Iodine Deficiency and Goiter Prevalence of the Adult Population in Erzurum

It is believed that total goiter prevalence in Turkey is as high as 30.5%. The iodine deficiency is the distinct etiologic factor in the development of goiter. The aim of this study was to determine goiter prevalence and iodine deficiency in adults living in Erzurum (1659 m above sea level) for at least 10 year. The study involved 340 people (192 females, 148 males). The median age was 38.5 year (ranging from 20 to 76 years). Ultrasound-measured thyroid volume (TV) for men (TV > 25 ml) and for women (TV > 18 ml) was considered goiter indicator. By this evaluation, goiter was diagnosed in 94 (27.6 %) cases, whereas the goiter prevalence, based on the palpation method, was 5.6%. Urinary iodine concentration (UIC) was measured by ammonium persulfate method. UIC in subjects with goiter was significantly lower than that of the others (median values 5.0 vs 7.8 μg/dl, p < 0.0001). While the value of UIC ≥ 10 μg/dl (no. 121, 36.6%) was accepted normal, the extent of iodine deficiency in other subjects was classified as severe (UIC < 2.0 μg/dl, no.53, 15.6%), moderate (UIC = 2.0–4.9 μg/dl, no.75, 22%) and mild (UIC = 5.0–9.9 μg/dl, no.91, 26.8%). TV values were found to be significantly different among the four groups (p < 0.05). TV values were significantly correlated with body surface area and UIC (r = 0.15 and r = -0.16, respectively, p < 0.005). Also, the prevalence of thyroid nodules was estimated as 2.1% by palpation and 18% by ultrasonography. We conclude that goiter originating from iodine deficiency has been an important health problem in Erzurum. Besides taking measures at national level, local factors and risks which interfere with the nationwide efforts should also be dealt with for the eradication of the iodine deficiency problem. In the region, periodical evaluation of iodine level and iodine related disorders will guide the measures to be taken for the well being of people’s general health.

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Thyroid ultrasound compared with World Health Organization 1960 and 1994 palpation criteria for determination of goiter prevalence in regions of mild and severe iodine deficiency

Acta Endocrinologica ◽

10.1530/eje.0.1430727 ◽

2000 ◽

pp. 727-731 ◽

Cited By ~ 62

Author(s):

M Zimmermann ◽

A Saad ◽

S Hess ◽

T Torresani ◽

N Chaouki

Keyword(s):

Iodine Deficiency ◽

Urinary Iodine ◽

Thyroid Volume ◽

Classification Systems ◽

World Health ◽

Urinary Iodine Concentration ◽

Thyroid Ultrasound ◽

Iodine Deficiency Disorders ◽

Goiter Prevalence

OBJECTIVES: In 1994, WHO/International Council for the Control of Iodine Deficiency Disorders recommended replacing the WHO 1960 four-grade goiter classification with a simplified two-grade system. The effect of this change in criteria on the estimation of goiter prevalence in field studies is unclear. In areas of mild iodine deficiency disorders (IDD) where goiters are small, ultrasound is preferable to palpation to estimate goiter prevalence. However, in areas of moderate to severe IDD, goiter screening by palpation may be an acceptable alternative to thyroid ultrasound. To address these two issues, we compared WHO 1960 and 1994 criteria with thyroid ultrasound for determination of goiter prevalence in areas of mild and severe IDD in Morocco. DESIGN: A cross-sectional study of 400 six- to 13-year-old children from two mountain villages (Ait M'hamed and Brikcha) in rural Morocco was carried out. METHODS: Urinary iodine concentration (UI), whole blood TSH and serum thyroxine were measured. Thyroid size was graded by inspection and palpation by two examiners using both WHO 1960 and 1994 criteria. Thyroid volume was determined by ultrasound. Variation between examiners and examination methods was assessed. Sensitivity and specificity of the two classification systems compared with ultrasound were calculated. RESULTS: Median UIs in Ait M'hamed and Brikcha were 183 and 24 microg/l respectively. In Ait M'hamed, using 1960 and 1994 criteria, goiter prevalence was 21 and 26% respectively, compared with 13% by ultrasound. In Brikcha, with 1960 and 1994 criteria, goiter prevalence was 64 and 67% respectively, compared with 64% by ultrasound. Agreement between observers was better with the 1994 criteria than with the 1960 criteria in Ait M'hamed (kappa=0.53 and 0.47 respectively), while in Brikcha observer agreement was similar with the two systems (kappa=0.67). Using either the 1994 or 1960 criteria, agreement with ultrasound was only moderate in Ait M'hamed (kappa=0.41-0.44), but good in Brikcha (kappa=0.55-0.64). Overall, compared with ultrasound, sensitivity increased 3-4% using 1994 criteria, while specificity decreased 4-5%. CONCLUSIONS: The WHO 1994 criteria are simpler to use than the 1960 criteria and provide increased sensitivity with only a small reduction in specificity. Agreement between observers is better with the 1994 criteria than with the 1960 criteria, particularly in areas of mild IDD. Like the 1960 criteria, the 1994 criteria overestimate goiter prevalence in areas of mild IDD, compared with ultrasound. However, the 1994 palpation criteria provide an accurate estimate of goiter prevalence in areas of severe IDD, and may be an acceptable and affordable alternative to thyroid ultrasound in these areas.

