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Fujita N, Ono Y, Kobayashi T, Kozono S, Horiuchi Y, Sano A, Kawamura Y, Miyoshi Y, Kimata M, Sekizawa A, Hashimoto K, Obuchi Y, Tanaka Y. Iodine-containing ointment-induced hypothyroidism in a patient with anorexia nervosa and sacral decubitus ulcer: a case report with literature review. Endocr J 2022; 69:1423-1429. [PMID: 36058848 DOI: 10.1507/endocrj.ej22-0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We present a case of a 58-year-old woman with anorexia nervosa and a sacral decubitus ulcer who developed hypothyroidism because of an iodine-containing ointment. Considering the absence of autoimmune thyroid diseases, the development of hypothyroidism after the use of an iodine-containing ointment, and the recovery of thyroid function after the discontinuation of the ointment, we presumed that her hypothyroidism was induced by the iodine-containing ointment. Although the hypothyroidism improved after discontinuing the iodine-containing ointment, she developed aspiration pneumonia and required long-term hospitalization. Many patients with autoimmune thyroid diseases develop hypothyroidism after excessive iodine intake. However, anorexia nervosa may have exacerbated the iodine-induced hypothyroidism in our patient. To the best of our knowledge, no previous study has reported a case of hypothyroidism caused by iodine-containing ointment in a patient with anorexia nervosa. Hence, physicians must pay careful attention to a patient's background factors to ensure the early diagnosis of hypothyroidism due to iodine-containing ointments.
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Affiliation(s)
- Naoya Fujita
- Department of General Medicine, National Defense Medical College, Saitama 359-8513, Japan
| | - Yosuke Ono
- Department of General Medicine, National Defense Medical College, Saitama 359-8513, Japan
| | - Takahiro Kobayashi
- Department of General Medicine, National Defense Medical College, Saitama 359-8513, Japan
| | - Sawako Kozono
- Department of General Medicine, National Defense Medical College, Saitama 359-8513, Japan
| | - Yugo Horiuchi
- Department of General Medicine, National Defense Medical College, Saitama 359-8513, Japan
| | - Azusa Sano
- Department of General Medicine, National Defense Medical College, Saitama 359-8513, Japan
| | - Yusuke Kawamura
- Department of General Medicine, National Defense Medical College, Saitama 359-8513, Japan
| | - Yuka Miyoshi
- Department of General Medicine, National Defense Medical College, Saitama 359-8513, Japan
| | - Motohiro Kimata
- Department of General Medicine, National Defense Medical College, Saitama 359-8513, Japan
| | - Akinori Sekizawa
- Department of General Medicine, National Defense Medical College, Saitama 359-8513, Japan
| | - Kenichi Hashimoto
- Department of General Medicine, National Defense Medical College, Saitama 359-8513, Japan
| | - Yasuhiro Obuchi
- Department of General Medicine, National Defense Medical College, Saitama 359-8513, Japan
| | - Yuji Tanaka
- Department of General Medicine, National Defense Medical College, Saitama 359-8513, Japan
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Quantitation of Free Thyroxine by Equilibrium Dialysis and Liquid Chromatography-Tandem Mass Spectrometry. Methods Mol Biol 2022; 2546:485-492. [PMID: 36127615 DOI: 10.1007/978-1-0716-2565-1_43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
A method for free thyroxine measurement in human serum using equilibrium dialysis followed by liquid chromatography tandem mass spectrometry (LC-MS/MS) is described. Free thyroxine in serum is first separated from protein-bound thyroxine by equilibrium dialysis and then measured by LC-MS/MS.
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Okamura K, Sato K, Fujikawa M, Bandai S, Ikenoue H, Kitazono T. Iodide-sensitive Graves' hyperthyroidism and the strategy for resistant or escaped patients during potassium iodide treatment. Endocr J 2022; 69:983-997. [PMID: 35321988 DOI: 10.1507/endocrj.ej21-0436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The effectiveness of potassium iodide (KI) (100 mg/day) was evaluated in 504 untreated patients with Graves' hyperthyroidism (GD). Initial response to KI within 180 days, the effect of additional methylmercaptoimidazole (MMI) or radioactive iodine (RI) in resistant or escaped patients, and long-term prognosis were evaluated. Serum fT4 levels became low or normal in 422 patients (83.7%, KI-sensitive group) without serious side effects. Among these patients, serum TSH levels became high (n = 92, hypothyroid) or normal (n = 78) in 170 patients (33.7%) (KI-sensitive with a recovered TSH response, Group A), but remained suppressed in 252 patients (50.0%) (KI-sensitive with TSH suppression, Group B). Serum fT4 levels decreased but remained high in 82 patients (16.3%) (KI-resistant, Group C). Older patients, or those with small goiter and mild GD were more KI-sensitive with a recovered TSH response than others. Escape from KI effect occurred in 0%, 36% and 82% in Group A, B and C, respectively. Patients in Group B and C were successfully treated with additional low-dosage MMI or RI. After 2-23 years' treatment (n = 429), remission (including possible remission) and spontaneous hypothyroidism were significantly more frequent in Group A (74.3% and 11.1%, respectively,) than in Groups B (46.3% and 2.8%, respectively) or C (53.6% and 1.5%, respectively) (p < 0.0001). In conclusion, a high KI sensitivity with a recovered TSH response was observed in about a third of the patients in GD associated with a better prognosis. Additional MMI or RI therapy was effective in escaped or KI-resistant patients with suppressed TSH level.
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Affiliation(s)
- Ken Okamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Kaori Sato
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Megumi Fujikawa
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Sachiko Bandai
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Hiroshi Ikenoue
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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Rump A, Eder S, Hermann C, Lamkowski A, Kinoshita M, Yamamoto T, Take J, Abend M, Shinomiya N, Port M. Modeling principles of protective thyroid blocking. Int J Radiat Biol 2021; 98:831-842. [PMID: 34762000 DOI: 10.1080/09553002.2021.1987570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE In the case of a nuclear incident, the release of radioiodine must be expected. Radioiodine accumulates in the thyroid and by irradiation enhances the risk of cancer. Large doses of stable (non-radioactive) iodine may inhibit radioiodine accumulation and protect the thyroid ('thyroid blocking'). Protection is based on a competition at the active carrier site in the cellular membrane and an additional temporary inhibition of the organification of iodide (Wolff-Chaikoff effect). Alternatively, other agents like e.g. perchlorate that compete with iodide for the uptake into the thyrocytes may also confer thyroidal protection against radioiodine exposure.Biokinetic models for radioiodine mostly describe exchanges between compartments by first order kinetics. This leads to correct predictions only for low (radio)iodide concentrations. These models are not suited to describe the kinetics of iodine if administered at the dosages recommended for thyroid blocking and moreover does not permit to simulate either the protective competition mechanism at the membrane or the Wolff-Chaikoff effect. Models adapted for this purpose must be used. Such models may use a mathematical relation between the serum iodide concentration and a relative uptake suppression or a dependent rate constant determining total thyroidal radioiodine accumulation. Alternatively, the thyroidal uptake rate constant may be modeled as a function of the total iodine content of the gland relative to a saturation amount. Newer models integrate a carrier-mechanism described by Michalis-Menten kinetics in the membrane and in analogy to enzyme kinetics apply the rate law for monomolecular irreversible enzyme reactions with competing substrates to model the competition mechanism. An additional total iodide uptake block, independent on competition but limited in time, is used to simulate the Wolff-Chaikoff effect. CONCLUSION The selection of the best model depends on the issue to be studied. Most models cannot quantify the relative contributions of the competition mechanism at the membrane and the Wolff-Chaikoff effect. This makes it impossible or exceedingly difficult to simulate prolonged radioiodine exposure and the effect of repetitive administrations of stable iodine. The newer thyroid blocking models with a separate modeling of competition and Wolff-Chaikoff effect allow better quantitative mechanistic insights and offer the possibility to simulate complex radioiodine exposure scenarios and various protective dosage schemes of stable iodine relatively easily. Moreover, they permit to study the protective effects of other competitors at the membrane carrier site, like e.g. perchlorate, and to draw conclusions on their protective efficacy in comparison to stable iodine.
