Mild Iodine Deficiency Research Articles

8759 Mild Iodine Deficiency During Pregnancy Impairs Hypothalamus-Pituitary-Thyroid Function Programing of the Adult Male Offspring

Abstract Disclosure: M. Oliveira: None. E. Tavares: None. G. Henrique: None. J. Pinto: None. C. Serrano-Nascimento: None. Introduction: Iodine plays a crucial role in the biosynthesis of thyroid hormones and is essential for proper thyroid embryonic development. While severe iodine deficiency during pregnancy and lactation has well-documented deleterious effects, the consequences of mild iodine deficiency (MID) remain not fully understood. MID during pregnancy is a reality in numerous countries, even in regions with seemingly adequate iodine supply in the diet. Previous studies have highlighted the adverse impact of MID on neurological development in offspring, but comprehensive data on thyroid function, particularly in progeny at different developmental stages, are lacking. This study aimed to investigate the repercussions of MID during pregnancy on the programming of thyroid dysfunctions during adulthood. Methods: Female CD1 mice were subjected to iodine-deficient animal chow and iodine-supplemented water, either at normal (NI; 0.2 mg/L) or mild iodine deficiency (MID; 0.8 mg/L) levels during pregnancy. Gene and protein expression in the hypothalamus, pituitary, and thyroid of adult male offspring animals (PND90) were evaluated using qPCR and Western blotting. Additionally, this study explored MID-induced programming of offspring thyroid gene expression through epigenetic mechanisms. Results: Maternal MID exposure led to increased gene and protein expression of thyrotropin-releasing hormone (TRH) and thyroid-stimulating hormone (TSH) in the hypothalamus and pituitary of the offspring animals. Thyroid protein and gene expression of sodium iodide symporter (NIS), TSH receptor (TSHR), thyroid peroxidase (TPO), thyroglobulin (TG), paired box 8 (PAX8), NK2 homeobox 1 (NKX2.1), and monocarboxylate transporter 8 (MCT8) were elevated in the offspring of MID-exposed animals. Epigenetic mechanisms appeared to contribute to the augmented thyroid gene expression in MID-exposed animals, with decreased DNA methyltransferase expression and reduced thyroid DNA global methylation. Additionally, histone 3 hypomethylation and increased acetylation of histones 3 and 4 were observed. Conclusion: The study suggests that MID exposure during pregnancy can be as harmful as severe iodine deficiency in programming the hypothalamus-pituitary-thyroid (HPT) axis, leading to HPT dysfunction during adult life. Consequently, our data suggest that monitoring iodine intake throughout pregnancy is crucial to prevent the occurrence of thyroid disorders in offspring during adulthood. Presentation: 6/1/2024

6621 Iodine Nutritional Status in Different Trimesters of Pregnancy: A Prospective Observational Study in Taiwan

Abstract Disclosure: L. Pan: None. C. Yeh: None. C. Yang: None. C. Hwu: None. H. Chen: None. F. Wang: None. C. Huang: None. Pregnant women are susceptible to iodine deficiency. Iodine nutritional studies in pregnant women were mostly cross sectional evaluations of iodine status. This prospective observational study was designed to longitudinally follow the iodine status of pregnant women in different trimesters of pregnancy and to assess the clinical parameters and dietary influences on iodine status. A total of 209 pregnant women in their first trimester were enrolled in Taipei Veterans General Hospital, Taiwan from March 2019 to March 2023. Subjects provided a spot urine sample and completed a food frequency questionnaire at each trimester. Urinary iodine concentration (UIC) was measured by inductively coupled plasma mass spectrometry. The median UIC for the first, second and third trimester was 156.3 μg/L (Interquartile range [IQR]: 100.7-241.1), 146.2 μg/L (84.6-224.4), and 169.9 μg/L (94.4-283.5), respectively. Mild iodine deficiency was observed in the second trimester despite adequate iodine status in the first and third trimesters. Compared to the first trimester, intake of seaweed (p = 0.004, p < 0.001, respectively), fish (p < 0.001, p < 0.001, respectively), and prenatal multivitamins (p < 0.001, p < 0.001, respectively) increased in the second and third trimesters. A gradual increment in dairy product intake was also noted between each trimesters through pregnancy (p < 0.001, p = 0.004, respectively). Multivariate analysis indicated a positive association between multiparity and increased UIC in the second trimesters (multiparity vs. uniparity; adjusted odds ratio [OR]: 2.273, 95% confidence interval [CI]: 1.202-4.310). Additionally, increased prenatal multivitamin intake elevated the odds of adequate UIC in the third trimester (≥ 3 days/week vs. ≤ 1 day/week; adjusted OR: 2.890, 95% CI: 1.351-6.173). This study revealed the longitudinal changes in iodine status during pregnancy and suggested that women who regularly took prenatal multivitamins and were multiparous were more likely to have adequate iodine nutrition. Presentation: 6/2/2024

8046 Milk Provision as a Potential Intervention to Improve Iodine Status in a Pregnant Cohort in Northern Ireland (NI), UK: A Randomised Controlled Trial