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Assessment of the iodine nutritional status among Chinese school-aged children

Endocrine Connections ◽

10.1530/ec-19-0568 ◽

2020 ◽

Vol 9 (5) ◽

pp. 379-386

Author(s):

Ning Yao ◽

Chunbei Zhou ◽

Jun Xie ◽

Xinshu Li ◽

Qianru Zhou ◽

...

Keyword(s):

Nutritional Status ◽

Urinary Iodine ◽

Thyroid Volume ◽

Iodine Content ◽

Iodine Concentration ◽

Iodine Intake ◽

Iodized Salt ◽

Urinary Iodine Concentration ◽

School Aged Children ◽

Goiter Prevalence

Objective The remarkable success of iodine deficiency disorders (IDD) elimination in China has been achieved through a mandatory universal salt iodization (USI) program. The study aims to estimate the relationship between urinary iodine concentration (UIC) and iodine content in edible salt to assess the current iodine nutritional status of school aged children. Methods A total of 5565 students from 26 of 39 districts/counties in Chongqing participated in the study, UIC and iodine content in table salt were measured. Thyroid volumes of 3311 students were examined by ultrasound and goiter prevalence was calculated. Results The overall median UIC of students was 222 μg/L (IQR: 150-313 μg/L). Median UIC was significantly different among groups with non-iodized salt (iodine content <5 mg/kg), inadequately iodized salt (between 5 and 21 mg/kg), adequately iodized (between 21 and 39 mg/kg) and excessively iodized (>39 mg/kg) salt (P < 0.01). The total goiter rate was 1.9% (60/3111) and 6.0% (186/3111) according to Chinese national and WHO reference values, respectively. Thyroid volume and goiter prevalence were not different within the three iodine nutritional status groups (insufficient, adequate and excessive, P > 0.05). Conclusions The efficient implementation of current USI program is able to reduce the goiter prevalence in Chongqing as a low incidence of goiter in school aged children is observed in this study. The widened UIC range of 100–299 μg/L indicating sufficient iodine intake is considered safe with a slim chance of causing goiter or thyroid dysfunction. Further researches were needed to evaluate the applicability of WHO reference in goiter diagnose in Chongqing or identifying more accurate criteria of normal thyroid volume of local students in the future.

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A Household-Based Survey of Iodine Nutrition in Moroccan Children Shows Iodine Sufficiency at the National Level But Risk of Deficient Intakes in Mountainous Areas

Children ◽

10.3390/children8030240 ◽

2021 ◽

Vol 8 (3) ◽

pp. 240

Author(s):

Laila El Ammari ◽

Naima Saeid ◽

Anouar Talouizte ◽

Hasnae Gamih ◽

Salwa Labzizi ◽

...