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Affiliation(s)
- Alexis Rump
- Institut für Radiobiologie der Bundeswehr, München, Germany
| | - Stefan Eder
- Institut für Radiobiologie der Bundeswehr, München, Germany
| | | | | | - Manabu Kinoshita
- Department of Immunology and Microbiology, National Defense Medical College, Tokorozawa, Japan
| | - Tetsuo Yamamoto
- NBC Countermeasure Medical Unit, Japan Ground Self Defense Force, Tokyo Japan
| | - Junya Take
- Department of Pediatrics, National Defense Medical College, Tokorozawa, Japan
| | - Michael Abend
- Institut für Radiobiologie der Bundeswehr, München, Germany
| | | | - Matthias Port
- Institut für Radiobiologie der Bundeswehr, München, Germany
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Tseng KH, Lin WJ, Chung MY, Tien DC, Stobinski L. Preparing Cuprous Iodide Nanocolloid by the Electrical Spark Discharge Method. J CLUST SCI 2021. [DOI: 10.1007/s10876-021-02127-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rump A, Eder S, Hermann C, Lamkowski A, Kinoshita M, Yamamoto T, Abend M, Shinomiya N, Port M. A comparison of thyroidal protection by iodine and perchlorate against radioiodine exposure in Caucasians and Japanese. Arch Toxicol 2021; 95:2335-2350. [PMID: 34003340 PMCID: PMC8241675 DOI: 10.1007/s00204-021-03065-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022]
Abstract
Radioactive iodine released in nuclear accidents may accumulate in the thyroid and by irradiation enhances the risk of cancer. Radioiodine uptake into the gland can be inhibited by large doses of stable iodine or perchlorate. Nutritional iodine daily intake may impact thyroid physiology, so that radiological doses absorbed by the thyroid as well as thyroid blocking efficacy may differ in Japanese with a very rich iodine diet compared to Caucasians. Based on established biokinetic-dosimetric models for the thyroid, we derived the parameters for Caucasians and Japanese to quantitatively compare the effects of radioiodine exposure and the protective efficacy of thyroid blocking by stable iodine at the officially recommended dosages (100 mg in Germany, 76 mg in Japan) or perchlorate. The maximum transport capacity for iodine uptake into the thyroid is lower in Japanese compared to Caucasians. For the same radioiodine exposure pattern, the radiological equivalent thyroid dose is substantially lower in Japanese in the absence of thyroid blocking treatments. In the case of acute radioiodine exposure, stable iodine is less potent in Japanese (ED50 = 41.6 mg) than in Caucasians (ED50 = 2.7 mg) and confers less thyroid protection at the recommended dosages because of a delayed responsiveness to iodine saturation of the gland (Wolff-Chaikoff effect). Perchlorate (ED50 = 10 mg in Caucasians) at a dose of 1000 mg has roughly the same thyroid blocking effect as 100 mg iodine in Caucasians, whereas it confers a much better protection than 76 mg iodine in Japanese. For prolonged exposures, a single dose of iodine offer substantially lower protection than after acute radioiodine exposure in both groups. Repetitive daily iodine administrations improve efficacy without reaching levels after acute radioiodine exposure and achieve only slightly better protection in Japanese than in Caucasians. However, in the case of continuous radioiodine exposure, daily doses of 1000 mg perchlorate achieve a high protective efficacy in Caucasians as well as Japanese (> 0.98). In Caucasians, iodine (100 mg) and perchlorate (1000 mg) at the recommended dosages seem alternatives in case of acute radioiodine exposure, whereas perchlorate has a higher protective efficacy in the case of longer lasting radioiodine exposures. In Japanese, considering protective efficacy, preference should be given to perchlorate in acute as well as prolonged radioiodine exposure scenarios.
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Affiliation(s)
- A Rump
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany.
| | - S Eder
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - C Hermann
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - A Lamkowski
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - M Kinoshita
- Japan Self Defense Forces National Defense Medical College Research Institute, Tokorozawa, Japan
| | - T Yamamoto
- Japan Ground Self Defense Force NBC Countermeasure Medical Unit, Tokyo, Japan
| | - M Abend
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - N Shinomiya
- Japan Self Defense Forces National Defense Medical College Research Institute, Tokorozawa, Japan
| | - M Port
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
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Abstract
Both insufficient and excessive maternal iodine consumption can result in congenital hypothyroidism. In East Asian cultures, seaweed is traditionally consumed in high quantities by peripartum women as it is thought to improve lactation. We present a case of transient congenital hypothyroidism due to maternal seaweed consumption at a daily basis during pregnancy and lactation in a Dutch family without Asian background. This case highlights that even in families of non-Asian background, high maternal intake of iodine-rich seaweed occurs and can result in transient or permanent hyperthyrotropinemia in the neonate with risk of impaired neurodevelopmental outcome if untreated.
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Affiliation(s)
- Hester Vlaardingerbroek
- Department of Pediatrics, Subdivision of Endocrinology, Willem Alexander Children's Hospital, LUMC, Leiden, The Netherlands .,Department of Pediatrics, Subdivision of Endocrinology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
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Eder S, Hermann C, Lamkowski A, Kinoshita M, Yamamoto T, Abend M, Shinomiya N, Port M, Rump A. A comparison of thyroidal protection by stable iodine or perchlorate in the case of acute or prolonged radioiodine exposure. Arch Toxicol 2020; 94:3231-3247. [PMID: 32656655 PMCID: PMC7415763 DOI: 10.1007/s00204-020-02809-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/15/2020] [Indexed: 12/14/2022]
Abstract
In the case of a nuclear power plant accident, repetitive/prolonged radioiodine release may occur. Radioiodine accumulates in the thyroid and by irradiation enhances the risk of cancer. Large doses of non-radioactive iodine may protect the thyroid by inhibiting radioiodine uptake into the gland (iodine blockade). Protection is based on a competition at the active carrier site in the cellular membrane and the Wolff-Chaikoff effect, the latter being, however, only transient (24-48 h). Perchlorate may alternatively provide protection by a carrier competition mechanism only. Perchlorate has, however, a stronger affinity to the carrier than iodide. Based on an established biokinetic-dosimetric model developed to study iodine blockade, and after its extension to describe perchlorate pharmacokinetics and the inhibition of iodine transport through the carrier, we computed the protective efficacies that can be achieved by stable iodine or perchlorate in the case of an acute or prolonged radioiodine exposure. In the case of acute radioiodine exposure, perchlorate is less potent than stable iodine considering its ED50. A dose of 100 mg stable iodine has roughly the same protective efficacy as 1000 mg perchlorate. For prolonged exposures, single doses of protective agents, whether stable iodine or perchlorate, offer substantially lower protection than after acute radioiodine exposure, and thus repetitive administrations seem necessary. In case of prolonged exposure, the higher affinity of perchlorate for the carrier in combination with the fading Wolff-Chaikoff effect of iodine confers perchlorate a higher protective efficacy compared to stable iodine. Taking into account the frequency and seriousness of adverse effects, iodine and perchlorate at equieffective dosages seem to be alternatives in case of short-term acute radioiodine exposure, whereas preference should be given to perchlorate in view of its higher protective efficacy in the case of longer lasting radioiodine exposures.
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Affiliation(s)
- Stefan Eder
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - Cornelius Hermann
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - Andreas Lamkowski
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - Manabu Kinoshita
- Japan Self Defense Forces National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Tetsuo Yamamoto
- Japan Ground Self Defense Forces Military Medicine Research Unit and Ministry of Defense Clinic, Tokyo, Japan
| | - Michael Abend
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - Nariyoshi Shinomiya
- Japan Self Defense Forces National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Matthias Port
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - Alexis Rump
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany.
