence and etiology of goiter in 3594 schoolchildren 17 years after an increase in salt iodization in Croatia. Thyroid size was determined by palpation in 1777 girls and 1817 boys aged 10-18 years. In goitrous children, a thyroid ultrasound and thyroid-stimulating hormone, free thyroxine (fT4), free triiodothyronine (fT3), thyroid peroxidase (TPO) and thyroglobulin (TG) antibody measurements were performed. Results Goiter was found in 32 children (0.89% vs. 2.8% in 1991, p<0.00001 and 27% in 1995, p<0.00001), simple goiter (SG) in 18/32 (56%) goitrous children vs. 126/152 (82.8%) in 1991 p<0.00001, autoimmune thyroiditis (AT) in 13/32 (40.6%) vs. 19/152 (12.5%) in 1991 p<0.0009, nodules in four: two cysts, toxic adenoma and carcinoma (in 1991 two adenomas and one cyst), Graves' disease was not found (four in 1991). Subclinical hypothyroidism was found in three children. Thyroid disease was diagnosed in four of 32 children before the investigation. Increased iodine supply decreased goiter prevalence and SG/AT ratio in goitrous patients. Conclusions As thyroid abnormalities were found in 0.89% of children and some required treatment, thyroid examination is important in apparently healthy children regardless of sufficient iodization.

Diffuse Nontoxic Goiter in Children and Its Impact on Dental Pathology

The objective of the research was to assess the thyroid status of children with diffuse nontoxic goiter and its effect on dental pathology depending on age.Materials and methods. Clinical observation of 226 children at the age of 12-15 years was conducted. To analyze their thyroid status, serum levels of total thyroxine, free thyroxine, total triiodothyronine, and thyroid stimulating hormone were determined using enzyme immunoassay. The following thyroid indices were calculated for the integral estimation of the functional state of the pituitary-thyroid system: the peripheral inversion index (total triiodothyronine/total thyroxine), the integral index (total triiodothyronine + total thyroxine/thyroid stimulating hormone) and the indices of thyroid stimulating hormone/total triiodothyronine and thyroid stimulating hormone/total thyroxine. Their dental status was determined by means of standard indices recommended by the World Health Organization.Conclusions. In children with euthyroid enlargement of the thyroid gland, there were detected changes in the thyroid status within the reference range. According to the direction of changes in the most indices, dysthyroidism is characterized by the reduced thyroid function that can affect metabolic processes in the body, including the dentofacial system, as evidenced by significantly worse indices of the intensity of damage to hard dental tissues and periodontal tissues in children with diffuse nontoxic goiter.