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Kim KN, Park S, Choi J, Hwang IU. Associations between short-term exposure to air pollution and thyroid function in a representative sample of the Korean population. ENVIRONMENTAL RESEARCH 2024; 252:119018. [PMID: 38685294 DOI: 10.1016/j.envres.2024.119018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/05/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Disruption of thyroid function can profoundly affect various organ systems. However, studies on the association between air pollution and thyroid function are relatively scarce and most studies have focused on the long-term effects of air pollution among pregnant women. OBJECTIVES This study aimed to explore the associations between short-term exposure to air pollution and thyroid function in the general population. METHODS Data from the Korea National Health and Nutrition Examination Survey (2013-2015) were analyzed (n = 5,626). Air pollution concentrations in residential addresses were estimated using Community Multiscale Air Quality models. The moving averages of air pollution over 7 days were set as exposure variables through exploratory analyses. Linear regression and quantile g-computation models were constructed to assess the effects of individual air pollutants and air pollution mixture, respectively. RESULTS A 10-ppb increase in NO2 (18.8-μg/m3 increase) and CO (11.5-μg/m3 increase) was associated with 2.43% [95% confidence interval (CI): 0.42, 4.48] and 0.19% (95% CI: 0.01, 0.36) higher thyroid-stimulating hormone (TSH) levels, respectively. A 10-μg/m3 increase in PM2.5 and a 10-ppb increase in O3 (19.6-μg/m3 increment) were associated with 0.87% (95% CI: 1.47, -0.27) and 0.59% (95% CI: 1.18, -0.001) lower free thyroxine (fT4) levels, respectively. A simultaneous quartile increase in PM2.5, NO2, O3, and CO levels was associated with lower fT4 but not TSH levels. CONCLUSIONS As the subtle changes in thyroid function can affect various organ systems, the present results may have substantial public health implications despite the relatively modest effect sizes. Because this was a cross-sectional study, it is necessary to conduct further experimental or repeated-measures studies to consolidate the current results.
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Affiliation(s)
- Kyoung-Nam Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - SoHyun Park
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Junseo Choi
- Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Il-Ung Hwang
- Division of Public Health and Medical Care, Seoul National University Hospital, Seoul, Republic of Korea.
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Li Q, Li S, Sun H, Niinomi M, Nakano T. Preparation and characterizations of antibacterial iodine-containing coatings on pure Ti. J Mech Behav Biomed Mater 2024; 151:106366. [PMID: 38176198 DOI: 10.1016/j.jmbbm.2023.106366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/28/2023] [Accepted: 12/31/2023] [Indexed: 01/06/2024]
Abstract
Iodine-containing coatings were prepared on pure Ti surfaces via electrochemical deposition to enhance their antibacterial properties. The factors influencing iodine content were analyzed using an orthogonal experiment. The electrochemically deposited samples were characterized using scanning electron microscopy with energy dispersive spectroscopy and X-ray photoelectron spectroscopy, and their antibacterial properties and cytotoxicity were evaluated. The results showed that changing the deposition time is an effective way to control the iodine content. The iodine content, coating thickness, and adhesion of the samples increased with deposition time. Iodine in the coatings mainly exists in three forms, which are I2, I3-, and pentavalent iodine. For samples with iodine-containing coatings, the antibacterial ratios against E. coli and S. aureus were greater than 90% and increased with increasing iodine content. Although the samples with iodine-containing coatings showed some inhibition of the proliferation of MC3T3-E1 cells, the cell viabilities were all higher than 80%, suggesting that iodine-containing coatings are biosafe.
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Affiliation(s)
- Qiang Li
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, PR China; Shanghai Engineering Research Center of High-Performance Medical Device Materials, Shanghai, 200093, PR China.
| | - Shuaishuai Li
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, PR China
| | - Hao Sun
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, PR China
| | - Mitsuo Niinomi
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, PR China; Institute for Materials Research, Tohoku University, 2-1-1, Katahira, Aoba-ku, Sendai 980-8577, Japan; Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka 565-0871, Japan
| | - Takayoshi Nakano
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka 565-0871, Japan
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Marongiu A, Nuvoli S, De Vito A, Vargiu S, Spanu A, Madeddu G. Hashimoto's Thyroiditis and Papillary Thyroid Carcinoma: A Follow-Up Study in Patients with Absence of Aggressive Risk Factors at the Surgery of the Primary Tumor. Diagnostics (Basel) 2023; 13:3068. [PMID: 37835813 PMCID: PMC10572807 DOI: 10.3390/diagnostics13193068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Hashimoto's thyroiditis (HT) is often associated with papillary thyroid carcinoma (PC); it is still a matter of controversy whether the behavior of carcinoma is more aggressive or not. During the follow-up, we retrospectively enrolled 97 patients with PC/HT after thyroidectomy without risk factors at the surgery of the primary tumor, such as multifocality/multicentricity, extrathyroid tumor extension, vascular invasion, neck and distant metastases, and aggressive histological variants. HT diagnosis was confirmed by histology and serum thyroid antibodies. Tumor size was ≤10 mm in 64 cases (microcarcinomas); 206 matched PC patients after thyroidectomy without HT and risk factors were enrolled as controls, totaling 122 microcarcinomas. During follow-up, metastases occurred in 15/97 (15.5%) PC/HT cases, eight microcarcinomas, and in 16/206 (7.8%) without HT, eight microcarcinomas (p = 0.04). Considering both PC/HT and PC patients without HT who developed metastases, univariate analysis showed an increased risk of metastases in patients with HT coexistence, OR: 2.17 (95% CI 1.03-4.60) p = 0.043. Disease-free survival (DFS) was significantly (p = 0.0253) shorter in PC/HT than in the controls. The present study seems to demonstrate that HT is not a cancer protective factor in PC patients given the less favorable outcomes and significantly shorter DFS. HT may also represent an independent recurrence predictor without other risk factors.
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Affiliation(s)
- Andrea Marongiu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (S.N.); (S.V.); (A.S.); (G.M.)
| | - Susanna Nuvoli
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (S.N.); (S.V.); (A.S.); (G.M.)
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy;
| | - Sonia Vargiu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (S.N.); (S.V.); (A.S.); (G.M.)
| | - Angela Spanu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (S.N.); (S.V.); (A.S.); (G.M.)
| | - Giuseppe Madeddu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (S.N.); (S.V.); (A.S.); (G.M.)
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Lisco G, De Tullio A, Triggiani D, Zupo R, Giagulli VA, De Pergola G, Piazzolla G, Guastamacchia E, Sabbà C, Triggiani V. Iodine Deficiency and Iodine Prophylaxis: An Overview and Update. Nutrients 2023; 15:nu15041004. [PMID: 36839362 PMCID: PMC9967346 DOI: 10.3390/nu15041004] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
The thyroid gland requires iodine to synthesize thyroid hormones, and iodine deficiency results in the inadequate production of thyroxine and related thyroid, metabolic, developmental, and reproductive disorders. Iodine requirements are higher in infants, children, and during pregnancy and lactation than in adult men and non-pregnant women. Iodine is available in a wide range of foods and water and is susceptible to almost complete gastric and duodenal absorption as an iodide ion. A healthy diet usually provides a daily iodine consumption not exceeding 50% of the recommended intake. Iodine supplementation is usually necessary to prevent iodine deficiency disorders (IDDs), especially in endemic areas. The community-based strategy of iodine fortification in salt has eradicated IDDs, such as endemic goiter and cretinism, in countries providing adequate measures of iodine prophylaxis over several decades in the 20th century. Iodized salt is the cornerstone of iodine prophylaxis in endemic areas, and the continuous monitoring of community iodine intake and its related clinical outcomes is essential. Despite the relevant improvement in clinical outcomes, subclinical iodine deficiency persists even in Western Europe, especially among girls and women, being an issue in certain physiological conditions, such as pregnancy and lactation, and in people consuming unbalanced vegetable-based or salt-restricted diets. Detailed strategies to implement iodine intake (supplementation) could be considered for specific population groups when iodized salt alone is insufficient to provide adequate requirements.
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Affiliation(s)
- Giuseppe Lisco
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Anna De Tullio
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Domenico Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Roberta Zupo
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology, Saverio de Bellis, Research Hospital, 70013 Bari, Italy
| | - Vito Angelo Giagulli
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giovanni De Pergola
- Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology, Saverio de Bellis, Research Hospital, 70013 Bari, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Carlo Sabbà
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
- Correspondence:
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Wang J, Gao Y, Zong Y, Gao W, Wang X, Sun J, Miao S. Nomogram Model Based on Iodine Nutrition and Clinical Characteristics of Papillary Thyroid Carcinoma to Predict Lateral Lymph Node Metastasis. Cancer Control 2023; 30:10732748231193248. [PMID: 37671703 PMCID: PMC10483970 DOI: 10.1177/10732748231193248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVE Preoperative evaluation of lateral lymph node metastasis (LLNM) in patients with papillary thyroid carcinoma (PTC) has been one of the major clinical challenges. This study aims to develop and validate iodine nutrition-related nomogram models to predict lateral cervical lymph node metastasis in patients with PTC. METHODS This is a retrospective study. Urinary iodine concentration (UIC) and serum iodine concentration (SIC) were measured in 187 LLNM patients and 289 non-LLNM (NLLNM) patients. All patients were randomized 3:1 into the training cohort (n = 355) and the validation cohort (n = 121). Using logistic regression analysis, we analyzed the influence of iodine nutrition-related factors and clinicopathological characteristics on LLNM in PTC patients. Lasso regression method was used to screen risk factors and construct a nomogram for predicting LLNM. The receiver operating characteristic curve (ROC curve), calibration curve, and decision curve analysis (DCA) of the nomogram models were carried out for the training and validation cohorts. RESULTS Gender, SIC, smoking history, drinking history, family history of PTC, multifocality, bilateral or unilateral tumors, TSH, Tg, and tumor size were included in the nomogram model predicting LLNM, with an area under the curve (AUC) of .795. The nomogram model showed good calibration and clinical benefit in both the training and validation cohorts. CONCLUSION The nomogram model based on iodine nutrition and other clinicopathological features is effective for predicting the lateral lymph node metastasis in PTC patients.