Abstract Disclosure: L.R. Kayes: None. K.R. Mullan: None. J.V. Woodside: None. Iodine deficiency is the leading cause of reversible mental retardation worldwide. During pregnancy there is ∼50% increase in iodine requirement for foetal neurodevelopment. The most recently studied cohorts of pregnant women across Ireland and UK consistently demonstrated mild iodine deficiency (target median urinary iodine concentration (mUIC) ≥150 µg/L). A recent study in NI has shown that women of child-bearing age provided with three litres of cow’s milk per week had improved iodine status. We wished to explore whether a similar milk intervention might improve iodine status during pregnancy. Pregnant women were recruited at their first antenatal appointment, and all were provided with the British Dietetic Association’s iodine food fact sheet. Participants were randomised to either milk intervention, (four litres/week milk delivered weekly free of charge), or no milk delivery (control group). Patients were stratified based on use of an iodine-containing multivitamin prior to randomisation. Urine was collected at recruitment, after 12-week intervention period, in the third trimester and 6-12 weeks postnatally along with an infant urine sample when possible. A total of 55 urine samples were collected from infants. A total of 118 women were recruited. Participants had a mean age of 32 years, (range 21 - 45) with a mean BMI of 27.5 kg/m2. Mean gestational age was 12 weeks (IQR 12-13 weeks). The mUIC in the whole group women was 53.2 µg/L in the first trimester. In the control group the mUIC at the first study visit (n=59) was 93.4 µg/L (22% achieving iodine sufficiency); at the second visit (n=38), the mUIC was 158.7 µg/L with 34% achieving sufficiency. In the milk group the mUIC at the first study visit (n=59) was 82.0 µg/L with 10% achieving sufficiency (no statistical significance between groups, p=0.08); at the second visit (n=43), mUIC was 154.7 µg/L with 37% achieving sufficiency (no statistical difference between groups p=0.78). The mean change in UIC between the first and second trimesters was 44.5 and 88.1 µg/L in the control and milk arms respectively (p=0.27). In this cohort, 71.4% of women reported taking an iodine-containing multivitamin in the first trimester of pregnancy with no difference between group randomised to milk intervention (p=0.95). In the infants, mUIC was 124.1 µg/L with no statistically difference in the proportion reaching iodine sufficiency according to maternal randomisation (p=0.64) or maternal use of an iodine-containing multivitamin (p=0.95). In this cohort, there was no significant improvement in mUIC in those receiving a milk intervention. Presentation: 6/1/2024

8046 Milk Provision as a Potential Intervention to Improve Iodine Status in a Pregnant Cohort in Northern Ireland (NI), UK: A Randomised Controlled Trial

Abstract Disclosure: L.R. Kayes: None. K.R. Mullan: None. J.V. Woodside: None. Iodine deficiency is the leading cause of reversible mental retardation worldwide. During pregnancy there is ∼50% increase in iodine requirement for foetal neurodevelopment. The most recently studied cohorts of pregnant women across Ireland and UK consistently demonstrated mild iodine deficiency (target median urinary iodine concentration (mUIC) ≥150 µg/L). A recent study in NI has shown that women of child-bearing age provided with three litres of cow’s milk per week had improved iodine status. We wished to explore whether a similar milk intervention might improve iodine status during pregnancy. Pregnant women were recruited at their first antenatal appointment, and all were provided with the British Dietetic Association’s iodine food fact sheet. Participants were randomised to either milk intervention, (four litres/week milk delivered weekly free of charge), or no milk delivery (control group). Patients were stratified based on use of an iodine-containing multivitamin prior to randomisation. Urine was collected at recruitment, after 12-week intervention period, in the third trimester and 6-12 weeks postnatally along with an infant urine sample when possible. A total of 55 urine samples were collected from infants. A total of 118 women were recruited. Participants had a mean age of 32 years, (range 21 - 45) with a mean BMI of 27.5 kg/m2. Mean gestational age was 12 weeks (IQR 12-13 weeks). The mUIC in the whole group women was 53.2 µg/L in the first trimester. In the control group the mUIC at the first study visit (n=59) was 93.4 µg/L (22% achieving iodine sufficiency); at the second visit (n=38), the mUIC was 158.7 µg/L with 34% achieving sufficiency. In the milk group the mUIC at the first study visit (n=59) was 82.0 µg/L with 10% achieving sufficiency (no statistical significance between groups, p=0.08); at the second visit (n=43), mUIC was 154.7 µg/L with 37% achieving sufficiency (no statistical difference between groups p=0.78). The mean change in UIC between the first and second trimesters was 44.5 and 88.1 µg/L in the control and milk arms respectively (p=0.27). In this cohort, 71.4% of women reported taking an iodine-containing multivitamin in the first trimester of pregnancy with no difference between group randomised to milk intervention (p=0.95). In the infants, mUIC was 124.1 µg/L with no statistically difference in the proportion reaching iodine sufficiency according to maternal randomisation (p=0.64) or maternal use of an iodine-containing multivitamin (p=0.95). In this cohort, there was no significant improvement in mUIC in those receiving a milk intervention. Presentation: 6/1/2024

Micronutrient intake and status in young vegans, lacto-ovo-vegetarians, pescatarians, flexitarians, and omnivores.