Keyword(s):

Iodine Deficiency ◽

Rural Areas ◽

Economic Status ◽

National Level ◽

Urinary Iodine ◽

Iodine Concentration ◽

Urinary Iodine Concentration ◽

Iodine Nutrition ◽

Salt Iodization ◽

Moroccan Children

Historically, mountainous areas of Morocco have been affected by endemic goiter and severe iodine deficiency. In 1995, Morocco legislated salt iodization to reduce iodine deficiency. There has been no national survey of iodine nutrition in school-age children for nearly 3 decades. Our aim was to assess iodine nutrition in a national sample of 6–12-year-old children in Morocco to inform the national salt iodization strategy. In this cross-sectional household-based survey, we randomly recruited healthy 6–12-year-old children from 180 clusters in four geographic zones (north and east, central, north and south) covering the 12 regions of Morocco. A questionnaire was completed, including socio-economic status and parental level of education. In addition, anthropometric measurements were taken to assess nutrition status, and a spot urine sample was collected to measure urinary iodine concentration (UIC). A total of 3118 households were surveyed, and 1043 eligible children were recruited, 56% from urban areas and 44% from rural areas. At the national level, the percentage of surveyed samples with UIC < 50 μg/L was 21.6% (19.2%; 24.2%), which exceeds the WHO suggestion of no more than 20% of samples below 50 μg/L, despite an adequate level of median urinary iodine concentration (mUIC) at 117.4 µg/L (110.2; 123.3). There were no statistically significant differences in mUIC comparing urban vs. rural areas and socio-economic status. However, the mUIC was significantly lower in the central (high-altitude non-coastal) zone (p < 0.004), where the mUIC (95% CI) was deficient at 89.2 µg/L (80.8; 102.9). There was also a significant difference in the mUIC by head of household education level (p = 0.008). The mUIC in Moroccan children >100 µg/L indicates iodine sufficiency at the national level. However, the percentage of surveyed samples with UIC < 50 μg/L above suggests that a significant proportion of children remain at risk for iodine deficiency, and it appears those at greatest risk are residing in the central (high altitude non-coastal) zone. A national level mUIC value may conceal discrepancies in iodine intake among different sub-groups, including those defined by geographic region.

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Silent iodine prophylaxis in Western Europe only partly corrects iodine deficiency; the case of Belgium

Acta Endocrinologica ◽

10.1530/eje.0.1430189 ◽

2000 ◽

pp. 189-196 ◽

Cited By ~ 39

Author(s):

F Delange ◽

A Van Onderbergen ◽

W Shabana ◽

E Vandemeulebroucke ◽

F Vertongen ◽

...

Keyword(s):

Iodine Deficiency ◽

Western Europe ◽

Urinary Iodine ◽

Iodine Concentration ◽

Urinary Iodine Concentration ◽

Iodine Nutrition ◽

Iodine Prophylaxis ◽

Salt Iodization ◽

Goiter Prevalence ◽

The Status

OBJECTIVE: Belgium is one of the Western European countries in which no program of iodine-deficiency correction using iodized salt has been implemented, in spite of well-documented mild iodine deficiency. In 1995, the median urinary iodine concentration was 55 microg/l (normal: 100-200) and the prevalence of goiter was 11% (normal: below 5%) in representative samples of schoolchildren aged 6-12 years. Based on these results, the authors of the present study and others had emphasized to health professionals and to the public the necessity for iodine supplementation. The objective of this study was to evaluate as to whether these efforts had resulted in an improvement in the status of iodine nutrition. DESIGN: We performed a national survey of the status of iodine nutrition in Belgium based on the determination of thyroid volume, obtained by ultrasonography, and urinary iodine concentrations in schoolchildren. METHODS: A mobile van equipped with an ultrasound instrument, a computer and a deep-freeze visited 23 schools selected from across the country. The sample included 2855 schoolchildren (1365 boys and 1490 girls) aged 6-12 years. RESULTS: The results show a homogeneous situation in the whole country, with a median urinary iodine concentration of 80 microg/l and a goiter prevalence of 5.7%. Urinary iodine slightly decreases with age in girls and reaches a critical value of 59 microg/l at the age of 12 years, together with a goiter prevalence of 18.4%. CONCLUSION: Iodine nutrition has improved slightly in Belgium but mild iodine deficiency continues, with public-health consequences. The improvement indicates silent iodine prophylaxis, as no official salt-iodization measures have been taken. Silent iodine prophylaxis only partly corrects iodine deficiency in Western Europe. Active measures, including the implementation of a program of salt iodization, are urgently required.