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Affiliation(s)
- Junrong Wang
- Department of Head and Neck Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yuzhang Gao
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, People’s Republic of China
| | - Yuxuan Zong
- Department of Breast Surgery, The First of hospital of Qiqihar, Qiqihar, China
| | - Weitong Gao
- Department of Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xueying Wang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, People’s Republic of China
| | - Ji Sun
- Department of Head and Neck Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Susheng Miao
- Department of Head and Neck Surgery, Harbin Medical University Cancer Hospital, Harbin, China
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Tadesse S, Hymete A, Lieberman M, Gebreyesus SH, Ashenef A. Iodine status, household salt iodine content, knowledge and practice assessment among pregnant women in Butajira, South Central Ethiopia. PLoS One 2022; 17:e0277208. [PMID: 36441747 PMCID: PMC9704620 DOI: 10.1371/journal.pone.0277208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 10/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Iodine is one of the crucial micronutrients needed by the human body, and is vitally important during pregnancy. This study aimed to determine the relationship between the iodine status of pregnant women and their knowledge, and practices regarding iodized salt. All participants were enrolled in the Butajira nutrition, mental health and pregnancy (BUNMAP) cohort, Butajira, Ethiopia in February-May, 2019. METHODS In this cross-sectional study, 152 pregnant women without hypertension or known thyroid disease before or during pregnancy were randomly selected from the BUNMAP mother to child cohort (n = 832). Spot urine samples were collected to estimate the level of urinary iodine concentration (UIC). Salt samples were also collected from their homes. The Sandall-Kolthoff (S-K) method was used to measure the level of iodine in the urine samples, and iodometric titration was used to measure the level of iodine in the salt. Data was entered and cleaned using Epi-info version 3.5.3 and then exported to SPSS version 20 for further analysis. Multivariate logistic regression analysis was performed to identify associations in the collected data. RESULTS The WHO recommended level of iodine for populations of pregnant women is 150-249 F06Dg/L. The median UIC among pregnant women in this study was 151.2 μg/L [interquartile range (IQR) = 85.5-236.2 F06Dg/L], at the low end of this range. About half (49.65%) of the participants were likely to be iodine deficient. There was a significant association between having a formal job (AOR = 2.56; CI = 1.11-5.96) and iodine sufficiency. Based on a cutoff of >15 ppm (mg/kg), 91.7% (95% CI: 87.2-96.2) of the salts collected from the household had adequate iodine content. The median iodine level of the collected salt samples was 34.9 mg/kg (ppm) (IQR = 24.2-44.6 mg/kg). CONCLUSIONS The UNICEF 2018 guidelines for adequate iodine nutrition in pregnant women include both a recommended median range of 150-249 μg/L, and an upper limit of 20% on the fraction of the population with UIC below 50 μg/L. Because our study population's median level is 151.2 μg/L and the percentage of pregnant women with urinary iodine concentration of less than 50 μg/L is 9.7% (14/145), the women received adequate iodine nutrition. The availability of adequately iodized salt in households is more than 90%, as recommended by WHO. In light of previous iodine deficiency in this region of Ethiopia, the salt iodization program promotes the health of babies and mothers.
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Affiliation(s)
- Senait Tadesse
- Department of Pharmaceutical Chemistry and Pharmacognosy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ariaya Hymete
- Department of Pharmaceutical Chemistry and Pharmacognosy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Marya Lieberman
- Department of Chemistry & Biochemistry, University of Notre Dame, Notre Dame, IN, United States of America
| | - Seifu Hagos Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ayenew Ashenef
- Department of Pharmaceutical Chemistry and Pharmacognosy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
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The Impact of Iodine Concentration Disorders on Health and Cancer. Nutrients 2022; 14:nu14112209. [PMID: 35684009 PMCID: PMC9182735 DOI: 10.3390/nu14112209] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 01/27/2023] Open
Abstract
Iodine deficiency is an ongoing problem. The implementation of salt iodization has significantly reduced the effects of iodine deficiency worldwide in recent years, and the remaining iodine deficiency is mild to moderate. Iodine is an essential substrate for the synthesis of thyroid hormones in the thyroid gland. It can also act as an antioxidant, as well as an anti-proliferative and pro-apoptotic factor. Pregnant women, breastfeeding women, and children are particularly affected by iodine deficiency. It leads to thyroid diseases and metabolic and developmental disorders, as well as cancer. However, an excessive iodine intake may, similarly to iodine deficiency, lead to the development of goiter, and toxic amounts of iodine can lead to thyroiditis, hyperthyroidism, and hypothyroidism, and even to the development of papillary thyroid cancer. Correcting iodine deficiency potentially reduces the chance of developing malignancies. Additional research is needed to better understand both the effect of iodine on carcinogenesis and the clinical outcome of iodine deficiency compensation on cancer patients' prognosis. The upcoming public health challenge appears to be reducing salt consumption, which could result in a lower iodine intake. Thus, an iodine enrichment vehicle other than salt could be considered if salt iodine levels are not increased to compensate, and urine iodine levels should be monitored more frequently.
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Impact of urinary iodine concentration on blood glucose levels and blood pressure: a nationwide population-based study. Eur J Nutr 2022; 61:3227-3234. [PMID: 35445294 DOI: 10.1007/s00394-022-02888-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 04/07/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Iodine is a vital trace element for systemic metabolic control as well as thyroid hormone synthesis. Though iodine has significant antioxidant and anti-inflammatory effects, reports on its effects on metabolic disorders are limited and inconsistent. METHODS Impact of urinary iodine concentrations (UICs) on fasting blood glucose (FBG) levels and blood pressure (BP) in the general Korean population was evaluated adjusting for covariates including thyrotropin level and presence of thyroid diseases. RESULTS The median UIC was 302.3 μg/L in all participants and was significantly lower in those with dysglycemia (303.6 μg/L in normal participants, 285.1 μg/L in participants with FBG levels of 100-125 mg/dL, and 261.8 μg/L in participants with FBG levels ≥ 126 mg/dL; p = 0.002). Similarly, the UIC was lower in participants with higher BP (311.6 μg/L in normal participants, 288.7 μg/L in prehypertensive participants, and 265.8 μg/L in hypertensive participants; p < 0.001). The multiple linear regression model showed a negative correlation between the UIC and FBG levels (p = 0.002), and the UIC and systolic BP (p < 0.001). One standard deviation increase in the UIC showed odds ratios of 0.84 (95% confidence interval [CI] = 0.73-0.98) for elevated FBG levels (≥ 100 mg/dL) and 0.94 (95% CI = 0.88-0.99) for elevated SBP (≥ 120 mm Hg) after full adjustment. CONCLUSION Higher UICs were associated with lower FBG and BP levels, independent of thyroid function and other confounding factors in Korea, an iodine-replete country.
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Ma B, Chen X, Zhao Z, Yin X, Ji Q, Zhou Y, Ma C, Wang J. Coexisting CLT in PTC is an independent predictor of tumor aggressiveness for patients aged under 55: a retrospective analysis of 635 patients. BMC Endocr Disord 2022; 22:55. [PMID: 35255870 PMCID: PMC8900407 DOI: 10.1186/s12902-022-00945-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 01/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study was aimed at investigating the potential role of chronic lymphocytic thyroiditis (CLT) in papillary thyroid cancer (PTC) aggressiveness for patients aged below 55, as well as to figure out factors influencing potential recurrence risk in different age groups. METHODS A total of 635 adult patients were retrospectively analyzed. 188 patients were diagnosed with coexistent CLT and the remaining 447 were classified as non-CLT. Then the characteristics of CLT-coexisted patients and non-CLT ones were compared respectively when patients were aged ≥ 55 years or below. The association among postoperative clinicopathological features were also analyzed using multivariate regression. In addition, the prognostic value of several variables relating to high-risk recurrence were estimated within different age groups. RESULTS When divided in two age groups (55 years as the borderline), non-CLT group (aged below 55 years) had a remarkable frequency of small size lesion (Dmax ≤ 1 cm) compared with CLT-coexisted patients (54.6% to 43.0%, p = 0.02). In addition, non-CLT patients tended to have intrathyroidal extension as opposed to those with coexistent CLT (20.2% to 28.2%, p = 0.05). In multivariate analysis, CLT still significantly acted as an independent risk factor of greater lesion size (Dmin > 1 cm) (OR = 1.7, p = 0.02) and mildly promoted gross extrathyroidal extension (ETE) (OR = 1.4, p = 0.06). However, associations didn't emerge in the characteristics mentioned above with CLT when patients were ≥ 55 years old. The prognostic value of CLT in high-risk recurrence was evident only in patients aged 35-44 years. (OR = 2.4, 95%CI:1.2-5.4, p = 0.02). Greater lesion size independently promoted gross ETE, no matter patients were aged above 55 years or not. Its prognostic value of high-risk recurrence was significant throughout all age groups. CONCLUSION These findings revealed that CLT coexistence might be the unfavorable factor of PTC aggressiveness in patients aged below 55 years. Its role as well as greater tumor size may potentially predict higher recurrence risk according to results figured out in the prediction model.
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Affiliation(s)
- Bing'e Ma
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, 210028, China
| | - Xiyi Chen
- The Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing, 210029, China
| | - Zhengping Zhao
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, 210028, China
| | - Xiaoyang Yin
- The First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Qin Ji
- The First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Yifan Zhou
- The First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Chaoqun Ma
- Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China.
| | - Jianhua Wang
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, China.
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, 210028, China.
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Thyroid dysfunction in Greece: Results from the national health examination survey EMENO. PLoS One 2022; 17:e0264388. [PMID: 35245310 PMCID: PMC8896672 DOI: 10.1371/journal.pone.0264388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 02/09/2022] [Indexed: 11/19/2022] Open
Abstract
Background Nationwide data on thyroid disease prevalence in Greece is lacking. Using the national health examination survey EMENO data resources, we aimed to estimate the prevalence of hypothyroidism and hyperthyroidism and associated risk factors in adults living in Greece. Methods A random sample of the adults (≥18 years) living in Greece was drawn by multi-stage stratified random sampling based on the 2011 census. During home visits, trained interviewers administered a standardized questionnaire to study participants. All participants answered questions concerning demographic parameters (e.g., age, sex, degree of urbanization, income) and questions concerning smoking habits, alcohol, dietary habits and psychological parameters such as anxiety and thyroid disease. Weighted logistic regression models were fitted to assess factors associated with thyroid disease. Results In total, 6006 individuals were recruited in the Greek Health Examination Survey EMENO (response rate 72%) of whom 5981 were eligible for this study. The prevalence of thyroid disease was 9%, where 0.4% was related to hyperthyroidism and 8.6% to hypothyroidism. The prevalence of thyroid disease was higher in women (14.9%) than men (2.7%) (p<0.001). The highest rates of thyroid disease were observed in former iodine-deficient areas. A decrease in the prevalence of thyroidopathies with increasing alcohol consumption was found. Thyroid disease was associated with anxiety in men. Multivariable regression analysis showed that age, geographic area, and smoking were related to thyroid disease. Conclusion The prevalence of thyroid disease in Greece is higher in women. Age, habits, and characteristics of geographic areas determine the distribution of thyroidopathies in Greece.
