Goiter In Children Research Articles

Goitre prevalence and epidemiological features in children living in areas with mildly excessive iodine in drinking-water

The prevalence of goitre in areas with mildly excessive iodine in drinking-water is still under debate. The aim of the present study was to explore the prevalence of goitre and its epidemiological characteristics in these areas using WHO criteria. To this end, three towns with a median water iodine (MWI) of 150-300 μg/l were selected randomly in Hengshui City of Hebei Province of China, and one town with a MWI of 105 μg/l was chosen as a control. A total of 452 children in the three towns and 120 children in the control town were randomly selected to measure thyroid volume (T vol) by ultrasound. The goitre status of these children was judged using the criteria recommended by the WHO. The overall goitre prevalences in the three towns were 24·6 % (111/452) by age-specific T vol and 33·0 % (149/452) by body surface area (BSA)-adjusted T vol, which were significantly higher than that in the control town by both age-specific T vol (14·0 % (17/120), P= 0·015) and BSA-adjusted T vol (17·5 % (21/120), P= 0·001). Significant differences were found neither in goitre prevalences across sex by both age-specific T vol (P= 0·078) and BSA-adjusted T vol (P= 0·692) nor in that across age group by both BSA-adjusted T vol (P= 0·461) and age-specific T vol (P= 0·183). The present study found a high prevalence of goitre in children living in areas with mildly excessive iodine in drinking-water in Hebei Province. No significant differences were found in goitre prevalences across sex and age group. These results suggest that the T vol reference values recommended by the WHO could be too low for Chinese children.

Novel DICER1 mutation as cause of multinodular goiter in children

BackgroundThe aim of this report was to present a rare case of an adolescent with multinodular goiter (MNG) found to have a DICER1 mutation.Methods and ResultsThe methodology includes a presentation and discussion of a chart review including endocrine hormone tests, thyroid ultrasound, and genetic testing for DICER1. A 12‐year‐old girl presented with a diffusely enlarged thyroid gland. Family history revealed an older sister with a history of bilateral ovarian Sertoli‐Leydig cell tumors and MNG. Thyroid function tests were normal. Serial thyroid ultrasounds showed enlarging multiple bilateral nodules. Fine‐needle aspiration suggested MNG. Genetic testing revealed a novel heterozygous premature termination mutation (c.1525C>T p.R509X) in the DICER1 gene.ConclusionsThyroid nodules are rare in children but carry a higher risk for malignancy. It is essential to inquire about family history and refer for genetic evaluation with a family history of MNG. In patients with DICER1 mutations, tumor surveillance is critical due to the increased risk of multiple tumors, including ovarian tumors and pleuropulmonary blastoma. © 2013 Wiley Periodicals, Inc. Head Neck 35: E369–E371, 2013

Thyroid status two decades after salt iodization: country‐wide data in school children from India

Country-wide evaluation of thyroid disorders in school children following two decades of universal salt iodization (USI) has not been carried out till date. This study was planned with aim to assess thyroid status of school children two decades after the launch of USI programme. Population survey. We collected data from 25 schools in 19 cities across five different geographical zones of India. Those children who were evaluated for anthropometry, and goitre status by palpation formed 'total population'. Children who consented to give blood samples were defined as 'study population'. Serum free T3, free T4, TSH, anti-TPO antibody and thyroid ultrasound. A total of 38,961 children aged 5-15 years formed total population. Goitre rate was 15.5% while thyroid hypoechogenicity was found in 4404 (11.3%) children. In the study population (13,790 children), 2258 (16.4%) had goitre, 505 (3.7%) had positive anti-TPO antibody titres, 1001 (7.3%) had hypothyroidism (TSH > 5.2 μIU/ml) and 41 (0.3%) had thyrotoxicosis (TSH < 0.1 μIU/ml). Among goitrous children, 203 (9.0%) had anti-TPO positivity, 365 (16.1%) had hypoechogenicity of thyroid and either of these were present in 488 (21.6%) children. Endemic goitre in school children persisted nationwide, despite more than two decades of USI programme. Thyroid autoimmunity only partially explains the increase in goitre prevalence.