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Kwon TE, Chung Y, Ha WH, Jin YW. Application of the new ICRP iodine biokinetic model for internal dosimetry in case of thyroid blocking. NUCLEAR ENGINEERING AND TECHNOLOGY 2020. [DOI: 10.1016/j.net.2020.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Eales JG. The relationship between ingested thyroid hormones, thyroid homeostasis and iodine metabolism in humans and teleost fish. Gen Comp Endocrinol 2019; 280:62-72. [PMID: 30980803 DOI: 10.1016/j.ygcen.2019.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/03/2019] [Accepted: 04/10/2019] [Indexed: 11/27/2022]
Abstract
Oral l-thyroxine (T4) therapy is used to treat human hypothyroidism but T4 fed to teleost fish does not raise plasma thyroid hormone (TH) levels nor induce growth, even though oral 3,5,3'-triiodo-l-thyronine (T3) is effective. This suggests a major difference in TH metabolism between teleosts and humans, often used as a starting thyroid model for lower vertebrates. To gain further insight on the proximate (mechanistic) and ultimate (survival value) factors underlying this difference, the several steps in TH homeostasis from intestinal TH uptake to hypothalamic-hypophyseal regulation were compared between humans and teleosts, and following dietary TH challenges. A major proximate factor limiting trout T4 uptake is a potent constitutive thiol-inhibited intestinal complete T4 deiodination that is ineffective for T3. At the hepatic level, T4 deiodination, conjugation and extensive biliary excretion with negligible T4 enterohepatic recycling can further block teleost T4 uptake to plasma. Such protection of plasma T4 from dietary T4 may be particularly critical for piscivorous fish consuming thyroid tissue, rich in T4 but not T3. It would prevent disruption by unregulated ingested T4 of the characteristic acute and transient changes in teleost plasma T4 due to diel rhythms, food intake and stress-related factors. These marked natural short-term fluctuations in teleost plasma T4 levels are enabled by the relatively small and rapidly-cleared plasma T4 pool, stemming largely from properties of the plasma T4-binding proteins. Humans, however, due mainly to plasma T4-binding globulin, have a relatively massive circulating pool of T4 and an extremely well-buffered free T4 level, consistent with the major TH role in regulating basal metabolic rate. Furthermore, this large well-buffered and slowly-cleared plasma T4 pool, in conjuction with enterohepatic recycling and relaxation of hypothalamic-hypophyseal negative feedback, allows humans to temporarily 'store' ingested T4 in plasma, thereby sparing endogenous TH secretion and conserving thyroidal iodine reserves. Indeed, iodine conservation is likely the key ultimate factor determining the divergent evolution of the human and teleost systems. For humans, ingested iodine in the form of I-, or TH and their derivatives, is the sole iodine source and may be limiting in many environments. However, most freshwater teleosts, in addition to their ability to assimilate dietary I-, can derive sufficient I- from their copious gill irrigation, with no selective advantage in absorbing dietary T4 which would disrupt their natural acute and transient changes in plasma T4. Thus T4 may act also as a vitamin (vitamone) in humans but not in teleosts; in contrast, T3, naturally ingested at much lower levels, may act as a vitamone in both humans and teleosts.
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Affiliation(s)
- J Geoffrey Eales
- Department of Biological Sciences, University of Manitoba, Winnipeg, Manitoba R3T2N2, Canada.
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Calissendorff J, Falhammar H. Lugol's solution and other iodide preparations: perspectives and research directions in Graves' disease. Endocrine 2017; 58:467-473. [PMID: 29075974 PMCID: PMC5693970 DOI: 10.1007/s12020-017-1461-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/17/2017] [Indexed: 12/03/2022]
Abstract
Lugol's solution and other preparations containing iodide have for almost a century been used as an adjuvant treatment in patients with Graves' disease planned for thyroidectomy. Iodide has been shown to decrease thyroid hormone levels and reduce blood flow within the thyroid gland. An escape phenomenon has been feared as the iodide effect has been claimed to only be temporary. Lugol's solution has many additional effects and is used in other settings beside the thyroid. Still, there are questions of its mode of action, which doses should be deployed, if it should be used preoperative in all thyroidectomies or only in a few selected ones if at all, what is its use in other forms of thyrotoxicosis besides Graves' disease, and what is the mechanism acting on the vasculature and if these effects are confined only to arterial vessels supporting the thyroid or not. This review aims to collate current available data about Lugol's solution and other iodide preparations in the management of Graves' disease and give some suggestions where more research is needed.
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Affiliation(s)
- Jan Calissendorff
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Henrik Falhammar
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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13
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Activation of the Nrf2-Keap 1 Pathway in Short-Term Iodide Excess in Thyroid in Rats. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:4383652. [PMID: 28133506 PMCID: PMC5241484 DOI: 10.1155/2017/4383652] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/29/2016] [Accepted: 11/23/2016] [Indexed: 12/21/2022]
Abstract
Wistar rats were randomly divided into groups of varying iodide intake: normal iodide; 10 times high iodide; and 100 times high iodide on Days 7, 14, and 28. Insignificant changes were observed in thyroid hormone levels (p > 0.05). Urinary iodine concentration and iodine content in the thyroid glands increased after high consumption of iodide from NI to 100 HI (p < 0.05). The urinary iodine concentration of the 100 HI group on Days 7, 14, and 28 was 60–80 times that of the NI group. The mitochondrial superoxide production and expressions of Nrf2, Srx, and Prx 3 all significantly increased, while Keap 1 significantly decreased in the 100 HI group when compared to the NI or 10 HI group on Days 7, 14, and 28 (p < 0.05). Immunofluorescence staining results showed that Nrf2 was localized in the cytoplasm in NI group. Although Nrf2 was detected in both cytoplasm and nucleus in 10 HI and 100 HI groups, a stronger positive staining was found in the nucleus. We conclude that the activation of the Nrf2-Keap 1 antioxidative defense mechanism may play a crucial role in protecting thyroid function from short-term iodide excess in rats.
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Mahapatra D, Chandra AK. Biphasic action of iodine in excess at different doses on ovary in adult rats. J Trace Elem Med Biol 2017; 39:210-220. [PMID: 27908417 DOI: 10.1016/j.jtemb.2016.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/30/2016] [Accepted: 10/18/2016] [Indexed: 12/01/2022]
Abstract
Iodine consumption in excess of its recommended levels over a prolonged period of time is well known to cause thyroid disorders. The thyroid hormones on the other hand are responsible in maintenance of the physiology of the reproductive system. Excess iodine intake affects male reproductive physiology. However, the effects of excess iodine on the ovarian structure and function is yet to be established. The present study has thus been undertaken to investigate the effect of excess iodine on the ovarian physiology. Excess iodine was administered through oral gavage in the form of potassium iodide (KI) for duration of 60days, at two different doses. The doses used were 100 EI, i.e., 100 times more than the recommended level but tolerable to the thyroid gland and 500 EI, i.e., 500 times more than the recommended level that altered thyroid physiology. The animals were divided into three groups, one control group, and the other two receiving two separate doses (100 EI and 500 EI) of excess KI. Estrous cyclical changes, ovarian morphological changes, ovarian iodine accumulation and ovarian steroidogenic enzyme activities were analysed. The thyroid functional status was studied from the serum thyroid hormones levels. The overall results revealed a biphasic action of excess iodine that depends on its dose. At 100 EI, excess iodine did not alter thyroid physiology but lead to the development of a hypoestrogenic state. There was an increased accumulation of iodine in the ovary with decreased activity of ovarian steroidogenic enzymes and lowered serum estradiol levels. However, at 500 EI, excess iodine developed a hyperthyroid condition, which further leads to a hyperestrogenic state. There was an increased activity of serum steroidogenic enzymes as well as elevated serum estradiol levels. Fertility index was zero in both the 100 EI and 500 EI treated groups of experimental animals. Thus excess iodine (100 EI) ingestion within tolerable range though maintained a euthyroid condition yet developed a state of hypofunctioning ovary. Conversely, excessive iodine (500 EI) is intolerable to thyroid, develops a hyperthyroid condition that leads to a hyperfunctioning ovary. Therefore prolonged exposure of iodine in excess exerts biphasic mode of action depending on the dose in female reproductive physiology and both the doses used in this study affected fertility equally.
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Affiliation(s)
- Dakshayani Mahapatra
- Endocrinology and Reproductive Physiology Laboratory, Department of Physiology, University of Calcutta, 92, A.P.C Road, Kolkata-700009, India
| | - Amar K Chandra
- Endocrinology and Reproductive Physiology Laboratory, Department of Physiology, University of Calcutta, 92, A.P.C Road, Kolkata-700009, India.
