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Gunnarsdóttir I, Brantsæter AL. Iodine: a scoping review for Nordic Nutrition Recommendations 2023. Food Nutr Res 2023; 67:10369. [PMID: 38187800 PMCID: PMC10770700 DOI: 10.29219/fnr.v67.10369] [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: 09/13/2021] [Revised: 04/27/2022] [Accepted: 11/10/2023] [Indexed: 01/09/2024] Open
Abstract
Iodine is essential for the synthesis of the thyroid hormones thyroxine (T4) and triiodothyronine (T3). As in many other parts of the world, insufficient iodine intake and consequently insufficient iodine status is a public health challenge in the Nordic and Baltic countries. The main dietary sources of iodine in the Nordic and Baltic countries include cow's milk, saltwater fish, eggs, products containing iodised salt, and iodised table salt. Only Denmark (DK), Finland (FI) and Sweden (SE) have implemented mandatory (DK) or voluntary (SE, FI) salt iodisation. New data, as well as recent studies from the Nordic and Baltic countries, strengthen the evidence that the main health challenges related to insufficient iodine intake remain thyroid function and thyroid disease, mental development, and cognitive function. Excessive intakes can also cause hyperthyroidism, autoimmune thyroid disease, and thyroid cancer.
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Affiliation(s)
- Ingibjörg Gunnarsdóttir
- Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
- Unit for Nutrition Research, Landspitali National University Hospital, Reykjavik, Iceland
| | - Anne Lise Brantsæter
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
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Li J, Li Y, Shi X, Teng D, Teng X, Teng W, Shan Z. Prevalence and risk factors of hypothyroidism after universal salt iodisation: a large cross-sectional study from 31 provinces of China. BMJ Open 2023; 13:e064613. [PMID: 36854590 PMCID: PMC9980360 DOI: 10.1136/bmjopen-2022-064613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVES To investigate the prevalence and risk factors of hypothyroidism after universal salt iodisation for 20 years in mainland China. DESIGN Nationwide, cross-sectional survey. SETTING AND PARTICIPANTS The Thyroid Disorders, Iodine Status and Diabetes epidemiological study included adults from 31 provinces of China. Data included demographic, physical characteristics, urine, serum thyroid-stimulating hormone (TSH), thyroid-peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb) and thyroid ultrasonography. Subclinical hypothyroidism (SCH) was classified into severe SCH (TSH >10 mU/L) and mild SCH (TSH 4.2-9.9 mU/L). A total of 78 470 (38 182 men and 40 288 women) participants were included in the final analysis. RESULTS The prevalence of hypothyroidism was 13.95%. The prevalence rates of overt hypothyroidism (OH) and SCH were 1.02% and 13.93%, which mild SCH was significantly higher than severe SCH (12.18% vs 0.75%). Prevalence was higher in women than in men, and this gender difference was noted among all age groups. The prevalence of mild SCH, severe SCH and OH increases by 1.16%, 1.40% and 1.29% for every 10 years older. TPOAb or/and TgAb positive were significantly associated with OH and severe SCH (OR 15.9, p<0.001). However, SCH was positively correlated with increased urine iodine concentration, but this correlation was only in antibody-negative female patients. In non-autoimmune and male populations, there was a U-shaped relationship between severe SCH and OH and urine iodine concentration. CONCLUSIONS Mild SCH is the most common form of hypothyroidism, which is related to iodine intake. Severe SCH is more similar to OH which autoimmune is the main cause. The various effects of iodine on hypothyroidism depend on thyroid autoimmune and gender.