P1-479 Iodine deficiency in children: a comparative study in the two districts of South-interior Karnataka

Introduction and ObjectiveIodine is an essential micronutrient. A daily consumption of 100–150 μg of Iodine is recommended for normal human growth and development. Iodine Deficiency Disorders (IDD) can be easily...

Insulin-like growth factor-1 and zinc status of goitrous primary-school children in Arak, Islamic Republic of Iran

Despite a successful national salt iodinization programme, endemic goitre still persists in Iranian children. In a cross-sectional study in Arak the prevalence of goitre was 5.2% in a sample of 6520 primary-school children. Subsamples of 193 children with goitre and 151 healthy children were assessed for urinary iodine excretion, thyroid hormone profile, insulin-like growth factor-1 (ICF-1) and serum zinc. The mean urinary iodine levels of goitrous children and healthy children were 17.4 microg/dL and 15.3 microg/dL respectively, suggesting that iodine consumption was adequate. No significant differences were found between goitrous and healthy schoolchildren in mean levels of urinary iodine, serum IGF-1 or serum zinc. Other factors need be evaluated to, explain the residual prevalence of goitre.

Association between Serum Ferritin and Goitre in Iranian School Children

Despite long-standing supplementation of iodine in Iran, the prevalence of goitre among general people remains high in some regions. The study investigated the role of iron status in the aetiology of goitre in school children in Isfahan, Iran. Two thousand three hundred and thirty-one school children were selected by multi-stage random sampling. Thyroid size was estimated by inspection and palpation. Urinary iodine concentration (UIC) and serum ferritin (SF) were measured. Overall, 32.9% of the children had goitre. The median UIC was 195.5 microg/L. The mean +/- SD of SF in the goitrous and non-goitrous children was 47.65 +/- 42.51 and 44.55 +/- 37.07 microg/L respectively (p=0.52). The prevalence of iron deficiency in goitrous and non-goitrous children was 9.6% and 3.1% respectively (p=0.007). Goitre is still prevalent in school children of Isfahan. However, their median UIC was well in the accepted range. Iron deficiency is associated with goitre in a small group of goitrous children. The role of goitrogens should also be investigated in this region.

Iodine: It's Important in Patients that Require Parenteral Nutrition

Iodine deficiency has multiple adverse effects on growth and development because of inadequate thyroid hormone production. Four methods are generally recommended for assessment of iodine nutrition: urinary iodine concentration, thyroid size, and blood concentrations of thyroid-stimulating hormone and thyroglobulin. Iodine intakes < or = 1 mg/d are well tolerated by most adults, because the thyroid is able to adjust to a wide range of intakes. A daily dose of 1 microg iodine/kg body weight is recommended for infants and children receiving parenteral nutrition (PN), but this is far below their requirement. Daily iodine requirements in adults receiving enteral nutrition or PN are estimated to be 70-150 microg, but most PN formulations do not contain iodine. Despite this, deficiency is unlikely because absorption from iodine-containing skin disinfectants and other adventitious sources can provide sufficient iodine. However, if chlorhexidine replaces iodine-containing disinfectants for catheter care, iodine deficiency may occur during long-term PN, and periodic testing of thyroid functions may be prudent. Infants may be particularly vulnerable because of their small thyroidal iodine store, but available data do not yet support routine supplementation of preterm infants with iodine. Adults may be less vulnerable because thyroidal iodine stores may be able to support thyroid hormone production for several months. More studies to clarify this issue would be valuable.