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Chen Y, Zheng X, Li N, Niu W, Hu B, Yuan X, Liang C, Lin Y. Impact of Iodinated Contrast Media in Patients Received Percutaneous Coronary Intervention: Focus on Thyroid Disease. Front Endocrinol (Lausanne) 2022; 13:917498. [PMID: 35813632 PMCID: PMC9259844 DOI: 10.3389/fendo.2022.917498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/19/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND With the rapid advance in percutaneous coronary intervention (PCI) technology, patients absorb large volume of iodinated contrast media (ICM). Recent studies suggested that ICM may lead to hyperthyroidism, but the association between ICM volume and thyroid is still unclear. We sought to evaluate the long-term influence of ICM on thyroid dysfunction and disease in patients received PCI. METHODS This single-center retrospective study included consecutive coronary artery disease (CAD) patients. A covariance (ANCOVA) model was performed to evaluate the change of serum TSH, FT3 and FT4 before and one-year after the PCI procedure. Restricted cubic splines and logistic regression were performed to evaluate the association between ICM volume and thyroid disease. RESULTS 2062 patients met inclusion criteria (1381 patients in the low-volume group and 681 patients in the high-volume group). The high-volume group was 0.238 ± 0.092 pmol/L higher than the low-volume group (P = 0.010) in the serum FT4. Restricted cubic splines show that there were linear dose-response relationships for ICM volume and composite endpoint and hyperthyroidism. In all models, there were significant differences in composite endpoint between the two groups. (OR 1.75, 95% CI (1.05, 2.92), P = 0.032, OR 1.73, 95% CI (1.01-2.96), P= 0.032 and OR 1.83, 95% CI (1.09-3.06), P= 0.022, respectively). The positive results were also showed for hyperthyroidism in all models (OR 2.35, 95% CI (1.14-4.84), P = 0.021, OR 10.36, 95% CI (1.20-89.00), P = 0.033 and OR 2.35, 95% CI (1.13-4.87), P = 0.022, respectively). CONCLUSION The present analysis gives an overview that ICM volume is associated with an increased risk of thyroid dysfunction and thyroid disease.
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Affiliation(s)
- Yasha Chen
- Department of Cardiology, Shanghai Changzheng Hospital, Navy Medical University, Shanghai, China
- Department of Cardiology, Fujian Medical University Union Hospital, Fujian Institute of Coronary Artery Disease, Fuzhou, China
| | - Xueyang Zheng
- Department of Organ Transplantation, Shanghai Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Na Li
- Department of Cardiology, Shanghai Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Wenhao Niu
- Department of Cardiology, Shanghai Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Bowen Hu
- Department of Cardiology, Shanghai Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Xun Yuan
- Department of Cardiology, Fujian Medical University Union Hospital, Fujian Institute of Coronary Artery Disease, Fuzhou, China
| | - Chun Liang
- Department of Cardiology, Shanghai Changzheng Hospital, Navy Medical University, Shanghai, China
- *Correspondence: Chun Liang, ; Yunling Lin,
| | - Yunling Lin
- Department of Cardiology, Fujian Medical University Union Hospital, Fujian Institute of Coronary Artery Disease, Fuzhou, China
- *Correspondence: Chun Liang, ; Yunling Lin,
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Abdulkhabirova FM, Bezlepkina OB, Brovin DN, Vadina TA, Melnichenko GA, Nagaeva EV, Nikankina LV, Peterkova VA, Platonova NM, Rybakova AA, Soldatova TV, Troshina EA, Shiryaeva TY. [Clinical practice guidelines "Management of iodine deficiency disorders"]. ACTA ACUST UNITED AC 2021; 67:10-25. [PMID: 34297498 DOI: 10.14341/probl12750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 12/16/2022]
Abstract
Iodine deficiency disorders is a sweeping term that includes structural and functional impairment of the thyroid gland.These clinical guidelines include algorithms for the diagnosis and treatment of euthyroid goiter and nodular/ multinodular goiter in adults and children. In addition, these clinical guidelines contain information on methods for an adequate epidemiological assessment of iodine deficiency disorders using such markers as the percentage of goiter in schoolchildren, the median urinary iodine concentration, the level of neonatal TSH, the median thyroglobulin in children and adults. As well from these clinical guidelines, you can get to know the main methods and groups of epidemiological studies of iodine deficiency disorders.
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Kim SW, Lee JH, Shon HS, Jeon E, Kim TY. Association of breastfeeding with thyroid function and autoimmunity in postmenopausal women. Endocrine 2021; 71:130-138. [PMID: 32562185 DOI: 10.1007/s12020-020-02385-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/08/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Whether breastfeeding influences thyroid function and autoimmunity is not elucidated. We examined the association of history of breastfeeding with thyroid hormones and thyroperoxidase antibody (TPOAb). DESIGN Cross-sectional study of data from the 2013-2015 Korea National Health and Nutrition Examination Survey. METHODS A total of 816 postmenopausal women were stratified into three groups according to the duration of breastfeeding and number of breastfed children. Thyroid hormones levels, TPOAb titers, and the prevalence of hypothyroidism and TPOAb positivity were evaluated in each group. RESULTS Subjects with a history of prolonged breastfeeding had lower levels of thyrotropin (TSH) and TPOAb than the others. After adjusting for multiple confounding factors, the estimated means of TSH and TPOAb were associated with cumulative duration of breastfeeding. Duration of breastfeeding per child was associated with TSH levels, and number of breastfed children was associated with TPOAb titers. The odds ratio (OR) of hypothyroidism was significantly lower in group for ≥36 months of cumulative duration of breastfeeding, and the OR of TPOAb positivity was significantly lower in group with ≥3 breastfed children. In addition, duration of breastfeeding and the number of breastfed children were linearly correlated with log TSH and TPOAb each other in the multivariate model. CONCLUSIONS The present study showed that prolonged breastfeeding was inversely associated with TSH and the prevalence of hypothyroidism. Moreover, TPOAb and the prevalence of TPOAb positivity were inversely associated with number of breastfed children. These results indicate that breastfeeding may exert a protective effect on thyroid function and autoimmunity.
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Affiliation(s)
- Sung-Woo Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ji-Hyun Lee
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ho-Sang Shon
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Eonju Jeon
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
| | - Tae-Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Ahn J, Lee JH, Lee J, Baek JY, Song E, Oh HS, Kim M, Park S, Jeon MJ, Kim TY, Kim WB, Shong YK, Kim WG. Association between urinary sodium levels and iodine status in Korea. Korean J Intern Med 2020; 35:392-399. [PMID: 29768912 PMCID: PMC7061011 DOI: 10.3904/kjim.2017.375] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 03/03/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS To evaluate the association between the urinary sodium concentration and iodine status in different age groups in Korea. METHODS This nationwide, population-based, cross-sectional study used data from the Korean National Health and Nutrition Examination Survey (VI 2-3, 2014 to 2015). We included 3,645 subjects aged 10 to 75 years with normal kidney function and without a history of thyroid disease. Adequate iodine intake was defined as a urinary iodine/creatinine (I/Cr) ratio of 85 to 220 µg/g. The urinary sodium/ creatinine (Na/Cr) ratios were classified as low (< 47 mmol/g), intermediate (47 to 114 mmol/g), or high (> 114 mmol/g). RESULTS The median urinary iodine concentration (UIC) was 292 µg/L (interquartile range [IQR], 157 to 672), and the median urinary I/Cr ratio was 195 µg/g (IQR, 104 to 478). Iodine deficiency (< 100 µg/L) and iodine excess (> 300 µg/L) were observed in 11.3% and 49.0% of subjects, respectively. The UIC was significantly associated with the urinary sodium concentration, and the urinary I/Cr ratio was significantly correlated with the urinary Na/Cr ratio (both p < 0.001). The distributions of UIC, urinary I/Cr ratio, and Na/Cr ratio varied among age groups. Low urinary I/Cr and Na/Cr ratios were most common in young adults (age, 19 to 29 years), while high urinary I/Cr and Na/Cr ratios were most common in elderly people (age, 60 to 75 years). CONCLUSION Iodine intake was significantly associated with sodium intake in the Korean population. Our study suggested that an adequately low salt intake might be helpful for preventing iodine excess in Korea.
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Affiliation(s)
- Jonghwa Ahn
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jang Ho Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jiwoo Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yeon Baek
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eyun Song
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye-Seon Oh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mijin Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suyeon Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence to Won Gu Kim, M.D. Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-5883 Fax: +82-2-3010-6962 E-mail:
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Kim S, Kwon YS, Kim JY, Hong KH, Park YK. Association between Iodine Nutrition Status and Thyroid Disease-Related Hormone in Korean Adults: Korean National Health and Nutrition Examination Survey VI (2013-2015). Nutrients 2019; 11:nu11112757. [PMID: 31766270 PMCID: PMC6893705 DOI: 10.3390/nu11112757] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/06/2019] [Accepted: 11/11/2019] [Indexed: 01/21/2023] Open
Abstract
This study aimed to observe the relationship between iodine nutrition status (dietary iodine intake and estimated iodine intake based on urinary iodine concentration (UIC)) and thyroid disease-related hormones. This study involved 6090 subjects >19 years old with valid UIC, assessed between 2013 and 2015 by the Korean National Health and Nutrition Examination Survey, using a stratified, multistage, clustered probability-sampling design. The estimated iodine intake in participants was measured using UIC and urine creatinine. To examine the effect of iodine intake on thyroid disease, the iodine intake was divided into Korean Dietary Reference Intakes groups, and logistic regression analysis was performed via the surveylogistic procedure to obtain odds ratios (ORs) and 95% confidence intervals (CIs). The estimated iodine intake showed a significant positive correlation with dietary iodine intake (r = 0.021, p < 0.001), UIC (r = 0.918, p < 0.001), and thyroid-stimulating hormone (TSH) (r = 0.043, p < 0.001), but a significant negative correlation with free thyroxine (FT4) (r = -0.037, p < 0.001). Additionally, as the estimated iodine intake increased, age, TSH, and UIC increased, but FT4 decreased (p for trend < 0.0001). The risk of thyroid disease was higher in the "≥tolerable upper intake level (UL ≥ 2400 µg/day)" group than in the "<estimated average requirement (EAR < 150 µg/day)" group in females (OR: 2.418; 95% CI: 1.010-5.787). Also, as iodine intake increased, the risk of thyroid disease increased (p for trend < 0.038).
