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Jiang Y, Gu S, Mo Z, Li X, Liu C, Li Y, Mao G, Wang Y, Guo F, Lou X, Wang X. Thyroglobulin as a Sensitive Biomarker of Iodine Status in Mildly and Moderately Iodine-Deficient Pregnant Women. Biol Trace Elem Res 2023:10.1007/s12011-023-03986-5. [PMID: 38048038 DOI: 10.1007/s12011-023-03986-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
Pregnant women are more susceptible to iodine deficiency. However, there are limitations in existing indicators for the evaluation of iodine nutrition in pregnant women. The study aimed to explore whether thyroglobulin (Tg) can be used as a more sensitive biomarker for pregnant women with mild and moderate iodine deficiency. A repeated-measure study was conducted among 1332 pregnant women in Zhejiang Province, China. Serum and urine specimens were collected at a mean of 10, 17, and 32 weeks of pregnancy, respectively; thyroid-stimulating hormone (TSH), Tg, and urinary iodine concentrations were measured. Linear mixed effects models were used to determine the associations between interaction of iodine concentrations and increasing gestation week and TSH and Tg, where participants were divided by urinary iodine concentration (UIC). The median Tg concentration was 11.56, 11.45, and 12.43 μg/L in the first, second, and third trimesters, respectively. After controlling the covariates, the interaction effects between the iodine status and gestation week were significant for both TSH and Tg (p = 0.038 and p = 0.007, respectively). TSH increased with the week of gestation in both iodine concentration groups. Tg increased with advancing pregnancy in the iodine-deficient group whereas it did not in the iodine-sufficient group. There was no significant variation in TSH at each trimester, and Tg was higher in the iodine-deficient group than in the iodine-sufficient group. Tg may be a more sensitive iodine status biomarker than TSH for pregnant women with mild-to-moderate iodine insufficiency.
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Affiliation(s)
- Yujie Jiang
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China
- Health Science Center, Ningbo University, Ningbo, 315211, China
| | - Simeng Gu
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Zhe Mo
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Xueqing Li
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Chenyang Liu
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Yahui Li
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Guangming Mao
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Yuanyang Wang
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Fanjia Guo
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Xiaoming Lou
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Xiaofeng Wang
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China.
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Xie Q, Zhang X, Ma J, Lu X, Zhang Y, Tong N. Effect of iodine nutritional status on the recurrence of hyperthyroidism and antithyroid drug efficacy in adult patients with Graves' disease: a systemic review. Front Endocrinol (Lausanne) 2023; 14:1234918. [PMID: 37900151 PMCID: PMC10600371 DOI: 10.3389/fendo.2023.1234918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Aim To probe the appropriate iodine nutritional status for patients with Graves'disease (GD) hyperthyroidism and on antithyroid drugs (ATD) or after drugwithdrawal. Method Studies were retrieved from three databases (Embase, Medline, and Cochrane Library) and were screened and evaluated using predefined criteria. The risk of bias of each trial was assessed using a tool from Cochrane. The iodine nutritional status of the subjects was redefined according to the World Health Organization (WHO) criteria and classified as insufficient/adequate/above requirements/excessive iodine intake. Result Two randomized controlled trials (RCTs) and 3 observational studies were selected from the 376 retrieved papers, which had different degrees of risk of bias in study design. The heterogeneity among them prevented us from further synthesizing effect indicators and subsequent statistical analyses. Two RCTs with high quality showed that insufficient or above requirements iodine intake was detrimental for ATD-treated GD patients; adequate iodine intake was associated with a lower risk of recurrence and better efficacy in controlling thyrotoxicosis. It could be speculated from three low-quality observational studies that excessive iodine intake may be associated with higher (or similar) recurrence rates and lower remission rates compared to above requirements iodine intake in these patients, but none of them could answer the question of the effect of insufficient or adequate iodine intake on this issue. Conclusion Although the available evidence is suboptimal, this systematic review tentatively suggests that in adult patients with GD hyperthyroidism receiving ATDs and according to WHO criteria for iodine nutritional status, adequate iodine intake is associated with a lower recurrence rate, a higher remission rate and a better efficacy to control thyrotoxicosis than insufficient, above requirement, or excessive iodine intake. Future RCTs with large samples are expected to elucidate the actual impact of different iodine nutritional statuses on the recurrence rate of hyperthyroidism and the efficacy of ATD to control thyrotoxicosis in these patients. Systematic review registration identifier CRD42022359451.