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A programme of iodine supplementation using only iodised household salt is efficient--the case of Poland

Acta Endocrinologica ◽

10.1530/eje.0.1440331 ◽

2001 ◽

pp. 331-337 ◽

Cited By ~ 12

Author(s):

Z Szybinski ◽

F Delange ◽

A Lewinski ◽

J Podoba ◽

M Rybakowa ◽

...

Keyword(s):

World War Ii ◽

Iodine Deficiency ◽

Urinary Iodine ◽

Thyroid Volume ◽

Iodine Concentration ◽

Urinary Iodine Concentration ◽

Mean Values ◽

Iodine Prophylaxis ◽

Epidemiological Surveys ◽

Study Results

BACKGROUND: Iodine prophylaxis in Poland started in 1935 and has been interrupted twice: by World War II and in 1980 for economic reasons. Epidemiological surveys carried out after the Chernobyl accident in 1989 as well as in 1992/1993 and in 1994 as a 'ThyroMobil' study, revealed increased prevalence of goitre in children and adults. Ninety per cent of Poland was classified as an area of moderate iodine deficiency, and 10%, in the seaside area, as mild iodine deficiency territory. Iodine prophylaxis based on iodisation of household salt was introduced again in 1986 as a voluntary model and in 1997 as a mandatory model with 30+/-10 mg KI/kg salt. OBJECTIVE: The evaluation of the obligatory model of iodine prophylaxis in schoolchildren from the same schools in 1994 and 1999. METHODS: Thyroid volume was determined by ultrasonography. Ioduria in casual morning urine samples was measured using Sandell-Kolthoff's method, within the framework of the ThyroMobil study. RESULTS: Goitre prevalence decreased from 38.4 to 7% and urinary iodine concentration increased from 60.4 to 96.2 microg/l mean values between 1994 and 1999. In four schools the prevalence of goitre diminished below 5%. In 1999, 70% of children excreted over 60 microg I/l, and 36% over 100 microg I/l, whereas in 1994 the values were 44 and 13% respectively. CONCLUSION: The present findings indicate that iodine prophylaxis based only on iodised household salt is highly effective.

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Determination of Thyroid Volume by Ultrasonography among Schoolchildren in Philippines

International Journal of Endocrinology ◽

10.1155/2012/387971 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 11

Author(s):

Bu Kyung Kim ◽

Young Sik Choi ◽

Chul Ho Oak ◽

Yo-Han Park ◽

Jae Hyun Kim ◽

...

Keyword(s):

Iodine Deficiency ◽

Reference Data ◽

Urinary Iodine ◽

Thyroid Volume ◽

Iodine Concentration ◽

Urinary Iodine Concentration ◽

Cross Sectional ◽

Mean Values ◽

Logistic Issue ◽

Reported Data

Objective. Iodine deficiency is defined by the goiter and the urinary iodine concentration. However, a lack of local thyroid volume reference data resulted in the vague definition of goiter, especially in school-aged children. The aim of this paper was to determine the thyroid volumes by ultrasonography in schoolchildren aged 6 to 12 years living in Cagayan areas in Philippine.Methods. Cross-sectional thyroid ultrasonographic data of 158 schoolchildren aged 6–12 years from Tuguegarao and Lagum in Cagayan valley, Philippine were used. Thyroid volumes were compared based on logistic issue and urban and rural area and compared with other previously reported data.Results. The mean values of thyroid volume in Tuguerago and Lagum were2.99±1.34 mL and2.42±0.92 mL. The thyroid size was significantly in association with age (P<0.00), weight (P<0.00), height (P<0.00), and BSA (P<0.00) by Pearson’s correlation. The median thyroid volumes of schoolchildren investigated in this study were generally low compared to international reference data by age group but not by BSA.Conclusions. We propose for the first time local reference ultrasound values for thyroid volumes in 6–12 aged schoolchildren that should be used for monitoring iodine deficiency disorders.

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Assessment of iodine status among school age children and pregnant women of Belarus in 2017–2018

Clinical and experimental thyroidology ◽

10.14341/ket9732 ◽

2018 ◽

Vol 14 (3) ◽

pp. 149-155

Author(s):

Tatiana V. Mokhort ◽

Sergei V. Petrenko ◽

Boris Y. Leushev ◽

Ekaterina V. Fedorenko ◽

Natalia D. Kolomiets ◽

...