Beneficial effects of iodized salt prophylaxis on thyroid volume in an iodine deficient area of southern Italy

Goitre prevalence in school-age children is an indicator of the severity of iodine deficiency disorders (IDD) in an endemic area. The aims of the present study were (i) to provide ultrasound thyroid volume (TV) reference values in a healthy population of school-children aged 11-14 year living in iodine-sufficient areas of Calabria region (ii) to assess both goitre prevalence and urinary iodine (UI) concentration in all children aged 11-14 year from four mildly iodine-deficient areas in which we have carried out a program of salt iodization and (iii) to evaluate the efficacy of the iodoprophylaxis in an adult population living in a small village of the same endemic area. Cross-sectional and prospective studies. TV was assessed by ultrasonography and iodine intake was estimated by measuring iodine excretion in spot urine samples. Results We provided the ultrasound normal reference values as a function of age and body surface area, which displayed significant differences from those recommended by the World Health Organization. By adopting local criteria, the prevalence of goitre in children ranged from 23.4% to 27.7% normalized for age and body surface area, respectively, while the UI excretion was < 100 microg/l in 38% of subjects studied. In an adult population living in the same endemic area, goitre prevalence was lowest in the 18-27-year-old age group, and increased progressively with age. We propose for the first time local reference ultrasound values for TV in a population of 11-14-year-old school-children that should be used for monitoring IDDs and have demonstrated the beneficial effects of iodoprophylaxis in consistent with reduced goitre prevalence in children and in the young adult population studied.

The role of thyroid autoantibodies in the etiology of endemic goiter in schoolchildren of Isfahan, Iran

Eleven years after the initiation of universal salt iodization program in Iran, the prevalence of goiter is still high in some areas. To investigate the role of thyroid autoimmunity in the etiology of residual goiter in schoolchildren of Isfahan, Iran. In a cross-sectional study, 2331 schoolchildren were selected by multi-stage random cluster sampling. Thyroid size was estimated in each child by inspection and palpation. Urinary iodine concentration (UIC), serum anti-thyroperoxidase antibody (anti-TPO Ab), and anti-thyroglobulin antibody (Anti-Tg Ab) were measured. Overall, 32.9% of children had goiter. The median UIC was 1955.5 microg/dl. There was significant difference in prevalence of positive anti-TPO Ab in goitrous (grade 2) and non-goitrous children (9.7 vs 3.7%, p= 0.02). Goitrous children had higher prevalence of positive anti-Tg Ab than non-goitrous ones (15.1 vs 3.1%, p<0.001). According to the present study, goiter is still a public health problem in this region. This study suggests that thyroid autoimmunity is among the contributors of goiter persistence after elimination of iodine deficiency in Isfahan.

More Than a Decade of Iodine Prophylaxis Is Needed to Eradicate Goiter Among School Age Children in a Moderately Iodine-Deficient Region

There are many studies regarding the effect of iodine supplementation on goiter, but relatively few reports on the duration of iodine supplementation required to eradicate goiter in iodine-deficient regions. In the current study, we aimed to determine goiter prevalence as determined by sonographic methods, as it relates to changes in median urinary iodine concentrations (UIC) among school age children (SAC), ages 9-11. This study was performed in Ankara, Turkey, before and 5-10 years after mandatory iodination of table salt. Three hundred to 400 SAC from the same primary schools were studied every year by measurement of UIC as part of Turkish Iodine Surveys. Sonographically determined thyroid volume of the SAC had been measured before the mandatory iodination in 1997 and 5-10 years afterward, in 2002 and 2007. The prevalence of goiter in children was evaluated using World Health Organization/International Council for the Control of Iodine Deficiency Disorders recommendations for age and sex. Moderate iodine deficiency was present in 1997 (median UIC, 25.5 microg/L), and it improved to mild iodine deficiency in 2001 (median UIC, 87 microg/L). Sufficient iodine intake (median UIC, 117 microg/L) was achieved by the year 2004. Goiter prevalence was 25% in 1997, 12.3% in 2001, and decreased to 1.3% in 2004. The time required to normalize the prevalence of goiter in SAC living in a moderately iodine-deficient environment was at least a decade. To achieve a goiter rate of less than 5% among SAC, it may require that, as a population, they were born and grew up under conditions of iodine sufficiency.

