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Monteiro MC, Assayag G, Botler R, Bergamin A, Conceição FL, Silva de Morais N, Seixas RPD, Berbara TMBL, Schtscherbyna A, Corcino CM, Saraiva DA, Vaisman M, Teixeira PFS. Thyroid Volume in Pregnancy is Associated with Parity, Gestational Age, and Body Mass Index in an Iodine-sufficient Area. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e557-e561. [PMID: 37944921 PMCID: PMC10635786 DOI: 10.1055/s-0043-1776028] [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: 12/06/2022] [Accepted: 08/01/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE We compared thyroid volume (TV) and presence of nodular goiter (NG) in pregnant vs. non-pregnant women in an iodine-sufficient area. We also evaluated the relationship between gestational age, parity, and TV in the pregnant women group, and determined the 2.5th and 97.5th percentiles of normal TV in pregnancy. METHODS This cross-sectional study included 299 healthy women (216 pregnant) without previous thyroid diseases. Thyroid ultrasounds were performed and compared between pregnant and non-pregnant women. The range of normal distribution of TV (2.5th and 97.5th percentiles) in pregnancy was determined after excluding individuals with positive thyroid antibodies, NG, and/or abnormal serum thyrotropin (TSH) or free thyroxine (FT4). RESULTS Thyroid volume was larger among pregnant compared to non-pregnant women (8.6 vs 6.1 cm3; p < 0.001) and was positively correlated with gestational age (rs = 0.221; p = 0.001), body mass index (BMI, rs 0.165; p = 0.002), and FT4 levels (rs 0.118 p = 0.021). Nodular goiter frequency did not differ between the two groups. There was a negative correlation between TV and TSH (rs -0.13; p = 0.014). Thyroid volume was lower among primiparous compared to multiparous patients (7.8 vs 8.9; p < 0.001) and was positively correlated with parity (rs 0.161; p = 0.016). The 2.5th and 97.5th percentiles of TV were 4.23 and 16.47 cm3, respectively. CONCLUSION Thyroid volume was higher in pregnant compared to non-pregnant women and was positively related to parity, BMI, and gestational age in a normal iodine status population. Pregnancy did not interfere with the development of NG.
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Affiliation(s)
- Mariana Couto Monteiro
- Endocrinology Postgraduate Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Gabriela Assayag
- Endocrinology Postgraduate Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Ricardo Botler
- Endocrinology Postgraduate Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Anice Bergamin
- Endocrinology Postgraduate Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Flávia Lúcia Conceição
- Endocrinology Postgraduate Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Nathalie Silva de Morais
- Endocrinology Postgraduate Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Annie Schtscherbyna
- Endocrinology Postgraduate Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Carolina Martins Corcino
- Endocrinology Postgraduate Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Débora Ayres Saraiva
- Endocrinology Postgraduate Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Mário Vaisman
- Endocrinology Postgraduate Program, Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Isiklar Ozberk D, Kutlu R, Kilinc I, Kilicaslan AO. Effects of mandatory salt iodization on breast milk, urinary iodine concentrations, and thyroid hormones: is iodine deficiency still a continuing problem? J Endocrinol Invest 2019; 42:411-418. [PMID: 30099723 DOI: 10.1007/s40618-018-0930-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 07/27/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate whether mandatory use of iodized salt in Turkey, since 1999 has sufficient effects on pregnant women and their newborns' urinary iodine concentrations (UIC), maternal and newborns' thyroid function tests and breast milk iodine concentrations (BMIC). METHODS This cross-sectional analytical-type study was conducted in an obstetrics and gynecology hospital in Konya, Turkey. One hundred and seven pregnant women and their 107 full-term newborns were included into the study. Levels of pregnant women and their newborns' UIC, thyroid-stimulated hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), thyroglobulin (Tg), and BMIC were studied. RESULTS Of 107 women with term pregnancy, mean TSH value and hypothyroidism frequency were found as 2.34 ± 1.33 mIU/L and 18.7%, respectively. Cord blood TSH level was found higher (≥ 10 mIU/L) in five newborns. Accordingly, the incidence of transient congenital hypothyroidism was 4.7% (5/107). Tg levels were observed to be higher in 50.5% of newborns and 22.4% of pregnant women. Frequency of iodized salt use in pregnancies was detected as 96.3% in general population, 97.5% in urban, and 92.9% in rural areas. Of pregnancies and newborns, 57.9 and 53.3% were found to have deficient urinary iodine, respectively, and BMIC deficiency was detected as 52.0%. There was a significant positive correlation between pregnant women's UIC, and newborns' UIC and BMIC. CONCLUSIONS Despite the effective struggle with iodine deficiency and salt iodination control program in Konya, we concluded that iodine deficiency still persists as a significant problem in pregnancies.
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Affiliation(s)
- D Isiklar Ozberk
- Department of Family Medicine, Güzelyurt District Government Hospital, Aksaray, Turkey.
| | - R Kutlu
- Department of Family Medicine, Meram Medical Faculty, University of Necmettin Erbakan, Konya, Turkey
| | - I Kilinc
- Department of Clinical Biochemistry, Meram Medical Faculty, University of Necmettin Erbakan, Konya, Turkey
| | - A O Kilicaslan
- Department of Family Medicine, Karatay Fetih Family Health Center, Konya, Turkey
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Adu-Afarwuah S, Young RT, Lartey A, Okronipa H, Ashorn P, Ashorn U, Zeilani M, Dewey KG. Supplementation during pregnancy with small-quantity lipid-based nutrient supplements or multiple micronutrients, compared with iron and folic acid, increases women's urinary iodine concentration in semiurban Ghana: A randomized controlled trial. MATERNAL AND CHILD NUTRITION 2017; 14:e12570. [PMID: 29210520 PMCID: PMC5900724 DOI: 10.1111/mcn.12570] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/24/2017] [Accepted: 11/01/2017] [Indexed: 12/12/2022]
Abstract
There is little information on whether prenatal multiple micronutrient (MMN) supplements containing iodine affect women's iodine status. In the International Lipid‐based Nutrient Supplements DYAD‐Ghana trial, we aimed to assess women's urinary iodine concentration (UIC, μg/L) during pregnancy, as one of the planned secondary outcomes. Women (n = 1,320) <20 weeks of gestation were randomized to consume 60 mg iron and 400 μg folic acid per day (iron and folic acid [IFA]); 18 vitamins and minerals including 250 μg iodine per day (MMN); or 20 g/day of small‐quantity lipid‐based nutrient supplements (LNS) with the same and additional 4 vitamins and minerals as the MMN (LNS). In a subsample (n = 295), we tested differences in groups' geometric mean UICs at 36 weeks of gestation controlling for baseline UIC and compared the geometric means (approximately median UICs) with the World Health Organization (WHO) cut‐offs: median UIC <150, 150–249, and ≥500 reflecting low, adequate, and excessive iodine intakes, respectively. At baseline, overall median UIC was 137. At 36 weeks of gestation, controlling for baseline UIC, geometric mean (95% confidence interval) UICs of the MMN (161 [133, 184]) and LNS (158 [132, 185]) groups did not differ; both values were significantly greater (overall p = .004) than that of the IFA group (116 [101, 135]). The median UICs of the MMN and LNS groups were within the WHO “adequate” range, whereas that of the IFA group was below the WHO adequate range. In this setting, supplementation during pregnancy with small‐quantity LNS or MMN providing iodine at the WHO‐recommended dose, compared with IFA, increases the likelihood of adequate iodine status.
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Affiliation(s)
- Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Rebecca T Young
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, California, USA
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Harriet Okronipa
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Per Ashorn
- Centre for Child Health Research, University of Tampere Faculty of Medicine and Life Sciences, and Tampere University Hospital, Department of Pediatrics, Tampere, Finland
| | - Ulla Ashorn
- Centre for Child Health Research, University of Tampere Faculty of Medicine and Life Sciences, and Tampere University Hospital, Department of Pediatrics, Tampere, Finland
| | | | - Kathryn G Dewey
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, California, USA
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Stinca S, Andersson M, Herter-Aeberli I, Chabaa L, Cherkaoui M, El Ansari N, Aboussad A, Weibel S, Zimmermann MB. Moderate-to-Severe Iodine Deficiency in the "First 1000 Days" Causes More Thyroid Hypofunction in Infants Than in Pregnant or Lactating Women. J Nutr 2017; 147:589-595. [PMID: 28202636 DOI: 10.3945/jn.116.244665] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/16/2016] [Accepted: 01/12/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Iodine deficiency early in the life cycle-the "first 1000 days"-can cause hypothyroidism and irreversibly impair neuromotor development. However, the relative vulnerability among women and infants during this critical period is unclear, making it difficult for country-based programs with limited resources to prioritize their iodine interventions.Objective: Our aim was to determine the prevalence of thyroid hypofunction in women and infants living in an area of moderate-to-severe iodine deficiency.Methods: In a cross-sectional survey in Morocco, we measured urinary iodine concentrations (UICs) and concentrations of thyroid-stimulating hormone (TSH) and total or free thyroxine (TT4 or fT4, respectively) in women of reproductive age (n = 156), pregnant women (n = 245), and lactating women (n = 239) and their young infants (n = 239). We calculated daily iodine intakes and measured iodine concentrations in breast milk and household salt. We compared the incidence of hypothyroidism between the 3 groups of women and with the infants.Results: Women of reproductive age, pregnant women, and lactating women had median (IQR) UICs of 41 (29-63), 32 (17-58), and 35 (19-62) μg/L; and estimated iodine intakes were ∼60%, 22%, and 26% of Recommended Nutrient Intakes (RNIs). The infants' median UIC was 73 (28-157) μg/L, which was greater than for all 3 groups of women (P < 0.001), and their dietary intakes were 27% of the RNI. The prevalence of hypothyroidism was not significantly different between the 4 groups, whereas the prevalence of hypothyroxinemia was higher in infants (40%) than in the 3 groups of women (11-14%) (P < 0.001). The median breast-milk iodine concentration was 42 (26-81) μg/L. Only 6% of salt samples were adequately iodized to a concentration of ≥15 ppm; 54% were inadequately iodized and 40% contained no measurable iodine.Conclusions: In an area of moderate-to-severe iodine deficiency, the prevalence of thyroid hypofunction is ∼4-fold higher in young infants compared with the 3 groups of women, suggesting that, in the "first 1000 days," infants are more vulnerable than their mothers and that programs should prioritize iodine prophylaxis for this group.