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Wei J, Ma D, Qiu M, Dan H, Zeng X, Jiang L, Zhou Y, Wang J, Chen Q. Medical treatments for pregnant patients with oral lichen planus. Acta Odontol Scand 2017; 75:67-72. [PMID: 27826983 DOI: 10.1080/00016357.2016.1250944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Oral lichen planus (OLP) is a common chronic inflammatory disorder that manifests as papular, reticular, or erosive lesions. OLP seriously affects a patient's quality of life, as it is associated with symptoms such as pain and a burning sensation. It is also accompanied by a risk of carcinogenic tendency. During pregnancy, the treatment will be more complicated because of the effect of medical treatment on both the mother and foetus. Thus, appropriate drugs for those pregnant patients will be more essential. This study aimed to review the safety of drugs used for the treatment of OLP during pregnancy and to establish an appropriate treatment plan for pregnant patients with OLP.
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Abstract
Iodine (I) toxicity is rare in animals and humans, but nuclear explosions that give off radioactive I and excessive stable I ingestion in parts of the world where seaweed is consumed represent specialized I toxicity concerns. Chronic overconsumption of I reduces organic binding of I by the thyroid gland, which results in hypothyroidism and goiter. Bromine can replace I on position 5 of both T3 and T4 with no loss of thyroid hormone activity. Avian work has also demonstrated that oral bromide salts can reverse the malaise and growth depressions caused by high doses of I (as KI) added as supplements to the diet. Newborn infants by virtue of having immature thyroid glands are most susceptible to I toxicity, whether of stable or radioactive origin. For the latter, the 1986 Chernobyl nuclear accident in Belarus has provided evidence that KI blockage therapy for exposed individuals 18 years of age and younger is effective in minimizing the development of thyroid cancer. Whether bromide therapy has a place in I toxicity situations remains to be determined.
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Affiliation(s)
- David H Baker
- Department of Animal Sciences and Division of Nutritional Sciences, 290 Animal Sciences Laboratory, University of Illinois, 1207 West Gregory Drive, Urbana, Illinois 61801, USA.
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Abstract
A review of thyrotoxic storm is presented. Included are causes, symptomatology, and mortality rates. Special emphasis is placed on the strong correlation between adrenergic blockade and success rates in treating thyrotoxic storm. Pharmacotherapy of the acute storm patient is discussed in detail with respect to agents that (1) decrease production of thyroid hormones; (2) block release of preformed thyroid hormones from the gland; (3) blunt the effects of excess thyroid hormones on the various target organs (e.g., CNS and heart); and (4) serve to decrease the metabolic strain on all organ systems caused by thyrotoxic storm.
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Martinovich NN, Abzianidze VV, Kuznetsov VA, Ramsh SM. Synthesis of new cyclic derivatives of isothiourea, potential inhibitors of NO-synthases. RUSS J GEN CHEM+ 2016. [DOI: 10.1134/s1070363216040381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Pilmis B, Jullien V, Sobel J, Lecuit M, Lortholary O, Charlier C. Antifungal drugs during pregnancy: an updated review. J Antimicrob Chemother 2014; 70:14-22. [PMID: 25204341 DOI: 10.1093/jac/dku355] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Antifungal prescription remains a challenge in pregnant women because of uncertainties regarding fetal toxicity and altered maternal pharmacokinetic parameters that may affect efficacy or increase maternal and fetal toxicity. We present updated data reviewing the available knowledge and current recommendations regarding antifungal prescription in pregnancy. Amphotericin B remains the first-choice parenteral drug in spite of its well-established toxicity. Topical drugs are used throughout pregnancy because of limited absorption. Recent data have clarified the teratogenic effect of high-dose fluconazole during the first trimester and provided reassuring cumulative data regarding its use at a single low dose in this key period. Recent data have also provided additional safety data on itraconazole and lipidic derivatives of amphotericin B. Regarding newer antifungal drugs, including posaconazole and echinocandins, clinical data are critically needed before considering prescription in pregnancy.
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Affiliation(s)
- Benoît Pilmis
- Infectious Diseases Department, Université Paris Descartes, Sorbonne Paris Cité, Centre d'Infectiologie Necker-Pasteur, Hôpital Necker-Enfants Malades, Paris, France
| | - Vincent Jullien
- Pharmacology Department, Université Paris Descartes, Sorbonne Paris Cité, Inserm U1129, Hôpital Européen Georges-Pompidou, Paris, France
| | - Jack Sobel
- Wayne State University, Detroit, MI, USA
| | - Marc Lecuit
- Infectious Diseases Department, Université Paris Descartes, Sorbonne Paris Cité, Centre d'Infectiologie Necker-Pasteur, Hôpital Necker-Enfants Malades, Paris, France
| | - Olivier Lortholary
- Infectious Diseases Department, Université Paris Descartes, Sorbonne Paris Cité, Centre d'Infectiologie Necker-Pasteur, Hôpital Necker-Enfants Malades, Paris, France
| | - Caroline Charlier
- Infectious Diseases Department, Université Paris Descartes, Sorbonne Paris Cité, Centre d'Infectiologie Necker-Pasteur, Hôpital Necker-Enfants Malades, Paris, France
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Iodine excess as an environmental risk factor for autoimmune thyroid disease. Int J Mol Sci 2014; 15:12895-912. [PMID: 25050783 PMCID: PMC4139880 DOI: 10.3390/ijms150712895] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 07/03/2014] [Accepted: 07/15/2014] [Indexed: 01/29/2023] Open
Abstract
The global effort to prevent iodine deficiency disorders through iodine supplementation, such as universal salt iodization, has achieved impressive progress during the last few decades. However, iodine excess, due to extensive environmental iodine exposure in addition to poor monitoring, is currently a more frequent occurrence than iodine deficiency. Iodine excess is a precipitating environmental factor in the development of autoimmune thyroid disease. Excessive amounts of iodide have been linked to the development of autoimmune thyroiditis in humans and animals, while intrathyroidal depletion of iodine prevents disease in animal strains susceptible to severe thyroiditis. Although the mechanisms by which iodide induces thyroiditis are still unclear, several mechanisms have been proposed: (1) excess iodine induces the production of cytokines and chemokines that can recruit immunocompetent cells to the thyroid; (2) processing excess iodine in thyroid epithelial cells may result in elevated levels of oxidative stress, leading to harmful lipid oxidation and thyroid tissue injuries; and (3) iodine incorporation in the protein chain of thyroglobulin may augment the antigenicity of this molecule. This review will summarize the current knowledge regarding excess iodide as an environmental toxicant and relate it to the development of autoimmune thyroid disease.
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McLachlan SM, Rapoport B. Breaking tolerance to thyroid antigens: changing concepts in thyroid autoimmunity. Endocr Rev 2014; 35:59-105. [PMID: 24091783 PMCID: PMC3895862 DOI: 10.1210/er.2013-1055] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 09/24/2013] [Indexed: 02/06/2023]
Abstract
Thyroid autoimmunity involves loss of tolerance to thyroid proteins in genetically susceptible individuals in association with environmental factors. In central tolerance, intrathymic autoantigen presentation deletes immature T cells with high affinity for autoantigen-derived peptides. Regulatory T cells provide an alternative mechanism to silence autoimmune T cells in the periphery. The TSH receptor (TSHR), thyroid peroxidase (TPO), and thyroglobulin (Tg) have unusual properties ("immunogenicity") that contribute to breaking tolerance, including size, abundance, membrane association, glycosylation, and polymorphisms. Insight into loss of tolerance to thyroid proteins comes from spontaneous and induced animal models: 1) intrathymic expression controls self-tolerance to the TSHR, not TPO or Tg; 2) regulatory T cells are not involved in TSHR self-tolerance and instead control the balance between Graves' disease and thyroiditis; 3) breaking TSHR tolerance involves contributions from major histocompatibility complex molecules (humans and induced mouse models), TSHR polymorphism(s) (humans), and alternative splicing (mice); 4) loss of tolerance to Tg before TPO indicates that greater Tg immunogenicity vs TPO dominates central tolerance expectations; 5) tolerance is induced by thyroid autoantigen administration before autoimmunity is established; 6) interferon-α therapy for hepatitis C infection enhances thyroid autoimmunity in patients with intact immunity; Graves' disease developing after T-cell depletion reflects reconstitution autoimmunity; and 7) most environmental factors (including excess iodine) "reveal," but do not induce, thyroid autoimmunity. Micro-organisms likely exert their effects via bystander stimulation. Finally, no single mechanism explains the loss of tolerance to thyroid proteins. The goal of inducing self-tolerance to prevent autoimmune thyroid disease will require accurate prediction of at-risk individuals together with an antigen-specific, not blanket, therapeutic approach.