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Affiliation(s)
- Jiashu Li
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yongze Li
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaoguang Shi
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Di Teng
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaochun Teng
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Weiping Teng
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, Liaoning, China
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Remer T. Why an Increase of TSH in Populations With Initially Mild-to-Moderate Iodine Deficiency Can Be Good News. Front Nutr 2022; 9:910160. [PMID: 35782934 PMCID: PMC9247351 DOI: 10.3389/fnut.2022.910160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/01/2022] [Indexed: 11/22/2022] Open
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Fuse Y, Ito Y, Shishiba Y, Irie M. Current Iodine Status in Japan: A Cross-sectional Nationwide Survey of Schoolchildren, 2014-2019. J Clin Endocrinol Metab 2022; 107:e2065-e2079. [PMID: 34935958 DOI: 10.1210/clinem/dgab919] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Japan has been regarded as a long-standing iodine-sufficient country without iodine fortification; however, data on nationwide iodine status are lacking. OBJECTIVE This study aimed to characterize the iodine status in Japan. METHODS From 2014 through 2019, a nationwide school-based survey was conducted across all districts in Japan. Urinary iodine concentration (UIC), creatinine (Cr) concentration, and anthropometry were assessed in healthy school-aged children (SAC) aged 6 to 12 years. Their iodine status is regarded as generally representative of the nation's iodine status. RESULTS A total of 32 025 children participated. The overall median UIC was 269 μg/L, which was within the World Health Organization's adequacy range. There was a regional difference in UIC values within 14 regions, and the lowest and highest median UICs were found in Tanegashima Island (209 μg/L) and Nakashibetsu, Hokkaido (1071 μg/L), respectively. The median UIC ≥ 300 μg/L was observed in 12 of 46 regions. By using estimated 24-hour urinary iodine excretion (UIE), the prevalence of SAC exceeding the upper tolerable limit of iodine for Japanese children was from 5.2% to 13.7%. The UIC values did not change with age, body surface area and body mass index percentile, whereas the Cr concentration simultaneously increased suggesting the effect of urinary creatinine on UI/Cr and estimated 24-hour UIE values. CONCLUSIONS The iodine intake of Japanese people is adequate, but in some areas it is excessive. The incidence and prevalence of thyroid disorders associated with iodine intake should be obtained, especially in the areas where high amounts of iodine are consumed.
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Affiliation(s)
- Yozen Fuse
- Research Committee on Iodine Related Health Problems, Foundation for Growth Science, Tokyo 113-0033, Japan
| | - Yoshiya Ito
- Research Committee on Iodine Related Health Problems, Foundation for Growth Science, Tokyo 113-0033, Japan
- Division of Clinical Medicine, Japanese Red Cross Hokkaido College of Nursing, Kitami, Hokkaido 090-0011, Japan
| | - Yoshimasa Shishiba
- Research Committee on Iodine Related Health Problems, Foundation for Growth Science, Tokyo 113-0033, Japan
| | - Minoru Irie
- Research Committee on Iodine Related Health Problems, Foundation for Growth Science, Tokyo 113-0033, Japan
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Chen Y, Xiang Q, Wang N, Zhang W, Zhu C, Wang Y, Wan H, Cheng J, Zhang K, Cai Y, Lu Y. Are ethnic differences, urinary iodine status, lead and cadmium exposure associated with thyroid autoimmunity and hypothyroid status? A cross-sectional study. BMJ Open 2022; 12:e056909. [PMID: 35177462 PMCID: PMC8860026 DOI: 10.1136/bmjopen-2021-056909] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the effects of different ethnicities and potential environmental exposure on the prevalence of thyroid autoimmune status and hypothyroid status. DESIGN The data were obtained from two cross-sectional studies. PARTICIPANTS 2105 participants in Shanghai (Han) and 772 participants in Yunnan Honghe Prefecture (Han, Yi, Miao and Hani), aged 18-75 were enrolled. METHODS Participants underwent several checkups, including urinary iodine concentration, blood lead (BPb) and blood cadmium (BCd), thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), thyroid stimulating hormone (TSH) as well as thyroid ultrasonography (US). Thyroid autoimmune status was defined as: antithyroid antibody positive (ATA+): TPOAb + or TgAb+; and ATA + and US+: TPOAb + or TgAb + together with characteristic US features. RESULTS The standardised prevalence of thyroid autoimmune positivity in Yunnan were higher than those in Shanghai (TPOAb+: 13.56% vs 8.27%, p<0.001; TgAb+: 9.28% vs 7.09%, p=0.045; ATA+: 16.96% vs 11.10%, p<0.001; ATA + and US+: 8.96% vs 6.64%, p=0.036). For urinary iodine-to-creatinine ratio (UI/Cr), compared with the level of 100.00-199.99 µg/g, the level of ≥300.00 µg/g had a 1.5-fold risk for ATA + and US+ (OR 1.455, p=0.041). The levels of 200.00-299.99 µg/g and ≥300.00 µg/g were positively associated with hypothyroid status (OR 1.509, p=0.002 and OR 1.338, p=0.043). Compared with the first quartiles, the fourth quartiles of BPb were positively associated with TPOAb+: (OR 1.637, p=0.006), ATA+ (OR 1.435, p=0.025), ATA + and US+ (OR 1.641, p=0.013), hypothyroid status (OR 1.467, p=0.013) and TSH levels (B 0.092, p=0.021). The fourth quartile of BCd was positively associated with the prevalence of ATA+ (OR 1.427, p=0.036). CONCLUSIONS Higher levels of UI/Cr, BPb and BCd may be associated with thyroid autoimmunity and hypothyroid status.