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Affiliation(s)
- Sara Stinca
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland;
| | - Maria Andersson
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Isabelle Herter-Aeberli
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Laila Chabaa
- Mohammed VI University Hospital, Marrakesh, Morocco; and.,Medical and Pharmaceutical Faculty, University Cady Ayyad, Marrakesh, Morocco
| | | | - Nawal El Ansari
- Mohammed VI University Hospital, Marrakesh, Morocco; and.,Medical and Pharmaceutical Faculty, University Cady Ayyad, Marrakesh, Morocco
| | - Abdelmounaim Aboussad
- Mohammed VI University Hospital, Marrakesh, Morocco; and.,Medical and Pharmaceutical Faculty, University Cady Ayyad, Marrakesh, Morocco
| | - Sandra Weibel
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland;
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Meyerholz MM, Mense K, Linden M, Raliou M, Sandra O, Schuberth HJ, Hoedemaker M, Schmicke M. Peripheral thyroid hormone levels and hepatic thyroid hormone deiodinase gene expression in dairy heifers on the day of ovulation and during the early peri-implantation period. Acta Vet Scand 2016; 58:52. [PMID: 27608831 PMCID: PMC5017029 DOI: 10.1186/s13028-016-0231-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 08/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Before the onset of fetal thyroid hormone production, the transplacental delivery of maternal thyroid hormones is necessary for embryonic and fetal development. Therefore, the adaptation of maternal thyroid hormone metabolism may be important for pregnancy success and embryo survival. The aims of this study were to determine the thyroid hormone levels during the early peri-implantation period until day 18 and on the day of ovulation, to determine whether pregnancy success is dependent on a "normothyroid status" and to determine whether physiological adaptations in maternal thyroid hormone metabolism occur, which may be necessary to provide sufficient amounts of biologically active T3 to support early pregnancy. Therefore, blood samples obtained on the day of ovulation (day 0) and days 14 and 18 of the Holstein-Friesian heifers (n = 10) during the respective pregnant, non-pregnant and negative control cycles were analyzed for thyroid-stimulating-hormone (TSH), thyroxine (T4) and triiodothyronine (T3). Liver biopsies (day 18) from pregnant and respective non-pregnant heifers were analyzed for mRNA expression of the most abundant hepatic thyroid hormone deiodinase (DIO1) by real time qPCR. RESULTS Although liver DIO1 mRNA expression did not differ between the pregnant and non-pregnant heifers on day 18, the serum concentrations of TSH and T3 on day 18 were higher in non-pregnant heifers compared to pregnant heifers (P < 0.05). Moreover, T3 decreased between day 0 and 18 in pregnant heifers (P < 0.001). CONCLUSIONS In conclusion, no associations between thyroid hormone patterns on day 18 and pregnancy success were detected. During the early peri-implantation period, TSH and T3 may be affected by the pregnancy status because both TSH and T3 were lower on day 18 in pregnant heifers compared to non-pregnant dairy heifers. In further studies, the thyroid hormone axis should be evaluated throughout the entire gestation to confirm these data and identify other possible effects of pregnancy on the thyroid hormone axis in cattle.
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Abstract
OBJECTIVE Various physiological changes occur in maternal thyroid economy during pregnancy. This review focuses on the events taking place during gestation that together strongly influence maternal thyroid function. METHODS Scientific reports on maternal thyroid physiology in pregnancy. RESULTS During the 1st trimester, human chorionic gonadotropin (hCG) induces a transient increase in free thyroxine (FT4) levels, which is mirrored by a lowering of thyroid-stimulating hormone (TSH) concentrations. Following this period, serum FT4 concentrations decrease of approximately 10 to 15%, and serum TSH values steadily return to normal. Also starting in early gestation, there is a marked increase in serum thyroxine-binding globulin (TBG) concentrations, which peak around midgestation and are maintained thereafter. This event, in turn, is responsible for a significant rise in total T4 and triiodothyronine (T3). Finally, significant modifications in the peripheral metabolism of maternal thyroid hormones occur, due to the expression and activity of placental types 2 and 3 iodothyronine deiodinases (D2 and D3, respectively). CONCLUSION In line with these variations, both free thyroid hormone and TSH reference intervals change throughout pregnancy, and most scientific societies now recommend that method- and gestation-specific reference ranges be used for interpreting results in pregnancy.The maternal iodide pool reduces during pregnancy because of increased renal clearance of iodine and transfer of iodine to the feto-placental unit. This results in an additional requirement of iodine during pregnancy of ~100% as compared to nonpregnant adults. In accordance, the recommended iodine intake in pregnancy is 250 μg/day. A daily iodine intake below this threshold poses risks of various degrees of thyroid insufficiency for both the mother and the fetus.
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Affiliation(s)
- Mariacarla Moleti
- Dipartimento di Medicina Clinica e Sperimentale, University of Messina, Messina, Italy
| | - Francesco Trimarchi
- Dipartimento di Medicina Clinica e Sperimentale, University of Messina, Messina, Italy
| | - Francesco Vermiglio
- Dipartimento di Medicina Clinica e Sperimentale, University of Messina, Messina, Italy
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Caron P. Neurocognitive outcomes of children secondary to mild iodine deficiency in pregnant women. ANNALES D'ENDOCRINOLOGIE 2015; 76:248-52. [PMID: 25934357 DOI: 10.1016/j.ando.2015.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 01/30/2015] [Indexed: 11/19/2022]
Abstract
Iodine deficiency is the most important preventable cause of brain damage worldwide. During pregnancy, severe iodine deficiency causes endemic cretinism, whereas mild-to-moderate iodine deficiency impairs neurocognitive function of the offspring. Numerous reports demonstrate the impact of iodine supplementation on prevention of cretinism, and recent studies evaluate the effects of iodine prophylaxis on neurocognitive development in children of women with mild-to-moderate iodine deficiency. Iodine prophylaxis is generally well tolerated without side effects for the pregnant women and the offspring. In France, the iodine status was recently considered as satisfactory in children and adult population, but regional studies conducted during the last two decades have shown that healthy women are mild-to-moderately iodine deficient during pregnancy. According to recent World Heath Organization guidelines, systematic iodine prophylaxis is recommended in women planning a pregnancy, during gestation and lactation in order to prevent maternal, neonatal and infantile consequences of mild-to-moderate iodine deficiency.
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Affiliation(s)
- Philippe Caron
- Service d'endocrinologie, maladies métaboliques et nutrition, pôle cardiovasculaire et métabolique, CHU Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France.
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Gronier H, Sonigo C, Jacquesson L. [Impact of thyroid function on fertility]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2015; 43:225-33. [PMID: 25724447 DOI: 10.1016/j.gyobfe.2015.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 01/13/2015] [Indexed: 05/21/2023]
Abstract
Until recently, anovulation or recurrent miscarriages were the only situations for screening a thyroid dysfunction in an infertile patient. Recent U.S. guidelines published in 2011 identify infertile women as being at risk for thyroid dysfunction. This paper proposes, on the occasion of the new recommendations, a review of the literature data on the known impact of thyroid dysfunction on fertility, on the first trimester of pregnancy and on the way to treat them.
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Affiliation(s)
- H Gronier
- Service de médecine de la reproduction, hôpital Jean-Verdier, AP-HP, avenue du 14-Juillet, 93143 Bondy cedex, France.
| | - C Sonigo
- Service de médecine de la reproduction, hôpital Jean-Verdier, AP-HP, avenue du 14-Juillet, 93143 Bondy cedex, France; Inserm U693, 63, avenue Gabriel-Péri, 94276 Le Kremlin-Bicêtre, France
| | - L Jacquesson
- Service d'endocrinologie, groupe hospitalier La Pitié-Salpêtrière - Charles-Foix, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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Sahin SB, Ogullar S, Ural UM, Ilkkilic K, Metin Y, Ayaz T. Alterations of thyroid volume and nodular size during and after pregnancy in a severe iodine-deficient area. Clin Endocrinol (Oxf) 2014; 81:762-8. [PMID: 24811142 DOI: 10.1111/cen.12490] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 03/31/2014] [Accepted: 05/01/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The effects of pregnancy on thyroid nodules were investigated in a few number of studies. We aimed to evaluate the prevalence of thyroid nodules, the changes in size, volume and number of nodules during pregnancy and after delivery in pregnant women. DESIGN AND METHODS This prospective study was performed in a severe iodine-deficient area and included 83 pregnant women (mean age 30·4 ± 5·5 years). We evaluated thyroid hormone levels, ultrasound examination of thyroid and urine iodine concentration (UIE) at each trimester and at 3-month post-partum period (PP). All patients with thyroid nodules >1 cm underwent fine-needle aspiration biopsy (FNAB) after the last visit at the PP. RESULTS Twenty-six women had thyroid nodules on thyroid ultrasonography at the first trimester. The volume of single/dominant nodule showed enlargement during pregnancy and remained at the PP; however, it was not significant (first trimester: 0·83 ± 0·8 ml; second trimester: 0·92 ± 1 ml; third trimester: 0·99 ± 1·2 ml; PP: 0·92 ± 1·2 ml). The maximum diameter of single/dominant nodule in the third trimester of pregnancy (12·6 ± 5·4 mm) was greater than the first trimester (11·9 ± 4·8 mm) (P = 0·002). The number of nodules did not change during pregnancy. The mean TV increased during pregnancy and remained 3 months after delivery (P < 0·001), and the maximum value of TV was reached in the third trimester (14·2 ± 7·9 ml). FNAB results revealed a 6·6% prevalence of malignancy among the nodules. CONCLUSIONS Thyroid nodules were present in 30·1% of pregnant women. While size of the single/dominant thyroid nodule increased significantly during pregnancy, the number of nodules did not change.