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Affiliation(s)
- Sandra M McLachlan
- Thyroid Autoimmune Disease Unit, Cedars-Sinai Research Institute, and University of California-Los Angeles School of Medicine, Los Angeles, California 90048
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Galgano M, Spalla I, Callegari C, Patruno M, Auriemma E, Zanna G, Ferro S, Zini E. Primary hypothyroidism and thyroid goiter in an adult cat. J Vet Intern Med 2014; 28:682-6. [PMID: 24417675 PMCID: PMC4857985 DOI: 10.1111/jvim.12283] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 09/25/2013] [Accepted: 11/19/2013] [Indexed: 10/26/2022] Open
Affiliation(s)
- M Galgano
- Istituto Veterinario di Novara, Granozzo Con Monticello, Italy
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López A, Montazerolghaem M, Engqvist H, Ott MK, Persson C. Calcium phosphate cements with strontium halides as radiopacifiers. J Biomed Mater Res B Appl Biomater 2013; 102:250-9. [PMID: 23997030 DOI: 10.1002/jbm.b.33002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 06/27/2013] [Accepted: 07/08/2013] [Indexed: 01/26/2023]
Abstract
High radiopacity is required to monitor the delivery and positioning of injectable implants. Inorganic nonsoluble radiopacifiers are typically used in nondegradable bone cements; however, their usefulness in resorbable cements is limited due to their low solubility. Strontium halides, except strontium fluoride, are ionic water-soluble compounds that possess potential as radiopacifiers. In this study, we compare the radiopacity, mechanical properties, composition, and cytotoxicity of radiopaque brushite cements prepared with strontium fluoride (SrF2 ), strontium chloride (SrCl2 ·6H2 O), strontium bromide (SrBr2 ), or strontium iodide (SrI2 ). Brushite cements containing 10 wt % SrCl2 ·6H2 O, SrBr2 , or SrI2 exhibited equal to or higher radiopacity than commercial radiopaque cements. Furthermore, the brushite crystal lattice in cements that contained the ionic radiopacifiers was larger than in unmodified cements and in cements that contained SrF2 , indicating strontium substitution. Despite the fact that the strontium halides increased the solubility of the cements and affected their mechanical properties, calcium phosphate cements containing SrCl2 ·6H2 O, SrBr2 , and SrI2 showed no significant differences in Saos-2 cell viability and proliferation with respect to the control. Strontium halides: SrCl2 ·6H2 O, SrBr2 , and SrI2 may be potential candidates as radiopacifiers in resorbable biomaterials although their in vivo biocompatibility, when incorporated into injectable implants, is yet to be assessed.
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Affiliation(s)
- Alejandro López
- Department of Engineering Sciences, Division of Applied Materials Science, The Ångström Laboratory, Uppsala University, 751 21, Uppsala, Sweden
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TSUBOTA-UTSUGI M, IMAI E, NAKADE M, MATSUMOTO T, TSUBOYAMA-KASAOKA N, NISHI N, TSUBONO Y. Evaluation of the Prevalence of Iodine Intakes above the Tolerable Upper Intake Level from Four 3-Day Dietary Records in a Japanese Population. J Nutr Sci Vitaminol (Tokyo) 2013; 59:310-6. [DOI: 10.3177/jnsv.59.310] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Role of iodine in the toxicity of diiodomethyl-p-tolylsulfone (DIMPTS) in rats: ADME. Regul Toxicol Pharmacol 2012; 62:482-95. [DOI: 10.1016/j.yrtph.2011.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 09/16/2011] [Accepted: 09/23/2011] [Indexed: 11/19/2022]
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Rajaram S, Exley CE, Fairlie F, Matthews S. Effect of antenatal iodinated contrast agent on neonatal thyroid function. Br J Radiol 2011; 85:e238-42. [PMID: 22167515 DOI: 10.1259/bjr/29806327] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess the effect on neonatal thyroid function of iodinated contrast media administered for CT pulmonary angiography (CTPA) in babies whose mothers were investigated for suspected pulmonary embolism during pregnancy. METHODS Retrospective review of 115 pregnant patients investigated for suspected pulmonary embolism. The patient cohort consisted of two groups: Group A consisted of 73 pregnant females who received iodinated contrast agent for CTPA, and Group B (control group) consisted of 42 pregnant females who were investigated by perfusion imaging only. The results of the neonatal thyroid function tests for the babies of the mothers in Groups A and B were compared. RESULTS All of the neonatal thyroid function tests for both groups were normal with no statistical difference between the two groups. CONCLUSION No adverse effect on thyroid function was demonstrated in neonates exposed to in utero iodinated contrast media. However, as our study involves a small patient group, the results should be interpreted with caution.
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Affiliation(s)
- S Rajaram
- Department of Radiology, Sheffield Teaching Hospital Trust, Sheffield, UK.
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Abstract
AbstractIntroduction:This article reviews the literature pertaining to bismuth iodoform paraffin paste.Overview:Bismuth iodoform paraffin paste is used in most otolaryngology departments on a daily basis. Questions about its properties are common in postgraduate otolaryngology examinations. This article reviews bismuth iodoform paraffin paste's current and historical usage, constituents, properties, side effects, and radiographic properties, and its alternatives in otological and rhinological practice.
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Lee HS, Min H. Iodine Intake and Tolerable Upper Intake Level of Iodine for Koreans. ACTA ACUST UNITED AC 2011. [DOI: 10.4163/kjn.2011.44.1.82] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Hyun Sook Lee
- Department of Food & Nutrition, Kookmin University, Seoul 136-702, Korea
| | - Hyesun Min
- Department of Food & Nutrition, Hannam University, Daejeon 305-811, Korea
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Abstract
The effects of physiological and environmental factors, of thyroid and non-thyroid diseases, and of drugs on the serum protein-bound iodine are described and discussed.
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Affiliation(s)
- J D Acland
- Department of Pathology, Central Middlesex Hospital, Park Royal, London
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Abstract
Several mechanisms are involved in the maintenance of normal thyroid hormone secretion, even when iodine intake exceeds physiologic needs by a factor of 100. The sodium-iodide symporter system contributes most to this stability. Faced with an iodine excess, it throttles the transport of iodide into the thyroid cells, the rate-limiting step of hormone synthesis. Even before the iodine symporter reacts, a sudden iodine overload paradoxically blocks the second step of hormone synthesis, the organification of iodide. This so-called Wolff-Chaikoff effect requires a high (>or=10(-3) molar) intracellular concentration of iodide. The block does not last long, because after a while the sodium-iodide symporter shuts down; this allows intracellular iodide to drop below 10(-3) molar and the near-normal secretion to resume. In some susceptible individuals (e.g., after radio-iodine treatment of Graves' disease or in autoimmune thyroiditis), the sodium-iodide symporter fails to shut down, the intracellular concentration of iodide remains high and chronic hypothyroidism ensues. To complicate matters, iodine excess may also cause hyperthyroidism. The current explanation is that this happens in persons with goitres, for example, after long-standing iodine deficiency. These goitres may contain nodules carrying a somatic mutation that confers a 'constitutive' activation of the TSH receptor. Being no more under pituitary control, these nodules overproduce thyroid hormone and cause iodine-induced hyperthyroidism, when they are presented with sufficient iodine. These autonomous nodules gradually disappear from the population after iodine deficiency has been properly corrected. More recent studies suggest that chronic high iodine intake furthers classical thyroid autoimmunity (hypothyroidism and thyroiditis) and that iodine-induced hyperthyroidism may also have an autoimmune pathogenesis.