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Affiliation(s)
| | | | | | | | | | - Nanwei Tong
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, Laboratory of Diabetes and Islet Transplantation Research, West China Hospital of Sichuan University, Chengdu, China
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Doggui R, McCormick BJ, Caulfield LE, Schulze KJ, Murray-Kolb LE. Adequacy of Iodine Status and Associations with Gut Health: A Prospective Cohort Study among Infants in 8 Low- and Middle-Income Countries. J Nutr 2023; 153:828-838. [PMID: 36797135 DOI: 10.1016/j.tjnut.2022.11.027] [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: 06/18/2022] [Revised: 10/25/2022] [Accepted: 11/15/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Environmental enteric dysfunction increases the likelihood of micronutrient deficiencies among infants, but few studies have assessed the potential impact of gut health on urinary iodine concentration (UIC) among this vulnerable group. OBJECTIVES We describe the trends of iodine status among infants from 6 to 24 mo old and examine the associations between intestinal permeability, inflammation, and UIC from 6 to 15 mo of age. METHODS Data from 1557 children enrolled in this birth cohort study conducted in 8 sites were included in these analyses. UIC was measured at 6, 15, and 24 mo of age by using the Sandell-Kolthoff technique. Gut inflammation and permeability were assessed using the concentrations of fecal neopterin (NEO), myeloperoxidase (MPO) and alpha-1-antitrypsin (AAT), and lactulose-mannitol ratio (LM). A multinomial regression analysis was used to assess the classified UIC (deficiency or excess). Linear mixed regression was used to test the effect of interactions among biomarkers on logUIC. RESULTS All studied populations had adequate (≥100 μg/L) to excess (≥371 μg/L) median UIC at 6 mo. Between 6 and 24 mo, 5 sites displayed a significant decline in the infant's median UIC. However, median UIC remained within the optimal range. An increase of NEO and MPO concentrations by +1 unit in ln scale reduced the risk of low UIC by 0.87 (95% CI: 0.78-0.97) and 0.86 (95% CI: 0.77-0.95), respectively. AAT moderated the association between NEO and UIC (P < 0.0001). The shape of this association appears to be asymmetric and in a reverse J-shape, with a higher UIC observed at both lower NEO and AAT concentrations. CONCLUSIONS Excess UIC was frequent at 6 mo and tended to normalize at 24 mo. Aspects of gut inflammation and increased permeability appear to reduce the prevalence of low UIC in children aged 6 to 15 mo. Programs addressing iodine-related health should consider the role of gut permeability in vulnerable individuals.
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Affiliation(s)
- Radhouene Doggui
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA.
| | | | - Laura E Caulfield
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kerry J Schulze
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Laura E Murray-Kolb
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA; Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
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Optimizing Growth: The Case for Iodine. Nutrients 2023; 15:nu15040814. [PMID: 36839172 PMCID: PMC9959690 DOI: 10.3390/nu15040814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/29/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
Iodine is an essential micronutrient and component of thyroid hormone. An adequate dietary iodine intake is critical to maintain and promote normal growth and development, especially during vulnerable life stages such as pregnancy and early infancy. The role of iodine in cognitive development is supported by numerous interventional and observational studies, and when iodine intake is too low, somatic growth is also impaired. This can be clearly seen in cases of untreated congenital hypothyroidism related to severe iodine deficiency, which is characterized, in part, by a short stature. Nevertheless, the impact of a less severe iodine deficiency on growth, whether in utero or postnatal, is unclear. Robust studies examining the relationship between iodine and growth are rarely feasible, including the aspect of examining the effect of a single micronutrient on a process that is reliant on multiple nutrients for optimal success. Conversely, excessive iodine intake can affect thyroid function and the secretion of optimal thyroid hormone levels; however, whether this affects growth has not been examined. This narrative review outlines the mechanisms by which iodine contributes to the growth process from conception onwards, supported by evidence from human studies. It emphasizes the need for adequate iodine public health policies and their robust monitoring and surveillance, to ensure coverage for all population groups, particularly those at life stages vulnerable for growth. Finally, it summarizes the other micronutrients important to consider alongside iodine when seeking to assess the impact of iodine on somatic growth.
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Zhang SC, Yan CJ, Li YF, Cui T, Shen MP, Zhang JX. Right time to detect urine iodine during papillary thyroid carcinoma diagnosis and treatment: A case report. World J Clin Cases 2022; 10:11010-11015. [PMID: 36338210 PMCID: PMC9631150 DOI: 10.12998/wjcc.v10.i30.11010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/07/2022] [Accepted: 09/19/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This is the first documentation of a spontaneous and nonspecific chemical reaction of an iodinated contrast media with ammonium persulfate used in As3+-Ce4+ catalytic spectrophotometry for urine iodine concentration (UIC) detection.