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Affiliation(s)
- Serap B Sahin
- Department of Endocrinology and Metabolism Disease, Recep Tayyip Erdogan University Medical School, Rize, Turkey
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A Longitudinal Study of Changes in Thyroid Related Hormones among Pregnant Women Residing in an Iodine Deficient Urban Area. ISRN ENDOCRINOLOGY 2013; 2013:234031. [PMID: 24236234 PMCID: PMC3818871 DOI: 10.1155/2013/234031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 09/01/2013] [Indexed: 11/18/2022]
Abstract
Problem Statement. Thyroid gland in women undergoes functional changes during pregnancy. A few studies have described such changes in pregnant women residing in iodine deficient areas. Objective. To document these changes in pregnant women residing in Lahore, a low iodine intake urban area of Pakistan. Patients and Methods. In 254 pregnant women, data of FT4, FT3, and TSH during the first and subsequent trimesters were obtained and compared with those of 110 nonpregnant women. These hormones were determined in serum by radioimmunoassay (RIA) techniques using commercial kits. Results. Compared to nonpregnant women mean FT4 level was decreased, and FT3 and TSH increased significantly (P < 0.05) in pregnant women. A negative correlation of FT4 with TSH was observed in all three trimesters. Serum FT3 was positively correlated with TSH only during the third trimester. As a function of gestation time, FT4 levels progressively decreased, and FT3 and TSH levels increased significantly (one-way ANOVA F = 108.2, 17.3, and 44.8, resp.; all P < 0.05) exhibiting thyroid gland adaptations. Conclusion. Pregnancy is associated with significant alterations in thyroid function due to low iodine intake in women residing in study area. The compensated thyroid function poses a risk of thyroid failure in a number of pregnant women.
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Aguayo A, Grau G, Vela A, Aniel-Quiroga A, Espada M, Martul P, Castaño L, Rica I. Urinary iodine and thyroid function in a population of healthy pregnant women in the North of Spain. J Trace Elem Med Biol 2013; 27:302-6. [PMID: 23992867 DOI: 10.1016/j.jtemb.2013.07.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 05/30/2013] [Accepted: 07/06/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Iodine is an essential trace element for the synthesis of thyroid hormones, which are keys in maternal metabolism during pregnancy as well as in neurological development during fetal and postnatal life. This was a prospective study on iodine status and thyroid function in women during pregnancy in the Basque country to assess whether there was any relationship among maternal urinary iodine, maternal thyroid function and thyrotropin (TSH) in newborns, and to explore any difference in women experiencing miscarriages. METHODS We analyzed TSH, free T(4) (FT(4)), free T(3) (FT(3)), thyroid peroxidase antibody (TPO-Ab) titers in serum and urinary iodine concentrations (UIC) in 2104 women in the first trimester of pregnancy and in 1322 of them in their second trimester. We obtained neonatal TSH levels in 1868 cases. RESULTS In the first (T1) and second trimesters (T2), the median UICs were 88.5 μg/L and 140 μg/L, respectively. No relationship was found between UIC and FT4, or maternal and neonatal TSH. In T1 and T2, 9.7% and 7.5% of women were TPO-Ab positive, respectively. The total miscarriage rate was 10%. The percentage of miscarriages in healthy women was 8.9%, lower than in women with overt hypothyroidism (21.2%; p < 0.001) and than in women with subclinical hypothyroidism (15.6%; p < 0.025). The miscarriage rate was not higher in TPO-Ab-positive women. CONCLUSIONS In this study most women had iodine deficiency during pregnancy. Neonatal TSH is not correlated with maternal UIC during pregnancy. Pregnant women with hypothyroidism have a higher rate of miscarriages.
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Affiliation(s)
- Anibal Aguayo
- Paediatric Endocrinology Section, Cruces University Hospital, UPV/EHU, Plaza de Cruces s/n, 48903 Barakaldo-Bizkaia, Spain; CIBERER (Center for Biomedical Research on Rare Diseases), Instituto de Salud Carlos III, Barcelona, Spain
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Fuse Y, Shishiba Y, Irie M. Gestational changes of thyroid function and urinary iodine in thyroid antibody-negative Japanese women. Endocr J 2013; 60:1095-106. [PMID: 23811988 DOI: 10.1507/endocrj.ej13-0184] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Iodine is an essential nutrient for thyroid hormone synthesis, and iodine deficiency especially in pregnant and lactating women results in serious damage to their infants. To characterize iodine nutrition throughout gestation by using a food frequency questionnaire (FFQ) and urinary iodine concentration (UIC) measurement, and to establish appropriate gestational age-specific reference ranges for serum TSH and FT₄ in thyroid autoantibody (ThAb) negative euthyroid Japanese women, a total number of 563 pregnant women including 422 subjects with negative ThAbs, 105 postpartum women and their 297 newborn infants were included in the study. Dietary iodine intake (DII) was evaluated by FFQ. Serum TSH, FT₄ and UIC were sequentially determined in the three trimesters of pregnancy and at the 31st postpartum day. The overall median UICs throughout pregnancy and in the postpartum period were 224.0 and 135.0 μg/L, respectively, suggesting sufficient iodine nutrition. The median DII was 842.4 μg/day in pregnant women. The median UIC in the first trimester (215.9 μg/L) significantly decreased in the second trimester (136.0 μg/L). The prevalence of pregnant women with a UIC below 150 μg/L was 31.6% and that in lactating women with a UIC below 100 μg/L was 33.3%. The pattern of gestational change in serum TSH and FT₄ was comparable to that in iodine-sufficient areas. A substantial percentage of women might be at risk for iodine deficiency if there is a restriction of iodine-rich foods. However, iodine supplementation for pregnant women must be carefully balanced against the risk of iodine excess particularly in Japan. Further research in larger samples is needed.
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Affiliation(s)
- Yozen Fuse
- Department of Health Policy, National Research Institute for Child Health and Development, Tokyo 157-8535, Japan
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Iodine status has no impact on thyroid function in early healthy pregnancy. J Thyroid Res 2012; 2012:168764. [PMID: 23251828 PMCID: PMC3515943 DOI: 10.1155/2012/168764] [Citation(s) in RCA: 25] [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: 05/01/2012] [Accepted: 10/19/2012] [Indexed: 11/27/2022] Open
Abstract
Aim. To assess the impact of iodine status in early pregnancy on thyroid function. Methods. Women >18 years old seen at their first prenatal consult before 12 weeks of amenorrhea and without personal thyroid history were proposed thyroid screening and were eligible if they had strictly normal thyroid tests (fT4 > 10th percentile, TSH < 2.5 mUI/L, negative anti-TPO antibodies). Evaluation included thyroid ultrasound, extensive thyroid tests, and ioduria (UIE). Results. 110 women (27.5 y, 8 weeks of amenorrhea, smoking status: 28% current smokers) were enrolled. Results are expressed as medians. UIE was 116 μg/L. 66.3% of women had iodine deficiency (ID) defined as UIE < 150. FT4 was 14.35 pmol/L; TSH 1.18 mUI/L; fT3 5 pmol/L; thyroglobulin 17.4 ng/mL; rT3 0.27 ng/mL; thyroid volume: 9.4 ml. UIE did not correlate with any thyroid tests, but correlated negatively with thyroid volume. UIE and all thyroid tests, except fT3, correlated strongly with βhCG. Smoking correlated with higher thyroid volume and thyroglobulin and with lower rT3. Conclusions. In pregnant women selected for normal thyroid function, mild ID is present in 66% during the 1st trimester. The absence of correlation between UIE and thyroid tests at that stage contrasts with the impact of βhCG and, to a lesser degree, maternal smoking.
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Hisada A, Shimodaira K, Okai T, Watanabe K, Takemori H, Takasuga T, Noda Y, Shirakawa M, Kato N, Yoshinaga J. Serum levels of hydroxylated PCBs, PCBs and thyroid hormone measures of Japanese pregnant women. Environ Health Prev Med 2012; 18:205-14. [PMID: 23054994 DOI: 10.1007/s12199-012-0306-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 09/04/2012] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES The purpose of this study was to investigate the associations between serum concentrations of hydroxylated PCBs (OH-PCBs) and PCBs and measures of thyroid hormone status of Japanese pregnant women. METHODS The concentrations of free thyroxine (fT4), thyroid stimulating hormone (TSH), and thyroxine binding globulin (TBG) as well as 16 OH-PCB isomers and 29 PCB isomers were analyzed in the serum of 129 women sampled in the first trimester of gestation. Dietary and lifestyle information of the subjects was obtained by self-administered questionnaire. Multiple regression analysis was performed using measures of thyroid hormones as the dependent variable and serum levels of OH-PCBs/PCBs, urinary iodine concentration, and other potential covariates (age, BMI, smoking, etc.) as independent variables. RESULTS Geometric mean (GM) concentration of the sum of 16 isomers of OH-PCBs was 120 pg/g wet wt. and that of 29 isomers of PCBs was 68 ng/g lipid wt., respectively, in the serum of the subjects. Iodine nutrition was considered adequate to high from urinary iodine level (GM, 370 μg/g creatinine). The mean concentration of TSH, fT4 and TBG was 1.34 ± 1.37 μIU/mL, 1.22 ± 0.16 ng/dL and 33.0 ± 6.4 μg/mL, respectively, with a small number of subjects who were outside the reference range. Multiple regression analysis revealed that serum concentrations of OH-PCBs/PCBs were not significantly associated with any of the measures of thyroid hormone status. CONCLUSIONS Exposure/body burden of OH-PCBs and PCBs at environmental levels does not have a measurable effect on thyroid hormones.
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Affiliation(s)
- Aya Hisada
- Department of Environmental Studies, The University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa, Chiba 277-8563, Japan
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Raverot V, Bournaud C, Sassolas G, Orgiazzi J, Claustrat F, Gaucherand P, Mellier G, Claustrat B, Borson-Chazot F, Zimmermann M. Pregnant French women living in the Lyon area are iodine deficient and have elevated serum thyroglobulin concentrations. Thyroid 2012; 22:522-8. [PMID: 22468941 DOI: 10.1089/thy.2011.0184] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Iodine deficiency (ID) remains common in Europe, and may be especially detrimental during pregnancy. The aim of our study was to assess iodine status and thyroid function in healthy pregnant women in the Lyon metropolitan area. METHODS In a cross-sectional study, healthy pregnant women (n=228) with no history of thyroid disease were consecutively recruited from an obstetric clinic during all trimesters. Thyrotropin (TSH), free thyroxine (FT4), anti-thyroid peroxidase (anti-TPO) antibodies, thyroglobulin (Tg), and urinary iodine concentration (UIC) (n=100) were measured. Thyroid functions were compared with those in a control group of nonpregnant adults. RESULTS The median (range) UIC was 81 (8-832) μg/L, and 77% of pregnant women had a UIC <150 μg/L, indicating inadequate iodine intake. Overall, 11% of women had abnormal TSH or anti-TPO. The median FT4 (pmol/L) was 14.9, 12.6, and 11.5 in the first, second, and third trimesters, respectively. The median Tg in pregnant women was 16.2 μg/L, did not differ across trimesters, and was significantly higher than in the control group of nonpregnant adults (11.7 μg/L) (p=0.02). Controlling for maternal age and week of gestation, UIC was not a significant predictor of any of the thyroid function tests. CONCLUSIONS Pregnant women in the Lyon area are iodine deficient and have increased serum Tg concentrations compared with nonpregnant controls, likely due to physiological thyroid hyperstimulation during gestation exacerbated by ID.