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Affiliation(s)
- Yi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Qian Xiang
- Department of Endocrinology, the Fifth affiliated Hospital of Kunming Medical University, Yunnan Honghe Prefecture Central Hospital (Ge Jiu People's Hospital), Yunnan, China
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Wen Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Chunfang Zhu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yuying Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Heng Wan
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jing Cheng
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Kun Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yan Cai
- Department of Endocrinology, the Fifth affiliated Hospital of Kunming Medical University, Yunnan Honghe Prefecture Central Hospital (Ge Jiu People's Hospital), Yunnan, China
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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Fang T, Lin L, Ou Q, Lin L, Zhang H, Chen K, Quan H, He Y. An Investigation on the Risk Factors of Thyroid Diseases in Community Population in Hainan. Int J Endocrinol 2022; 2022:4514538. [PMID: 35855806 PMCID: PMC9288325 DOI: 10.1155/2022/4514538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/05/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In recent years, the incidence of thyroid diseases has increased significantly, which has seriously affected people's work and life. The purpose of this study was to explore the epidemiological characteristics of thyroid diseases and autoantibodies. METHOD According to the principle of overall sampling, resident residents ≥18 years and who will not move within 5 years are randomly selected. A total of 2136 eligible individuals were divided into case and control groups according to whether they have thyroid disease. Finally, the impact of potential risk factors on thyroid diseases was evaluated. RESULTS The overall prevalence of thyroid disease was 58.3%, and there was a significant difference in the prevalence of thyroid disease between women and men (p = 0.004). Except for the age group ≥70 years, with the increase in age, the prevalence gradually increased (p < 0.05). Participants with positive thyroid autoantibodies (TPOAb or TgAb) had a higher prevalence than participants with negative autoantibodies. The positive rate of autoantibodies in women was higher than that in men (p < 0.05). UIC (p = 0.004) and free thyroid hormone (FT4) (p = 0.001) levels of men were higher than those of women, and the TSH level of women was higher than that of men (p = 0.002). The regression analysis showed that women, older age, and family history of thyroid disease were independent risk factors for thyroid disease. CONCLUSION The prevalence of thyroid diseases in Hainan was high. Women are more susceptible to thyroid disease than men, and the prevalence increased with age.