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Affiliation(s)
- Sohye Kim
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea;
- Nutrition Care Services, Seoul National University of Bundang Hospital, Seongnam 13620, Korea
| | | | - Ju Young Kim
- Department of Family Medicine, Seoul National University of Bundang Hospital, Seongnam 13620, Korea;
| | - Kyung Hee Hong
- Department of Food Science and Nutrition, Dongseo University, Pusan 47011, Korea;
| | - Yoo Kyoung Park
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea;
- Correspondence:
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Leidig-Bruckner G. Jodhaltige Kontrastmittel bei Patienten mit Schilddrüsenerkrankungen. Radiologe 2019; 59:413-424. [DOI: 10.1007/s00117-019-0520-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kang MJ, Hwang IT, Chung HR. Excessive Iodine Intake and Subclinical Hypothyroidism in Children and Adolescents Aged 6-19 Years: Results of the Sixth Korean National Health and Nutrition Examination Survey, 2013-2015. Thyroid 2018; 28:773-779. [PMID: 29737233 DOI: 10.1089/thy.2017.0507] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Iodine is an important element for the synthesis of thyroid hormone, and its deficiency or excessive intake is associated with various thyroid diseases. Little is known about the association between iodine status and thyroid function among children and adolescents living in iodine-rich areas. Therefore, this study analyzed this association using data from a nationwide survey. METHODS From the Korea National Health and Nutrition Examination Surveys VI (2013-2015) data, 1288 subjects (711 male) aged 6-19 years who underwent a urinary iodine concentration (UIC) test and 1000 subjects (564 male) aged 10-19 years who underwent a thyroid function test were included in this study. Serum levels of thyrotropin (TSH), free thyroxine (fT4), and thyroperoxidase antibodies (TPOAb) were analyzed. Subclinical hypothyroidism (SCH) was defined as TSH >5.5 μIU/mL with a normal fT4 level. Median daily iodine intake was calculated from the UIC. Daily sodium intake was derived from the nutritional survey data of 1181 subjects. RESULTS The median UIC was 449 μg/L (range 15-21,905 μg/L), and the prevalence rates of UIC ≥300 μg/L and ≥1000 μg/L were 64.9% and 25.0%, respectively. The prevalence rates of a sodium intake >2000 mg/day and iodine intake >2400 μg/day were 75.0% (885/1181) and 12.7% (164/1288), respectively. The prevalence rates of SCH and TPOAb >34 IU/mL were 7.2% (72/1000) and 2.3% (23/1000), respectively. The prevalence of SCH was significantly higher in the iodine deficient and iodine excess groups compared to those in the UIC 100-299.9 μg/L group (p = 0.038). Therefore, there was a U-shaped and inverted U-shaped correlation between serum levels of TSH and fT4 with UIC, respectively. These correlations were especially prominent when UIC was >1000 μg/L. There was no definite correlation between TPOAb and UIC. CONCLUSIONS Excess iodine was prevalent in Korean children and adolescents, and it may be associated with SCH. Therefore, monitoring the iodine status and education on adequate intake are needed in iodine-rich areas.
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Affiliation(s)
- Min Jae Kang
- 1 Department of Pediatrics, Hallym University Sacred Heart Hospital , Anyang, Korea
| | - Il Tae Hwang
- 2 Department of Pediatrics, Kangdong Sacred Heart Hospital , Seoul, Korea
| | - Hye Rim Chung
- 3 Department of Pediatrics, Seoul National University Bundang Hospital , Seongnam, Korea
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Babli S, Payne RJ, Mitmaker E, Rivera J. Effects of Chronic Lymphocytic Thyroiditis on the Clinicopathological Features of Papillary Thyroid Cancer. Eur Thyroid J 2018; 7:95-101. [PMID: 29594061 PMCID: PMC5869368 DOI: 10.1159/000486367] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 12/01/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The effects of chronic lymphocytic thyroiditis (CLT) on the presentation and outcome of papillary thyroid carcinoma (PTC) have long been a topic of controversy. OBJECTIVE To evaluate the effect of coexistent CLT on the clinicopathological features of PTC. DESIGN Retrospective study. PATIENTS All patients with PTC who had been followed by the 2 co-investigators (Juan Rivera and Richard J. Payne) between 2006 and 2011 were included. RESULTS CLT was present in 35% (166) of the included patients and was associated with a higher proportion of patients with TNM stage I (p = 0.027) and fewer patients with persistent disease (p = 0.014) in comparison with the PTC-only group. Analysis of the data based on age (<45 or >45 years) revealed that in the older group, the presence of CLT was associated with fewer patients with persistent disease (p = 0.03) and capsular invasion (p = 0.05). However, in patients <45 years of age, the presence of CLT was associated with more capsular invasion (p = 0.003) and extrathyroidal extension (p = 0.004) compared with the PTC-only group. CONCLUSIONS CLT in patients with PTC was associated with lower-stage disease and less disease persistence in patients >45 years of age. In patients <45 years, the presence of CLT appeared to be associated with unfavorable pathological features.
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Affiliation(s)
- Saleha Babli
- Division of Endocrinology and Metabolism, Department of Medicine, Montreal General Hospital, McGill University, Montreal, Québec, Canada
- Department of Endocrinology and Diabetes, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- *Saleha Babli, PO Box 20026, 31911 Qateef (Saudi Arabia), E-Mail
| | - Richard J. Payne
- Department of Otolaryngology, Royal Victoria Hospital, McGill University, Montreal, Québec, Canada
| | - Elliot Mitmaker
- Department of Surgery, Montreal General Hospital, McGill University, Montreal, Québec, Canada
| | - Juan Rivera
- Division of Endocrinology and Metabolism, Department of Medicine, Montreal General Hospital, McGill University, Montreal, Québec, Canada
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Kwon H, Kim WG, Jeon MJ, Han M, Kim M, Park S, Kim TY, Shong YK, Kim WB. Age-specific reference interval of serum TSH levels is high in adolescence in an iodine excess area: Korea national health and nutrition examination survey data. Endocrine 2017; 57:445-454. [PMID: 28762216 DOI: 10.1007/s12020-017-1375-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/07/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Serum thyroid-stimulating hormone level was influenced by several factors, including age, gender, thyroid auto-antibodies, race, and intake of dietary iodine. We evaluated age-specific reference interval of serum thyroid-stimulating hormone levels in Korea, an iodine excess area. METHODS This nationwide population-based cross-sectional study included representative civilian, non-institutional population (n = 6564) who underwent thyroid function tests from Korea National Health and Nutrition Examination Survey VI (2013-2015). The reference interval of serum thyroid-stimulating hormone levels was defined between the 2.5th and 97.5th percentiles in the reference population. RESULTS The geometric mean of serum thyroid-stimulating hormone levels in the reference population was 2.17 mIU/L with a reference interval of 0.62-6.84 mIU/L. In the reference population, the geometric mean of serum TSH levels in each age group of 10-18, 19-29, 30-39, 40-49, 50-59, 60-69, and equal or older than 70 years was 2.47, 2.20, 2.07, 2.04, 2.23, 2.12, and 2.27 mIU/L, with a reference interval of 0.74-7.35, 0.67-6.42, 0.63-6.04, 0.62-6.20, 0.56-7.37, 0.57-6.90, and 0.42-6.58 mIU/L, respectively. In the reference population, the urinary iodine concentrations were consistently high in all age groups (median 298.5 μg/L). Subjects aged 10-18 years had the highest urinary iodine concentrations. CONCLUSIONS There was no shift toward higher levels with age in the distribution of serum thyroid-stimulating hormone levels. The reference interval of serum thyroid-stimulating hormone levels was consistently high in all age group, especially from adolescence 10-18 years in a Korean population who had excessive intake of dietary iodine.
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Affiliation(s)
- Hyemi Kwon
- Departments of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 03181, Korea
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea.
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea
| | - Minkyu Han
- Departments of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea
| | - Mijin Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea
| | - Suyeon Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea
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Abstract
Hyperthyroidism is a form of thyrotoxicosis in which there is excess thyroid hormone synthesis and secretion. Multiple etiologies can lead to a common clinical state of "thyrotoxicosis," which is a consequence of the high thyroid hormone levels and their action on different tissues of the body. The most common cause of thyrotoxicosis is Graves' disease, an autoimmune disorder in which stimulating thyrotropin receptor antibodies bind to thyroid stimulating hormone (TSH) receptors on thyroid cells and cause overproduction of thyroid hormones. Other etiologies include: forms of thyroiditis in which inflammation causes release of preformed hormone, following thyroid gland insult that is autoimmune, infectious, mechanical or medication induced; secretion of human chorionic gonadotropin in the setting of transient gestational thyrotoxicosis and trophoblastic tumors; pituitary thyrotropin release, and exposure to extra-thyroidal sources of thyroid hormone that may be endogenous or exogenous. © 2017 American Physiological Society. Compr Physiol 7:67-79, 2017.