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Affiliation(s)
- Véronique Raverot
- Laboratory of Hormonology, East Center for Biology and Pathology, East Hospital Group, Civil Hospices of Lyon, 59 boulevard Pinel, Bron, France.
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Caron P. Dysthyroïdies et grossesse. Presse Med 2011; 40:1174-81. [DOI: 10.1016/j.lpm.2011.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 06/13/2011] [Accepted: 09/27/2011] [Indexed: 11/29/2022] Open
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Abstract
OBJECTIVE To evaluate the peer-reviewed literature on iodine deficiency and hypothyroxinemia in pregnancy. METHODS We review published studies on isolated hypothyroxinemia in pregnancy, methodology of free thyroxine (T4) assays, impact of iodine deficiency on free T4 levels, and status of ongoing prospective randomized trials of isolated hypothyroxinemia during pregnancy. RESULTS Hypothyroxinemia during pregnancy is common. Studies have demonstrated the pivotal role exerted by maternal T4 on fetal brain development and the negative impact of hypothyroxinemia on neurobehavioral performance in offspring. Two intervention studies have demonstrated a positive effect on neurodevelopment in children of mothers promptly supplemented with iodine compared with the neurodevelopment in children of nonsupplemented mothers. Free T4 assays presently in clinical use have limitations. Preliminary results of the Controlled Antenatal Thyroid Study (CATS) are somewhat mixed, and the National Institutes of Health Maternal Fetal Medicine Thyrotropin Study (TSH Study) will be completed in 2015. Knowledge regarding the impact of isolated hypothyroxinemia has progressed, but major questions remain. An optimal diagnostic test for free T4 during pregnancy (accurate, inexpensive, and widely available) remains elusive. Trimester-specific normative data and normal ranges from different geographic regions do not exist. CONCLUSIONS Data published to date are insufficient to recommend levothyroxine therapy in pregnant women with isolated hypothyroxinemia. Adequate iodine intake should be recommended before conception and early in pregnancy.
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Affiliation(s)
- Roberto Negro
- Division of Endocrinology, V. Fazzi Hospital, 73100, Lecce, Italy.
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Wémeau JL, Sadoul JL, d'Herbomez M, Monpeyssen H, Tramalloni J, Leteurtre E, Borson-Chazot F, Caron P, Carnaille B, Léger J, Do C, Klein M, Raingeard I, Desailloud R, Leenhardt L. Guidelines of the French society of endocrinology for the management of thyroid nodules. ANNALES D'ENDOCRINOLOGIE 2011; 72:251-281. [PMID: 21782154 DOI: 10.1016/j.ando.2011.05.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 05/13/2011] [Indexed: 01/21/2023]
Abstract
The present document is a follow-up of the clinical practice guidelines of the French Society of Endocrinology, which were established for the use of its members and made available to scientific communities and physicians. Based on a critical analysis of data from the literature, consensuses and guidelines that have already been published internationally, it constitutes an update of the report on the diagnostic management of thyroid nodules that was proposed in France, in 1995, under the auspices of the French National Agency for Medical Evaluation (l'Agence nationale d'évaluation médicale). The current guidelines were deliberated beforehand by a number of physicians that are recognised for their expertise on the subject, coming from the specialities of endocrinology (the French Thyroid Research Group) and surgery (the French Association for Endocrine Surgery), as well as representatives from the fields of biology, ultrasonography, cytology and nuclear medicine. The guidelines were presented and submitted for the opinion of the members of the Society at its annual conference, which was held in Nice from 7-10 October 2009. The amended document was posted on the website of the Society and benefited from additional remarks of its members. The final version that is presented here was not subjected to methodological validation. It does not claim to be universal in its scope and will need to be revised in concert with progress made in technical and developmental concepts. It constitutes a document that the Society deems useful for distribution concerning the management of thyroid nodules, which is current, efficient and cost effective.
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Affiliation(s)
- J-L Wémeau
- Hôpital Claude-Huriez, clinique endocrinologique, CHRU, 59037 Lille cedex, France.
| | - J-L Sadoul
- Endocrinologie, hôpital de l'Archet, CHU 06202 Nice cedex, France
| | - M d'Herbomez
- Département de médecine nucléaire, centre de biologie pathologie, centre hospitalier régional, 59037 Lille cedex, France
| | - H Monpeyssen
- Centre de radiologie, imagerie médicale et échographie thyroïdienne, hôpital Necker, 141, rue de Sèvres, 75015 Paris, France
| | - J Tramalloni
- Centre de radiologie, imagerie médicale et échographie thyroïdienne, hôpital Necker, 141, rue de Sèvres, 75015 Paris, France
| | - E Leteurtre
- Inserm U560, service d'anatomie pathologique, CHRU de Lille, Lille, France
| | - F Borson-Chazot
- Hôpital Louis-Pradel, CHU des hospices civils de Lyon, 28, avenue Doyen-Lépine, 69500 Bron, France
| | - P Caron
- CHU Larrey, avenue du Jean-Poulhès, 31400 Toulouse, France
| | - B Carnaille
- Hôpital Claude-Huriez, clinique endocrinologique, CHRU, 59037 Lille cedex, France
| | - J Léger
- Service d'endocrinologie et diabétologie pédiatriques, hôpital Robert-Debré, 48, boulevard Sérurier, 75935 Paris cedex 19, France
| | - C Do
- Hôpital Claude-Huriez, clinique endocrinologique, CHRU, 59037 Lille cedex, France
| | - M Klein
- Service d'endocrinologie, CHU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - I Raingeard
- Service des maladies métaboliques et endrocriennes, hôpital Lapeyronie, 34295 Montpellier cedex 5, France
| | - R Desailloud
- Service d'endocrinologie, diabétologie et nutrition, hôpital Sud, CHU d'Amiens, avenue René-Laënnec, 80054 Amiens, France
| | - L Leenhardt
- Service de médecine nucléaire, hôpital Pitié-Salpêtrière, université Paris VI, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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Luton D, Alberti C, Vuillard E, Ducarme G, Oury JF, Guibourdenche J. Iodine deficiency in northern Paris area: impact on fetal thyroid mensuration. PLoS One 2011; 6:e14707. [PMID: 21359193 PMCID: PMC3040245 DOI: 10.1371/journal.pone.0014707] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Accepted: 01/10/2011] [Indexed: 12/12/2022] Open
Abstract
Introduction Iodine is essential for normal fetal and neonatal development. We studied the prevalence and impact on fetal thyroid development of iodine deficiency in pregnant women in the northern part of the Paris conurbation. Materials and Methods 110 patients underwent several determinations of urinary iodine excretion (UIE) and of serum FT4, FT3, and TSH. Fetal thyroid gland size was assessed using ultrasonography. Results We found evidence of widespread iodine deficiency (mean UIE, 49.8 µg/L [standard deviation, 2.11]). Iodine deficiency did not correlate significantly with maternal thyroid parameters but showed a significant negative correlation with fetal thyroid gland size (rho = 0.25, P = 0.02). Conclusion Iodine deficiency during pregnancy is still a problem in our geographical area and affects the fetal thyroid gland. Clinical Trials.gov NCT00162539
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Affiliation(s)
- Dominique Luton
- Université Paris VII, AP-HP, GHU Nord, Hôpital Beaujon, Service de Gynécologie Obstétrique, Clichy, France.
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Zewdie T, Smith CM, Hutcheson M, West CR. Basis of the Massachusetts reference dose and drinking water standard for perchlorate. ENVIRONMENTAL HEALTH PERSPECTIVES 2010; 118:42-48. [PMID: 20056583 PMCID: PMC2831965 DOI: 10.1289/ehp.0900635] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Revised: 01/30/2009] [Accepted: 07/13/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Perchlorate inhibits the uptake of iodide in the thyroid. Iodide is required to synthesize hormones critical to fetal and neonatal development. Many water supplies and foods are contaminated with perchlorate. Exposure standards are needed but controversial. Here we summarize the basis of the Massachusetts (MA) perchlorate reference dose (RfD) and drinking water standard (DWS), which are considerably lower and more health protective than related values derived by several other agencies. We also review information regarding perchlorate risk assessment and policy. DATA SOURCES MA Department of Environmental Protection (DEP) scientists, with input from a science advisory committee, assessed a wide range of perchlorate risk and exposure information. Health outcomes associated with iodine insufficiency were considered, as were data on perchlorate in drinking water disinfectants. DATA SYNTHESIS We used a weight-of-the-evidence approach to evaluate perchlorate risks, paying particular attention to sensitive life stages. A health protective RfD (0.07 microg/kg/day) was derived using an uncertainty factor approach with perchlorate-induced iodide uptake inhibition as the point of departure. The MA DWS (2 microg/L) was based on risk management decisions weighing information on perchlorate health risks and its presence in certain disinfectant solutions used to treat drinking water for pathogens. CONCLUSIONS Current data indicate that perchlorate exposures attributable to drinking water in individuals at sensitive life stages should be minimized and support the MA DEP perchlorate RfD and DWS. Widespread exposure to perchlorate and other thyroid toxicants in drinking water and foods suggests that more comprehensive policies to reduce overall exposures and enhance iodine nutrition are needed.