Keyword(s):

Pregnant Women ◽

Iodine Deficiency ◽

Urinary Iodine ◽

Thyroid Volume ◽

Iodine Concentration ◽

School Age Children ◽

Normative Values ◽

Urinary Iodine Concentration ◽

School Age ◽

Iodine Sufficiency

Background. Despite the measures taken by the Government of Belarus, the problem of iodine deficiency among the population remains actual. Aims. To determine iodine sufficiency in children and pregnant women living in Belarus. Materials and methods. The study included 873 schoolchildren aged 9–12 years of both sexes, of which 650 children were in regular schools, and the remaining children in boarding schools. A separate group consisted of 700 practically healthy pregnant women (during gestation from 16 to 36 weeks). Questioning, determination of urinary iodine concentration and thyroid volume with ultrasound was carried out. Results. Urine iodine median was 191 µg/L in the 873 children in 16 regions of Belarus. Thyroid volume corresponds to the normative values in children. According to the survey, 81% of households used iodized salt, constantly – 46%. Indicator of iodine sufficiency of 700 pregnant women (median urinary iodine concentration was 121 µg /l) is a non-optimal for this population group. Conclusions. Currently adequate iodine supplementation in school age children has been achieved. The prevalence of thyroid gland diseases caused by iodine deficiency in children decreased significantly. In pregnant women iodine supply is still insufficient.

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Severe Iodine Deficiency in Southern Albania

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831.73.5.347 ◽

2003 ◽

Vol 73 (5) ◽

pp. 347-350 ◽

Cited By ~ 5

Author(s):

Zimmermann ◽

Bridson ◽

Bozo ◽

Grimci ◽

Selimaj ◽

...

Keyword(s):

Iodine Deficiency ◽

Rural Schools ◽

School Children ◽

Primary Schools ◽

Regional Distribution ◽

Urinary Iodine ◽

Iodine Concentration ◽

Primary School Children ◽

Urinary Iodine Concentration ◽

Goiter Prevalence

Albania does not yet have a national program for control of iodine deficiency and there are no recent data on the severity of the iodine deficiency disorders (IDD) in the country. The aim of the present study was to assess current IDD status in southern Albania. In primary school children in urban and rural areas urinary iodine concentration (UI) and iodine concentration in salt at retail and household levels was measured. Goiter was graded by palpation and thyroid volume determined by ultrasound. Children aged 5–14 yr (n = 826) were sampled at 2 urban and 5 rural primary schools. In the 2 urban schools, the median UI was 45 mug/L, the goiter prevalence was 32%, and salt iodine levels were inadequate (< 15 mug/g) in 78% of household salt samples. In the rural schools, the median UI was 17 mug/L, the goiter prevalence was 95%, and no household salt samples were adequately iodized. Among children in the rural schools, 73% had grade 2 goiter and 20% had nodular changes detected by thyroid ultrasound. In southern Albania, school children in urban areas are moderately iodine deficient and those in rural villages are severely iodine deficient. These findings suggest that regional distribution of oral iodized oil capsules is indicated to control IDD in vulnerable groups until salt iodization is implemented.

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Iodine nutrition among the adult population of the Faroe Islands – a population-based study

British Journal Of Nutrition ◽

10.1017/s0007114521001938 ◽

2021 ◽

pp. 1-22

Author(s):

Herborg Líggjasardóttir Johannesen ◽

Gunnar Sjúrðarson Knudsen ◽

Stig Andersen ◽

Pál Weihe ◽

Anna Sofía Veyhe

Keyword(s):

