Knowledge and awareness of rural adults regarding endemic goitre

Knowledge and awareness related to goitre is very much important at community level for its prevention. Goitre is an iodine deficiency disease, which is in endemic in northern part of Bangladesh. This is a community based cross-sectional study conducted in rural areas of Kaharol Upzilla of Dinajpur district from January to December 2018. Data were collected by face to face interview from one adult in each of the purposively selected 377 households and a semi-structured questionnaire was used to collect data. The study result showed that mean age of the respondents was 36.85±12.36 years where most of the respondents (82.2%) were female and 42.7% were illiterate. All of the respondents (100.0%) of the present study knew that endemic goitre means visible swelling in front of the neck. The present study revealed that 24.9% knew that endemic goitre is caused by lack of iodine in diet and having adequate iodine in diet was a way to prevent endemic goitre and 69.2% knew which food contained iodine. Majority of the respondents (57.2%) new that iodized salt contains iodine. The present study revealed that 0.8% had good knowledge regarding endemic goitre, 50.1% had average knowledge regarding endemic goitre and 49.1% had poor knowledge regarding endemic goitre. Most of the respondents, (81.7%) considered iodine an important element for body and 69.5% took iodine rich food. Though, the respondents had positive awareness regarding use of iodized salt. Level of knowledge regarding endemic goitre was associated with age (p=0.001), educational status (p<0.000), occupational status (p<0.006). Community based awareness program among school children, clubs, housewife etc. may increase the knowledge on endemic goitre at community members.

Endemic goitre and hypothyroidism in an adult female patient dependent on total parenteral nutrition

Summary We present the case of a thirty-year-old female patient who was referred to the endocrinology team with an enlarging goitre and biochemical hypothyroidism. She had been dependent on total parenteral nutrition for the previous six years as a result of intestinal failure thought to be caused by possible underlying mitochondrial disease. The patient also suffers from a Desmin myopathy, and at present, the exact aetiology behind her intestinal failure is not certain. The goitre was smooth and had been enlarging slowly over the previous few months. Thyroid peroxidase antibodies were found to be within normal range. Further analysis of the case showed that twelve months earlier the patients total parenteral nutrition (TPN) feed had been altered as a result of manganese toxicity. The current feeding regimen did not contain a trace element additive which had previously supplied iodine supplementation. A little detective work established that iodine content to the TPN had been reduced, the trace element additive (Additrace) was recommenced providing 1 µmol of iodine per day, equating to 130 µg of iodine. Following this change, thyroid-stimulating hormone levels returned to normal and the goitre quickly reduced in size. We present a rare case of endemic goitre and hypothyroidism in a patient receiving inadequate iodine supplementation through total parenteral nutrition. Learning points: Endemic goitre and hypothyroidism secondary to iodine deficiency are rare in the developed world. However, the diagnosis should be considered in the setting of a diffuse goitre and negative thyroid antibodies. Although rare, endemic goitre should be considered in patients who present with hypothyroidism and who are dependent on total parenteral nutrition. Treatment with levothyroxine is not required in endemic goitre as thyroid function tests generally normalise with the addition of iodine to the diet/total parenteral nutrition regimen. Iodine supplementation at a level recommended by the European Society for Clinical Nutrition and Metabolism (ESPEN) was observed to quickly normalise this patient’s thyroid function tests.

Excessive iodine intake, water chemicals and endemic goitre in a Sudanese coastal area

ObjectiveTo study the associations between intakes of iodine and water chemicals and the thyroid gland status of schoolchildren living in the coastal city of Port Sudan.DesignIn our previous nationwide study on goitre, it was observed that the prevalence of goitre was high in Port Sudan city despite high urinary iodine excretion. A cross-sectional study including schoolchildren aged 6–12 years was designed. Measurements determined the prevalence of goitre, urinary iodine concentration and thiocyanate secretion in casual urine samples, serum levels of thyroxine, triiodothyronine, thyroid-stimulating hormone and thyroglobulin, as well as the levels of Cl–, F–, Ca2+, Mg2+and total hardness of drinking water.SubjectsSchoolchildren (n654) aged 6–12 years.SettingPort Sudan city is located at the western bank of the Red Sea. The city is surrounded by a mountainous area known as the Red Sea Hills. It is the main sea port in the Sudan, inhabited by ethnically and socio-economically heterogeneous populations.ResultsThe prevalence of goitre in Port Sudan was 34·86 % while the median urinary iodine concentration was 46·4 μg/dl. Out of thirty-one pupils from Port Sudan, twenty-four (77·42 %) were found to have urinary iodine concentration greater than 30 μg/dl and twelve (38·71 %) had different degrees of biochemical hypothyroidism. Excessive concentrations of Cl–, Ca2+, Mg2+and water hardness (369·2, 116·48, 60·21 and 539·0 mg/l, respectively) were detected in drinking water samples collected from Port Sudan that exceeded levels permitted by the WHO.ConclusionsThe coastal city of Port Sudan is a goitre-endemic area. In contrast to other Sudanese cities in which endemic goitre is related to iodine deficiency, goitre in Port Sudan is associated with iodine excess. Water chemicals seemed to have no effects on thyroid status.

Management of nontoxic multinodular goitre

Goitres can be classified according to thyroid function into toxic goitres, hypothyroid goitres, and euthyroid or nontoxic goitres (see Chapter 3.5.1). The most prevalent causes of nontoxic goitre are endemic (iodine-deficient) goitre and sporadic nontoxic goitre (diffuse or nodular). The disease entity of sporadic nontoxic goitre is defined as a benign enlargement of the thyroid gland of unknown cause, in euthyroid patients (normal serum free thyroxine (T4) and free triiodothyronine (T3) concentrations) living in an area without endemic goitre. The diagnosis is by exclusion. The prevalence of sporadic nontoxic goitre (also called simple goitre) in the adult population is high, 3.2% in the UK (see Chapter 3.1.7), and it is more common in women (5.3%) than in men (0.8%). This chapter deals predominantly with sporadic nontoxic multinodular goitre.