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Affiliation(s)
| | - C. Mark Smith
- Address correspondence to C.M. Smith, Massachusetts Department of Environmental Protection, Office of Research and Standards, 1 Winter St., Boston, MA 02108 USA. Telephone: (617) 292-5509. Fax: (617) 556-1006. E-mail:
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Influence of Iodine Deficiency and Excess on Thyroid Function Tests. THYROID FUNCTION TESTING 2010. [DOI: 10.1007/978-1-4419-1485-9_3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Symposium on 'Geographical and geological influences on nutrition': Iodine deficiency in industrialised countries. Proc Nutr Soc 2009; 69:133-43. [PMID: 19968908 DOI: 10.1017/s0029665109991819] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Iodine deficiency is not only a problem in developing regions; it also affects many industrialised countries. Globally, two billion individuals have an insufficient iodine intake, and approximately 50% of continental Europe remains mildly iodine deficient. Iodine intakes in other industrialised countries, including the USA and Australia, have fallen in recent years. Iodine deficiency has reappeared in Australia, as a result of declining iodine residues in milk products because of decreased iodophor use by the dairy industry. In the USA, although the general population is iodine sufficient, it is uncertain whether iodine intakes are adequate in pregnancy, which has led to calls for iodine supplementation. The few available data suggest that pregnant women in the Republic of Ireland and the UK are now mildly iodine deficient, possibly as a result of reduced use of iodophors by the dairy industry, as observed in Australia. Representative data on iodine status in children and pregnant women in the UK are urgently needed to inform health policy. In most industrialised countries the best strategy to control iodine deficiency is carefully-monitored salt iodisation. However, because approximately 90% of salt consumption in industrialised countries is from purchased processed foods, the iodisation of household salt only will not supply adequate iodine. Thus, in order to successfully control iodine deficiency in industrialised countries it is critical that the food industry use iodised salt. The current push to reduce salt consumption to prevent chronic diseases and the policy of salt iodisation to eliminate iodine deficiency do not conflict; iodisation methods can fortify salt to provide recommended iodine intakes even if per capita salt intakes are reduced to <5 g/d.
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Prévention des désordres thyroïdiens au cours de la grossesse. ACTA ACUST UNITED AC 2009; 38:574-9. [DOI: 10.1016/j.jgyn.2008.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2008] [Revised: 12/14/2008] [Accepted: 12/18/2008] [Indexed: 11/18/2022]
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Statut iodé et fonction thyroïdienne chez 330 femmes de la région niçoise évaluées en deuxième partie de grossesse. ANNALES D'ENDOCRINOLOGIE 2009; 70:218-24. [DOI: 10.1016/j.ando.2009.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 01/20/2009] [Accepted: 03/24/2009] [Indexed: 11/17/2022]
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Abstract
AbstractObjectiveTo assess dietary iodine intakes among adults and to investigate the relationships of dietary, lifestyle, demographic and geographical characteristics with dietary iodine status. Adequacy of iodine intakes was also assessed.DesignCross-sectional study. Linear regression analyses and logistic regression modelling were used to determine correlates of iodine intakes. Usual iodine mean intake was calculated by averaging six 24 h dietary records completed over a 2-year period.SubjectsFemales aged 35–60 years (n2962) and males aged 45–60 years (n2117) living in France and who participated in the SU.VI.MAX study.ResultsIodine intakes ranged from 30·0 to 446·3 μg/d. The median iodine intake was 150·7 μg/d for males and 131·4 μg/d for females. High-level (97·5th percentile) intakes were 273·4 μg/d for males and 245·0 μg/d for females. Overall, 8·5 % of males and 20·3 % of females had intakes <100 μg/d (P< 0·001). Alcohol drinkers and smokers tended to have lower iodine intakes than abstainers or non-smokers. Regular physical activity and both intermediate and high education levels were associated with a lower risk of iodine intake of <150 μg/d. For both males and females there were significant overall regional differences (P< 0·001) in multivariate-adjusted iodine intakes, with higher adjusted iodine intakes in Brittany and Normandy than in the north-eastern region.ConclusionsOur data show a borderline low iodine intake in this middle-aged French population. However, differences in iodine intakes may contribute to explaining only a small part of the effects of sex and age on thyroid disease incidence.
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Mian C, Vitaliano P, Pozza D, Barollo S, Pitton M, Callegari G, Di Gianantonio E, Casaro A, Nacamulli D, Busnardo B, Mantero F, Girelli ME. Iodine status in pregnancy: role of dietary habits and geographical origin. Clin Endocrinol (Oxf) 2009; 70:776-80. [PMID: 18785991 DOI: 10.1111/j.1365-2265.2008.03416.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES A study was conducted on iodine status during pregnancy and its dependence on dietary habits, racial and geographical origin, and time since arrival in Italy. DESIGN AND METHODS We enrolled 322 consecutive pregnant women: 217 Italians, 62 Eastern Europeans and 43 from Northern and Central Africa. All women completed a food frequency questionnaire on their dietary habits. The urinary iodide concentration (UIC) was determined in spot morning urine samples. RESULTS In the group as a whole, the median UIC was 83 microg/l; the UIC was < 50 in 33% and of 150 microg/l or more in 27%; it was significantly lower in Africans and Eastern Europeans than in Italians (medians 45 and 46 vs. 100 microg/l, respectively, P = 0.005). For the foreign women, there was a significant correlation between UIC and time since arrival in Italy (r = 0.22, P = 0.02). A significant link emerged between UIC and cow's milk intake (P = 0.0001). Iodine supplements were used by 40% of the women, and UIC were higher in those who did so than in those who did not (median 103 vs. 75 microg/l, P = 0.03), particularly if the latter did not drink milk (median 98 vs. 42 microg/l, P = 0.01). Multivariate analysis showed that milk was the only variable influencing UIC (OR 1.29, P = 0.0005). CONCLUSIONS (i) Iodine levels are too low among pregnant women in our region, and particularly in foreign women. (ii) Cow's milk intake is their main source of iodine. (iii) Iodine supplementation is mandatory during pregnancy, particularly for women do not drink milk.
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Affiliation(s)
- Caterina Mian
- Department of Medical and Surgical Sciences, Endocrinology Unit, University of Padua, Padua, Italy.
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Impact du jeûne intermittent sur la maturation et le remodelage de l’os chez les jeunes rats. NUTR CLIN METAB 2008. [DOI: 10.1016/j.nupar.2008.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Ducarme G, Châtel P, Luton D. [Postpartum endocrine syndrome]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2008; 37:223-228. [PMID: 18314279 DOI: 10.1016/j.jgyn.2008.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Revised: 01/09/2008] [Accepted: 01/16/2008] [Indexed: 05/26/2023]
Abstract
Postpartum endocrine syndromes occur in the year after delivery. They are due to immunologic and vascular modifications during pregnancy. The Sheehan syndrome is the first described postpartum endocrine syndrome and consists on a hypophyse necrosis in relation with a hypovolemic shock during delivery. The immunologic consequences of the pregnancy are the most frequent, sometimes discrete and transitory. The physiological evolution of the endocrine glands during pregnancy and the most frequent post-partum endocrine syndromes are discussed: postpartum lymphocytic hypophysitis, thyroiditis and Sheehan' syndrome.
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Affiliation(s)
- G Ducarme
- Service de gynécologie obstétrique, hôpital Beaujon, Assistance publique-hôpitaux de Paris (AP-HP), université Paris-7, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
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Abstract
OBJECTIVE To examine the importance of iodine nutrition during pregnancy. DESIGN Review of existing literature of iodine in pregnancy. SETTING Population surveys and metabolic studies. SUBJECTS Pregnant women. RESULTS The main changes in thyroid function associated with pregnancy are due to an increase in hormone requirements that begin in the first trimester of gestation. This increase can only be met by a proportional increase in hormone production, something that depends directly upon the availability of iodine. When dietary iodine is lacking, an adequate physiological adaptation is difficult to achieve and is progressively replaced by pathological alterations that occur in parallel with the degree and duration of iodine deprivation. CONCLUSIONS Iodine prophylaxis should be given systematically to women during pregnancy. In most public health programmes dealing with the correction of iodine deficiency disorders, iodised salt has been used as the preferred means to deliver iodine to households. Iodised salt, however, is not the ideal means of delivering iodine in the specific instances of pregnancy, breast-feeding and complementary feeding because of the need to limit salt intake during these periods. In European countries, presently it is proposed that iodine is given to pregnant women and breast-feeding mothers by systematically administering multivitamin tablets containing iodine in order to reach the recommended dietary allowance of 250 microg iodine day-1.
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Iodine requirements during pregnancy, lactation and the neonatal period and indicators of optimal iodine nutrition. Public Health Nutr 2008; 10:1571-80; discussion 1581-3. [PMID: 18053281 DOI: 10.1017/s1368980007360941] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This paper re-evaluates the requirements for iodine during pregnancy, lactation and the neonatal period, and formulates original proposals for the median concentrations of urinary iodine (UI) that indicate optimal iodine nutrition during these three critical periods of life. This paper also discusses the measurements that are used to explore thyroid functions during the same periods. DESIGN An extensive and critical review of the literature on thyroid physiopathology during the perinatal period. SETTING Human studies conducted in various regions throughout the world. SUBJECTS Pregnant women, lactating women, and newborns. RESULTS The following proposals are made after extensive review of the literature: the requirement for iodine by the mother during pregnancy is 250-300 microg day-1; during lactation the requirement is 225-350 microg day-1; and during the neonatal period the requirement of the infant is 90 microg day-1. The median UI that indicates an optimal iodine nutrition during these three periods should be in the range of 150-230 microg day-1. These figures are higher than recommended to date by the international agencies. CONCLUSIONS Pregnant women and young infants, but especially the second group, are more sensitive to the effects of an iodine deficiency (ID) than the general population because their serum thyroid-stimulating hormone (TSH) and thyroxine are increased and decreased, respectively, for degrees of ID that do not seem to affect thyroid function in the general population. Systematic neonatal thyroid screening using primary TSH could be the most sensitive indicator to monitor the process of ID control.
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Negro R. Thyroid insufficiency during pregnancy: complications and implications for screening. Expert Rev Endocrinol Metab 2008; 3:137-146. [PMID: 30764088 DOI: 10.1586/17446651.3.2.137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In 2007, clinical practice guidelines concerning the management of thyroid dysfunction during pregnancy and postpartum were published in the Journal of Clinical Endocrinology and Metabolism. They were elaborated on by a panel of experts, representative of the Latin American Thyroid Society, the Asia and Oceania Thyroid Society, the American Thyroid Association, the European Thyroid Association, the American Association of Clinical Endocrinologists and the Endocrine Society. In women not known to have thyroid dysfunction, universal screening during pregnancy is not recommended, but thyroid function tests are advised in those with prior therapeutic head or neck irradiation, a history of preterm delivery, in cases of infertility and in the presence of risk factors for thyroid disease. Risks factors for thyroid dysfunction are considered as a personal or family history of thyroid diseases, presence of thyroid antibodies (when known), personal history of autoimmune diseases and the presence of signs or symptoms suggesting hypo- or hyperthyroidism. In this review, we summarize the modifications of the pituitary-thyroid axis during pregnancy, with particular attention on thyroid insufficiency. We consider the most important risk factors for thyroid dysfunction and focus our attention on the complications for the progeny, deriving from a condition of maternal thyroid impairment. We will discuss the matters in favor of or against a thyroid-screening program at the beginning of pregnancy.