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Affiliation(s)
- Hans Bürgi
- International Council for the Control of Iodine Deficiency Disorders (ICCIDD), CH-4500 Solothurn, Switzerland.
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Tahirović H, Toromanović A, Grbić S, Bogdanović G, Fatusić Z, Gnat D. Maternal and neonatal urinary iodine excretion and neonatal TSH in relation to use of antiseptic during caesarean section in an iodine sufficient area. J Pediatr Endocrinol Metab 2009; 22:1145-9. [PMID: 20333874 DOI: 10.1515/jpem.2009.22.12.1145] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To evaluate the influence of topical iodine-containing antiseptics on neonatal TSH in full-term infants born by Caesarean section in an iodine sufficient area. POPULATION AND METHODS Urinary iodide excretion (UIE) was estimated in 86 mothers on the second day after delivery by Caesarean section and their 86 full-term neonates. The mothers were divided into two groups according to the use of antiseptic to prepare Cesarean sections: 42 mothers who were prepared with povidone-iodine (Isosept, Bosnalijek) comprised the study group, and 47 mothers who were prepared with alcoholic solution (Skinsept color, Ecolab) formed the control group. Neonatal TSH was measured in whole blood drawn between day 3 and 5 of life, spotted on filter paper using a sensitive fluorometric assay (Delfia). RESULTS Maternal and neonatal UIE were significantly higher (p < 0.05) in the study group compared to the control group. No significant difference was found for neonatal TSH. CONCLUSION Our data suggest that perinatal iodine exposure of full-term neonates who were born by Caesarean section in an iodine sufficient area did not influence neonatal TSH, although median UIE was higher, suggesting optimal iodine intake during pregnancy. Further research is needed to define a critical value of urinary iodine concentrations in full-term neonates in an iodine sufficient area that may lead to the impairment of thyroid function.
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Affiliation(s)
- Husref Tahirović
- Department of Pediatrics, Division of Endocrinology & Diabetes, University Clinical Center, Tuzla, Bosnia and Herzegovina.
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Bocanegra A, Bastida S, Benedí J, Ródenas S, Sánchez-Muniz FJ. Characteristics and nutritional and cardiovascular-health properties of seaweeds. J Med Food 2009; 12:236-58. [PMID: 19459725 DOI: 10.1089/jmf.2008.0151] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
While marine algae have traditionally formed part of the Oriental diet, their major use in Western countries has been in the phytocolloid industry. Only a few coastal communities outside Asia have customarily used seaweeds as components of special dishes. Of late, however, seaweeds have gained importance as foodstuffs in Western countries and most recently as components of functional foods because of their high dietary fiber, mineral, vitamin, and phytochemical content, low energy levels, and high concentrations of certain polyunsaturated fatty acids. The present paper reviews the available data for some of the components of the major edible algae and studies several factors that can affect their physiochemical properties (e.g., hydration, water and oil-holding capacity, fermentability, binding capacity, etc.) and, in turn, their nutritional importance. The effects of marine alga consumption on growth and body weight, mineral availability, lipid metabolism, blood pressure, and antioxidant properties are reviewed, together with preliminary data on the effects of some functional foods containing seaweeds on lipid metabolism and gene expression of enzymes engaged in antioxidant protection. This review concludes with some remarks regarding the danger of the improper use of seaweeds in herbal medications. In addition, as the properties of algae are highly dependent on their individual composition, any generalization regarding these properties may be considered misleading and scientifically inappropriate.
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Affiliation(s)
- Aránzazu Bocanegra
- Departamento de Nutrición y Bromatología I (Nutrición), Instituto del Frío, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
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Ares S, Quero J, de Escobar GM. Iodine balance, iatrogenic excess, and thyroid dysfunction in premature newborns. Semin Perinatol 2008; 32:407-12. [PMID: 19007678 DOI: 10.1053/j.semperi.2008.09.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Iodine is a trace element that is essential for the synthesis of thyroid hormones. The thyroid hormones, thyroxine and 3,5,3'-triiodothyronine, are necessary for adequate growth and development throughout fetal and extrauterine life. The iodine intake of newborns is entirely dependent on the iodine content of breast milk and the formula preparations used to feed them. An inadequate iodine supply (deficiency and excess) might be especially dangerous in the case of premature babies. The minimum recommended dietary allowance is different depending on age groups. The iodine intake required is at least 15 microg/kg/d in full-term infants and 30 microg/kg/d in preterms. Premature infants are in a situation of iodine deficiency, precisely at a stage of psychomotor and neural development that is extremely sensitive to alterations of thyroid function.
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Affiliation(s)
- Susana Ares
- Neonatology Unit, University Hospital La Paz, Paseo Castellana, Madrid, Spain.
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Aruna AS. Nature's Secrets: Implications of Herbal and Complementary Therapies in HIV. ACTA ACUST UNITED AC 2008. [DOI: 10.3109/10601339909005307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Neonatal thyroid function after administration of IV iodinated contrast agent to 21 pregnant patients. AJR Am J Roentgenol 2008; 191:268-71. [PMID: 18562757 DOI: 10.2214/ajr.07.3336] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to document neonatal thyroid function after in utero exposure to nonionic iodinated contrast material to determine the potential risk of subsequent neonatal hypothyroidism. MATERIALS AND METHODS We identified pregnant patients ("maternal patient") who underwent CT with iodinated IV contrast material between February 2000 and October 2006. The specifics of the CT examinations were reviewed including patient age, gestational age of conceptus at time of exposure, type of CT, and type and dose of contrast agent. The neonatal serum thyroid-stimulating hormone (TSH) level obtained from the exposed infant ("neonatal patient") was retrieved from the Minnesota Department of Health. RESULTS Twenty-one patients gave us consent to review the requested data concerning their 23 children (two mothers had twins). Mean maternal age at the time of CT was 29 years (range, 19-41 years). Mean gestational age (based on last menstrual period) at the time of CT was 23 weeks (range, 8-37 weeks). Neonatal patients were born at a mean of 38 weeks of gestation (range, 24-41 weeks of gestation). Serum TSH was collected at a mean of 43 hours after delivery (range, 24-70 hours). For all neonatal patients, serum TSH levels were normal. Mean serum TSH was 9.7 muIU/mL (range, 2.2-28.8 muIU/mL). No maternal patient reported thyroid trouble in her child. CONCLUSION Based on neonatal TSH measurements in a small number of patients, we found no ill effect of iodinated contrast agents on neonatal thyroid function after in utero exposure.
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Restani P, Persico A, Ballabio C, Moro E, Fuggetta D, Colombo ML. Analysis of food supplements containing iodine: a survey of Italian market. Clin Toxicol (Phila) 2008; 46:282-6. [PMID: 18363118 DOI: 10.1080/15563650701373788] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Iodine is an essential nutrient for humans as a critical constituent of thyroid hormones; both iodine deficiency and excess have adverse consequences for the thyroid gland. The aims of this research were to compare claimed concentrations of iodine with measured ones in various iodine-supplemented products, estimate the amount of iodine ingested by Italian consumers who use these products, and compare the calculated intakes to the Recommended Daily Allowance and tolerable Upper Level. A convenience sample of 43 food supplements was analyzed for iodine concentration. Analytical values resembled those declared in the label in fewer than half of the examples; in four cases, the maximal daily dose was higher than the tolerable upper level for iodine of 600 microg/day. Labeling of iodine-rich food supplements appears to be unreliable and caution should be exercised in the consumption of food supplements rich in iodine as there is a risk of exceeding the established safe upper level of daily intake.