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Affiliation(s)
- Ishita Singh
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare Systems, Los Angeles, California, USA
| | - Jerome M Hershman
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare Systems, Los Angeles, California, USA
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Tagami T, Tsuiki M, Nakao K, Nakatani R, Kakita M, Ueda Y, Matsuo N, Usui T, Naruse M, Shimatsu A. Specific Symptoms of Thyrotoxicosis in Japanese Patients: A Reevaluation of Classical Symptoms in Modern Thyroid Function Tests. J Gen Fam Med 2016. [DOI: 10.14442/jgfm.17.3_225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Kornelius E, Chiou JY, Yang YS, Lo SC, Peng CH, Lai YR, Huang CN. Iodinated Contrast Media-Induced Thyroid Dysfunction in Euthyroid Nodular Goiter Patients. Thyroid 2016; 26:1030-8. [PMID: 27315873 DOI: 10.1089/thy.2016.0051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The risks of thyroid dysfunction after iodinated contrast media exposure in patients with euthyroid nodular goiter are largely unknown. METHODS This observational, retrospective cohort study included a random selection of one million people in Taiwan. All patients with iodinated contrast media exposure during this study period were selected. Patients with euthyroid nodular goiter were identified as cases, while patients without thyroid nodule were selected as controls. We followed these patients until the first event of thyroid dysfunction including hyperthyroidism or hypothyroidism after iodinated contrast media exposure. RESULTS A total of 334 cases and 2672 matched controls were selected in this study. The mean age of cases and controls were 58.6 and 58.4 years old, and mean follow-up durations were 2.1 and 2 years respectively. After adjustment, patients with euthyroid nodular goiter had a higher risk of thyroid dysfunction (hazard ratio 5.43, [confidence interval (CI) 3.01-9.80]) compared with controls after iodinated contrast media exposure. In the subgroup analysis, the risks of hyperthyroidism and hypothyroidism in cases compared with controls were 5.77 [CI 2.64-12.62] and 4.95 [CI 2.15-11.40] respectively. Half of the euthyroid nodular goiter cases developed thyroid dysfunction within one year after iodinated contrast media exposure. Interestingly, all thyroid-related comorbidities and drug prescriptions did not increase the risk of thyroid dysfunction. CONCLUSIONS Presence of euthyroid nodular goiter was associated with higher risk of thyroid dysfunction including hyperthyroidism and hypothyroidism after iodinated contrast media exposure.
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Affiliation(s)
- Edy Kornelius
- 1 Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital , Taichung, Taiwan
- 2 Institute of Medicine of Chung Shan Medical University , Taichung, Taiwan
| | - Jeng-Yuan Chiou
- 3 School of Health Policy and Management, Institute of Medicine of Chung Shan Medical University , Taichung, Taiwan
| | - Yi-Sun Yang
- 1 Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital , Taichung, Taiwan
- 2 Institute of Medicine of Chung Shan Medical University , Taichung, Taiwan
| | - Shih-Chang Lo
- 1 Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital , Taichung, Taiwan
| | - Chiung-Huei Peng
- 4 Division of Basic Medical Research, Hung Kuang University , Taichung, Taiwan
| | - Yung-Rung Lai
- 5 Pharmacy, Chung Shan Medical University Hospital , Taichung, Taiwan
| | - Chien-Ning Huang
- 1 Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital , Taichung, Taiwan
- 2 Institute of Medicine of Chung Shan Medical University , Taichung, Taiwan
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Chen XY, Lin CH, Yang LH, Li WG, Zhang JW, Zheng WW, Wang X, Qian J, Huang JL, Lei YX. The Effect on Sodium/Iodide Symporter and Pendrin in Thyroid Colloid Retention Developed by Excess Iodide Intake. Biol Trace Elem Res 2016; 172:193-200. [PMID: 26660892 DOI: 10.1007/s12011-015-0580-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/27/2015] [Indexed: 01/07/2023]
Abstract
It is well known that excess iodide can lead to thyroid colloid retention, a classic characteristic of iodide-induced goiter. However, the mechanism has not been fully unrevealed. Iodide plays an important role in thyroid function at multiple steps of thyroid colloid synthesis and transport among which sodium/iodide symporter (NIS) and pendrin are essential. In our study, we fed female BALB/c mice with different concentrations of high-iodine water including group A (control group, 0 μg/L), group B (1500 μg/L), group C (3000 μg/L), group D (6000 μg/L), and group E (12,000 μg/L). After 7 months of feeding, we found that excess iodide could lead to different degrees of thyroid colloid retention. Besides, NIS and pendrin expression were downregulated in the highest dose group. The thyroid iodide intake function detected by urine iodine assay and thyroidal (125)I experiments showed that the urine level of iodine increased, while the iodine intake rate decreased when the concentration of iodide used in feeding water increased (all p < 0.05 vs. control group). In addition, transmission electron microscopy (TEM) indicated a reduction in the number of intracellular mitochondria of thyroid cells. Based on these findings, we concluded that the occurrence of thyroid colloid retention exacerbated by excess iodide was associated with the suppression of NIS and pendrin expression, providing an additional insight of the potential mechanism of action of excess iodide on thyroid gland.
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Affiliation(s)
- Xiao-Yi Chen
- School of Public Health, Guangzhou Medical University, 195 Dongfengxi Road, Guangzhou, 510182, People's Republic of China
| | - Chu-Hui Lin
- School of Public Health, Guangzhou Medical University, 195 Dongfengxi Road, Guangzhou, 510182, People's Republic of China
| | - Li-Hua Yang
- School of Public Health, Guangzhou Medical University, 195 Dongfengxi Road, Guangzhou, 510182, People's Republic of China
| | - Wang-Gen Li
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, People's Republic of China
| | - Jin-Wei Zhang
- School of Public Health, Guangzhou Medical University, 195 Dongfengxi Road, Guangzhou, 510182, People's Republic of China
| | - Wen-Wei Zheng
- School of Public Health, Guangzhou Medical University, 195 Dongfengxi Road, Guangzhou, 510182, People's Republic of China
| | - Xiang Wang
- School of Public Health, Guangzhou Medical University, 195 Dongfengxi Road, Guangzhou, 510182, People's Republic of China
| | - Jiang Qian
- School of Public Health, Guangzhou Medical University, 195 Dongfengxi Road, Guangzhou, 510182, People's Republic of China
| | - Jia-Luan Huang
- School of Public Health, Guangzhou Medical University, 195 Dongfengxi Road, Guangzhou, 510182, People's Republic of China
| | - Yi-Xiong Lei
- School of Public Health, Guangzhou Medical University, 195 Dongfengxi Road, Guangzhou, 510182, People's Republic of China.
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Jooste P, Zimmermann M. Progress towards eliminating iodine deficiency in South Africa. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2016. [DOI: 10.1080/16070658.2008.11734145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tang KT, Wang FF, Pan WH, Lin JD, Won GS, Chau WK, Lin HD, Hsieh YT. Iodine status of adults in Taiwan 2005-2008, 5 years after the cessation of mandatory salt iodization. J Formos Med Assoc 2015; 115:645-51. [PMID: 26272351 DOI: 10.1016/j.jfma.2015.06.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 06/26/2015] [Accepted: 06/30/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/PURPOSE Iodine deficiency causes a broad spectrum of disorders across all ages. Mandatory salt iodization in Taiwan successfully reduced the goiter rate from 21.6% to 4.3% in schoolchildren surveyed in 1971. The program continued until 2003 when salt iodization was changed from mandatory to voluntary. The purpose of this study was to investigate the iodine status of Taiwanese individuals after the change in the iodine policy. METHODS Urinary iodine (UI) was measured in samples from adults in the Nutrition and Health Survey in Taiwan 2005-2008. RESULTS The median UI level was 100 μg/L, and the percentage of populations with UI levels below 100 μg/L and 50 μg/L was 50.1% and 15.1%, respectively, indicating that the iodine status was borderline adequate. Men had a higher UI level than women (102 μg/L vs. 98 μg/L, p = 0.003), and older individuals (age > 60 years) had a lower UI level than younger people, particularly in women. The iodine status of the population < 50 years was sufficient, but it was insufficient in older groups. Mild iodine insufficiency was noted in all areas of Taiwan except the Southern area and Penghu islands, with the lowest UI level of 79 μg/L in the Mountain area. Although the UI level of women of childbearing age (19-44 years) was 103 μg/L, there may be a risk of iodine deficiency during pregnancy. CONCLUSION The iodine nutrition of the Taiwanese population in 2005-2008 was borderline adequate, with insufficiency in some subgroups. Further monitoring of the iodine status is necessary.
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Affiliation(s)
- Kam-Tsun Tang
- Division of Endocrinology and Metabolism, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Fan-Fen Wang
- Department of Medicine, Yangming Branch, Taipei City Hospital, Taipei, Taiwan
| | - Wen-Harn Pan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Jiunn-Diann Lin
- Division of Endocrinology and Metabolism, Shuang Ho Hospital, Taipei, Taiwan
| | - Ging-Shing Won
- Division of Endocrinology and Metabolism, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wing-Keung Chau
- Division of Hematology and Oncology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hong-Da Lin
- Division of Endocrinology and Metabolism, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yao-Te Hsieh
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
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Lee SY, Chang DL, He X, Pearce EN, Braverman LE, Leung AM. Urinary iodine excretion and serum thyroid function in adults after iodinated contrast administration. Thyroid 2015; 25:471-7. [PMID: 25744578 PMCID: PMC4426305 DOI: 10.1089/thy.2015.0024] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Iodinated contrast media (ICM) is a source of excess iodine that may induce thyroid dysfunction. A prospective cohort study was conducted to assess the effects of ICM on urinary iodine clearance and serum thyroid function tests (TFTs) in adults. METHODS In this prospective cohort study of 54 adults undergoing elective computed tomography (CT) scans at an academic medical center, serial urinary iodine concentrations (UIC) and serum TFTs were obtained until UIC normalized following ICM administration. Thyroid volume/nodularity were assessed by ultrasound. Associations between covariates and peak UIC, duration for UIC to peak and normalize, and thyroid dysfunction risk were assessed. RESULTS The mean±standard deviation (SD) iodine administered was 34.6±6.0 g. Baseline median (range) UIC was 105.1 (17.0-866.1) μg/L, and serum thyrotropin (TSH) concentration was 1.26 (0.5-11.2) mIU/L. The mean±SD times to achieve peak UIC (median [range]: 3519 [233-157,500] μg/L] and normalized UIC were 1.1±0.5 and 5.2±4.0 weeks, respectively. Four subjects had elevated baseline TSH, and one had missing baseline TSH values. Of the remaining 49 subjects, 11 (22%) developed an abnormal TSH within one to four weeks (six elevated and five decreased). Administered iodine amount correlated with peak UIC following ICM administration (p<0.001). Increasing age and administered iodine amount predicted peak UIC (p=0.024 and p<0.001, respectively). Age, sex, race/ethnicity, smoking status, family history of thyroid disease, personal or family history of thyroid autoimmunity, thyroid volume, presence of thyroid nodules ≥1 cm, iodine dose, baseline UIC, and baseline TFTs were not predictive of durations to achieve peak or normalized UIC. CONCLUSION Peak UIC occurred at 1.1 weeks and normalized by 5.2 weeks following ICM administration for outpatient CT scans. Because thyroid dysfunction developed in 22% of individuals following a single ICM dose, monitoring of thyroid function should be considered in at-risk patients.