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Affiliation(s)
- Tuanyu Fang
- Department of Endocrinology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Leweihua Lin
- Department of Endocrinology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Qianying Ou
- Department of Endocrinology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Lu Lin
- Department of Endocrinology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Huachuan Zhang
- Department of Endocrinology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Kaining Chen
- Department of Endocrinology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Huibiao Quan
- Department of Endocrinology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yangli He
- Department of Health Care Centre, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
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Zou Y, Li H, Pang J, Liu X, Zejipuchi, Tian L, Yu S, Wang D, Hou L, Yin Y, Ma C, Xie S, Cheng Q, Guo X, Cheng X, Xia L, Yang H, Qiu L. An evaluation of urine and serum iodine status in the population of Tibet, China: No longer an iodine-deficient region. Nutrition 2020; 82:111033. [PMID: 33183897 DOI: 10.1016/j.nut.2020.111033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/02/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Iodine is a critical trace element for the synthesis of thyroid-related hormones, and either low or high iodine status can lead to thyroid dysfunction. This study aimed to evaluate the iodine status of the Tibetan population. METHODS From September 2016 to August 2018, we enrolled 1499 healthy adults from three areas of varying altitudes in Tibet. Urine iodine concentrations (UICs), adjusted UICs, and serum iodine concentrations (SICs) were measured using inductively coupled plasma mass spectrometry. RESULTS The median UIC, adjusted UIC, and SIC was 137.9 μg/L, 118.4 µg/gCr, and 58.3 μg/L, respectively. Of the participants, 30.4% had UICs <100 µg/L, 63.0% had UICs ranging from 100 to 300 µg/L, and 9.6% had UICs >300 µg/L. The correlation between UIC, adjusted UIC, and SIC was good (r > 0.65, P < 0.01). The SICs were more stable than the UICs, and were not associated with age or sex. The prevalence of clinical hyperthyroidism, clinical hypothyroidism, subclinical hyperthyroidism, subclinical hypothyroidism, positive thyroid peroxide antibody, positive thyroglobulin antibody, either positive and both positive was 0.5%, 1.3%, 1.7% and 17.9%, 9.3%, 6.5%, 12.5%, and 2.5%, respectively. The prevalence of almost all thyroid disorders was higher in women than in men. CONCLUSION This multicenter cross-sectional study found that the human iodine status of adults in Tibet was considered adequate, based on the World Health Organization's criteria.
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Affiliation(s)
- Yutong Zou
- Department of Laboratory Medicine , Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Honglei Li
- Department of Laboratory Medicine , Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Jinrong Pang
- Department of Clinical Laboratory, People's Hospital of Tibet Autonomous Region, Tibet Lhasa, China
| | - Xiaoxing Liu
- Department of Clinical Laboratory, Ali District People's Hospital, Tibet Ali, China
| | - Zejipuchi
- Department of Clinical Laboratory, Shigatse City, Sang Zhu Zi District People's Hospital, Tibet Shigatse, China
| | - Liping Tian
- Department of Clinical Laboratory, Maternal and Child Health Hospital, Tibet Nyingchi, China
| | - Songlin Yu
- Department of Laboratory Medicine , Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Danchen Wang
- Department of Laboratory Medicine , Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Li'an Hou
- Department of Laboratory Medicine , Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Yicong Yin
- Department of Laboratory Medicine , Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Chaochao Ma
- Department of Laboratory Medicine , Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Shaowei Xie
- Department of Laboratory Medicine , Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Qian Cheng
- Department of Laboratory Medicine , Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Xiuzhi Guo
- Department of Laboratory Medicine , Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Xinqi Cheng
- Department of Laboratory Medicine , Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Liangyu Xia
- Department of Laboratory Medicine , Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Hongyan Yang
- Department of Clinical Laboratory, People's Hospital of Tibet Autonomous Region, Tibet Lhasa, China.
| | - Ling Qiu
- Department of Laboratory Medicine , Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China.
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Lou X, Wang X, Wang Z, Mao G, Zhu W, Wang Y, Pan X, Chen Z, Mo Z. The Effect of Iodine Status on the Risk of Thyroid Nodules: A Cross-Sectional Study in Zhejiang, China. Int J Endocrinol 2020; 2020:3760375. [PMID: 32908502 PMCID: PMC7450337 DOI: 10.1155/2020/3760375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/09/2020] [Accepted: 08/05/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore whether iodine nutrition is associated with the risk of thyroid nodules among adult population in Zhejiang Province, China. METHODS A cross-sectional study was conducted in the general population aged 18 years or older. A total of 2,710 subjects received physical examination, questionnaires, and thyroid ultrasonography. Urinary iodine concentration (UIC) and thyroid hormone levels were measured and documented for each subject. 4 multiple logistic regression models adjusted for other risk factors were applied to analyze the association between iodine nutrition and thyroid nodules. RESULTS The prevalence of thyroid nodules was 15.5% among all adults. As indicated by all 4 models, subjects with UIC varying from 200 μg l-1 to 399 μg l-1 had lower risk of thyroid nodules compared with those with relatively low UIC (<100 μg l-1), with approximately 37-57 percent reduction in risk. Moreover, subjects with UIC between 100 and 199 μg l-1 had a decreased risk of thyroid nodules in model 1 and 2 (OR = 0.75, 95% CI, 0.58-0.97; OR = 0.75, 95% CI, 0.58-0.97, respectively). However, there was no significant difference of risk in thyroid nodules between subjects with high UIC (≥400 μg l-1) and low UIC (<100 μg l-1). Furthermore, intake of iodized salt was inversely associated with risk of thyroid nodules, with approximately 69-77 percent reduction in risk. CONCLUSION The relationship between UIC and the risk of thyroid nodules is U-shaped. Consumption of noniodized salt is an independent risk factor of thyroid nodules.