Increased goiter prevalence in schoolchildren of Isfahan despite long-term iodine sufficiency

Iodine Deficiency (ID) was for years considered a contributing factor for endemic goiter in Iran. The present study was conducted to assess the goiter prevalence and iodine status in schoolchildren of Isfahan 16 years after the initiation of salt iodization in Iran. 2331 schoolchildren, aged 6-13 years were selected by multistage random sampling. Thyroid size was estimated in each child by inspection and palpation and was graded according to the criteria recommended by WHO. Urinary Iodine Concentration (UIC) was also measured. Overall, 32.9% of the 2331 students had goiter. 4.6% of them were classified as goitrous grade 2. The median UIC was 195.5 microg/l (Range: 10-580 microg/l). 15.8% of total samples had iodine excretion level below 100 microg/l and 3.7% had iodine level below 50 microg/l. UIC in nongoitrous and goitrous children was (mean+/-SD) 220.91+/-119.44 microg/l and 220.16+/-114.64microg/l, respectively (p= 0.949). According to the present study there is no biochemical ID and the iodine intake of the total population is adequate. Goiter prevalence has decreased significantly after the new legislation, nevertheless it is still a public health problem in this region. The data suggest that other goitrogens, micronutrient deficiencies and thyroid autoimmunity may be operative and must be investigated in Isfahan schoolchildren.

Vitamin A status does not contribute to the residual goiter in schoolchildren of Isfahan, an iodine replenished area

Two thousand three hundred and thirty-one schoolchildren were selected by multi-stage random sampling. The thyroid size was estimated by inspection and palpation. The urinary iodine concentration and serum retinol (SR) were measured in 454 and 468 schoolchildren, respectively. Overall, 32.9% of 2,331 children had goiter. The median urinary iodine concentration was 195.5 µg/l. The mean±standard deviation of SR in goitrous and non-goitrous children was 34.84±7.28 µg/dl and 33.73±7.87 µg/dl, respectively (P=0.14). There was no child with vitamin A deficiency (SR <20 µg/dl) in both the goitrous and non-goitrous groups. The prevalence of subjects with low vitamin A status (SR <30 µg/dl) in the goitrous and non-goitrous groups was 27.7% and 33.3%, respectively (P=0.21). In conclusion, the present study reveals that vitamin A deficiency and low vitamin A status are not among the contributing factors of goiter persistence in the studied area, and the role of other responsible factors should be investigated.

Selenium Deficiency as a Possible Contributor of Goiter in Schoolchildren of Isfahan, Iran

The prevalence of goiter still remains high in some areas of Iran in spite of iodine supplementation. In the present study, we investigated the role of selenium (Se) deficiency in the etiology of goiter in Isfahan. Two thousand three hundred thirty-one schoolchildren were selected by multistage random sampling. Thyroid size was estimated in each child by inspection and palpation. Urinary iodine concentration (UIC) and plasma Se were measured. Overall, 32.9% of the 2,331 children had goiter. The median UIC was 19.55 microg/dl. Plasma Se was measured in 96 goitrous and 72 nongoitrous children. The mean +/- SD of plasma Se in goitrous and nongoitrous children was 66.86 +/- 21.82 and 76.67 +/- 23.33 microg/l, respectively (P = 0.006). Goitrous girls had lower plasma Se level than nongoitrous girls (65.62 +/- 21.64 vs. 76.51 +/- 22.61 microg/dl, P = 0.02). Goitrous boys had lower plasma Se level than nongoitrous boys (68.45 +/- 22.21 vs. 76.91 +/- 24.76 microg/l, P = 0.14). The prevalence of Se deficiency was significantly higher in goitrous boys and girls than nongoitrous children. Se deficiency is among the contributors of goiter in Isfahan goitrous schoolchildren. However, the role of other micronutrient deficiencies or goitrogens should be investigated in this region.

Goiter Persistence After Iodine Replenishment, the Potential Role of Selenium Deficiency in Goitrous Schoolchildren of Semirom, Iran

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

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.