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Affiliation(s)
- Sun Y. Lee
- Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, Massachusetts
| | - Donny L.F. Chang
- Department of Endocrinology, Reliant Medical Group, Worcester, Massachusetts
| | - Xuemei He
- Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, Massachusetts
| | - Elizabeth N. Pearce
- Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, Massachusetts
| | - Lewis E. Braverman
- Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, Massachusetts
| | - Angela M. Leung
- Division of Endocrinology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
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Lee SY, Rhee CM, Leung AM, Braverman LE, Brent GA, Pearce EN. A review: Radiographic iodinated contrast media-induced thyroid dysfunction. J Clin Endocrinol Metab 2015; 100:376-83. [PMID: 25375985 PMCID: PMC4318903 DOI: 10.1210/jc.2014-3292] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 10/30/2014] [Indexed: 12/17/2022]
Abstract
CONTEXT Thyroid hormone production is dependent on adequate iodine intake. Excess iodine is generally well-tolerated, but thyroid dysfunction can occur in susceptible individuals after excess iodine exposure. Radiological iodinated contrast media represent an increasingly common source of excess iodine. OBJECTIVE This review will discuss the thyroidal response after acute exposure to excess iodine; contrast iodine-induced thyroid dysfunction; risks of iodine-induced thyroid dysfunction in vulnerable populations, such as the fetus, neonate, and patients with impaired renal function; and recommendations for the assessment and treatment of contrast iodine-induced thyroid dysfunction. METHODS Data for this review were identified by searching PubMed, Google Scholar, and references from relevant articles from 1948 to 2014. CONCLUSIONS With the increase in the use of computed tomography scans in the United States, there is increasing risk of contrast-induced thyroid dysfunction. Patients at risk of developing iodine-induced thyroid dysfunction should be closely monitored after receiving iodinated contrast media and should be treated as needed.
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Affiliation(s)
| | | | - Angela M. Leung
- Section of Endocrinology, Diabetes, and Nutrition (S.Y.L., L.E.B., E.N.P.), Boston University School of Medicine, Boston, Massachusetts 02118; Division of Nephrology and Hypertension (C.M.R.), Department of Medicine, University of California Irvine, Orange, California 92868; and Division of Endocrinology (A.M.L., G.A.B.), Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095
| | - Lewis E. Braverman
- Section of Endocrinology, Diabetes, and Nutrition (S.Y.L., L.E.B., E.N.P.), Boston University School of Medicine, Boston, Massachusetts 02118; Division of Nephrology and Hypertension (C.M.R.), Department of Medicine, University of California Irvine, Orange, California 92868; and Division of Endocrinology (A.M.L., G.A.B.), Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095
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Prete A, Paragliola RM, Corsello SM. Iodine Supplementation: Usage "with a Grain of Salt". Int J Endocrinol 2015; 2015:312305. [PMID: 25873950 PMCID: PMC4383497 DOI: 10.1155/2015/312305] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/10/2015] [Indexed: 12/16/2022] Open
Abstract
Iodine supplementation through salt iodization is a worldwide, effective strategy for preventing iodine deficiency-related problems. Its safety and efficacy profile has been extensively investigated, and benefits far outweigh the potential iodine-induced risks. Moreover, iodine supplementation during pregnancy in order to avoid brain damage in the newborn is considered a mainstay of preventive medicine. Exposure to high amounts of iodine is actually well tolerated in most cases and can be unrecognized. Nevertheless, at-risk individuals may develop thyroid dysfunction even when they are exposed to increases in iodine intake universally considered as safe. Iodine-induced thyroid disorders include thyroid autoimmunity, thyrotoxicosis, iodine-induced goiter, and hypothyroidism. Moreover, a relationship between iodine intake and histotype distribution of differentiated thyroid cancer has been observed, with a progressive shift from follicular to papillary thyroid cancer. To date, evaluating iodine status in a clinical setting has limitations, and assessing the actual risk for each individual can be challenging, since it is influenced by personal history, genetics, and environmental factors. In conclusion, iodine supplementation programs need to be continued and strengthened, but iodine should be used "with a grain of salt," because a growing number of susceptible individuals will be exposed to the risk of developing iodine-induced thyroid disorders.
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Affiliation(s)
- Alessandro Prete
- Endocrinology Unit, Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168 Rome, Italy
| | - Rosa Maria Paragliola
- Endocrinology Unit, Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168 Rome, Italy
| | - Salvatore Maria Corsello
- Endocrinology Unit, Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168 Rome, Italy
- *Salvatore Maria Corsello:
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van Hoek I, Hesta M, Biourge V. A critical review of food-associated factors proposed in the etiology of feline hyperthyroidism. J Feline Med Surg 2014; 17:837-47. [PMID: 25366172 DOI: 10.1177/1098612x14556558] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Since the first description of feline hyperthyroidism (HT) in 1979, several studies have been undertaken to define the etiology of the disease. Epidemiologic studies, after investigating non-food- and food-associated factors, suggest a multifactorial etiology. However, in the absence of prospective cohort studies that can confirm a cause-and-effect relationship between HT and associated risk factors, no causative factor for HT has been identified to date. Feline HT resembles toxic nodular goiter in humans, with autonomously functioning upregulated iodide uptake systems. Contribution of the diet to HT development remains controversial. The purpose of this paper is to review critically the reported food-associated risk factors for HT.
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Affiliation(s)
- Ingrid van Hoek
- Royal Canin Research & Development Center, Aimargues, France
| | - Myriam Hesta
- Department of Nutrition, Genetics and Ethology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Vincent Biourge
- Royal Canin Research & Development Center, Aimargues, France
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Paparodis R, Imam S, Todorova-Koteva K, Staii A, Jaume JC. Hashimoto's thyroiditis pathology and risk for thyroid cancer. Thyroid 2014; 24:1107-14. [PMID: 24708347 PMCID: PMC4080848 DOI: 10.1089/thy.2013.0588] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hashimoto's thyroiditis (HT) has been found to coexist with differentiated thyroid cancer (DTC) in surgical specimens, but an association between the two conditions has been discounted by the medical literature. Therefore, we performed this study to determine any potential relationship between HT and the risk of developing DTC. METHODS We collected data for thyrotropin (TSH), thyroxine (T4), thyroid peroxidase antibody (TPO-Ab) titers, surgical pathology, and weight-based levothyroxine (LT4) replacement dose for patients who were referred for thyroid surgery. Patients with HT at final pathology were studied further. To estimate thyroid function, patients with preoperative hypothyroid HT (Hypo-HT) were divided into three equal groups based on their LT4 replacement: LT4-Low (<0.90 μg/kg), LT4-Mid (0.90-1.43 μg/kg), and LT4-High (>1.43 μg/kg). A group of preoperatively euthyroid (Euth-HT) patients but with HT by pathology was also studied. All subjects were also grouped based on their TPO-Ab titer in TPO-high (titer >1:1000) or TPO-low/negative (titer <1:1000 or undetectable) groups. The relationship of HT and DTC was studied extensively. RESULTS Of 2811 subjects, 582 had HT on surgical pathology, 365 of whom were Euth-HT preoperatively. DTC was present in 47.9% of the Euth-HT, in 59.7% of LT4-Low, 29.8% of LT4-Mid, and 27.9% of LT4-High groups. The relative risk (RR) for DTC was significantly elevated for the Euth-HT and LT4-Low groups (p<0.001), but not for the LT4-Mid or LT4-High replacement dose groups. TPO-low/negative status conferred an increased RR in the Euth-HT and LT4-Low replacement dose groups (p<0.001 both), while TPO-high status decreased it in Euth-HT group (p<0.05) and made it nonsignificant in the LT4-Low group. CONCLUSIONS HT pathology increases the risk for DTC only in euthyroid subjects and those with partially functional thyroid glands (LT4-Low) but not in fully hypothyroid HT (LT4-Mid and LT4-High). High TPO-Ab titers appear to protect against DTC in patients with HT.
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Affiliation(s)
- Rodis Paparodis
- Endocrine Autoimmunity Unit, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Shahnawaz Imam
- Endocrine Autoimmunity Unit, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Kristina Todorova-Koteva
- Endocrine Autoimmunity Unit, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Anca Staii
- Endocrine Autoimmunity Unit, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Juan Carlos Jaume
- Endocrine Autoimmunity Unit, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
- Veterans Affairs Medical Center, Madison Wisconsin
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Cohen-Lehman J, Charitou MM, Klein I. Tiratricol-induced periodic paralysis: a review of nutraceuticals affecting thyroid function. Endocr Pract 2012; 17:610-5. [PMID: 21803722 DOI: 10.4158/ep10137.ra] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To review the potential adverse effects of thyroid hormone-based nutraceuticals and describe a case of thyrotoxic periodic paralysis (TPP) after abuse of a dietary supplement containing 3,5,3'-triiodothyroacetic acid (tiratricol). METHODS We review the literature on potential dangers and therapeutic misadventures of thyroid hormone-based nutraceuticals and present the clinical, laboratory, and radiologic data of a bodybuilder in whom hypokalemic TPP developed after use of "Triax Metabolic Accelerator". RESULTS A 23-year-old white man developed lower extremity paralysis, diaphoresis, and palpitations in the setting of low serum potassium levels. Laboratory results showed suppressed thyroid-stimulating hormone, low levels of free and total thyroxine, low total triiodothyronine level, and very low 24-hour radioiodine uptake. The patient ultimately admitted to taking a supplement containing tiratricol for approximately 2 months, and hypokalemic TPP was diagnosed. He was treated with potassium supplementation and a β-adrenergic blocking agent, which completely resolved his symptoms. Results of thyroid function tests normalized or approached normal 1 week after hospitalization, and future use of dietary supplements was strongly discouraged. Despite 2 warnings by the US Food and Drug Administration, products containing tiratricol are still available for sale on the Internet. CONCLUSION This report illustrates both an unusual adverse effect of a nutraceutical containing tiratricol and the importance of educating our patients about the risks versus benefits of using these widely available but loosely regulated products.