Whether youth who follow plant-based diets in Nordic countries meet their dietary needs for micronutrients remains unclear. This study aims to evaluate micronutrient intake and status in Norwegian youth following vegan, lacto-ovo-vegetarian, pescatarian, flexitarian and omnivore diets. Cross-sectional design, with healthy 16-to-24-year-olds (n = 165). Participants were asked to complete a questionnaire and four 24-hour dietary recalls. Dried blood spots (DBS) and spot-urine samples were collected for analysis of methyl malonic acid (MMA) (n = 65), haemoglobin (Hb) (n = 164) and urinary iodine concentration (UIC) (n = 163). Vegans reported highest habitual supplement usage of multivitamin (58%), B12 (90%) and macroalgae consumption (32%), while flexitarians reported highest habitual usage of omega-3 supplements (56%). For daily supplement usage, vegans reported highest use of multivitamins (42%), B12 (79%), iodine (37%) and iron (63%). Increased risk of inadequate intake (energy-adjusted) were found for vitamin D (60% within lacto-ovo-vegetarians), selenium (70% within lacto-ovo-vegetarians, 65% within omnivores), and iodine (63% within vegans). Median MMA levels suggest low risk of insufficient B12 status across all groups (MMA 0.04‒0.37µmol/l) and 2% had MMA levels indicating possible B12 deficiency and 8% had elevated levels. Median Hb levels indicated low risk of anemia across all groups (≥ 12.0 females, ≥ 13.0g/dl males), though 7% had Hb values indicating risk of mild anemia and 4% risk of moderate anemia. The median UIC indicates mild iodine deficiency in all groups (UIC < 100µg/l), except vegans, who were moderately iodine deficient (UIC < 50µg/l). Our study indicated that the participating youth had low risk of inadequate intake of most micronutrients, partly due to high supplement usage. However, for iodine, vitamin D, and selenium higher risk of inadequate intake was found. UIC corroborated the low iodine intake among vegans. Thus, we suggest iodine status of youth in Norway should be monitored, especially among young fertile women who omits dietary iodine sources, until a mandatory iodine fortification program is implemented. Furthermore, we suggest that food education on how to secure sufficient nutrients from food in general should be provided to the Norwegian youth population, especially how to secure adequate intake of vitamin D, selenium and iodine.

Prevalence of high neonatal thyroid stimulating hormone levels as an indicator of iodine deficiency in the province of La Pampa: An epidemiological analysis.

Introduction. Iodine plays a key role in human metabolism, growth, and development. During pregnancy and childhood, the demand for this micronutrient increases notably. Increased neonatal thyroid stimulating hormone (nTSH) levels, defined as nTSH ≥ 5 mIU/L, are a marker of iodine deficiency in a population if its prevalence is higher than 3%. Objective. To establish the prevalence of nTSH ≥ 5 in La Pampa in the 2021-2022 period, analyze its correlation with different variables, and compare it with data from a historical cohort. Population and methods. Cross-sectional, descriptive-analytical study in a population of newborn infants born in the 5 health regions of the province of La Pampa in 2021 and 2022. Results. Of the 5778 assessed newborn infants, 9.6% had nTSH levels ≥ 5 mIU/L. It was reported that 70.4% of these measurements were done after the third day of life. No significant differences were observed in the frequency of high nTSH levels by year of birth, birth weight, or days until sample collection. A higher prevalence was observed among male infants (10.6% versus 8.5%; p = 0.007) and term infants (9.8% versus 6.6%; p = 0.02). The prevalence of high TSH levels was superior to that observed in the 2001-2002 cohort. Conclusions. The prevalence of high nTSH levels in La Pampa during 2021 and 2022 was 9.6%, suggesting the presence of mild iodine deficiency in the population of this province, higher that what had been reported 2 decades ago.

Trimester specific thyroid hormone reference range in mild iodine deficiency compared to normal iodine nutrition

Trimester specific thyroid hormone reference range in mild iodine deficiency compared to normal iodine nutrition

Exploring Salivary Iodine Concentration as a Biomarker for Iodine Status and Thyroid Nodules in Females From Different Water Iodine Areas: a Cross-sectional Study