CASE SUMMARY We herein report an incidental case who had a dual source computed tomography examination for papillary thyroid carcinoma diagnosis. Serial spot urine specimens were collected during her hospitalization and were measured by As3+-Ce4+ catalytic spectrophotometry on a Beckman Coulter AU5800. The reacted solutions were “brownish”, and the results showed extremely high iodine concentrations despite serial dilutions. The patient claimed no dietary habit of iodized salt or iodine-containing medical history, which strongly pointed to iodinated contrast media (ICM) via intravenous injection. Even with 0.01% ICM, its interruption is still profound on the desired urine iodine reaction with ammonium persulfate, leading to inaccurate UIC and possibly inappropriate treatment.
CONCLUSION The following laboratory suggestions should be considered: (1) As3+-Ce4+ catalytic spectrophotometry is only suitable for UIC measurement after confirmed ICM renal clearance; (2) A mass spectrometry-based method can be applied as an alternative during the ICM clearance period; and (3) The UIC baseline can be confirmed after ICM injection by consecutive detection for at least 2 mo.
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Affiliation(s)
- Shi-Chang Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Cheng-Jing Yan
- Department of Laboratory Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Yun-Fei Li
- Department of Laboratory Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Ting Cui
- Department of Laboratory Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Mei-Ping Shen
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Jie-Xin Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
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Koeder C, Perez-Cueto FJA. Vegan nutrition: a preliminary guide for health professionals. Crit Rev Food Sci Nutr 2022; 64:670-707. [PMID: 35959711 DOI: 10.1080/10408398.2022.2107997] [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] [Indexed: 11/03/2022]
Abstract
Since the beginning of the 21st century, interest in vegan diets has been rapidly increasing in most countries. Misconceptions about vegan diets are widespread among the general population and health professionals. Vegan diets can be health-promoting and may offer certain important advantages compared to typical Western (and other mainstream) eating patterns. However, adequate dietary sources/supplements of nutrients of focus specific to vegan diets should be identified and communicated. Without supplements/fortified foods, severe vitamin B12 deficiency may occur. Other potential nutrients of focus are calcium, vitamin D, iodine, omega-3 fatty acids, iron, zinc, selenium, vitamin A, and protein. Ensuring adequate nutrient status is particularly important during pregnancy, lactation, infancy, and childhood. Health professionals are often expected to be able to provide advice on the topic of vegan nutrition, but a precise and practical vegan nutrition guide for health professionals is lacking. Consequently, it is important and urgent to provide such a set of dietary recommendations. It is the aim of this article to provide vegan nutrition guidelines, based on current evidence, which can easily be communicated to vegan patients/clients, with the goal of ensuring adequate nutrient status in vegans.
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Affiliation(s)
- Christian Koeder
- Institute of Food Science and Human Nutrition, Leibniz University Hanover, Hanover, Germany
- Department of Nutrition, University of Applied Sciences Münster, Münster, Germany
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Andersson M, Braegger CP. The Role of Iodine for Thyroid Function in Lactating Women and Infants. Endocr Rev 2022; 43:469-506. [PMID: 35552681 PMCID: PMC9113141 DOI: 10.1210/endrev/bnab029] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Indexed: 12/18/2022]
Abstract
Iodine is a micronutrient needed for the production of thyroid hormones, which regulate metabolism, growth, and development. Iodine deficiency or excess may alter the thyroid hormone synthesis. The potential effects on infant development depend on the degree, timing, and duration of exposure. The iodine requirement is particularly high during infancy because of elevated thyroid hormone turnover. Breastfed infants rely on iodine provided by human milk, but the iodine concentration in breast milk is determined by the maternal iodine intake. Diets in many countries cannot provide sufficient iodine, and deficiency is prevented by iodine fortification of salt. However, the coverage of iodized salt varies between countries. Epidemiological data suggest large differences in the iodine intake in lactating women, infants, and toddlers worldwide, ranging from deficient to excessive intake. In this review, we provide an overview of the current knowledge and recent advances in the understanding of iodine nutrition and its association with thyroid function in lactating women, infants, and toddlers. We discuss risk factors for iodine malnutrition and the impact of targeted intervention strategies on these vulnerable population groups. We highlight the importance of appropriate definitions of optimal iodine nutrition and the need for more data assessing the risk of mild iodine deficiency for thyroid disorders during the first 2 years in life.