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Penín M, Rodríguez R, Luna R. [Iodine-induced subclinical hyperthyroidism in a patient with Hashimoto's disease]. ENDOCRINOLOGIA Y NUTRICION : ORGANO DE LA SOCIEDAD ESPANOLA DE ENDOCRINOLOGIA Y NUTRICION 2012; 59:72-73. [PMID: 21775225 DOI: 10.1016/j.endonu.2011.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 05/03/2011] [Accepted: 05/05/2011] [Indexed: 05/31/2023]
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Poole A, Saghir SA. Diiodomethyl-p-tolylsulfone: evaluation of the mode of action for reproductive toxicity. Regul Toxicol Pharmacol 2011; 62:504-12. [PMID: 22166729 DOI: 10.1016/j.yrtph.2011.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 11/14/2011] [Accepted: 11/28/2011] [Indexed: 11/29/2022]
Abstract
The mode of action (MOA) underpinning the reproductive toxicity of diiodomethyl-p-tolylsulfone (DIMPTS) is excess systemic iodine levels, resulting in hypothyroidism. This MOA evaluation also addresses the potential for toxicity and adverse health outcomes during critical windows of development for different tissues. The data indicate that testicular development in the neonate represents the tissue and life-stage that are most sensitive to iodine toxicity. Life-stage specific dosimetry appears to be a major determinant of this sensitivity, with the neonate being exposed to higher levels of iodine than the fetus during the period of testicular development, in particular Sertoli cell maturation and differentiation. While no reports could be found in the literature linking excess iodine exposure in humans to testicular toxicity, there is evidence that neonates born to mothers with excessive iodine intake do exhibit signs of transient hypothyroidism. Although there are major physiological and temporal differences in testicular development and Sertoli cell replication between the rat and human, it is not inconceivable that continuous long term exposures to excess iodine first from maternal milk and then in the diet through to the onset of puberty could affect testicular development. However, exposures to iodinated substances - such as DIMPTS - contribute less than 1% of the required daily iodine intake for normal fetal and neonatal development and, consequently, continuous exposure to excess iodine during the pre-pubertal period is unlikely. As exposures to DIMPTS are both very low and sporadic in nature it is not likely that they represent any risk to health at any life-stage.
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Affiliation(s)
- Alan Poole
- Toxicology and Environmental Research and Consulting, Dow Europe GmbH, Bachtobelstrasse 3, CH-8810 Horgen, Switzerland.
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Hwang S, Lee EY, Lee WK, Shin DY, Lee EJ. Correlation between iodine intake and thyroid function in subjects with normal thyroid function. Biol Trace Elem Res 2011; 143:1393-7. [PMID: 21340678 DOI: 10.1007/s12011-011-8997-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 02/07/2011] [Indexed: 10/18/2022]
Abstract
Excessive iodine intake is known to induce hypothyroidism in people who have underlying thyroid disorders. However, few studies have been performed on subjects with normal thyroid function without a history of autoimmune thyroid disease. We hypothesized that high iodine intake may cause a subtle change in thyroid function even in subjects with normal thyroid function. We analyzed 337 subjects (64 men and 273 women; mean age, 49 years) who showed normal levels of thyroid peroxidase antibodies (TPO-Ab) and thyroglobulin antibodies (Tg-Ab) by measuring the urinary iodine excretion, free T4 (FT4), and thyroid-stimulating hormone (TSH). The results showed urinary iodine excretion had negative correlation with FT4 (γ = -0.11, p = 0.043) and showed a positive trend with TSH (γ = 0.10, p = 0.068). We found that 61.7% of subjects had circulating TPO-Ab within normal reference range. In all subjects, TPO-Ab levels were negatively correlated with FT4 (γ = -0.17, p = 0.002) and positively with TSH (γ = 0.13, p = 0.021). In conclusion, high iodine intake can negatively affect thyroid hormone levels in subjects with normal thyroid function. Population-based study will be helpful for further clarification.
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Affiliation(s)
- Sena Hwang
- Endocrinology, Severance Hospital Integrative Research Institute for Cerebral and Cardiovascular Diseases, Department of Internal Medicine, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, 120-752, South Korea
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Calvi L, Daniels GH. Acute thyrotoxicosis secondary to destructive thyroiditis associated with cardiac catheterization contrast dye. Thyroid 2011; 21:443-9. [PMID: 21385076 DOI: 10.1089/thy.2010.0300] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Thyrotoxicosis caused by destructive thyroiditis is self-limited and results from the subacute release of preformed thyroid hormone. Common etiologies include painful subacute thyroiditis and silent (painless) subacute thyroiditis (including postpartum thyroiditis, amiodarone-associated destructive thyroiditis, and lithium-associated thyroiditis). Thyrotoxicosis commonly evolves slowly over a matter of weeks. PATIENT FINDINGS We report a unique case of severe thyrotoxicosis caused by acute- onset painful destructive thyroiditis in a patient who received large amounts of nonionic contrast dye Hexabrix® for cardiac catheterization. The results of thyroid function and physical examination were normal before the catheterization. SUMMARY The acute onset of severe thyroid pain, rapid increase in serum Free Thyroxine Index, and thyroglobulin concentrations with a triiodothyronine to free thyroxine index ratio of < 20 to 1 were compatible with an acute onset destructive thyroiditis, likely related to direct toxicity from the iodinated contrast material. CONCLUSIONS In light of the large number of patients who receive these contrast agents during cardiac catheterization, clinicians should be advised of this potentially serious complication, particularly in the setting of unstable cardiac disease.
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Affiliation(s)
- Laura Calvi
- Endocrine Division, Department Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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van Doorn L, Eskens FALM, Visser TJ, van der Lugt A, Mathijssen RHJ, Peeters RP. Sorafenib induced thyroiditis in two patients with hepatocellular carcinoma. Thyroid 2011; 21:197-202. [PMID: 21275767 DOI: 10.1089/thy.2010.0234] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sorafenib is a multi-targeted tyrosine kinase inhibitor licensed for the treatment of hepatocellular carcinoma and renal cell carcinoma. Thyroid function test abnormalities have been reported for different tyrosine kinase inhibitors, but only limited data on thyroid function test abnormalities related to sorafenib are available, demonstrating the occurrence of hypothyroidism in patients treated with sorafenib. SUMMARY We describe two patients who developed temporary hyperthyroidism during the course of sorafenib treatment, which was followed by overt and subclinical hypothyroidism, respectively. Thyroid ultrasonography showed an atrophic thyroid gland in patient 1 , and signs of thyroiditis in patient 2 . Detailed reassessment of thyroid volumes on routinely performed computerized tomography scans showed a gradual decrease in thyroid volume during sorafenib treatment in one patient, suggesting progressive thyroid destruction. CONCLUSION This case report describes in detail and for the first time two cases of sorafenib-induced thyroiditis. We assume that this sorafenib-induced destructive thyroiditis is an important cause of sorafenib-induced hypothyroidism.
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Affiliation(s)
- Leni van Doorn
- Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Kim SS, Lee BJ, Lee JC, Kim SJ, Jeon YK, Kim MR, Huh JE, Mok JY, Kim BH, Kim YK, Kim IJ. Coexistence of Hashimoto's thyroiditis with papillary thyroid carcinoma: the influence of lymph node metastasis. Head Neck 2010; 33:1272-7. [PMID: 21837696 DOI: 10.1002/hed.21594] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 06/28/2010] [Accepted: 07/29/2010] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the influence of coexistent Hashimoto's thyroiditis with papillary thyroid carcinoma on lymph node metastasis. METHODS The coexistent Hashimoto's thyroiditis group was defined by the presence of thyroid autoantibodies or pathologic confirmation. The control group did not have autoantibodies, disease, or ultrasound findings of Hashimoto's thyroiditis. RESULTS For the Hashimoto's thyroiditis group, only central lymph node metastasis had a lower frequency and the mean number of central metastatic lymph nodes was lower than in the control group after adjustment. With regard to lateral lymph node involvement, there was no significant difference between the 2 groups. The multivariate analysis showed a negative association between the coexistence of Hashimoto's thyroiditis and central lymph node metastasis. CONCLUSIONS Coexisting Hashimoto's thyroiditis in patients with papillary thyroid carcinoma was identified as a negative independent predictive factor for central lymph node metastasis.
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Affiliation(s)
- Sang Soo Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
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Edinboro CH, Scott-Moncrieff JC, Glickman LT. Feline Hyperthyroidism: Potential Relationship with Iodine Supplement Requirements of Commercial Cat Foods. J Feline Med Surg 2010; 12:672-9. [PMID: 20800208 DOI: 10.1016/j.jfms.2010.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Article rationale Since the late 1970s, there has been a significant increase in the prevalence of feline hyperthyroidism (FH). It is now recognized worldwide as the most common endocrinopathy of older cats, resembling toxic nodular goiter of older humans in iodine-deficient areas. The purpose of this article is to identify the potential for iodine concentrations in the diet to contribute to the etiology of FH. Historical context Iodine concentrations of commercial cat foods vary widely. A review of historical iodine recommendations revealed that the units of iodine supplementation changed in the 1970s. Given this change, foods minimally supplemented since the late 1970s would have been iodine deficient for most cats. Practical relevance Iodine supplementation of commercial cat foods should be evaluated in the light of the iodine recommendations revised in 2006. Foods may remain deficient in iodine if supplemented at the minimum recommended concentration, possibly contributing to the development of FH.