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Affiliation(s)
- Xiaoming Lou
- Department of Environmental Health, Zhejiang Provincial Center for Disease Prevention and Control, 3399 Binsheng Road, Hangzhou 310051, Zhejiang, China
| | - Xiaofeng Wang
- Department of Environmental Health, Zhejiang Provincial Center for Disease Prevention and Control, 3399 Binsheng Road, Hangzhou 310051, Zhejiang, China
| | - Zhifang Wang
- Department of Environmental Health, Zhejiang Provincial Center for Disease Prevention and Control, 3399 Binsheng Road, Hangzhou 310051, Zhejiang, China
| | - Guangming Mao
- Department of Environmental Health, Zhejiang Provincial Center for Disease Prevention and Control, 3399 Binsheng Road, Hangzhou 310051, Zhejiang, China
| | - Wenming Zhu
- Department of Environmental Health, Zhejiang Provincial Center for Disease Prevention and Control, 3399 Binsheng Road, Hangzhou 310051, Zhejiang, China
| | - Yuanyang Wang
- Department of Environmental Health, Zhejiang Provincial Center for Disease Prevention and Control, 3399 Binsheng Road, Hangzhou 310051, Zhejiang, China
| | - Xuejiao Pan
- Department of Environmental Health, Zhejiang Provincial Center for Disease Prevention and Control, 3399 Binsheng Road, Hangzhou 310051, Zhejiang, China
| | - Zhijian Chen
- Department of Environmental Health, Zhejiang Provincial Center for Disease Prevention and Control, 3399 Binsheng Road, Hangzhou 310051, Zhejiang, China
| | - Zhe Mo
- Department of Environmental Health, Zhejiang Provincial Center for Disease Prevention and Control, 3399 Binsheng Road, Hangzhou 310051, Zhejiang, China
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Zhu Y, Xu F, Shen J, Liu Y, Bi C, Liu J, Li Y, Wang X, Gao Z, Liang L, Chen Y, Sun W, Guan Q, Zhang J, Luo Z, Guo L, Cai X, Li L, Xiu L, Yan L, Li C, Shi X, Zhu M, Kuang J, Li G, Ji L. Prevalence of thyroid dysfunction in older Chinese patients with type 2 diabetes-A multicenter cross-sectional observational study across China. PLoS One 2019; 14:e0216151. [PMID: 31048873 PMCID: PMC6497275 DOI: 10.1371/journal.pone.0216151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/15/2019] [Indexed: 02/06/2023] Open
Abstract
Type 2 diabetes [T2D] and thyroid dysfunction [TD] often co-occur, have overlapping pathologies, and their risk increases with age. Since 1995, universal salt iodization has been implemented in China to prevent disorders caused by iodine deficiency. However, after two decades of implementation of universal salt iodization, the prevalence of TD in elderly Chinese patients with T2D is not well described and may have been underestimated. We conducted a questionnaire-based survey across 24 endocrinology centers in China between December 2015 and July 2016. Demographic and clinical data from 1677 patients with T2D were obtained and analyzed to examine the prevalence of TD along with T2D in these patients. We assessed TD prevalence according to the four TD subtypes [subclinical hypothyroidism, clinical hypothyroidism, subclinical hyperthyroidism, and clinical hyperthyroidism], TD history, gender, and age. The diagnosis rates were calculated for TD and also for the TD subtype. The number of patients reaching treatment goals for T2D [hemoglobin A1c <7%] and TD [normal free thyroxine and thyroid-stimulating hormone [TSH]] and the incidences of complications and comorbidities were recorded. Among the enrolled patients with T2D [N = 1677], TD was diagnosed in 23.79% [399/1677] out of which 61% (245/399) were previously diagnosed and 38.59% (154/399) were newly diagnosed cases. Subclinical hypothyroidism, clinical hypothyroidism, subclinical hyperthyroidism, and clinical hyperthyroidism were reported in 4.89%, 9.3%, 1.13%, and 3.16% of the total population, respectively. Among patients previously diagnosed with TD, the incidence in women [166/795; 20.88%] was higher than in men [79/882; 8.96%]. The treatment goals for TD and T2D were attained in 39.6% [97/245] and 34.41% [577/1677] of the cases, respectively. Diabetic complications and comorbidities were reported in 99.7% of patients, with peripheral neuropathy being the most common [43.46%] followed by cataract [24.73%]. We had found that the incidences of dyslipidemia, elevated LDL levels, and osteoporosis were significantly higher in patients with TD than those without TD. TD is underdiagnosed in elderly Chinese patients with T2D.