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Affiliation(s)
- Maria Andersson
- Nutrition Research Unit, University Children's Hospital Zurich, CH-8032 Zürich, Switzerland
| | - Christian P Braegger
- Nutrition Research Unit, University Children's Hospital Zurich, CH-8032 Zürich, Switzerland
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Liu L, Qian T, Sun R, Du Y, Li M, Liu L, Liu P, Fan L, Meng F. Comparative Analysis of Five Correction Methods for Thyroid Volume by Ultrasound and Their Recommended Reference Values in Chinese Children Aged 8-10 Years. Br J Nutr 2022; 129:1-28. [PMID: 35416137 DOI: 10.1017/s0007114522001003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Considering the influence of body's growth and development on thyroid volume (TVOL), whether five existed corrected methods could be applied to correct TVOL remains unclear, in terms of Chinese children's increased growth and development trends. This study aimed to compare the applicability of five correction methods for TVOL: Body Surface Area corrected Volume (BSAV), Body Mass Indicator corrected Volume (BMIV), Weight and Height corrected Volume Indicator (WHVI), Height corrected Volume Indicator 1 (HVI1) and Height corrected Volume Indicator 2 (HVI2); to establish the reference values for correction methods. The data of Iodine Nutrition and Thyroid Function Survey was used to analyse the differences in TVOL between normal and abnormal thyroid function children. Data of National Iodine Deficiency Disorders Survey were used to compare five correction methods and to establish their reference values. The median urinary iodine concentration of children surveyed were 256.1μg/L in 2009 and 192.6μg/L in 2019, respectively. No significant difference was found in TVOL and thyroid goitre rate between children with normal and abnormal thyroid function. In the determination of goitre, HVI1, HVI2, BSAV and BMIV all showed high agreement with TVOL, while the area under the ROC curve (AUC) of WHVI was relatively low for children aged 8(AUC=0.8993) and 9(AUC=0.8866). Most differences of TVOL between light and heavy weight, short and tall height children can be eliminated by BSAV correction. BSAV was the best method of TVOL correction in this research. Reference values were established for corrected thyroid volumes in Chinese children aged 8-10 years by sex.
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Affiliation(s)
- Lanchun Liu
- Key lab of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504) & Key Laboratory of Trace Elements and Human Health, Centre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University, Harbin, 150081
| | - Tingting Qian
- Key lab of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504) & Key Laboratory of Trace Elements and Human Health, Centre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University, Harbin, 150081
| | - Rong Sun
- Key lab of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504) & Key Laboratory of Trace Elements and Human Health, Centre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University, Harbin, 150081
| | - Yang Du
- Key lab of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504) & Key Laboratory of Trace Elements and Human Health, Centre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University, Harbin, 150081
| | - Ming Li
- Key lab of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504) & Key Laboratory of Trace Elements and Human Health, Centre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University, Harbin, 150081
| | - Lixiang Liu
- Key lab of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504) & Key Laboratory of Trace Elements and Human Health, Centre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University, Harbin, 150081
| | - Peng Liu
- Key lab of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504) & Key Laboratory of Trace Elements and Human Health, Centre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University, Harbin, 150081
| | - Lijun Fan
- Key lab of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504) & Key Laboratory of Trace Elements and Human Health, Centre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University, Harbin, 150081
| | - Fangang Meng
- Key lab of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504) & Key Laboratory of Trace Elements and Human Health, Centre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University, Harbin, 150081
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Abstract
PURPOSE OF REVIEW Iodine deficiency is a global concern, and in recent years, there has been a significant improvement in the number of countries identified as being iodine-sufficient. This review considers the best strategies to ensure iodine sufficiency among breastfeeding women and their infants. RECENT FINDINGS Fortification strategies to improve iodine intake have been adequate for school-age children (SAC); however, often, iodine deficiency remains for breastfeeding women and their infants. Daily supplementation with iodine is not an ideal strategy to overcome deficiency. Countries defined as iodine-sufficient, but where pregnant and breastfeeding women have inadequate intake, should consider increasing salt iodine concentration, such that the median urinary iodine concentration of SAC can be up to 299 µg/L. This will ensure adequate intake for mothers and infants, without SAC being at risk thyroid dysfunction. Consensus is required for thresholds for iodine adequacy for breastfeeding women and infants.