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Affiliation(s)
- Charlotte H Edinboro
- Exponent Inc, 149 Commonwealth Drive, Menlo Park, CA 94025, USA
- Department of Comparative Pathobiology, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
| | - J Catharine Scott-Moncrieff
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
| | - Larry T Glickman
- Department of Comparative Pathobiology, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
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41
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The prevalence of iodine deficiency in women of reproductive age in the United States of America. Public Health Nutr 2007; 10:1532-9; discussion 1540-1. [DOI: 10.1017/s1368980007360862] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective: To review the iodine status of women as assessed through National Health and Nutrition Examination Surveys from 1971 to 2002.Design and Setting: National normative estimates of iodine status of the civilian, non-institutionalized population in the United States of America.Subjects: Women of reproductive age and pregnant women.Results: In the United States of America, iodine began to be added to the diet in the 1920s. An excessive iodine intake was documented by the first National Health and Nutrition Examination Survey (NHANES I) in the 1970s which reported a median urinary iodine (UI) concentration of 320 μg l-1. In the NHANES III survey, conducted between 1988 and 1994, the median UI concentration had decreased to 145 μg l-1, while 14.9% of women aged 15-44 years and 6.9% of pregnant women had a UI concentration 50 μg l-1. The concentrations of serum T4 and thyroid-stimulating hormone of women with a low UI concentration did not, however, indicate an iodine deficiency.Conclusions: Further studies of the association between iodine excretion and biochemical and physiological changes should be undertaken to better understand women's needs for iodine and to develop criteria to monitor them in pregnancy. Because of the potential harm caused by iodine deficiency during pregnancy, we support the use of iodine supplements for all pregnancies while these data are being collected.
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Müssig K, Thamer C, Bares R, Lipp HP, Häring HU, Gallwitz B. Iodine-induced thyrotoxicosis after ingestion of kelp-containing tea. J Gen Intern Med 2006; 21:C11-4. [PMID: 16808731 PMCID: PMC1924637 DOI: 10.1111/j.1525-1497.2006.00416.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Revised: 11/11/2005] [Accepted: 01/09/2006] [Indexed: 11/30/2022]
Abstract
Complementary medication is en vogue and an increasing number of patients consume herbal medicine without reporting their use to physicians. We report a case of iodine-induced hyperthyroidism due to the ingestion of a kelp-containing tea. A 39-year-old woman with multinodular goiter presented with typical signs of hyperthyroidism, which was confirmed by endocrine tests. She was not exposed to iodinated radiocontrast media and did not take medications containing iodine, such as amiodarone. However, a detailed medical history revealed that she had been treated for a period of 4 weeks by a Chinese alternative practitioner with a herbal tea containing kelp because of her enlarged thyroid. The consumption of the tea was discontinued and an antithyroid drug therapy was initiated. Physicians should advise patients with underlying thyroid disease to avoid all complementary or alternative medications containing iodine.
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Affiliation(s)
- Karsten Müssig
- Division of Endocrinology, Metabolism and Pathobiochemistry, Department of Internal Medicine, University Hospital of Tübingen, Germany.
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Sidorov J. Computer-assisted technology: not if, not when, but how. A systematic review of interactive computer-assisted technology in diabetes care. J Gen Intern Med 2006; 21:201-2. [PMID: 16606384 PMCID: PMC1484652 DOI: 10.1111/j.1525-1497.2006.0344.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kramer A, Jünger M, Kampf G. [Hygienic and dermatologic aspects of hand disinfection and prophylactic skin antisepsis]. Hautarzt 2006; 56:743-51. [PMID: 15995868 DOI: 10.1007/s00105-005-0987-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hygienic hand disinfection must be carried out after all patient-care activities associated with contamination risks, as well as when moving from contaminated to clean body sites, after contact with environmental surfaces in the immediate vicinity of patients, after glove removal and before aseptic procedures. Preparatory handwashing (for about 10 seconds) to mechanically remove soil and bacterial spores should be performed at least 10 minutes before surgical hand disinfection. This allows time for the normalization of increased skin hydration, a prerequisite for effective hand disinfection. Depending on the manufacturer's instructions, application times of 1.5, 3 or 5 minutes can be observed. The regular use of skin care and skin protection products can help to prevent toxic skin irritation. For skin antisepsis the recommended exposure times are > or =15 seconds before subcutaneous injections, > or =1 minute before puncture of joints and body cavities as well as preoperatively, and > or =10 minutes on skin areas rich in sebaceous glands. For all 3 indications, alcohol-based formulations are the agents of choice.
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Affiliation(s)
- A Kramer
- Institut für Hygiene und Umweltmedizin, Ernst-Moritz-Arndt-Universität Greifswald.
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Laurberg P, Andersen S, Karmisholt J. Antithyroid drug therapy of Graves' hyperthyroidism: realistic goals and focus on evidence. Expert Rev Endocrinol Metab 2006; 1:91-102. [PMID: 30743772 DOI: 10.1586/17446651.1.1.91] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Only a minority of patients with hyperthyroidism caused by Graves' disease will experience cure of disease with a permanent euthyroid state without medication. Antithyroid drugs are useful in attaining euthyroidism, and most patients will gradually enter remission of the autoimmune abnormality after becoming euthyroid. A stable euthyroid state may be sustained by prolonged low-dose medication. The risk of relapse of hyperthyroidism after withdrawal of medication seems to be independent of duration of therapy, once remission has been induced. A number of risk factors influence the outcome of therapy and they should be evaluated when planning duration of therapy with antithyroid drugs.
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Affiliation(s)
- Peter Laurberg
- a Aalborg Hospital, Århus University Hospital, Department of Endocrinology and Internal Medicine, Postboks 561, 9100 Aalborg, Denmark.
| | - Stig Andersen
- b Aalborg Hospital, Århus University Hospital, Department of Endocrinology and Internal Medicine, Postboks 561, 9100 Aalborg, Denmark.
| | - Jesper Karmisholt
- c Aalborg Hospital, Århus University Hospital, Department of Endocrinology and Internal Medicine, Postboks 561, 9100 Aalborg, Denmark.
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Okochi M, Yokokawa H, Lim TK, Taguchi T, Takahashi H, Yokouchi H, Kaiho T, Sakuma A, Matsunaga T. Disinfection of microorganisms by use of electrochemically regenerated periodate. Appl Environ Microbiol 2005; 71:6410-3. [PMID: 16204569 PMCID: PMC1265992 DOI: 10.1128/aem.71.10.6410-6413.2005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Accepted: 05/13/2005] [Indexed: 11/20/2022] Open
Abstract
A new method for disinfection of microorganisms by electrochemically regenerated periodate was developed. Oxidation of iodate to periodate was observed at 1.25 V versus a silver/silver chloride electrode in a cyclic voltammogram of potassium iodate. When 1.25 V was applied in 1.0 mM potassium iodate, approximately 4-log inactivation of Escherichia coli was observed in 30 min.
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Affiliation(s)
- Mina Okochi
- Department of Biotechnology and Life Sciences, Tokyo University of Agriculture and Technology, 2-24-16, Naka-cho, Koganei, Tokyo 184-8588, Japan
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Caldwell KL, Jones R, Hollowell JG. Urinary iodine concentration: United States National Health And Nutrition Examination Survey 2001-2002. Thyroid 2005; 15:692-9. [PMID: 16053386 DOI: 10.1089/thy.2005.15.692] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Urine iodine has been measured in the U.S. population by the National Health and Nutrition Examination Survey (NHANES) since 1971. A downward trend was noted between NHANES I (320 +/- 6 microg/L in 1971-1974) and NHANES III (145 +/- 3 microg/L in 1988-1994). This report presents data from NHANES 2001-2002 that indicates that the U.S. median urine iodine (UI) level has stabilized since the initial drop between NHANES I and NHANES III. The median UI concentration in the U.S. population in NHANES 2001-2002 was found to be 167.8 microg/L (95% confidence interval [CI] 159.3-177.6). The NHANES 2001-2002 data confirm the current stability of the U.S. iodine intake and continued adequate iodine nutrition for the country.
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Affiliation(s)
- Kathleen L Caldwell
- Inorganic Toxicology and Nutrition Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control, Atlanta, Georgia 30341, USA.
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Laurberg P, Andersen S, Bülow Pedersen I, Carlé A. Hypothyroidism in the elderly: pathophysiology, diagnosis and treatment. Drugs Aging 2005; 22:23-38. [PMID: 15663347 DOI: 10.2165/00002512-200522010-00002] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Some degree of hypothyroidism is common in the elderly. It affects 5-20% of women and 3-8% of men. The occurrence varies with genetics with a high prevalence in Caucasians, and the disease is more common in populations with a high iodine intake. The common causes of hypothyroidism are autoimmune destruction of the thyroid gland and previous thyroid surgery or radioiodine therapy. Various types of medication, including amiodarone, cytokines and lithium, often induce hypothyroidism. Symptoms may be atypical and measurement of serum thyroid-stimulating hormone (TSH) levels should be part of biochemical testing for undiagnosed medical conditions in elderly subjects. The finding of an elevated serum TSH level should be confirmed by repeated testing and supplemented with measurements of serum levels of thyroxine (T(4)) and thyroid peroxidase antibodies to verify, quantify and subclassify the abnormality. The recommended and appropriate replacement therapy for hypothyroidism is levothyroxine sodium. The initial replacement dose should be low if heart disease is suspected. Because of the long half-life of levothyroxine sodium small dosage adjustments may be performed by adding or withdrawing a tablet once or twice weekly. Levothyroxine sodium is only partly absorbed after oral ingestion, and food, minerals, drugs and tablet composition influence absorption. Studies performed a few years ago suggested that a combination of levothyroxine sodium and liothyronine may improve clinical results, but recent more comprehensive studies have not supported this hypothesis. Accordingly, liothyronine replacement is not documented to be of benefit. If liothyronine is added to replacement, the liothyronine dose should be kept low, within the physiological range and, preferably be administered twice daily. Thyroid hormone therapy has no beneficial effect above placebo in elderly individuals with normal serum TSH levels and T(4) levels. The major risk of levothyroxine sodium therapy is over-replacement, with anxiety, muscle wasting, osteoporosis and atrial fibrillation as adverse effects. Subclinical hypothyroidism with elevated serum TSH levels but T(4) levels within the laboratory reference range is a mild variant of overt hypothyroidism. Patients with subclinical hypothyroidism should be informed about the disease and offered the possibility of replacement. Only some patients treated for subclinical hypothyroidism will feel better after therapy. In elderly patients on replacement therapy, care should include estimation of serum TSH level once or twice a year, with small dosage adjustments of levothyroxine sodium to keep serum TSH level within the normal range.
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Affiliation(s)
- Peter Laurberg
- Department of Endocrinology and Medicine, Aalborg Hospital, Aarhus University Hospital, DK-9000 Aalborg, Denmark.
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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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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: 92] [Impact Index Per Article: 4.6] [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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