Familial Aggregation of Endemic Congenital Hypothyroidism Syndrome in Congo (DR): Historical Data

Familial aggregation of endemic congenital hypothyroidism (CH) in an iodine-deficient population from northern Congo (Democratic Republic (DR)) was analysed on data collected four decades ago (1979–1980). During a systematic survey of 62 families, 46 endemic CH subjects (44 myxedematous and 2 neurological) were identified based on clinical evidence within a village cohort of 468 subjects. A distribution analysis showed that two families presented significant excess of cases versus a random background distribution. Both families were characterised by two healthy parents having all of their five offspring affected by some form of endemic CH. Goitre prevalence in endemic CH was lower than that in the general population, while goitre prevalence in the unaffected part of the cohort (parents and siblings) was similar to that of the general population. Some unidentified genetic/epigenetic factor(s) could contribute to the evolution of some iodine-deficient hypothyroid neonates through irreversible and progressive loss of thyroid functional capacity during early childhood (<5 years old). Besides severe iodine deficiency, environmental exposure to thiocyanate overload and selenium deficiency, factors not randomly distributed within families and population, intervened in the full expression of endemic CH. Further exploration in the field will remain open, as iodine deficiency in Congo (DR) was eliminated in the 1990s.

Stable Iodine Nutrition During Two Decades of Continuous Universal Salt Iodisation in Sri Lanka

Universal salt iodisation (USI) was introduced in Sri Lanka in 1995. Since then, four national iodine surveys have assessed the iodine nutrition status of the population. We retrospectively reviewed median urine iodine concentration (mUIC) and goitre prevalence in 16,910 schoolchildren (6–12 years) in all nine provinces of Sri Lanka, the mUIC of pregnant women, drinking-water iodine level, and the percentage of households consuming adequately (15 mg/kg) iodised salt (household salt iodine, HHIS). The mUIC of schoolchildren increased from 145.3 µg/L (interquartile range (IQR) = 84.6–240.4) in 2000 to 232.5 µg/L (IQR = 159.3–315.8) in 2016, but stayed within recommended levels. Some regional variability in mUIC was observed (178.8 and 297.3 µg/L in 2016). There was positive association between mUIC in schoolchildren and water iodine concentration. Goitre prevalence to palpation was a significantly reduced from 18.6% to 2.1% (p < 0.05). In pregnant women, median UIC increased in each trimester (102.3 (61.7–147.1); 217.5 (115.6–313.0); 273.1 (228.9–337.6) µg/L (p = 0.000)). We conclude that the introduction and maintenance of a continuous and consistent USI programme has been a success in Sri Lanka. In order to sustain the programme, it is important to retain monitoring of iodine status while tracking salt-consumption patterns to adjust the recommended iodine content of edible salt.

MON-100 Prevalence of Goitre and Thyroid Disorders in Healthy School Children of Kashmir Valley. A Multistage Cross-Sectional Survey

Background There has been a gradual transition among pattern and prevalence of thyroid dysfunctions among paediatric population post iodisation phase making it imperative to look into it with periodic surveys. Objective To comprehend the existent thyroid disease burden along with goitre prevalence in healthy paediatric population of Kashmir Valley. Design It was a cross sectional survey including 666 healthy school children of Kashmir valley of the age 6-18 years out of which 421 were girls and 245 were boys. Goitre was graded as per WHO grading system. Thyroid function test (TFT-TSH, TT4, TT3) were measured in all study subjects. Urinary iodine excretion UIE was measured in 40 subsampled children. Results The overall prevalence of thyroid dysfunction (goiter and or abnormal TFT) among children was 7.8% (CI 5.9-10.1%) with a prevalence of 9.3% in females (CI 2.9-8.9%) and 5.3% (CI 6.7-12.4%) in males. The overall prevalence of goitre was 2.4% with a significant difference observed in boys and girls as all 16 children with goitre were girls. UIE ranged from 71 to 558ug/gm of creatinine (median,150). TFT results were available in 563 children with abnormal results observed in 6.6% (n=37) subjects. Most common TFT abnormality was subclinical hypothyroidism (SCH) with total of 4.3% while 1.6% subjects had overt hypothyroidism and 0.7% had subclinical thyrotoxicosis. Children with subclinical disease were observed and those with overt hypothyroidism were treated accordingly. Conclusions Total goitre prevalence has decreased in Kashmir Valley post iodisation and continues to decrease further when we compared with previous prevalence study by Masoodi et al 2013*. However, there is a need for periodic large-scale cross-sectional surveys to know the thyroid status of our population. The most frequent thyroid function abnormality in our survey was SCH which needs judicious management as treating these children strain out stretched health resources. *Masoodi S R et al. Goitre and urinary iodine excretion survey in schoolchildren of Kashmir Valley. Clin Endocrinol (Oxf) 2014;80(1):141–7.