BackgroundIt is unclear whether salivary iodine concentration (SIC) can assess iodine status in females from different water iodine regions. ObjectivesThrough a cross-sectional study, we explored the feasibility of SIC as a biomarker to assess iodine status in females and develop optimal cutoff values. MethodsA total of 1991 females were analyzed in this cross-sectional study from the coastal iodine-deficient areas (CIDAs), inland iodine-deficient areas (IIDAs), iodine-adequate areas (IAAs), iodine-excess areas (IEAs), and iodine extra-high areas (IEHAs). SIC, spot urine iodine concentration (SUIC), and daily total iodine intake (TII) were assessed, and ultrasonography was performed in all subjects. ResultsThere was a positive correlation between SIC and SUIC (r = 0.67; 95% CI: 0.64, 0.69; P < 0.001), and TII (r = 0.47; 95% CI: 0.43, 0.50; P < 0.001). The prevalence of thyroid nodules (TN) showed an upward trend with SIC increasing (Z = −2.83; P-trend = 0.005). The area under the receiver-operating characteristic (ROC) curve for SIC to assess iodine deficiency was 0.62 (95% CI: 0.60, 0.65; P < 0.001) and 0.75 (95% CI: 0.73, 0.77; P < 0.001) for iodine excess. The cutoff values were as follows: SIC < 93.32 μg/L, iodine deficiency; 93.32–224.60 μg/L, iodine adequacy; and >224.60 μg/L, iodine excess. When SIC > 224.60 μg/L, the odds ratio (OR) for UIC > 300 μg/L, excessive TII, and the prevalence of TN were 6.44, 3.68, and 1.27 (95% CI: 4.98, 8.31; 2.83, 4.79; and 1.02, 1.56, respectively; P < 0.05); when SIC < 93.32 μg/L, the OR for UIC < 100 μg/L and insufficient TII were 2.34 and 1.94 (95% CI: 1.73, 3.14 and 1.33, 2.83, respectively; P < 0.05). ConclusionsUsing SIC as a biomarker, females in CIDA exhibited mild iodine deficiency, those in IIDA and IAA demonstrated moderate iodine deficiency, and those in IEA and IEHA exhibited an excess of iodine, consistent with SUIC to assess iodine status. SIC can be used as a good biomarker to evaluate the iodine status in population.

Specific thyroid status and iode supply in pregnant women in Yakutsk city and rural locations

Insufficient iodine intake in the body of pregnant women may lead to failure of adaptive and compensatory mechanisms, development of hormonal decompensation in the form of decreased synthesis of thyroid hormones and disorders of development and formation of the child's body. The aim of the work is to evaluate the peculiarities of thyroid status and iodine supply in pregnant women of Yakutsk city and rural areas. Materials and methods. Sixty-eight pregnant women in the 2-3rd trimester of pregnancy in Yakutsk city and rural areas participated in the study. The indicator of urinary iodine excretion was used to assess the degree of iodine deficiency. The level of urinary iodine excretion (ioduria) was determined by inductively coupled argon plasma mass spectrometry. The results can be summarized a s follows: the mean urinary iodine concentration in pregnant women living in Yakutsk and in rural areas was in the range of mild iodine deficiency (59 and 84 μg/L, respectively, the differences were statistically significant at p=0.06). It was found that in rural areas the degree of iodine deficiency was less pronounced - the median urinary iodine concentration ranged from 58.5 to 126 μg/l. Conclusion. The territory of Yakutia belongs to the geochemical regions where the degree of iodine deficiency is pronounced. However, the research conducted has shown that the degree of iodine deficiency in the city of Yakutsk and in rural areas is mild. The data obtained confirm the results of research, which indicate that in conditions of iodine deficiency, adaptation mechanisms are activated in the indigenous population.

Thyroglobulin as a Sensitive Biomarker of Iodine Status in Mildly and Moderately Iodine-Deficient Pregnant Women

Pregnant women are more susceptible to iodine deficiency. However, there are limitations in existing indicators for the evaluation of iodine nutrition in pregnant women. The study aimed to explore whether thyroglobulin (Tg) can be used as a more sensitive biomarker for pregnant women with mild and moderate iodine deficiency. A repeated-measure study was conducted among 1332 pregnant women in Zhejiang Province, China. Serum and urine specimens were collected at a mean of 10, 17, and 32 weeks of pregnancy, respectively; thyroid-stimulating hormone (TSH), Tg, and urinary iodine concentrations were measured. Linear mixed effects models were used to determine the associations between interaction of iodine concentrations and increasing gestation week and TSH and Tg, where participants were divided by urinary iodine concentration (UIC). The median Tg concentration was 11.56, 11.45, and 12.43 μg/L in the first, second, and third trimesters, respectively. After controlling the covariates, the interaction effects between the iodine status and gestation week were significant for both TSH and Tg (p = 0.038 and p = 0.007, respectively). TSH increased with the week of gestation in both iodine concentration groups. Tg increased with advancing pregnancy in the iodine-deficient group whereas it did not in the iodine-sufficient group. There was no significant variation in TSH at each trimester, and Tg was higher in the iodine-deficient group than in the iodine-sufficient group. Tg may be a more sensitive iodine status biomarker than TSH for pregnant women with mild-to-moderate iodine insufficiency.

Relation between iodine nutrition and thyroid diseases in Qinghai, China.