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Affiliation(s)
- Roberto Negro
- a Ospedale 'V. Fazzi', Piazza F. Muratore 73100, Lecce, Italy.
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The impact of iodised salt or iodine supplements on iodine status during pregnancy, lactation and infancy. Public Health Nutr 2007; 10:1584-95. [DOI: 10.1017/s1368980007360965] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectives:Monitoring of iodine status during pregnancy, lactation and infancy is difficult as there are no established reference criteria for urinary iodine concentration (UI) for these groups; so it is uncertain whether iodized salt programs meet the needs of these life stages.Design and Subjects:The method used in this paper was: 1) to estimate the median UI concentration that reflects adequate iodine intake during these life stages; and 2) to use these estimates in a review of the literature to assess whether salt iodisation can control iodine deficiency in pregnant and lactating women, and their infants.Results:For pregnancy, recommended mean daily iodine intakes of 220-250 μg were estimated to correspond to a median UI concentration of about 150 μg l− 1, and larger surveys from the iodine sufficient countries have reported a median UI in pregnant women ≥ 140 μg l− 1. Iodine supplementation in pregnant women who are mild-to-moderately iodine deficient is beneficial, but there is no clear affect on maternal or newborn thyroid hormone levels. In countries where the iodine intake is sufficient, most mothers have median breast milk iodine concentration (BMIC) greater than the concentration (100-120 μg l− 1) required to meet an infant's needs. The median UI concentration during infancy that indicates optimal iodine nutrition is estimated to be ≥ 100 μg l− 1. In iodine-sufficient countries, the median UI concentration in infants ranges from 90-170 μg l− 1, suggesting adequate iodine intake in infancy.Conclusions:These findings suggest pregnant and lactating women and their infants in countries with successful sustained iodised salt programs have adequate iodine status.
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Al-Yatama FI, Al-Bader MD, Al-Mazidi ZM, Ali A, Al-Omair A, Al-Ajmi NH, Mouneer M, Molla A, Mohammed F. Iodine status among pregnant women in Kuwait. J Endocrinol Invest 2007; 30:914-9. [PMID: 18250611 DOI: 10.1007/bf03349237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
UNLABELLED Up to now, little has been known about iodine intake and the prevalence of iodine deficiency (ID), if any, in Kuwait. Urinary iodine excretion (UIE) and changes in thyroid function during pregnancy were thus evaluated. METHODS Urinary iodide level was measured in random urine samples collected from 326 pregnant women at different gestational trimesters. Blood samples were drawn for free T4 (FT4) and TSH level determination. RESULTS Median UIE levels fall within the normal range during all gestational trimesters i.e. >100 microg/l. However, if the new suggested recommendation for pregnant women <140 microg/l, is applied, median UIE values during trimesters 2 and 3 indicate ID. Mean serum TSH levels increased between trimesters 1 and 3 (p<0.05), whereas serum FT4 decreased between first and second trimesters (p<0.05), and this reduction continued at the third trimester. Furthermore, an increase in TSH levels for subjects with mild and moderate ID (Mi and Mo, respectively) were noticed (p<0.05) during the second trimester. However, FT4 levels dropped in subjects with Mi and Mo ID during the first trimester (p<0.05). In conclusion, these results suggest that 56.8% of pregnant women had median UIE level <145 microg/l, associated with high TSH and low FT4 levels. CONCLUSION Data obtained may indicate insufficient iodine intake among pregnant women in Kuwait.
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Affiliation(s)
- F I Al-Yatama
- Medical Laboratory Department, Faculty of Allied Health, Kuwait University, P.O. Box 267, Al-Yarmouk 72653, Kuwait.
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Clewell RA, Merrill EA, Gearhart JM, Robinson PJ, Sterner TR, Mattie DR, Clewell HJ. Perchlorate and radioiodide kinetics across life stages in the human: using PBPK models to predict dosimetry and thyroid inhibition and sensitive subpopulations based on developmental stage. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2007; 70:408-28. [PMID: 17454566 DOI: 10.1080/15287390600755216] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Perchlorate (ClO4(-)) is a drinking-water contaminant, known to disrupt thyroid hormone homeostasis in rats. This effect has only been seen in humans at high doses, yet the potential for long term effects from developmental endocrine disruption emphasizes the need for improved understanding of perchlorate's effect during the perinatal period. Physiologically based pharmacokinetic/dynamic (PBPK/PD) models for ClO4(-) and its effect on thyroid iodide uptake were constructed for human gestation and lactation data. Chemical specific parameters were estimated from life-stage and species-specific relationships established in previously published models for various life-stages in the rat and nonpregnant adult human. With the appropriate physiological descriptions, these kinetic models successfully simulate radioiodide data culled from the literature for gestation and lactation, as well as ClO4(-) data from populations exposed to contaminated drinking water. These models provide a framework for extrapolating from chemical exposure in laboratory animals to human response, and support a more quantitative understanding of life-stage-specific susceptibility to ClO4(-). The pregnant and lactating woman, fetus, and nursing infant were predicted to have higher blood ClO4(-) concentrations and greater thyroid iodide uptake inhibition at a given drinking-water concentration than either the nonpregnant adult or the older child. The fetus is predicted to receive the greatest dose (per kilogram body weight) due to several factors, including placental sodium-iodide symporter (NIS) activity and reduced maternal urinary clearance of ClO4(-). The predicted extent of iodide inhibition in the most sensitive population (fetus) is not significant (approximately 1%) at the U.S. Environmental Protection Agency reference dose (0.0007 mg/kg-d).
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Affiliation(s)
- Rebecca A Clewell
- CIIT Centers for Health Research, Research Triangle Park, North Carolina 27709-2137, USA.
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Ouzounian S, Bringer-Deutsch S, Jablonski C, Théron-Gérard L, Snaifer E, Cédrin-Durnerin I, Hugues JN. [Hypothyroidism: from the desire for pregnancy to delivery]. ACTA ACUST UNITED AC 2007; 35:240-8. [PMID: 17321188 DOI: 10.1016/j.gyobfe.2007.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Accepted: 01/19/2007] [Indexed: 11/28/2022]
Abstract
The link between hypothyroidism and infertility is still a matter of debate. Hypothyroidism can result in cycle disturbances, such as oligomennorhea and functional bleeding. Additionally, several studies have shown that thyroid autoimmunity (detection of anti peroxydase antibodies) may account for the occurrence of repetitive miscarriages. In infertility work-up, screening thyroid function should be specifically recommended for women with clinical hypothyroidism, with a personal, familial history of thyroid or other auto immune diseases (such as type I diabetes) as well as for women with unexplained anovulation or functional bleeding. Moreover, detection of thyroid antibody seems to be worthwhile for the assessment of recurrent miscarriages, due to the potential benefit of thyroid supplementation. In pregnant women, assessment of thyroid function seems specifically crucial to ensure adequate foetal development. Indeed, it has been well established that untreated maternal hypothyroidism may be associated with disturbances of brain development and low intellectual quotient. Additionally, other foetal (growth deficiency, premature birth, low birth weight) as well as maternal (gestational hypertension, pre-eclampsia...) complications have been also reported in pregnant women with untreated hypothyroidism. Consequently, screening of thyroid function should be performed in every woman at risk of thyroid disease. Recent studies even advocate that thyroid screening should be extended to the overall pregnant population. The objective is to adjust L-thyroxin supplementation to maintain serum TSH concentrations below the threshold of 2.5 mUI/l. Finally, iodine deficiency, currently observed in pregnant women, should be prevented by iodine supply prior to conception, during pregnancy and during breast feeding as well.
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Affiliation(s)
- S Ouzounian
- Service de Médecine de la Reproduction, CHU Jean-Verdier, Avenue du 14-Juillet, 93143 Bondy cedex, France.
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Ducarme G, Bertherat J, Vuillard E, Polak M, Guibourdenche J, Luton D. [Pregnancy and thyroid disorders]. Rev Med Interne 2007; 28:314-21. [PMID: 17399855 DOI: 10.1016/j.revmed.2007.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2007] [Accepted: 01/06/2007] [Indexed: 11/28/2022]
Abstract
Association between pregnancy and thyroid disorders is a frequent event. In case of maternal hyperthyroidism, strict guidelines relying mainly on foetal thyroid monitoring echographic scanning will allow in most cases the delivery of a healthy euthyroid newborn. Hypothyroidia, providing an adequate substitution has no significant impact on pregnancy, biological monitoring is the key of monitoring. Iodine deficiency is a matter of concern when considering neurodevelopmental outcome, however it is still an unsolved issue in France. However involvement of a multidisciplinary team is of good practice in most of the cases.
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Affiliation(s)
- G Ducarme
- Service de gynécologie obstétrique, hôpital Beaujon, APHP, université Paris-VII, 100, boulevard du Général-Leclerc, 92110 Clichy, France
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Luton D, Ducarme G, Vuillard E, Polak M. [Specific follow-up for pregnant patients with a thyroid dysfunction]. ACTA ACUST UNITED AC 2006; 35:60-5. [PMID: 17196869 DOI: 10.1016/j.gyobfe.2006.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Accepted: 11/13/2006] [Indexed: 11/21/2022]
Abstract
Association between thyroidian disease and pregnancy is a frequent event. Thyroidian hormones are mandatory for foetal development especially at the level of brain structures. Any shortage of thyroidian hormone can severely and irreversibly alter neurological development. On the other hand it is also clear that an excess of thyroidian hormone can jeopardize the embryo then the foetus. In case of maternal hyperthyroidism, strict guidelines relying mainly on foetal thyroid monitoring echographic scanning will allow in most cases the delivery of a healthy euthyroid newborn. Hypothyroidia, providing an adequate substitution, has no significant impact on pregnancy. Biological monitoring is the key of monitoring. Iodine deficiency is a matter of concern when considering neurodevelopmental outcome, however it is still an unsolved issue in France. A multidisciplinary team will sometimes be necessary for taking care of pregnant patients with active Graves' disease.
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Affiliation(s)
- D Luton
- Service de maternité, hôpital Robert-Debré, APHP, université Paris-VII, 48, boulevard Sérurier, 75019 Paris, France.