Goitre Prevalence and Urinary Iodine Concentration in School-Aged Children in the Ashanti Region of Ghana

Background. Iodine deficiency is a public health problem. The universal salt iodization (USI) program is the main, simple, and cost-effective intervention strategy to control iodine deficiency. The study examined the iodine status in school-aged children in Ashanti region, Ghana, using thyroid volumes along with urinary iodine concentrations, the methods recommended by the WHO/ICCIDD for monitoring the sustained impact of USI programs. Methods. This cross-sectional study was conducted among school-aged children (6–12 years) from randomly selected schools in the central and northern part of the Ashanti region, Kumasi Metropolis, and Ejura-Sekyedumase Municipality, respectively. A total of 852 children were enrolled in the study. Thyroid volume and urinary iodine concentrations of the children were determined using the standardized methods recommended by WHO/ICCIDD. Anthropometric measurements were also evaluated. Results. The mean values of thyroid volume in female and male school-aged children were 3.53 ± 0.09 and 3.32 ± 0.07, respectively. The thyroid size was significantly associated with age (P<0.0001), weight (P<0.0001), height (P<0.0001), BMI (P<0.05), and BSA (P<0.0001) by Pearson’s correlation in both males and females. The P50 (median) thyroid volumes of school children investigated in this study were generally larger compared to the WHO/ICCIDD reference data by age and body surface area. The median value of urinary iodine concentration was 201.85 μg/L, which showed significant sex difference (P value <0.0001). Excessive iodine nutrition (≥300 μg/L) was observed among 34.4% of male children and 27.6% of female children. Also, 12.8% of the male and 19.5% of the female children had UIC below requirement (<100 μg/L). The criteria of thyroid volume per age yielded a goitre prevalence of 2.2%. In contrast, the criteria of thyroid volume by body surface area yielded a goitre prevalence of 0.9%. Conclusion. The study clearly indicated that adequate iodine nutrition exists generally among the school children. However, insufficient and excessive iodine intakes still persist among some of the children. The establishment of local reference values for thyroid volume that might be applicable to precisely define goitre prevalence in the Ghanaian context is highly recommended.

Assessment of goitre among primary school children in district Chamba, Himachal Pradesh, India

Background: Goiter is one of the most visible manifestations of iodine deficiency disorders (IDD) that is caused due to overstimulation of thyroid as an adaptation to Iodine deficiency. IDD is among the major public health threats and important micronutrient deficiencies in developing countries.Methods: This cross-sectional study was conducted among 6-12 years school children in district Chamba of Himachal Pradesh from February to June 2019. The sample size of 336 was calculated and a total of 504 children from government schools were enrolled in the study. The assessment of goitre was done clinically by inspection and palpation of thyroid gland.Results: In this study, 504 school aged children of 6-12 yrs from district Chamba with mean age of 9±1.86 years were included. The prevalence of total goitre rate was 16% with mean age of 8.75±1.37 years. The highest prevalence (%) was observed in age of 10 years (28.4%) followed by 8 years and 9 years (25.9 % and 23.5% respectively).Conclusions: This study showed mild goitre prevalence in school aged children of 6-12 years in district Chamba of Himachal Pradesh. There is dire need of periodic survey to assess the magnitude of IDD in future.