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Arsenic in Herbal Kelp Supplements: Schenker et al. Respond. ENVIRONMENTAL HEALTH PERSPECTIVES 2007; 115. [PMCID: PMC2137125 DOI: 10.1289/ehp.10393r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Kotyzová D, Eybl V, Mihaljevic M, Glattre E. Effect of long-term administration of arsenic (III) and bromine with and without selenium and iodine supplementation on the element level in the thyroid of rat. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2007; 149:329-33. [PMID: 16601782 DOI: 10.5507/bp.2005.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to evaluate the influence of arsenic and bromine exposure with or without iodine and selenium supplementation on the element level in the thyroid of rats. Four major groups of Wistar female rats were fed with respective diets: group A - standard diet, group B - iodine rich diet (10 mg I/kg food), group C - selenium rich diet (1 mg Se/kg) and group D - iodine and selenium rich diet (as in group B and C). Each group was divided into four subgroups per 7 animals each receiving either NaAsO(2) ip (6.5 mg.kg(-1) twice a week for two weeks and 3.25 mg.kg(-1) for six weeks) or KBr in drinking water (58.8 mg.l(-1)) for 8 weeks or combined administration of both substances. Remaining subgroup served as controls. After 8 weeks thyroid glands were analyzed by ICP-MS for As, Br, Se, and I content. The exposition of rat to arsenic or bromine causes the accumulation of these elements in the thyroid gland ( approximately 18 ppm of As, approximately 90 ppm of Br) and significantly affects iodine and selenium concentration in the thyroid. In iodine and/or selenium supplemented rats the bromine intake into the thyroid was lowered to approximately 50% of the level in unsupplemented animals. Also selenium thyroid level elevated due to KBr administration was lowered by iodine supplementation in the diet. The accumulation of arsenic in the thyroid was not influenced by selenium or iodine supplementation; however, As(III) administration increased iodine thyroid level and suppressed selenium thyroid level in selenium or iodine supplemented group of animals.
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Affiliation(s)
- Dana Kotyzová
- Department of Pharmacology and Toxicology, Charles University in Prague, Faculty of Medicine in Pilsen, Karlovarská 48, Pilsen, Czech Republic.
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Rosa C, O’Hara TM, Hoekstra PF, Refsal KR, Blake JE. Serum thyroid hormone concentrations and thyroid histomorphology as biomarkers in bowhead whales (Balaena mysticetus). CAN J ZOOL 2007. [DOI: 10.1139/z07-035] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Serum thyroid hormone (TH) concentrations have been used alone or with other measurements to assess health status or effects of toxicant exposure in marine mammals. Histological sections from thyroid glands of the bowhead whale ( Balaena mysticetus L., 1758) were examined in conjunction with serological TH analyses. Serum was assayed for total and free triiodothyronine and total and free thyroxine via radioimmunoassay. Histomorphology of thyroid tissue was assessed by light microscopy and the utilization of an epithelial-follicular index (EFI). Age, sex, or season did not significantly affect serum TH levels. However, TH concentrations in pregnant or lactating females were found to be significantly lower than in the other sex and reproductive groups investigated. The EFI and epithelial height (EH) were greater in spring subadult and adult whales compared with those that were landed in the fall. No correlation was found between serum TH concentrations and serum, blubber, or liver levels of select polychlorinated biphenyl metabolites and organochlorine congeners examined. Low variability in concentrations of the serum THs across age, season, and sex and reproductive groups supports the existence of strong homeostatic mechanisms for maintaining TH concentrations in these presumably healthy animals. Departures from these ranges may indicate a disturbance in these regulatory mechanisms and may be a useful indication of toxicity or other health disorders.
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Affiliation(s)
- Cheryl Rosa
- Institute of Arctic Biology, University of Alaska Fairbanks, 311 Irving I Building, Fairbanks, AK 99775, USA
- Department of Wildlife Management, North Slope Borough, P.O. Box 69, Barrow, AK 99852, USA
- University of Guelph, Department of Environmental Biology, Guelph, ON N1G 2W1, Canada
- Diagnostic Center for Population and Animal Health, College of Veterinary Medicine, Michigan State University, 4125 Beaumont Road, Lansing, MI 48910-8104, USA
| | - Todd M. O’Hara
- Institute of Arctic Biology, University of Alaska Fairbanks, 311 Irving I Building, Fairbanks, AK 99775, USA
- Department of Wildlife Management, North Slope Borough, P.O. Box 69, Barrow, AK 99852, USA
- University of Guelph, Department of Environmental Biology, Guelph, ON N1G 2W1, Canada
- Diagnostic Center for Population and Animal Health, College of Veterinary Medicine, Michigan State University, 4125 Beaumont Road, Lansing, MI 48910-8104, USA
| | - Paul F. Hoekstra
- Institute of Arctic Biology, University of Alaska Fairbanks, 311 Irving I Building, Fairbanks, AK 99775, USA
- Department of Wildlife Management, North Slope Borough, P.O. Box 69, Barrow, AK 99852, USA
- University of Guelph, Department of Environmental Biology, Guelph, ON N1G 2W1, Canada
- Diagnostic Center for Population and Animal Health, College of Veterinary Medicine, Michigan State University, 4125 Beaumont Road, Lansing, MI 48910-8104, USA
| | - Kent R. Refsal
- Institute of Arctic Biology, University of Alaska Fairbanks, 311 Irving I Building, Fairbanks, AK 99775, USA
- Department of Wildlife Management, North Slope Borough, P.O. Box 69, Barrow, AK 99852, USA
- University of Guelph, Department of Environmental Biology, Guelph, ON N1G 2W1, Canada
- Diagnostic Center for Population and Animal Health, College of Veterinary Medicine, Michigan State University, 4125 Beaumont Road, Lansing, MI 48910-8104, USA
| | - John E. Blake
- Institute of Arctic Biology, University of Alaska Fairbanks, 311 Irving I Building, Fairbanks, AK 99775, USA
- Department of Wildlife Management, North Slope Borough, P.O. Box 69, Barrow, AK 99852, USA
- University of Guelph, Department of Environmental Biology, Guelph, ON N1G 2W1, Canada
- Diagnostic Center for Population and Animal Health, College of Veterinary Medicine, Michigan State University, 4125 Beaumont Road, Lansing, MI 48910-8104, USA
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Abstract
Physicians are generally reluctant to prescribe dermatologic drugs to pregnant or nursing women because treatment is often elective and can be harmful to the patient, her fetus, or nursing infant; concerns for potential litigation also give pause. Yet, some effective dermatologic drugs have been determined to be safe during pregnancy and lactation. Of great practicality is an easily accessed reference guide that condenses information on such drugs into a set of tables that list pregnancy and teratogenicity ratings. Indications and contraindications are ordered in relation to the phases and trimesters of pregnancy. A discussion of the necessity of considering stages of childbearing in choosing drug therapies introduces the tables. A summary list of cautions spells out the steps physicians should take in treating women of childbearing age.
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Affiliation(s)
- Sancy A Leachman
- Tom C. Mathews Jr. Familial Melanoma Research Clinic, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Suite 5242, Salt Lake City, UT 84112, USA
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Affiliation(s)
- Rajat Prakash
- Department of Human Nutrition All India Institute of Medical Sciences New Delhi 110029 India
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Nishikawa A, Ikeda T, Son HY, Okazaki K, Imazawa T, Umemura T, Kimura S, Hirose M. Pronounced synergistic promotion of N-bis(2-hydroxypropyl)nitrosamine-initiated thyroid tumorigenesis in rats treated with excess soybean and iodine-deficient diets. Toxicol Sci 2005; 86:258-63. [PMID: 15901912 DOI: 10.1093/toxsci/kfi206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We have reported that excess soybean treatment and iodine deficiency synergistically interact, resulting in remarkable induction of thyroid hyperplasias in rats. In the present study, modifying effects of excess soybean and iodine-deficient diets were investigated in the post-initiation phase of N-bis(2-hydroxypropyl)nitrosamine [DHPN]-initiated thyroid tumorigenesis in rats. AIN-93G in which casein was replaced with gluten was used as a basal diet to avoid possible iodine contamination. In Experiment 1, F-344 rats of both sexes were sc injected with DHPN at a dose of 2800 mg/kg body weight and then fed a diet containing 0%, 0.8%, 4%, or 20% defatted soybean for 12 weeks, with proportional replacement of gluten by soybean flour. Although no thyroid proliferative lesions were found in any group, the absolute thyroid weights were significantly (p < 0.01) elevated with the 20% soybean treatment. In Experiment 2, after similar sc injection of DHPN, rats were fed a basal diet or a diet containing 20% soybean under iodine normal or deficient conditions for 12 weeks. Soybean feeding to both sexes under iodine deficient but not normal conditions dramatically enhanced the development of thyroid follicular adenomas (p < 0.01) and adenocarcinomas (p < 0.05), in good agreement with decrease in thyroxine and increase in thyroid-stimulating hormone. Thus co-exposure to excess soybean and iodine deficiency results in synergistic promotion of DHPN-initiated thyroid tumorigenesis in rats, of which mechanisms appear to primarily involve effects on serum hormone levels.