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Affiliation(s)
- Yu Zhu
- Peking University People’s Hospital, Beijing, China
| | - Fengmei Xu
- General Hospital of Hebi Coal Industry [Group] Co., Ltd., Hebi, China
| | - Jie Shen
- The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Youshuo Liu
- The Second Xiangya Hospital of Central South University, Changsha, China
| | | | - Jing Liu
- Gansu Provincial Hospital, Lanzhou, China
| | - Yufeng Li
- Beijing Pinggu Hospital, Beijing, China
| | - Xueqin Wang
- Beijing Huairou Hospital of University of Chinese Academy Sciences, Beijing, China
| | - Zhengnan Gao
- Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian, China
| | - Linlang Liang
- The General Hospital of Shenyang Military Region, Shenyang, China
| | - Yanyan Chen
- Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Weiping Sun
- The First People’s Hospital of Xiangtan City, Xiangtan, China
| | - Qingbo Guan
- Shandong Provincial Hospital, Shandong, China
| | | | - Zuojie Luo
- The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | | | - Xiaopin Cai
- China-Japan Friendship Hospital, Beijing, China
| | - Ling Li
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Lingling Xiu
- First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Li Yan
- Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chunlin Li
- The General Hospital of the People's Liberation Army [301 Hospital], Beijing, China
| | - Xiaoyun Shi
- The General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - Mei Zhu
- General Hospital, Tianjin Medical University, Tianjin, China
| | - Jian Kuang
- Guangdong General Hospital, Guangzhou, China
| | - Guangwei Li
- Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Linong Ji
- Peking University People’s Hospital, Beijing, China
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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: 90] [Impact Index Per Article: 18.0] [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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Investigation of adrenal and thyroid gland dysfunction in dogs with ultrasonographic diagnosis of gallbladder mucocele formation. PLoS One 2019; 14:e0212638. [PMID: 30811473 PMCID: PMC6392329 DOI: 10.1371/journal.pone.0212638] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/06/2019] [Indexed: 12/12/2022] Open
Abstract
Gallbladder mucocele formation is an emerging disease in dogs characterized by increased secretion of condensed granules of gel-forming mucin by the gallbladder epithelium and formation of an abnormally thick mucus that can culminate in obstruction of the bile duct or rupture of the gallbladder. The disease is associated with a high morbidity and mortality and its pathogenesis is unknown. Affected dogs have a significantly increased likelihood of concurrent diagnosis of hyperadrenocorticism, hypothyroidism, and hyperlipidemia. Whether these endocrinopathies represent coincidental primary disease processes that exacerbate gallbladder mucocele formation in predisposed dogs or reflect a concurrent disruption of endocrine and lipid metabolism is unclear. In this study, we investigated a hypothesis that dogs with gallbladder mucocele formation would have a high prevalence of occult and atypical abnormalities in adrenal cortical and thyroid gland function that would suggest the presence of endocrine disruption and provide deeper insight into disease pathogenesis. We performed a case-control study of dogs with and without ultrasonographic diagnosis of gallbladder mucocele formation and profiled adrenal cortical function using a quantitative mass spectrometry-based assay of serum adrenal-origin steroids before and after administration of synthetic cosyntropin. We simultaneously profiled serum thyroid hormone concentrations and evaluated iodine sufficiency by measurement of urine iodine:creatinine ratios (UICR). The studies were complemented by histological examination of archival thyroid tissue and measurements of thyroid gland organic iodine from