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Caron P, Glinoer D, Lecomte P, Orgiazzi J, Wémeau JL. Apport iodé en France: prévention de la carence iodée au cours de la grossesse et l’allaitement. ANNALES D'ENDOCRINOLOGIE 2006; 67:281-6. [PMID: 17072231 DOI: 10.1016/s0003-4266(06)72599-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Iodine intake varies with age and physiological status: in pregnant and lactating women, recommended iodine intake ranges from 200 to 250 mg/day. Recent epidemiological studies in France demonstrate the presence of moderate iodine deficiency in the majority of pregnant and lactating women. This iodine deficiency induces maternal thyroid hyperplasia and then development of goiter in women, as well as impaired thyroid parameters. Maternal hypothyroxinemia during the first trimester of pregnancy can be associated with abnormal cognitive development and intellectual outcomes in the newborn and the children. According to the recent World Health Organization recommendations for the prevention and control of iodine deficiency in pregnant and lactating women, systematic iodine supplementation is indicated in France: 100 microg/day for women of reproductive age and 200 microg/day in pregnant and lactating women in order to eradicate iodine deficiency during pregnancy and lactation, and prevent the maternal and fetal consequences.
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Affiliation(s)
- Ph Caron
- Département d'Endocrinologie des CHU de Toulouse, Bruxelles, Tours, Lyon, Lille.
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Téllez Téllez R, Michaud Chacón P, Reyes Abarca C, Blount BC, Van Landingham CB, Crump KS, Gibbs JP. Long-term environmental exposure to perchlorate through drinking water and thyroid function during pregnancy and the neonatal period. Thyroid 2005; 15:963-75. [PMID: 16187904 DOI: 10.1089/thy.2005.15.963] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We have conducted a longitudinal epidemiologic study among pregnant women from three cities in northern Chile: Taltal with 114 microg/L, Chañaral with 6 microg/L, and Antofagasta with 0.5 microg/L perchlorate in the public drinking water. We tested the hypothesis that long-term exposure to perchlorate at these levels may cause a situation analogous to iodine deficiency, thus causing increases in thyrotropin (TSH) and thyroglobulin (Tg) levels and decreased levels of free thyroxine (FT4), in either the mother during the early stages of gestation or the neonate at birth, or in the fetus cause growth retardation. We found no increases in Tg or TSH and no decreases in FT4 among either the women during early pregnancy (16.1 +/- 4.1 weeks), late pregnancy (32.4 +/- 3.0 weeks), or the neonates at birth related to perchlorate in drinking water. Neonatal birth weight, length, and head circumference were not different among the three cities and were consistent with current U.S. norms. Therefore, perchlorate in drinking water at 114 microg/L did not cause changes in neonatal thyroid function or fetal growth retardation. Median urinary iodine among the entire cohort was 269 microg/L, intermediate between that of pregnant women in the United States at National Health and Nutrition Examination Survey (NHANES) I and at NHANES III and consistent with current World Health Organization (WHO) recommendations. Median breast milk iodine was not decreased in the cities with detectable perchlorate. Analysis of maternal urinary perchlorate excretion indicates an additional dietary source of perchlorate.
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Fields C, Dourson M, Borak J. Iodine-deficient vegetarians: A hypothetical perchlorate-susceptible population? Regul Toxicol Pharmacol 2005; 42:37-46. [PMID: 15896441 DOI: 10.1016/j.yrtph.2005.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2004] [Revised: 12/28/2004] [Accepted: 01/01/2005] [Indexed: 11/29/2022]
Abstract
Recent risk assessments of environmental perchlorate have been subject to much debate. A particular concern is whether appropriate susceptible sub-populations have been identified. Iodine-deficient pregnant women, especially vegetarians, have been proposed as such a potential susceptible sub-population, but there is no evidence of iodine deficiency in the US population and the adequacy of iodine nutrition has not been studied in US vegetarians. To understand the possibility that US vegetarians might be iodine deficient, we reviewed the prevalence, demography, and lifestyle characteristics of US vegetarians as well as the world literature on iodine nutrition in vegetarians. Our findings indicate that strict vegetarians and vegans, who comprise probably less than 0.1% of the US population, have higher education, higher incomes, and healthier lifestyles than the general population. Field studies indicate that vegetarian diets need not lead to iodine deficiency and vegans may suffer excess iodine intake. It is remains uncertain whether there are iodine-deficient vegans or pregnant women in the US. Of more general concern is whether the 10-fold default uncertainty factor is needed for intraspecies (i.e., within human) variability to protect such hypothetical susceptible sub-populations.
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Affiliation(s)
- Cheryl Fields
- Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, CT, USA
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Abstract
Pregnancy has an effect on thyroid economy with significant changes in iodine metabolism, serum thyroid binding proteins, and the development of maternal goiter especially in iodine-deficient areas. Pregnancy is also accompanied by immunologic changes, mainly characterized by a shift from a T helper-1 (Th1) lymphocyte to a Th2 lymphocyte state. Thyroid peroxidase antibodies are present in 10% of women at 14 weeks' gestation, and are associated with (i) an increased pregnancy failure (i.e. abortion), (ii) an increased incidence of gestational thyroid dysfunction, and (iii) a predisposition to postpartum thyroiditis. Thyroid function should be measured in women with severe hyperemesis gravidarum but not in every patient with nausea and vomiting during pregnancy. Graves hyperthyroidism during pregnancy is best managed with propylthiouracil administered throughout gestation. Thyroid-stimulating hormone-receptor antibody measurements at 36 weeks' gestation are predictive of transient neonatal hyperthyroidism, and should be checked even in previously treated patients receiving thyroxine. Postpartum exacerbation of hyperthyroidism is common, and should be evaluated in women with Graves disease not on treatment. Radioiodine therapy in pregnancy is absolutely contraindicated. Hypothyroidism (including subclinical hypothyroidism) occurs in about 2.5% of pregnancies, and may lead to obstetric and neonatal complications as well as being a cause of infertility. During the last few decades, evidence has been presented to underpin the critical importance of adequate fetal thyroid hormone levels in order to ensure normal central and peripheral nervous system maturation. In iodine-deficient and iodine-sufficient areas, low maternal circulating thyroxine levels have been associated with a significant decrement in child IQ and development. These data suggest the advisability of further evaluation for a screening program early in pregnancy to identify women with hypothyroxinemia, and the initiation of prompt treatment for its correction. Hypothyroidism in pregnancy is treated with a larger dose of thyroxine than in the nonpregnant state. Postpartum thyroid dysfunction (PPTD) occurs in 50% of women found to have thyroid peroxidase antibodies in early pregnancy. The hypothyroid phase of PPTD is symptomatic and requires thyroxine therapy. A high incidence (25-30%) of permanent hypothyroidism has been noted in these women. Women having transient PPTD with hypothyroidism should be monitored frequently, as there is a 50% chance of these patients developing hypothyroidism during the next 7 years.
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Affiliation(s)
- John H Lazarus
- Department of Medicine, University of Wales College of Medicine, Cardiff, Wales, UK.
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Zimmermann M, Delange F. Iodine supplementation of pregnant women in Europe: a review and recommendations. Eur J Clin Nutr 2004; 58:979-84. [PMID: 15220938 DOI: 10.1038/sj.ejcn.1601933] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Nearly two-thirds of the population of Western and Central Europe live in countries that are iodine deficient. Damage to reproductive function and to the development of the fetus and newborn is the most important consequence of iodine deficiency. The objective of this review was to examine the iodine status of pregnant women in Europe and the potential need for iodine supplementation. DESIGN A MEDLINE/PubMed search and compilation of all published studies since 1990 of iodine nutrition and iodine supplementation of pregnant women in Europe, as well as an Internet-based search and review on availability and legislation of iodine supplements in the European Union. RESULTS Although the data suggest most women in Europe are iodine deficient during pregnancy, less than 50% receive supplementation with iodine. Mild-to-moderate iodine deficiency during pregnancy adversely affects thyroid function of the mother and newborn and mental development of the offspring and these adverse effects can be prevented or minimized by supplementation. There are no published data on the effect of iodine supplementation on long-term maternal and child outcomes. The iodine content of prenatal supplements in Europe varies widely; many commonly used products contain no iodine. The European Union is developing legislation to establish permissible levels for iodine in food supplements. CONCLUSIONS In most European countries, pregnant women and women planning a pregnancy should receive an iodine-containing supplement ( approximately 150 microg/day). Kelp and seaweed-based products, because of unacceptable variability in their iodine content, should be avoided. Prenatal supplement manufacturers should be encouraged to include adequate iodine in their products. Professional organizations should influence evolving EU legislation to ensure optimal doses for iodine in prenatal vitamin-mineral supplements. SPONSORSHIP International Council for Control of Iodine Deficiency Disorders.
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Affiliation(s)
- M Zimmermann
- Laboratory for Human Nutrition, Institute of Food Science and Nutrition, Swiss Federal Institute of Technology, Rüschlikon, Zürich, Switzerland.
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. IM, . FR, . SAN. Iodine Intake and Stimulation of Thyroid Related Hormones During First Trimester of Pregnancy. JOURNAL OF MEDICAL SCIENCES 2004. [DOI: 10.3923/jms.2004.257.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Glinoer D. The regulation of thyroid function during normal pregnancy: importance of the iodine nutrition status. Best Pract Res Clin Endocrinol Metab 2004; 18:133-52. [PMID: 15157832 DOI: 10.1016/j.beem.2004.03.001] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The main change in thyroid function associated with the pregnant state is the requirement of an increased production of thyroid hormone that depends directly upon the adequate availability of dietary iodine and integrity of the glandular machinery. Physiologic adaptation takes place when the iodine intake is adequate, while this is replaced by pathologic alterations when there is a deficient iodine intake. Pregnancy acts typically, therefore, as a revelator of underlying iodine restriction. Iodine deficiency (ID) has important repercussions for both the mother and the fetus, leading to sustained glandular stimulation, hypothyroxinemia and goitrogenesis. Furthermore, because severe ID may be associated with an impairment in the psycho-neuro-intellectual outcome in the progeny-because both mother and offspring are exposed to ID during gestation (and the postnatal period), and because ID is still prevalent today in several European countries-it has been proposed already in the early 1990s that iodine supplements be given systematically to pregnant and breast-feeding women. Particular attention is required to ensure that pregnant women receive an adequate iodine supply, by administering multivitamin tablets containing iodine supplements, in order to achieve the ideal recommended dietary allowance of 200-250 microg iodine/day.
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Affiliation(s)
- Daniel Glinoer
- Department of Internal Medicine and Endocrinology, University Hospital Saint Pierre, Thyroid Investigation Clinic, 322, Rue Haute, B-1000 Brussels, Belgium.