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Affiliation(s)
- Akiyoshi Nishikawa
- Division of Pathology, National Institute of Health Sciences, Tokyo 158-8501, and Showa Women's University, Tokyo 154-8533, Japan.
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Zimmermann MB, Ito Y, Hess SY, Fujieda K, Molinari L. High thyroid volume in children with excess dietary iodine intakes. Am J Clin Nutr 2005; 81:840-4. [PMID: 15817861 DOI: 10.1093/ajcn/81.4.840] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are few data on the adverse effects of chronic exposure to high iodine intakes, particularly in children. OBJECTIVE The objective of the study was to ascertain whether high dietary intakes of iodine in children result in high thyroid volume (Tvol), a high risk of goiter, or both. DESIGN In an international sample of 6-12-y-old children (n = 3319) from 5 continents with iodine intakes ranging from adequate to excessive, Tvol was measured by ultrasound, and the urinary iodine (UI) concentration was measured. Regressions were done on Tvol and goiter including age, body surface area, sex, and UI concentration as covariates. RESULTS The median UI concentration ranged from 115 microg/L in central Switzerland to 728 microg/L in coastal Hokkaido, Japan. In the entire sample, 31% of children had UI concentrations >300 microg/L, and 11% had UI concentrations >500 microg/L; in coastal Hokkaido, 59% had UI concentrations >500 microg/L, and 39% had UI concentrations >1000 microg/L. In coastal Hokkaido, the mean age- and body surface area-adjusted Tvol was approximately 2-fold the mean Tvol from the other sites combined (P < 0.0001), and there was a positive correlation between log(UI concentration) and log(Tvol) (r = 0.24, P < 0.0001). In the combined sample, after adjustment for age, sex, and body surface area, log(Tvol) began to rise at a log(UI concentration) >2.7, which, when transformed back to the linear scale, corresponded to a UI concentration of approximately 500 microg/L. CONCLUSIONS Chronic iodine intakes approximately twice those recommended-indicated by UI concentrations in the range of 300-500 microg/L-do not increase Tvol in children. However, UI concentrations >/=500 microg/L are associated with increasing Tvol, which reflects the adverse effects of chronic iodine excess.
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Affiliation(s)
- Michael B Zimmermann
- Human Nutrition Laboratory, Swiss Federal Institute of Technology, Zürich, Switzerland.
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De Santis M, Straface G, Carducci B, Cavaliere AF, De Santis L, Lucchese A, Merola AM, Caruso A. Risk of drug-induced congenital defects. Eur J Obstet Gynecol Reprod Biol 2005; 117:10-9. [PMID: 15474237 DOI: 10.1016/j.ejogrb.2004.04.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2004] [Indexed: 11/19/2022]
Abstract
Defects attributable to drug therapy represent about 1% of congenital defects of known aetiology. This means that a precautionary attitude and correct use of drugs in fertile, and especially pregnant, women is a feasible form of prevention. Drugs currently in use with proven teratogenic effect number approximately 25, but new pharmaceutical drugs are constantly in preparation. Recognition of a drug-induced teratogenic effect is a complex procedure taking into account not only experimental animal data but also experience in humans. Considering that 40% of pregnancies are not planned, it follows that any drug with known or suspected teratogenic potential must be used only under strict medical control. Also, adequate knowledge on potential teratogenicity of a drug permits modification of therapy before conception. It goes without saying that any drug should be used during pregnancy only if it is essential, and it would be prudent to use only those where adequate information is provided and prior clinical experience is available. Teratology Information Services can assist both physicians and patients when any doubt exists.
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Affiliation(s)
- Marco De Santis
- Telefono Rosso-Teratology Information Service, Institute of Obstetrics and Gynaecology, Catholic University Sacred Heart, Largo A. Gemelli 8, Rome 00168, Italy.
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Nishiyama S, Mikeda T, Okada T, Nakamura K, Kotani T, Hishinuma A. Transient hypothyroidism or persistent hyperthyrotropinemia in neonates born to mothers with excessive iodine intake. Thyroid 2004; 14:1077-83. [PMID: 15650362 DOI: 10.1089/thy.2004.14.1077] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Perinatal exposure to excess iodine can lead to transient hypothyroidism in the newborn. In Japan, large quantities of iodine-rich seaweed such as kombu (Laminaria japonica) are consumed. However, effects of iodine from food consumed during the perinatal period are unknown. The concentration of iodine in serum, urine, and breast milk in addition to thyrotropin (TSH), free thyroxine (FT(4)), and thyroglobulin was measured in 34 infants who were positive at congenital hypothyroidism screening. Based on the concentration of iodine in the urine, 15 infants were diagnosed with hyperthyrotropinemia caused by the excess ingestion of iodine by their mothers during their pregnancy. According to serum iodine concentrations, these infants were classified into group A (over 17 microg/dL) and group B (under 17 microg/dL) of serum iodine. During their pregnancies these mothers consumed kombu, other seaweeds, and instant kombu soups containing a high level of iodine. It was calculated that the mothers of group A infants ingested approximately 2300-3200 microg of iodine, and the mothers of group B infants approximately 820-1400 microg of iodine per day during their pregnancies. Twelve of 15 infants have required levo-thyroxine (LT(4)) because hypothyroxinemia or persistent hyperthyrotropinemia was present. In addition, consumption of iodine by the postnatal child and susceptibility to the inhibitory effect of iodine may contribute in part to the persistent hyperthyrotropinemia. We propose that hyperthyrotropinemia related to excessive iodine ingestion by the mother during pregnancy in some cases may not be transient.
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Affiliation(s)
- Soroku Nishiyama
- Department of Pediatrics, Kumamoto University School of Medicine, Kumamoto, Japan.
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Czeizel AE, Kazy Z, Vargha P. Vaginal treatment with povidone--iodine suppositories during pregnancy. Int J Gynaecol Obstet 2004; 84:83-5. [PMID: 14698837 DOI: 10.1016/s0020-7292(03)00270-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- A E Czeizel
- Foundation for the Community Control of Hereditary Diseases, Budapest, Hungary.
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49
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Abstract
Risk assessment of essential trace elements examines high intakes resulting in toxicity and low intakes resulting in nutritional deficiencies. This paper analyzes the risk assessments carried out by several U.S. governmental and private organizations for eight essential trace elements: chromium, copper, iodine, iron, manganese, molybdenum, selenium, and zinc. The compatibility of the toxicity values with the nutritionally essential values is examined, in light of recently derived values, termed Dietary Reference Intakes, set by the U.S. Food and Nutrition Board of the Institute of Medicine. The results show that although there are differences in the values set by the different organizations, increased coordination has resulted in values that are more compatible than revealed in past evaluations.
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50
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Abstract
The use of any medication in pregnant women requires careful consideration of benefit to the mother versus risk posed to the fetus. Fungal infections are not uncommon in pregnant women; in fact, the incidence of certain infections such as Candida vaginitis is increased in this patient population. A variety of antimycotic agents are currently available to treat systemic or mucocutaneous fungal infections. Many of these agents are capable of penetrating the placental barrier and entering fetal cord blood, therefore adverse effects of these agents on the fetus are a valid concern. The use of topical azoles for the treatment of superficial fungal infections is safe and efficacious. However, there are some data suggesting a dose-related increase in the risk of teratogenicity associated with the use of systemic azoles. Amphotericin B remains the drug of choice for the treatment of systemic fungal infections in pregnancy. There are serious risks of fetal malformations associated with the use of griseofulvin, ketoconazole, voriconazole, flucytosine and potassium iodide. These drugs are contraindicated in pregnancy. There are insufficient data regarding the use of caspofungin in pregnancy. This article will review available data regarding the safety of antifungal drug use in pregnant women.
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Affiliation(s)
- Varsha V Moudgal
- Division of Infectious Diseases, Harper Hospital, 3990 John R, 4 Brush Center, Detroit, MI 48201, USA
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