Is iodine deficiency still a problem in sub-Saharan Africa?: a review

Iodine is an essential trace mineral, vital for its functions in many physiological processes in the human body. Both iodine deficiency (ID) and excess are associated with adverse health effects; ID and excess iodine intake have both been identified in sub-Saharan Africa (SSA). The review aims to (1) review the iodine status among populations in SSA until October 2018, and (2) identify populations at risk of excess or inadequate iodine intakes. A systematic search of relevant articles was carried out by a seven-member research team using PubMed, Science Direct and Scopus. A total of twenty-two articles was included for data extraction. Of the articles reviewed, the majority sought to determine the prevalence of iodine status of the study populations; others measured the impact of uncontrolled and unmonitored salt iodisation on iodine excess and tested the effectiveness of water iodisation. Although iodine status varied largely in study populations, ID and excessive iodine intake often coexisted within populations. The implementation of nutrition interventions and other strategies across SSA has resulted in the reduction of goitre prevalence. Even so, goitre prevalence remains high in many populations. Improvements in access to iodised salt and awareness of its importance are needed. The emerging problem of excess iodine intakes, however, should be taken into consideration by policy makers and programme implementers. As excessive iodine intakes may have adverse health effects greater than those induced by iodine deficient diets, more population-based studies are needed to investigate iodine intakes of the different population groups.

A community based cross sectional study on prevalence of iodine deficiency disorders among 6-12 years children of a district of North Karnataka

Background: Iodine deficiency is the major preventable cause of irreversible mental retardation in the world with nearly 2 billion people with iodine deficiency disorders (IDD).In India district level surveys conducted in 2006 in 324 districts have revealed that IDD is a major public health problem in 263 districts that is total goitre prevalence rate of more than 10% in the population. Methods: The survey was conducted from November 2016 to January 2017, after obtaining permission from Institutional Ethical Committee, using population proportionate to size (PPS) sampling method among of 6-12 years children. In the selected villages, primary schools were visited and a sample of 90 children was selected and was examined after consent from school authority. Prevalence of goitre was assessed and graded by standard palpation method. In few selected children urine and house hold salts are examined. Results: The prevalence of goitre among the 6 to 12 years children was found to be 22.78%. There was not much difference in prevalence of goitre in females compared to males in all the age groups and prevalence of goitre was observed to increase with age, which was found to be statistically significant (p=0.00001). Conclusions: Prevalence of iodine deficiency is significantly high and higher prevalence was found with increasing age.

Study on Goitre In The Villages of Sirajgonj In Bangladesh

A total of 551 subjects were studied, 363 males and 188 females in some villages in Sirajgonj. The purpose of the study was to unravel the relation of goitre to intake of iodized-salt, mustard oil and cabbage. In our study the prevalence of goitre was 28.13%, in which the goitre of grade 1 and grade 2 was 21.96% and 6.17% respectively. In our study males were suffering more than the females. In this study goitre prevalence in those taking iodized salt was 28.57% and in those taking non-iodized salt was 28.05%. It is wonder to note that after more than two decades of enacting iodized salt more than 80% took non-iodized salt and even then the prevalence of goitre in the two groups were almost identical, with utter surprise goitre prevalence was more in those who took iodized salt. In this study goitre prevalence in those taking mustard oil was 28.6% and in those taking non-mustard oil was 24.14%. Goitre prevalence was much more in those who took mustard oil than those who took non-mustard oil. In this study goitre prevalence in those taking cabbage was 28.12% and in those taking non-cabbage was 28.21%.KYAMC Journal Vol. 5, No.-2, Jan 2015, Page 524-526