Zinc Status and Relation to Thyroid Hormone Profile in Iranian Schoolchildren

Zinc is an essential element involved in many basic biochemical reactions in thyroid. However, little is known about concentration of this mineral in goitrous Iranian schoolchildren. This study was undertaken to determine the prevalence of zinc deficiency and the current zinc status in goitrous schoolchildren. A cross-sectional study in which 1188 schoolchildren in the age group of 8-13 years were evaluated for goiter prevalence, urinary iodine and zinc status. Zinc measurement was performed by atomic absorption spectrometry apparatus and urinary iodine was measured by digestion method. Goiter was graded according to WHO classification and serum concentration of thyroid hormones and thyroid-stimulating hormone were determined by commercial kits. This study showed an adequate iodine supply. Eleven percent of all cases had low zinc levels and the mean serum zinc concentration was 84.1 +/- 20.7 microg/dl with a significant difference between the boys and girls (86.6 +/- 22.7 microg/dl vs. 82 +/- 18.7 microg/dl, p = 0.017). The mean concentration in goitrous children was 85.1 +/- 23 microg/dl and for those without goiters was 82.6 +/- 16.7 microg/dl which was not statistically significant. No significant difference was noticed between those with low and normal zinc levels in the prevalence of goiter. In view of normal iodine status, other goitrogenic factors should be evaluated to explain the residual goiter prevalence.

Urinary iodine excretion and antiperoxidase enzyme antibody in goitrous and healthy primary school children of Arak, Iran

To determine urinary iodine excretion (UIE) and antiperoxidase enzyme antibody (anti-TPO Ab) in primary school-age children living in Arak, Iran, in 2005, after 10 yr of iodized salt distribution in an effort to ameliorate iodine deficiency. Through an observational, case-control study and by means of satisfied sampling, 6520 primary school children were examined for goiter, and then 193 goiterous children (case) and 151 healthy (control) children were assessed as representative samples for thyroid function tests, antiperoxidase antibody, and urinary iodine excretion. Normal values of anti-TPO Ab were <40 U/ml and high values >75 U/ml. Normal values of urinary iodine concentration were > or =10.0 microg/dl, and severe iodine deficiency were <2 microg/dl. The data were analyzed and compared by the Chi- Square tests and Mann-Whitney U in SPSS software; p-values <0.05 were considered statistically significant. Total mean prevalence of goiter was 5.2%, ranging from 3.6 to 6.4% in different schools. The prevalence of goiter increased with age; it was 3% in children aged 6-7 yr and 6.3% in children aged 11 yr (p<0.001). Mean iodine urinary concentration was 16.36 microg/dl (+/-1.58). No difference was seen between the mean urinary iodine in girls (17.30+/-3.80 micorg/dl) and boys (15.72+/-2.72 microg/dl). No difference was seen between the mean urinary iodine in goiterous and healthy school children (17.4+/-3.7 microg/dl vs 15.3+/-3.18 microg/dl, p=0.78). About 49.5% of school children had UIE<10 microg/dl and 28% had UIE<5 microg/dl. High levels of anti-TPO Ab were found in 21 school children (18 goiterous vs 3 healthy children, p=0.01) resulting in a total prevalence of 6.1%. In females, the prevalence was 1.3 times higher than in males (male:female ratio 3/4). Thirteen out of 21 (62%) children with positive antibodies had significant goiter (grade 2), and 5 (24%) had small goiter (grade 1), whereas only 3 children (14%) had normal thyroid size (p=0.001). If urinary iodine concentration is considered an index of total body iodine content, this study demonstrated that prolonged iodized salt intake has minimized the occurrence of iodine deficiency goiter and now autoimmune thyroid enlargement is one cause for continuous goiter in primary school children, although there are unknown etiologies that need to be considered in further studies.

High prevalence of goiter in an iodine replete area: do thyroid auto-antibodies play a role?