To investigate the adult iodine nutrition and the prevalence of thyroid diseases in Qinghai Province, and analyze the correlation between iodine and thyroid diseases, so as to provide a basis for adjusting the salt iodization plan in Qinghai Province. Using cluster and stratified sampling method to select 2628 permanent residents over 18 years old in Qinghai Province for questionnaire survey, physical examination, thyroid color ultrasound, and laboratory index detection. 1. The coverage of iodized salt in adults is 99.71%. 2. The detection rates of thyroid disorders in adults were as follows: Clinical hyperthyroidism was 1.20%, subclinical hyperthyroidism was 0.20%, clinical hypothyroidism was 1.00%, subclinical hypothyroidism was 29.20%, and the goiter was 2.10%. The percentages positivity of TPO Ab, TG Ab, goiter was 9.80%, 9.20%, 2.10%, respectively. Among them single thyroid nodule was 6.40%, multi-nodule thyroid gland was 1.80%. 3. The percentages of mild iodine deficiency, moderate iodine deficiency, Severe iodine deficiency, adequate iodine intake (AI), more than adequate iodine intake (MAI)and excessive iodine intake (EI)were 8.41%, 2.17%, 0.26%, 33.22%, 28.35%, and 27.59%, respectively. The percentages of mild, moderate and severe iodine deficiency in urban populations (7.13%, 0.87%, 0.0%) were significantly lower than those in rural populations (9.81%, 3.59%, 0.56%) (P < 0.05), and the rates of adequate, more than adequate iodine intake in urban populations (36.03%, 30.93%) were significantly higher than that in rural populations (30.14%, 25.52%). The rate of excess iodine intake was higher in rural areas (30.38%) than in urban areas (25.04%). 4. The positive rates of subclinical hypothyroidism, goiter, TPO Ab and TG Ab in female adults (35.28%, 3.39%, 13.54%, 13.94%) were higher than those in male adults (23.58%, 0.96%, 6.266%, 4.79%). The detection rate of single thyroid nodules was higher in urban (8.01%) than rural populations (4.70%), while the detection rate of hypothyroidism, subclinical hypothyroidism, and goiter (0.58%, 25.84%, 1.38%) was lower than that in rural populations (1.52%, 32.96%, 2.96%) (P<0.05). 5. There was no statistical significance in the detection rates of clinical hyperthyroidism, subclinical hypothyroidism, subclinical hypothyroidism, goiter, thyroid nodules, TPO Ab and TG Ab positive rates in different iodine nutritional status (P>0.05). The positive rate of hypothyroidism in the iodine deficiency group is higher than in other iodine nutrition groups. The nutritional status of iodine in Qinghai Province is iodine excess. Subclinical hypothyroidism was detected at a high rate. Subclinical hypothyroidism, goiter, TPO Ab, and TG Ab were more common in female than in male. The proportion of mild, moderate, and severe iodine deficiency was higher in urban areas than in rural areas. The detection rate of thyroid nodules was higher in urban than in rural areas, and that of hypothyroidism, subclinical hypothyroidism, and goiter was lower than that in rural populations. The detection rate of clinical hypothyroidism was statistically significant in different iodine nutritional states (P< 0.05).

Prevalence of goitre and iodine deficiency among school children (6-12 years) in rural areas of North Karnataka, India: A cross-sectional survey, 2016-19.

Iodine deficiency disorders (IDD) have remained an unresolved public health problem in India. In this survey, we have estimated the prevalence of IDD among 6-12 years of school children in rural areas of north Karnataka, India and estimated the prevalence of low iodine content (<15 ppm) in salt at the household level and urine iodine excretion in this population. In this cross-sectional survey, we recruited 16,827 children between 6 and 12 years of age through multistage sampling from six districts. Goitre was examined clinically for all children. Household-level salt iodine estimation and urinary iodine estimation were carried out among a subset of the participants. Overall prevalence of goitre was 17.1% (95% CI: 16.5, 17.7). Out of this, 76.7% (n = 2116) had Grade-1 goitre, and 23.7% (n = 656) had Grade-2 goitre. The prevalence of goitre was higher among females (17.9%, vs. male 16.4%, P < 0.05). The prevalence of low iodine content (<15 ppm) in salt was 48.5% (95%CI: 46.7, 50.3). The overall median iodine excretion in urine was 85 μg/L (IQR: 60-150 μg/L). In total, 37.2% (n = 601) had mild iodine deficiency, 5.2% (n = 84) had moderate deficiency, and 10.1% (n = 163) had severe deficiency. All parameters showed high inter- and intradistrict variations. North Karnataka has a high goitre prevalence. Low use of iodized salt can be a major reason for the high prevalence of the condition. Ensuring the availability of iodized salt in this region and periodic surveillance to measure the impact of the programme should be the priority in this region.

An update: maternal iodine supplementation, thyroid function tests, and child neurodevelopmental outcomes.

The impact of maternal iodine supplementation (MIS) during pregnancy on thyroid function and child neurodevelopmental outcomes in areas of mild-to-moderate iodine deficiency (MMID) remains unclear. Despite growing success of salt iodization programs, a 2022 meta-analysis found that 53% of pregnant patients worldwide continue to have insufficient iodine intake during pregnancy. A 2021 randomized controlled trial (RCT) found that MIS in women with mild iodine deficiency led to iodine sufficiency and positive effects on maternal thyroglobulin. A 2021 cohort study of MIS initiated prior to pregnancy was associated with lower thyroid-stimulating hormone (TSH), higher FT3, and FT4. Other cohort studies, however, found that neither salt iodization nor MIS were adequate to meet pregnancy iodine needs. Data have been mixed regarding maternal iodine status and pregnancy outcomes in patients of MMID. Meta-analyses have not shown any clear benefit on infant neurocognitive outcomes with MIS of MMID patients. A 2023 meta-analysis found that the prevalence of excess iodine intake in pregnancy was 52%. MMID continues to exist during pregnancy. Salt iodization alone may be insufficient to ensure adequate iodine status during pregnancy. There is an absence of high-quality data to support routine MIS in areas of MMID. However, patients with specialized diets (vegan, nondairy, no seafood, noniodized salt, and so on) may be at risk for inadequate iodine status in pregnancy. Excess iodine intake can be detrimental to the fetus and should be avoided during pregnancy.