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10
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Tachibana M, Miyoshi Y, Fukui M, Onuma S, Fukuoka T, Satomura Y, Yasuda K, Kimura T, Bessho K, Ozono K. Urinary iodine and thyroglobulin are useful markers in infants suspected of congenital hypothyroidism based on newborn screening. J Pediatr Endocrinol Metab 2021; 34:1411-1418. [PMID: 34388329 DOI: 10.1515/jpem-2021-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/22/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Iodine deficiency and excess both cause thyroid dysfunction. Few data describe the relationship between iodine status and outcomes of congenital hypothyroidism (CH) in iodine-sufficient areas. We investigated urinary iodine (UI) concentration and its relationship with the clinical course of CH. METHODS We reviewed and retrospectively analyzed patients with positive newborn screening (NBS) for CH from January 2012 to June 2019 in Japan, obtaining UI and UI-urine creatinine ratio (UI/Cr), serum TSH, free T4, free T3 and thyroglobulin (Tg) at the first visit, TSH at NBS, levothyroxine (LT4) dose, and subsequent doses. A UI value of 100-299 μg/L was considered adequate. RESULTS Forty-eight patients were included. Median UI and UI/Cr were 325 μg/L and 3,930 µg/gCr, respectively. UI was high (≥300 μg/L) in 26 (54%) and low (≤99 μg/L) in 11 (23%). LT4 was administered to 34 patients. Iodine status was not related to the need for treatment. We found a U-shaped relationship between Tg and UI/Cr. Patients with high Tg (≥400 ng/mL) and abnormal UI levels required significantly lower LT4 doses (≤20 µg/day) at three years of age. Even if they showed severe hypothyroidism initially, they did not need subsequent dose increments. CONCLUSIONS Abnormal UI levels with Tg elevation were associated with lower LT4 dose requirements. The evaluation of iodine status and Tg concentrations were considered useful in patients suspected of CH.
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Affiliation(s)
- Makiko Tachibana
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoko Miyoshi
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Health and Nutrition, Faculty of Health and Nutrition, Osaka Shoin Women's University, Osaka, Japan
| | - Miho Fukui
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinsuke Onuma
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoya Fukuoka
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshinori Satomura
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kie Yasuda
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Kimura
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuhiko Bessho
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
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11
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Prpić M, Franceschi M, Vidranski V, Andersson M, Zimmermann MB, Hunziker S, Milošević M, Kusić Z, Jukić T. IODINE STATUS AND THYROID FUNCTION IN LACTATING WOMEN AND INFANTS - A SURVEY IN THE ZAGREB AREA, CROATIA. Acta Clin Croat 2021; 60:259-267. [PMID: 34744276 PMCID: PMC8564841 DOI: 10.20471/acc.2021.60.02.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/24/2019] [Indexed: 11/24/2022] Open
Abstract
Lactating women (LW) and infants have high dietary iodine requirements and are at risk of iodine deficiency. The aim of the study was to assess iodine status and thyroid function in LW and their breastfed infants in Zagreb, Croatia. The study included 133 LW and breastfed infant pairs. Urinary iodine concentration (UIC) and thyroid function parameters were measured in all subjects. In LW, breast milk iodine concentration (BMIC) was measured and iodine and salt rich food frequency questionnaire data were collected. Results of analysis indicated that 99.2% of the LW used iodized salt in household and 20.4% used iodine-containing vitamin and mineral supplements. Median (IQR) UIC was 75 µg/L (19.0-180.5 µg/L) in LW and 234 µg/L (151.0-367.5 µg/L) in infants, whereas BMIC was 121 µg/kg (87.8-170.8 µg/kg). Multivariate regression analysis revealed BMIC to be a significant predictor of infant UIC (p<0.001). Positive correlation was recorded between LW and infant thyroid function. This was the first study in Croatia demonstrating BMIC to be a reliable biomarker of iodine status during lactation and predicting iodine intake in breastfed infants. The study confirmed that mandatory salt iodization in Croatia ensured sufficient dietary iodine for LW and optimal iodine intake for breastfed infants via breast milk.