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Kurtoglu S, Akcakus M, Kocaoglu C, Gunes T, Budak N, Atabek ME, Karakucuk I, Delange F. Iodine status remains critical in mother and infant in Central Anatolia (Kayseri) of Turkey. Eur J Nutr 2004; 43:297-303. [PMID: 15309449 DOI: 10.1007/s00394-004-0474-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2003] [Accepted: 11/10/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Severe iodine deficiency disorders have been eradicated in many parts of the world, but milder forms still exist and may escape detection. Turkey has long been known to be a mild to moderate iodine deficiency area. AIM OF THE STUDY The aim of this study was to assess the iodine nutritional status and the thyroid function of pregnant women and their neonates in the region of Kayseri (central Anatolia of Turkey) that appeared to be iodine deficient in previous studies performed before the introduction of mandatory salt iodization. METHODS A cross-sectional voluntary screening study was performed in the Maternity Unit of a university hospital. A total of 70 mothers and their healthy full-term neonates were included in this study. Urinary iodine concentration was estimated in spot urine samples obtained from mothers and their neonates on day 5. All the neonates were breastfed. The iodine content was determined in the breast milk of all mothers on day 5. Serum concentrations of TSH, thyroglobulin (Tg), free triiodothyronine (FT3) and free thyroxine (FT4) were investigated in the cord serum of neonates and compared to those of mothers immediately after parturition RESULTS The median urinary iodine on day 5 in mothers and their babies were 30.20 and 23.80 microg/l, respectively. These figures are much lower than normal for these age groups (150-200 microg/l). The median iodine content of breast-milk was 73 microg/l. It is again much lower than in iodine sufficient areas, indicating that the status of iodine nutrition of pregnant and lactating women is clearly insufficient. The median concentrations (and ranges) of neonatal TSH, Tg, FT3 and FT4 were 7.44 mU/l, 71.62 ng/ml, 1.30 pg/ml and 1.34 ng/dl respectively. The corresponding levels for the mothers during labor were 2.19 mU/l, 25.65 ng/ml, 1.31 pg/ml and 1.23 ng/dl respectively. The median neonatal serum concentrations of TSH and Tg were significantly higher than the corresponding maternal levels (P < 0.0001, P < 0.0001, respectively) and 27.1% of the neonates had serum TSH concentrations above 10 mU/l and 57.1 % had cord blood serum Tg concentrations above 54 ng/ml. None of the mothers showed TSH concentrations above 5 mU/l and 41.4% had serum Tg concentrations above 30 ng/ml. CONCLUSION Iodine deficiency with low urinary iodine excretion and high serum Tg and TSH concentrations were recognized among pregnant women and their babies in Kayseri in spite of the program of salt iodization. National measures are urgently required for improving the correction of iodine deficiency in Turkey. This includes regular supplementation with iodine, starting at preconception or in early pregnancy and continuing during the period of nursing in this region.
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Affiliation(s)
- Selim Kurtoglu
- Erciyes University, School of Medicine, Dept. of Pediatrics Divisions of Endocrinology & Neonatology, 38039 Kayseri, Turkey.
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Domínguez I, Reviriego S, Rojo-Martínez G, Valdés MJ, Carrasco R, Coronas I, López-Ojeda J, Pacheco M, Garriga MJ, García-Fuentes E, González Romero S, C-Soriguer Escofet FJ. Déficit de yodo y función tiroidea en una población de mujeres embarazadas sanas. Med Clin (Barc) 2004; 122:449-53. [PMID: 15104955 DOI: 10.1016/s0025-7753(04)74269-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Studies from Spain suggest that the intake of iodine in pregnant women is below nutritional requirements. This study was designed to determine iodine intake and its relation with thyroid volume during pregnancy in women from southeast Spain. PATIENTS AND METHOD A total of 520 healthy pregnant women were studied during the full three trimesters of their pregnancy. A control group was composed of 373 non-pregnant women. The following variables were measured: TSH, FT3, FT4, thyroglobulin, antiperoxidase antibodies, urinary iodine levels, and thyroid volume. RESULTS Median urinary iodine levels were below 100 g/l in the controls and the pregnant women during their first trimester. These levels rose progressively and significantly over the second and third trimesters. Thyroid volume increased during the second and third trimesters compared with the first. TSH levels were lower during the first trimester compared to controls, and increased significantly during the third trimester. FT4 levels fell significantly during the third trimester. There was a significant negative correlation between TSH levels and thyroid volume (r = 0.22; p = 0.005). CONCLUSIONS Iodine intake in pregnant women in Malaga is low. The results suggest a deficit in thyroid function secondary to iodine deficiency, which is worsened as pregnancy advances. The data support the convenience of systematic administration of an iodine supplement in healthy pregnant women.
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Glinoer D, Demeester R, Lemone M, Larsimont D, Andry G. Acute increase in goiter size during a normal pregnancy: an exceptional case report. Thyroid 2003; 13:881-4. [PMID: 14588104 DOI: 10.1089/105072503322401096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This case report illustrates an exceptional clinical situation in which a pregnant woman abruptly presented, at 5 months' gestation, with major swelling of the thyroid gland that led to respiratory symptoms and emergency hospitalization. The medical condition was shown to be caused by acute intrathyroidal hemorrhage within a preexisting-albeit until then unnoticed-multinodular goiter. The cause of the intrathyroidal hemorrhage could not be firmly delineated, although it remains possible that an unusual extraneous cause constituted a "trauma" that triggered this rare medical condition.
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Affiliation(s)
- Daniel Glinoer
- Thyroid Investigation Clinic, Hospital Saint Pierre, Brussels, Belgium.
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Fuse Y, Igari T, Yamada C, Sakano S, Ito H, Umenai T, Irie M. Epidemiological survey of thyroid volume and iodine intake in schoolchildren, postpartum women and neonates living in Ulaan Baatar. Clin Endocrinol (Oxf) 2003; 59:298-306. [PMID: 12919152 DOI: 10.1046/j.1365-2265.2003.01840.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Although endemic goiter had been recognized in most parts of the country, there are few available data on iodine-deficiency disorders (IDDs) in Mongolia. This study aimed to characterize the current status of iodine deficiency in Ulaan Baatar, Mongolia's capital city. DESIGN Cross-sectional, observational study designed and performed according to the surveillance methods for IDD prevalence recommended by WHO/UNICEF/ICCIDD. SUBJECTS A total of 505 schoolchildren aged 9-14 years (237 girls and 268 boys) and 138 mothers and their neonatal infants were selected to clinical and biochemical examination of the thyroid in 1996 and 1999. MEASUREMENTS The anthropometric measurements, thyroid volume determined by ultrasound, blood TSH and FT4 concentrations, urinary iodine concentration and iodine content of salt consumed in households. RESULTS Median thyroid volumes based on age were generally higher than those in iodine-sufficient areas and comparative to those reported in mild iodine-deficiency areas. Application of the updated WHO/ICCIDD reference values in iodine-replete European schoolchildren to the Mongolian children aged 10-12 years resulted in a goiter prevalence of 43.3%. The median value of urinary iodine concentration was 152.5 micro g/l (1.20 micro mol/l) and 40.3% of children excreted iodine below 100 micro g/l. Iodized salt (> 40 ppm) was consumed in 63.1% of households and in the children using noniodized salt their urinary iodine concentration was lower than those using ionized salt. In postpartum women, median thyroid volume and urinary iodine concentration were 11.3 ml and 107 micro g/l (0.84 micro mol/l), respectively, and 46% of women excreted less than 100 micro g/l (0.79 micro mol/l) of iodine. Of their neonates, 17.8% had elevated blood TSH levels (> 5 mU/l). In a 1999 survey, the goiter prevalence and ratio of low iodine excretion in schoolchildren decreased to 29.8% and 31.3%, respectively, while median urinary iodine concentration remain unchanged (160 micro g/l; 1.26 micro mol/l). CONCLUSION The present study clearly indicates the presence of mild iodine deficiency in Mongolia. Enlarged thyroid gland and normal iodine excretion observed in schoolchildren living in Ulaan Baatar may result from the residual effects of iodine deficiency previously and presumably still exist in the city. Slight reduction in the rate of children with enlarged thyroid and low urinary iodine excretion after the onset of national iodinization programme suggests incomplete normalization of thyroid volume in children and that the correction of iodine deficiency is now in progress in Ulaan Baatar. Further nationwide surveys together with monitoring the progress of the national programme eliminating IDD are required in suburban areas surrounding the city and also in rural areas.
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Affiliation(s)
- Yozen Fuse
- Department of Neonatology, Toho University School of Medicine, The University of Tokyo, Japan.
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Schulze KJ, West KP, Gautschi LA, Dreyfuss ML, LeClerq SC, Dahal BR, Wu LSF, Khatry SK. Seasonality in urinary and household salt iodine content among pregnant and lactating women of the plains of Nepal. Eur J Clin Nutr 2003; 57:969-76. [PMID: 12879092 DOI: 10.1038/sj.ejcn.1601632] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the extent and causes of iodine deficiency among women during pregnancy and lactation in the southeastern plains of Nepal. DESIGN, SETTING AND SUBJECTS Urinary iodine (UI) was assessed as an indicator of iodine status in spot urine samples of women participating in a field trial in three rural communities in the plains of southeastern Nepal. Samples were collected during pregnancy (n=1021) and during lactation at 3-4 months postpartum (n=1028) at a central clinic; 613 women were assessed at both times. Salt iodine (SI) content was assessed semiquantitatively at 6-7 months postpartum in households (n=1572). RESULTS During pregnancy and lactation, median UI concentrations were 0.756 and 0.483 micromol/l, respectively, indicating mild iodine deficiency. UI and SI concentrations covaried markedly by season and were highest during hot, dry, premonsoon months and lowest during and following the humid monsoon season. Within women who contributed urine samples during both pregnancy and the postpartum period, iodine status determined by UI was not correlated. The percentage of households with adequately iodized salt (30 ppm) ranged from 85 to 44% from the hot, dry to the humid seasons, respectively. CONCLUSIONS In the rural southern plains of Nepal, iodine deficiency remains a mild-to-moderate public health problem among pregnant and lactating women despite the availability of iodized salt. Marked seasonality in SI content may account for the lack of intraindividual correlation between maternal iodine status during pregnancy and postpartum periods and contribute to periodicity in the risk of iodine deficiency.
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Affiliation(s)
- K J Schulze
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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