Trimester-specific reference intervals for thyroid function parameters in pregnant Caucasian women using Roche platforms: a prospective study

BackgroundStandard thyroid function parameters reference intervals (RI) are unsuitable during pregnancy, potentially resulting in incongruous treatments that may cause adverse effects on pregnancy outcomes. We aimed at defining trimester-specific TSH, FT4 and FT3 RI, using samples longitudinally collected from healthy Caucasian women.Materials and methodsBlood samples from 150 healthy Caucasian women, who had a physiological gestation and a healthy newborn at term, were collected in each trimester and at around six months post-partum. They showed mild iodine deficiency. After excluding women with overt TSH abnormalities (> 10 mU/L) and/or TPO antibodies, data from 139 pregnant women were analyzed by means of widely used Roche platforms, and TSH, FT4 and FT3 trimester-specific RI were calculated. Post-partum data were available for 55 subjects.ResultsSerum TSH RI were 0.34–3.81 mU/L in the first trimester, and changed slightly to 0.68–4.07 U/L and 0.63–4.00 mU/L in the second and third trimester, respectively. Conversely, both FT4 and FT3 concentrations progressively decreased during pregnancy, the median values in the third trimester being 14.8% and 13.2% lower, respectively, than in the first trimester. Thyroid function parameters in the first trimester were similar to those measured after the end of pregnancy.ConclusionsThis study calculates trimester-specific RI for thyroid function parameters in pregnancy, and proposes the reference limits that should be adopted when using Roche platforms in Caucasian women.

Course of pregnancy and childbirth in women with primary hypothyroidism

Introduction. Primary hypothyroidism is observed in women of reproductive age in 2–3 % of cases. The most common thyroid pathology during pregnancy is subclinical hypothyroidism (SHT), which is caused by newly diagnosed autoimmune thyroiditis (AIT) or severe iodine deficiency. In some regions of the Russian Federation, the population has a mild iodine deficiency, the average concentration of iodine in the urine being found at 78 µg/L (the normal range is 100–200 µg/L). In women with primary hypothyroidism, complications of pregnancy and childbirth include: premature birth, weakness of labor, eclampsia, premature rupture of premature rupture of membranes (PROM), gestational diabetes mellitus (GDM), intrauterine growth retardation syndrome, fetal macrosomia, congenital hypothyroidism in the fetus, etc.Aim: to study the features of pregnancy and childbirth course in women with primary hypothyroidism.Materials and Methods. In a retrospective study, there were analyzed 62 birth histories, of which 37 were for patients with thyroid diseases. Two groups were formed: the main group – 25 patients with primary hypothyroidism, the comparison group – 25 patients without thyroid pathology. During the study, the next parameters were analyzed: age, number of pregnancies, number of births, term of delivery, body mass index, level of thyroid stimulating hormone (TSH), titer of thyroid peroxidase antibodies, newborn body weight, newborn assessment according to Apgar scale.Results. In the main group, the cause of primary hypothyroidism was as follows: newly diagnosed SHT – in 18 (48.6 %), AIT – in 7 (18.9 %) pregnant women. In the first trimester of pregnancy, TSH level in patients with hypothyroidism was 3.06 ± 0.36 mU/L. The following complications of pregnancy and childbirth course were identified: GDM (32.0 %), anemia of the first degree (12.0 %), large fetus (12.0 %), PROM (12.0 %), perineal rupture of the first degree (16.0 %), anomalies of labor activity with ineffective labor stimulation (8.0 %), pelvic-head disproportion (8.0 %).Conclusion. Timely diagnosis and compensation of hypothyroidism with hormone replacement therapy and iodine preparations, prediction of possible complications and correction of identified complications are the main ways to achieve a successful outcome of pregnancy and childbirth for mother and fetus.

Оценка йодной обеспеченности детей-вегетарианцев

Objective. To study the iodine supply of children on a vegetarian diet and to evaluate the effectiveness of iodized salt for the prevention of iodine deficiency. Methods. 65 vegetarian children( from 7 to 11 years) were examined. The control group included 40 healthy children of the same age which had no any dietary restrictions. All children lived in the Donetsk Republic. The study of iodine supply was carried out by determining the median of ioduria in the group. Taking into account the identified changes in the iodine supply of children of the surveyed groups, we prescribed them the prevention of iodine deficiency using iodised salt. The effectiveness was evaluated in 6 months. Results. In the main group, the median iodine was 68.4 μg/L, which is mild iodine deficiency. At the same time, 33.9% of children of the main group had a level of ioduria &lt;50 μg / l. In the control group, the median iodine was 97.1 μg/L. Ioduria &lt;50 μg/L had 25.0% of children. In 6 months from the beginning of iodised salt use in the main group, the median iodine was 107.8 μg/L, which is normal iodine supply, and the proportion of children with an iodine concentration in the urine &lt;50 μg/L was 16.9%. In turn, in the control group, after preventive use, the median iodine was 122.5 μg/L, and the proportion of children with ioduria &lt;50 μg/L decreased to 12.5%. Conclusion. The children living in the Donbass have a mild iodine deficiency. Vegetarianism without the use of iodised salt leads to an even more pronounced iodine deficiency. The received data allows to consider that vegetarian children have a risk of iodine deficiency. Regular iodized salt use is an effective prevention of iodine deficiency not only in traditionally fed children, but also in vegetarian children. Key words: vegetarianism, iodine, iodine deficiency, children, iodised salt