dogs with gallbladder mucocele formation and control dogs. Dogs with gallbladder mucocele formation demonstrated an exaggerated cortisol response to adrenal stimulation with cosyntropin. A prevalence of 10% of dogs with gallbladder mucocele formation met laboratory-based criteria for suspect or definitive diagnosis of hyperadrenocorticism. A significantly greater number of dogs with gallbladder mucocele formation had basal serum dehydroepiandrosterone (DHEAS) increases compared to control dogs. A high percentage of dogs with gallbladder mucocele formation (26%) met laboratory-based criteria for diagnosis of hypothyroidism, but lacked detection of anti-thyroglobulin antibodies. Dogs with gallbladder mucocele formation had significantly higher UICRs than control dogs. Examination of thyroid tissue from an unrelated group of dogs with gallbladder mucocele formation did not demonstrate histological evidence of thyroiditis or significant differences in content of organic iodine. These findings suggest that dogs with gallbladder mucocele formation have a greater capacity for cortisol synthesis and pinpoint DHEAS elevations as a potential clue to the underlying pathogenesis of the disease. A high prevalence of thyroid dysfunction with absent evidence for autoimmune thyroiditis suggest a disrupted thyroid hormone metabolism in dogs with gallbladder mucocele formation although an influence of non-thyroidal illness cannot be excluded. High UICR in dogs with gallbladder mucocele formation is of undetermined significance, but of interest for further study.
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12
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Barbaro D, Orrù B, Unfer V. Iodine and Myo-Inositol: A Novel Promising Combination for Iodine Deficiency. Front Endocrinol (Lausanne) 2019; 10:457. [PMID: 31379737 PMCID: PMC6660248 DOI: 10.3389/fendo.2019.00457] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/24/2019] [Indexed: 12/19/2022] Open
Abstract
Despite universal salt iodization programmes implemented over the last decades, iodine deficiency remains a major public health problem in many countries worldwide. Endeavors are still required to ensure sufficient iodine intake in the populations at risk in order to eliminate deficiency. Iodine is crucial for the synthesis of thyroid hormones triiodothyronine (T3) and thyroxine (T4), as well as for the thyroid health. When iodine levels are insufficient, T4 attests toward the lower limit of the physiological range, causing subtle fluctuations in the T3:T4 ratio. Monitoring these variations may be an accurate way to assess patient's iodine status. Recently, a number of published clinical studies documented a growing interest toward the use of myo-inositol in thyroid diseases. Myo-inositol, a carbocyclic polyol, regulates the generation of hydrogen peroxide (H2O2) in thyrocytes, crucial for iodine organification and thyroid hormone biosynthesis. Thus, combined supplementation of iodine and myo-inositol may promote higher iodine availability in thyrocytes improving thyroid functionality. This review presents novel strategies for the diagnosis and the management of iodine deficiency, focusing on the potential role of myo-inositol combined with iodine.
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Affiliation(s)
- Daniele Barbaro
- U.O. Endocrinologia, ASL Nord Ovest Toscana, Livorno, Italy
- *Correspondence: Daniele Barbaro
| | - Beatrice Orrù
- Medical Affairs Department, Lo.Li. Pharma, Rome, Italy
| | - Vittorio Unfer
- Department of Experimental Medicine, Sapienza University, Rome, Italy
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A PRISMA-compliant systematic review and meta-analysis of the relationship between thyroid disease and different levels of iodine intake in mainland China: Erratum. Medicine (Baltimore) 2018; 97:e9593. [PMID: 29505547 PMCID: PMC5943104 DOI: 10.1097/md.0000000000009593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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