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Affiliation(s)
| | - Maja Franceschi
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Valentina Vidranski
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Maria Andersson
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Michael B Zimmermann
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Sandra Hunziker
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Milan Milošević
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Zvonko Kusić
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Tomislav Jukić
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
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Theurich MA, Grote V, Koletzko B. Complementary feeding and long-term health implications. Nutr Rev 2020; 78:6-12. [PMID: 33196095 DOI: 10.1093/nutrit/nuaa059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Melissa A Theurich
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universitaet, Munich, Germany
| | - Veit Grote
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universitaet, Munich, Germany
| | - Berthold Koletzko
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universitaet, Munich, Germany
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13
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Giordano C, Barone I, Marsico S, Bruno R, Bonofiglio D, Catalano S, Andò S. Endemic Goiter and Iodine Prophylaxis in Calabria, a Region of Southern Italy: Past and Present. Nutrients 2019; 11:nu11102428. [PMID: 31614658 PMCID: PMC6836275 DOI: 10.3390/nu11102428] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/02/2019] [Accepted: 10/08/2019] [Indexed: 01/23/2023] Open
Abstract
Iodine, a micronutrient that plays a pivotal role in thyroid hormone synthesis, is essential for proper health at all life stages. Indeed, an insufficient iodine intake may determine a thyroid dysfunction also with goiter, or it may be associated to clinical features such as stunted growth and mental retardation, referred as iodine deficiency disorders (IDDs). Iodine deficiency still remains an important public health problem in many countries, including Italy. The effective strategy for the prevention and control of IDDs is universal salt iodization, which was implemented in Italy in 2005 as a nationwide program adopted after the approval of an Italian law. Despite an improvement in the iodine intake, many regions in Italy are still characterized by mild iodine deficiency. In this review, we provide an overview of the historical evolution of the iodine status in the Calabria region, located in the South of Italy, during the past three decades. In particular, we have retraced an itinerary from the first epidemiological surveys at the end of the 1980s to the establishment of the Regional Observatory of Endemic Goiter and Iodine Prophylaxis, which represents an efficient model for the surveillance of IDDs and monitoring the efficacy of iodine prophylaxis.
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Affiliation(s)
- Cinzia Giordano
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende (CS), Italy.
- Centro Sanitario, University of Calabria, 87036 Rende (CS), Italy.
| | - Ines Barone
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende (CS), Italy.
| | - Stefania Marsico
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende (CS), Italy.
- Centro Sanitario, University of Calabria, 87036 Rende (CS), Italy.
| | - Rosalinda Bruno
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende (CS), Italy.
- Centro Sanitario, University of Calabria, 87036 Rende (CS), Italy.
| | - Daniela Bonofiglio
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende (CS), Italy.
- Centro Sanitario, University of Calabria, 87036 Rende (CS), Italy.
| | - Stefania Catalano
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende (CS), Italy.
- Centro Sanitario, University of Calabria, 87036 Rende (CS), Italy.
| | - Sebastiano Andò
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende (CS), Italy.
- Centro Sanitario, University of Calabria, 87036 Rende (CS), Italy.
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14
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Farebrother J, Zimmermann MB, Andersson M. Excess iodine intake: sources, assessment, and effects on thyroid function. Ann N Y Acad Sci 2019; 1446:44-65. [PMID: 30891786 DOI: 10.1111/nyas.14041] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/30/2019] [Accepted: 02/02/2019] [Indexed: 12/15/2022]
Abstract
Iodine is essential for thyroid hormone synthesis. High iodine intakes are well tolerated by most healthy individuals, but in some people, excess iodine intakes may precipitate hyperthyroidism, hypothyroidism, goiter, and/or thyroid autoimmunity. Individuals with preexisting thyroid disease or those previously exposed to iodine deficiency may be more susceptible to thyroid disorders due to an increase in iodine intake, in some cases at intakes only slightly above physiological needs. Thyroid dysfunction due to excess iodine intake is usually mild and transient, but iodine-induced hyperthyroidism can be life-threatening in some individuals. At the population level, excess iodine intakes may arise from consumption of overiodized salt, drinking water, animal milk rich in iodine, certain seaweeds, iodine-containing dietary supplements, and from a combination of these sources. The median urinary iodine concentration (UIC) of a population reflects the total iodine intake from all sources and can accurately identify populations with excessive iodine intakes. Our review describes the association between excess iodine intake and thyroid function. We outline potential sources of excess iodine intake and the physiological responses and consequences of excess iodine intakes. We provide guidance on choice of biomarkers to assess iodine intake, with an emphasis on the UIC and thyroglobulin.
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Affiliation(s)
- Jessica Farebrother
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland.,Department of Women and Children's Health, King's College London, London, UK
| | - Michael B Zimmermann
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland.,Iodine Global Network, Ottawa, Ontario, Canada
| | - Maria Andersson
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland.,Iodine Global Network, Ottawa, Ontario, Canada.,Division of Gastroenterology and Nutrition, University Children's Hospital Zurich, Zurich, Switzerland
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