Iodine Deficiency ◽

Adult Population ◽

Urinary Iodine ◽

Iodine Concentration ◽

Population Based ◽

Iodine Intake ◽

World Health ◽

Urinary Iodine Concentration ◽

Faroe Islands ◽

Iodine Nutrition

Abstract The World Health Organization recommends monitoring iodine status in all populations with median urinary iodine concentration below 100 µg/L suggesting iodine deficiency. There are no data on the iodine intake among the population of the Faroe Islands. This study aimed to provide data on iodine nutrition in a representative sample of the general adult population from the Faroe Islands. We conducted a population-based cross-sectional survey in 2011-2012 and measured iodine in urine from 491 participants (294/197 men/women) using the ceri/arsen method after alkaline ashing. Participants include around 100 subjects in each of four adult decades and included participants from both the capital city and villages. The median urinary iodine concentration was low within the recommended range 101 µg/L (range 21-1870 µg/L). No samples were in the range suggesting severe iodine deficiency, but half of the samples were in the range of just adequate or mildly insufficient iodine intake with urinary iodine concentration markedly lower in women than in men (86 versus 115 µg/L; P<0·001). Intake of fish and whale meals affected the urinary iodine concentrations. In conclusion, nearly half of the population had an iodine excretion in the range of borderline or mild iodine deficiency. The lowest iodine nutrition level among Faroese women is a concern as it may extend to pregnancy with increased demands on iodine nutrition. In addition, we found large variations and the intermittently excessive iodine intakes warrants follow-up on thyroid function in the population of the Faroe Islands.

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A survey of iodine intake and thyroid volume in Dutch schoolchildren: reference values in an iodine-sufficient area and the effect of puberty

Acta Endocrinologica ◽

10.1530/eje.0.1440595 ◽

2001 ◽

pp. 595-603 ◽

Cited By ~ 60

Author(s):

WM Wiersinga ◽

J Podoba ◽

M Srbecky ◽

M van Vessem ◽

HC van Beeren ◽

...

Keyword(s):

The Netherlands ◽

Iodine Deficiency ◽

Reference Values ◽

Dietary Habits ◽

Urinary Iodine ◽

Thyroid Volume ◽

Iodine Concentration ◽

Iodine Intake ◽

Height Velocity ◽

Urinary Iodine Concentration

BACKGROUND: Iodine deficiency and endemic goiter have been reported in the past in The Netherlands, especially in the southeast. OBJECTIVE: To evaluate iodine intake and thyroid size in Dutch schoolchildren, contrasting those living in a formerly iodine-deficient region in the east (Doetinchem) with those living in an iodine-sufficient region in the west (Amsterdam area). DESIGN: Cross-sectional survey of 937 Dutch schoolchildren aged 6--18 years, of whom 390 lived in the eastern and 547 in the western part of the country. METHODS: Thyroid size was assessed by inspection and palpation as well as by ultrasound. Iodine intake was evaluated by questionnaires on dietary habits and by measurement of urinary iodine concentration. RESULTS: Eastern and western regions were similar with respect to median urinary iodine concentration (15.7 and 15.3 microg/dl, NS, Mann-Whitney U test), goiter prevalence by inspection and palpation (0.8 and 2.6%, P=0.08, chi-squared test), and thyroid volumes. The P97.5 values of thyroid volumes per age and body surface area group were all lower than the corresponding sex-specific normative WHO reference values. Iodized salt was not used by 45.7% of households. Daily bread consumption was five slices by boys and four slices by girls. Weekly milk consumption was 3 liters by boys and 2 liters by girls. Seafish was consumed once monthly. From these figures we calculated a mean daily iodine intake of 171 microg in boys and 143 microg in girls, in good agreement with the measured median urinary concentration of 16.7 microg/dl in boys and 14.5 microg/dl in girls. The sex difference in iodine excretion is fully accounted for by an extra daily consumption of one slice of bread (20 microg I) and one-seventh of a liter of milk (8.3 microg I) by boys. Thyroid volume increases with age, but a steep increase by 41% was observed in girls between 11 and 12 years, and by 55% in boys between 13 and 14 years, coinciding with peak height velocity. Girls have a larger thyroid volume at the ages of 12 and 13 years, but thyroid volume is larger in boys as of the age of 14 years. CONCLUSIONS: (1) Iodine deficiency disorders no longer exist in The Netherlands. (2) Bread consumption remains the main source of dietary iodine in The Netherlands; the contribution of iodized table salt and seafish is limited. (3) The earlier onset of puberty in girls renders their thyroid volume larger than in boys at the age of 12--13 years, but boys have a larger thyroid volume as of the age of 14 years.

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