Neurocognitive functions and some electroencephalographic changes in preadolescent children with different degrees of primary hypothyroidism and mild iodine deficiency

Neurologic and electrophysiologic changes in children with mild hypothyreosis andeuthyroidgoiteratthebackgroundofmildIDarenotwellunderstoodand euthyroid goiter at the background of mild ID are not well understood atpresent.Ourgoalwastoevaluateofsomecognitivedisturbancesandal-at present. Our goal was to evaluate of some cognitive disturbances and al-terationofsomeEEGparametersinpreadolescentchildrenatearlystagesofteration of some EEG parameters in preadolescent children at early stages of thedevelopmentofprimaryhypothyreosisandeuthyroidgoiter.55somaticallythe development of primary hypothyreosis and euthyroid goiter. 55 somatically healthypreadolescentchildren,aged8-12yearswiththe1healthy preadolescent children, aged 8-12 years with the 1ststdegreeofdiffuse degree of diffuse goiterunderwentclinicalandneurologicalinvestigationofcognitivefunctions:goiter underwent clinical and neurological investigation of cognitive functions: ”copycopy”,, ”timetocopytime to copy”and and ”recognitionrecognition”usingReyComplexFigureTestand using Rey Complex Figure Test and recognitiontrialaswellasRochesterfatigueDiarytest;MotorFatigueindex,recognition trial as well as Rochester fatigue Diary test; Motor Fatigue index, PASAT–3(secondversion)andlassitudewasevaluated.Digital21channeledPASAT – 3 (second version) and lassitude was evaluated. Digital 21 channeled EEGstudywasalsoperformed.Studygroupswererandomizedto:childrenEEG study was also performed. Study groups were randomized to: children withovertmildhypothyreosis;childrenwithsubclinicalhypothyreosis;euthyroidwith overt mild hypothyreosis; children with subclinical hypothyreosis; euthyroid children;healthycontrols.MedianaofUIE64wasinthelower3children; healthy controls. Mediana of UIE 64 was in the lower 3rdrdintherange in the range formildID.Childrenofthestudygroupmoreoftenhadnon-specificneurolog-for mild ID. Children of the study group more often had non-specifi c neurolog-icsymptoms.Allindicesofneurocognitivedysfunctionweremorefrequentinic symptoms. All indices of neurocognitive dysfunction were more frequent in patients with overt hypothyreosis (P&lt;0,001) and in lesser extent were present in subclinicalhypothyreosisandeuthyroidgoiter,comparedtocontrols.Thiswassubclinical hypothyreosis and euthyroid goiter, compared to controls. This was accompaniedbythechangesofEEGparameters.Thepathologicvisualversionaccompanied by the changes of EEG parameters. The pathologic visual version ofEEGhad90%ofchildrenwithoverthypothyreosis.Inturnedoutthatinof EEG had 90% of children with overt hypothyreosis. In turned out that in prepubertalchildrenisaccompaniedbycognitivedisordersrepresentedbyMildprepubertal children is accompanied by cognitive disorders represented by Mild CognitiveImpairment;amongneurologicsubclinicalsignsofmanifestationofCognitive Impairment; among neurologic subclinical signs of manifestation of IDtheFatiguetestisofgreatsensitivity;evenmildIDischaracterizedbyspe-ID the Fatigue test is of great sensitivity; even mild ID is characterized by spe-cificchangesofthefrequencyandamplitudeofphysiologicspectrumofEEGcifi c changes of the frequency and amplitude of physiologic spectrum of EEG activity,mainlyofaA;pathologicconsequencesofIDaremanifestedbothinactivity, mainly of aA; pathologic consequences of ID are manifested both in overtandsubclinicalhypothyroidismandinlesserextentinpatientswitheuthy-overt and subclinical hypothyroidism and in lesser extent in patients with euthyroid goiter.