Despite long standing iodine supplementation in Iran the prevalence of goiter remains high in some areas. This may suggest that causes other than iodine deficiency, such as autoimmune thyroid diseases, should also be considered. We therefore assessed the prevalence of anti-thyroid antibodies in children living in an inland area in Iran and correlated these findings with prevalence of goiter within this region. In a cross-sectional study, 1948 students were selected by multistage random cluster sampling from the 108 primary schools (age, 7-13 year-old) of the urban and rural areas of Semirom. After obtaining written consent from their parents, the children were examined by endocrinologists for goiter grading. Grade 2 goitrous children (108 cases) were compared with non-goitrous children (111 children as control group) for anti-thyroid antibodies. Overall, 36.7% of 1948 students had goiter. The mean urinary iodine excretion level was 1.49+/-0.7 micromol/L. This was within normal limits. Of 219 children studied, 4.3% presented with subclinical hypothyroidism, and 7.3% had positive anti-thyroid antibodies. There was non-significant difference of positive thyroperoxidase antibody (anti-TPO) (Odds Ratio= 3.2, p= 0.13) but significant difference of anti Tg between goitrous and non goitrous children (Odds Ratio: 5.6, 95% CI: 1.18-26.0, p: 0.015). This study suggests that autoimmunity may be one of the mechanisms responsible for goiter persistence after iodine replenishment in this iodine deficient region, but the role of other factors should also be considered.

Juvenile Autoimmune Thyroiditis

Autoimmune thyroiditis is a frequent cause of goiter in children and studies point to the increasing prevalence of juvenile autoimmune thyroiditis (JAT) in children and adolescents. Clinically, JAT can manifest, depending on the presence or absence of goiter, as either a goitrous form or atrophic form. Both are characterized by the presence of thyroid antibodies in serum, with the goitrous form being more common in children. Recent evidence suggests that thyroid autoimmunity originates from an interaction of genetic, endogenous and environmental factors which end up activating thyroid-specific autoreactive T-cells in susceptible children. In addition to underlying genetic/HLA predisposition, factors including sex hormones, glucocorticoids, low birth weight, radiation and drugs may play a role in thyroid autoimmunity. Patients with JAT can present due to thyroid enlargement or symptoms arising due to hypothyroidism. Asymptomatic enlargement of the thyroid gland is a common presenting complaint, especially in older children and adolescents. Thyroid function can vary from euthyroidism to subclinical or overt forms of hypothyroidism and less commonly hyperthyroidism. Accordingly, patients can be symptomatic. There is considerable debate regarding the management of patients with euthyroidism or subclinical hypothyroidism. Available evidence indicates the presence of residual goiter in endemic form and a high prevalence of JAT in children. It is suggested that children should be screened for goiter as part of school health examinations, and goitrous children should be monitored for thyroid function.

Iron Deficiency in Goitrous Schoolchildren of Semirom, Iran

Background: Iodine deficiency produces the spectrum of iodine deficiency disorders (IDDs): endemic goiter, hypothyroidism, cretinism, and congenital anomalies. Other factors, including goitrogens and micronutrient deficiencies, may influence the prevalence and severity of IDDs and response to iodine supplementation. This cross-sectional, descriptive study was performed in 2003 on elementary school children of Semirom, a mountainous region of Iran, where goiter was hyper-endemic in 1994, but the goiter prevalence had not decreased as expected many years after salt iodization and iodine injection. Some possible risk factors associated with goiter in that area were evaluated, and the results of iron study are presented here. Methods: 1,869 cases were selected by a multistage cluster sampling procedure. Grade 2 goitrous children were compared with equal number of nongoitrous children for serum iron, ferritin, transferrin, thyroxin, TSH and urine iodine concentrations (UIC). Results: 210 children (105 goiter grade 0 and 105 goiter grade 2) entered this sub-study. Of 210 participants, 70 children had low transferrin saturation, 13 had low serum ferritin and 9 children had both problems. There was no significant difference in goiter rate between children with low iron indices and others.There was no significant correlation between serum iron, ferritin or transferrin saturation with other variables including T4, UIC and goiter stage. Conclusion: The present study reveals that in the area studied, iron deficiency cannot explain the high prevalence of goiter, so other responsible factors should be investigated.