Reference intervals of thyroidstimulating hormone in pregnant women living in the central regions of the Russian Federation

Pregnancy is a condition with important structural and physiological changes in the thyroid gland. In this regard, experts of thyroid associations have recommended developing specific reference intervals taking into account the natural and socio-geographical characteristics of the region under study. To conduct an epidemiological analysis and evaluate TSH reference intervals in pregnant women living in the central regions of the Russian Federation with mild iodine deficiency. We have conducted the observational multicenter cross-sectional study included 2008 healthy pregnant women at different trimesters of pregnancy, from three regions of the Russian Federation (Moscow, Ivanovo and Smolensk). We assessed the level of thyroid-stimulating hormone, antibodies to thyroid peroxidase, antibodies to serum thyroglobulin, the level of iodine concentration in the morning portion of urine (cerium arsenic method) and we have conducted a questionnaire (date birth and gestational age). Women with elevated titers of anti-TPO and/or anti-TG antibodies were excluded from the study (245 women). As a result, we assessed high and medium levels of TSH and its overestimation with iodine sufficiency in pregnant women. The results are presented using the calculation of 2.5 and 97.5 percentiles. We confirmed the presence of iodine deficiency in the study areas. The median concentration of iodine in the urine was: in Moscow 106 μg/l, in Ivanovo 119 μg/l, in Smolensk 134 μg/l. Pregnant women were divided into 2 groups according to iodine adequacy. In the group with optimal iodine supply, the level of TSH was 0,006-3,36 in the 1st trimester, 0,20-3,74 in the 2nd trimester, and 0,33-3,68 mIU/L in the 3rd trimester. In the group with mild iodine deficiency - in the 1st trimester it was 0,11-3,00, in the 2nd trimester 0,22-3,78, in the 3rd trimester 0,07-3,04 mIU/l. Statistical analysis of the data revealed that when comparing the level of TSH by trimester, depending on the place of residence, no statistical difference was found (p = 0,239). We obtained that the level of TSH in healthy pregnant women living in the central regions of the Russian Federation does not exceed 3.8 mIU/l in all trimesters.

Assessing the trend of iodine deficiency among antenatal patients of the university of Port Harcourt teaching hospital

Background: Iodine deficiency is a global health problem of public health significance; it is the leading cause of preventable neurodevelopmental impairment in children globally. This deficiency can occur in pregnancy leading to various degree of morbidity. Aims and objective: This study was aimed at determining the pattern and severity of iodine deficiency amongst pregnant women in the University of Port Harcourt Teaching Hospital. Methodology: This study was a hospital-based cross-sectional comparative study that measured the urinary iodine concentration in two subgroups of the population; pregnant women and non- pregnant women of reproductive age. Structured questionnaires were administered to and urine samples were obtained from the participants. The urinary iodine concentration was measured using the Sandell-Kolthoff reaction. The data from the structured questionnaire was entered into a spreadsheet and analyzed using the statistical package for social sciences 25.0 software package (IBM, Armonk, NY, USA). Results: The mean age for the pregnant study group was 32.15±5.2, the median and modal age was 31 years, with a range of 23 to 43 years. Mild iodine deficiency was seen in 57.1% of the non-pregnant respondents and 34.4% of the pregnant respondents. Moderate iodine deficiency was seen in 42.9% of non-pregnant respondents and 56.2% of pregnant respondents. Severe Iodine deficiency was observed only among the pregnant respondents (9.4%) The median urinary iodine concentration (Median UIC) among pregnant women was 42.87ug/l, while the median UIC among non-pregnant women was 52.33ug/l. A Mann-Whitney U test indicated that this difference was statistically significant, U (NPregnant=66, Nnon-pregnant =63) =1234.5, z= -3.98, p≤ 0.001). Conclusion: This study found that iodine deficiency was prevalent among women in the study population (pregnant and non-pregnant women), however, it was more severe in pregnant women. Based on the results of our study there is an urgent need for iodine supplementation in our pregnant women.

The Magnitude of Hidden Hunger and Cognitive Deficits among Children Living in Orphanages in Kumasi, Ghana

This study assessed the magnitude of hidden hunger (micronutrient deficiencies) and cognitive deficits of 130 school-aged children (6–13 years old) living in three selected orphanages in Kumasi, Ghana. Sociodemographic data assessment, anthropometric assessment (BMI for age and height for age), dietary assessment (3-day repeated 24-hour dietary recall), urinary iodine level assessment, and cognitive performance assessment (Raven’s Coloured Progressive Matrices) were performed. Boys formed 50.8% of the study population, while girls formed 49.2%. The median age of participants was 10.50 years. About 12.3%, 7%, and 10.0% of participants were stunted, thin, and overweight/obese, respectively. The prevalence of mild iodine deficiency (i.e., 50–99 μg/L) was 16.2%. Iodine deficiency was significantly higher (23.6%) in participants who had lived for at least 7 years in the orphanage compared to those who had lived less than 7 years (10.7%) ( p = 0.047 ). About 17% of the participants performed poorly (&lt;50%) on the cognition test. Mean cognition test scores were significantly different among the orphanages ( p = 0.027 ). The majority of participants, 89.2%, 54.6%, 76.9%, and 77.7%, had adequate intake of iron, zinc, vitamin C, and folate, respectively, whereas intake of vitamins A and B12 was inadequate for the majority of participants (90.8% and 50.8%, respectively). There was no significant correlation between micronutrient intake and cognitive performance. However, mean cognition test scores were significantly different between participants with adequate and inadequate iron and vitamin A intake ( p = 0.007 and p &lt; 0.001 , respectively). The findings of this study warrant a closer look at nutritional intakes in orphanages to improve hidden hunger and cognitive performance.